Downloadable Forms from Infinity Trust
Medicare :: Vision
Please Note: All forms may be filled out electronically.
Download the desired form to your local device and save.
Complete the form and click the EMAIL button to submit electronically.
For hard copy submissions, click the PRINT button and mail or fax to us at:
Insurance Strategy Inc., 6368 Pearl Road, Cleveland, Ohio 44130; Fax: 440-842-8669
Acrobat Reader is required. Click the logo to download the software.
Senior Medical Insurance Plan - Options & Rates
 Plan 1
|
 Plan 2
|
 Plan 3
|
 Plan 4
|
 Retiree Rx Care Part D |
 2021 Medicare Rates |
 Change of Address Form |
Forms for Employers
 Employer Application |
 Autowithdraw Application |
 Employee Enroll/Change |
 Employee Termination |
VSP Signature Series
 Plan A |
 Plan B |
 Plan C |
 Exam Plus |
 Rate Sheet |
VSP Choice Series With Lens Options
 Plan A |
 Plan B |
 Plan C |
 Rate Sheet |
VSP Choice Series Without Lens Options
 Plan A |
 Plan B |
 Plan C |
 Rates |
VSP Individual Vision Coverage
Choice Series With Lens Options
|
Plan A |
Plan B |
Plan C |
 Individual Rates |