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Opticare of Utah prides itself on its ability to provide comprehensive vision quotes with timeliness and ease. Please fill out the fields and submit, and an Opticare of Utah representative will provide a quote in 24 hours or less.

Please provide us as much information as possible to provide you with the most cost effective, comprehensive quote.
Group Information
Group Name:
How Many Eligible Employees:
How Many Total Employees:
Are there other specific eligibility requirements?	Yes No
If yes, please describe:
Voluntary or Employer Contribution What percentage%
Are there other details regarding employer contribution?	Yes No
If yes, please describe:
Desired Plan Design(s)	Basic Premier 10-70 10-120
Proposal Information
Does this client currently offer a vision plan other than Opticare of Utah?	Yes No
Are copies of the current vision plan design available?	Yes No
Formal RFP Required?	Yes No
Date of Proposal Deadline (MM/DD/YYYY):
How many copies of Proposal to send:
Send to Address:
Can Proposal be submitted electronically?	Yes No
Email Address:
Additional Information Regarding this quote:
Effective Date
Term of Contract: 12 months, 24 months or other:
Agent Information
Agent Name:
Agency:
Phone Number:
Additional Phone Number
Email Address:
Do you or your agency need to get appointed to Opticare of Utah?(go to appointment PDF)


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