Guide Preferred Provider Plan Vision Service Areas

By County

Barnstable County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Berkshire County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Vision Preferred GR-9 et al.
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage C-9059MA (12/08)
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Access
 
C-9083MA
 

Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Insight C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Select
 
C-9083MA
 

Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Access C-9093MA
 

Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Insight C-9093MA
 

Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Select C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Bristol County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Dukes County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Guardian Life Insurance Company Superior Vision Plan NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA
Group Vision PPO Plan
C22439DBG-MA
Principal Life Insurance Company Group Vision Expense GC 9000
Union Security Insurance Company Group Vision Certificate w/VSP Form GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Essex County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company
 
Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Advantage
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Access
 
C-9093MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Advantage
 
C-9093MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Insight
 
C-9093MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Select
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company  Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company
Group Vision w/Insight Network
VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Franklin County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Hampden County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Hampshire County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Group Eye Care Insurance w/VSP Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company  Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Middlesex County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company
 
Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Advantage
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Access
 
C-9093MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Advantage
 
C-9093MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Insight
 
C-9093MA
 
Fidelity Security Life Insurance Company
 
EyeMed Vision Plan - Select
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Nantucket County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
Principal Life Insurance Company Group Vision Expense GC 9000
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Norfolk County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company
 
Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP  9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Plymouth County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company
 
Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Suffolk County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company
 
Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan  VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Advantage
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9093MA
 
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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Worcester County Preferred Provider Plan Vision Service

VISION
Insured Preferred Provider Plans
Product Name Form Number
Aetna Life Insurance Company
 
Aetna Vision Preferred
 
GR-9 et al.
 
Ameritas Life Insurance Corp. Group Eye Care Insurance 9021 Ed. 01-05
Ameritas Life Insurance Corp. Group Eye Care Insurance w/VSP 9021 MA VSP PPO Ed. 02-17
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 -Access Network BCBS-VC 20/20 (8-1-2013)
Blue Cross and Blue Shield of Massachusetts, Inc. Blue 20/20 - Insight Network BCBS-VC 20/20 (8-1-2013)
Chesapeake Life Insurance Company Premiere Vision Plan CH-26120-IP (01/12) OON MA
Chesapeake Life Insurance Company Vision Insurance w/EyeMed Select CH-26023-IP (5/07) MA
Combined Insurance Company of America Combined Advantage Vision Plan VN C63007 0817-ADV-MA
Combined Insurance Company of America Combined Insight Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Select Vision Plan VN C63007 0817-MA
Combined Insurance Company of America Combined Access Vision Plan VN C63007 0817-MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9059MA (05/09)
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9083MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Access
 
C-9093MA
 
Fidelity Security Life Insurance Company EyeMed Vision Plan - Insight
 
C-9093MA
Fidelity Security Life Insurance Company EyeMed Vision Plan - Select
 
C-9093MA
(The) Guardian Life Insurance Company of America VisionGuard CGP-3-VSN-96-VIS et al.
(The) Guardian Life Insurance Company of America Davis Vision CGP-3-Davis-11-MA
HM Life Insurance Company Stand Alone Vision HMC 902-VIS (6/10)
Humana Insurance Company Group Vision w/Insight Network MA-70149-01 CERT
Humana Insurance Company Humana Vision Care Plan HUM VGRP CERT.002 (MA)
Humana Insurance Company Humana Vision Care Plan MA-70147-01
Massachusetts Vision Service Plan, Inc. Group Vision Care Plan REG COC-7/00
Mid-West National Life Insurance Company of TN Vision Service Certificate MW-25213-MA (3/06)
 
National Guardian Life Insurance Company National Vision Administrators NVIGRPCT-MA 01/13
National Guardian Life Insurance Company Superior Vision Plan
 
NVIGRP 5/07-MA
 
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA
National Union Fire Insurance Co. of Pitt., PA Group Vision PPO Plan C22439DBG-MA (EyeMed)
Principal Life Insurance Company Group Vision Expense GC 9000
Reliance Standard Life Insurance Company Group Eye Care Insurance 9021 Ed. 01-05
Reliance Standard Life Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Standard Insurance Company Group Eye Care Insurance w/ VSP 9021 ed. 02-17 et al.
Starmount Life Insurance Company Group Vision Care Insurance VI-2007CT-MA
Starmount Life Insurance Company Group Vision w/Insight Network VI-2007CT-MA-EM
United HealthCare Insurance Company Group Vision Care
 
VCOC.INT.06
 
Union Security Insurance Company Group Vision Certificate w/VSP GC-10 Vis CFP et al.

* Please note that the following companies or product(s) do not appear above due to their decision to discontinue the offer of the plan(s) in Massachusetts - American General Life Insurance Company  (Form# C22439 MA),  (The) Chesapeake Life Insurance Company (Form# CH-25213-MA-7/01) ), Columbian Life Insurance Company (Form# 9F121P-CL (Rev. 8/01)), Combined Insurance Company of America (Form# VN C63007A/B 0603-MA and VN C63007CVC 0603-MA), and Fidelity Security Life Insurance Company (Form# C-9059MA)

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