Enrollment Forms

Ver. 3.0.8370.34580

Avēsis Incorporated and Avēsis Third Party Administrators, Inc., are wholly owned subsidiaries of Guardian. Guardian® is a registered service mark of The Guardian Life Insurance Company of America, New York, NY. ©2023 Avēsis Incorporated. ©2023 Guardian. All rights reserved. Used with express permission. #2023-76061 (exp. 8/21)

Commercial vision products are marketed and administered by Avēsis and may be underwritten and issued by Avēsis, Guardian, Fidelity Security Life Insurance Company, and National Guardian Life Insurance Company, depending on state of issue.

Amplifon is a managed discount-card program for hearing care and hearing aids provided through a third-party arrangement between Avēsis and Amplifon. Avēsis and Guardian assume no responsibility for products or services offered by Amplifon.

CBTR Optical Labs is an independent, full-service, digital lab providing optical lenses and services for Guardian and Avēsis. CBTR Optical Labs is not affiliated with Guardian or Avēsis.

QualSight® LASIK is a vision correction benefit management company that provides certain vision correcting procedures through a third-party arrangement between Avēsis and QualSight.

Medicaid, CHIP, and Medicare Advantage dental, eye care and hearing programs are administered by Avēsis Third Party Administrators, Inc., as a subcontractor to Medicaid and Medicare Managed Care Organizations. Avesis Third Party Administrators, Inc. is a wholly owned subsidiary of Guardian. Guardian® is a registered service mark of The Guardian Life Insurance Company of America, New York, NY. ©2023 Avēsis Incorporated. ©2023 Guardian. All rights reserved.

SecureADVANTAGE supplemental gap policies are marketed by Avēsis, underwritten by Fidelity Security Life Insurance Company, and administered by Special Insurance Services, Inc.

Enrollment Forms

Useful Links

Please select a state below to download your enrollment form.

Useful Links

Vision

Dental