Sign Up for Your Company’s Group Plan

If you have already received group plan information, use the form below to create your individual account.

Currently not available in the states of Utah and Idaho

1 Step 1
Username & password
2 Step 2
E-mail Verification
3 Step 3
Choose a Group
4 Step 4
User Information
5 Step 5
Add Dependents
6 Step 6
End User Agreement

Please set your login information

Password must be 8 characters long and have at least one upper case letter and a number:

Select security question and provide answer:

Please verify your e-mail adress

This e-mail will be used for verifying your credentials and sending you important information regarding your account

Enter code that was sent to your e-mail address into the field below

Find Group

Please verify your personal information

* – Required fields.

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Add Dependents

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(mm/dd/yyyy) * *

Use Primary's address
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Remove this dependent

Affirmation of Supplied Information

I affirm that all the information and statements provided by me in this Questionnaire to be true, complete and factual. I understand that any false or incomplete information regarding this form will affect my membership.

Please note, an electronic signature is legally valid and binding in accordance with the United States Electronic Signatures in Global and National Commerce Act (ESIGN Act). Also, in accordance with the ESIGN Act you are granted the right to choose to submit a paper copy of this form instead. If you do not want to sign electronically, you may download and fill out the PDF version of this form.

I understand and agree.

Title

Individual Plans | Get a Group Quote | Sell VCD | Join Provider Panel

405 S Holland, Suite A, Wichita, KS 67209

T: (877) 488-8900

admin@visioncaredirect.com

simple. flexible. affordable. - vision plans built with you in mind