www.eyeconic.com
Open in
urlscan Pro
165.254.198.136
Public Scan
Submitted URL: https://click.e.vsp.com/?qs=81e4073204e666fe68d420f13d13310edb6819c65c19e19cfee67d4cf85cfae5c5ed9d10cb94877c3defc03b261b...
Effective URL: https://www.eyeconic.com/?utm_source=ono&utm_medium=vspcom&utm_campaign=ono_vspcom_202240220_examonly_touch2_shopnow&cid=...
Submission: On December 17 via manual from US — Scanned from DE
Effective URL: https://www.eyeconic.com/?utm_source=ono&utm_medium=vspcom&utm_campaign=ono_vspcom_202240220_examonly_touch2_shopnow&cid=...
Submission: On December 17 via manual from US — Scanned from DE
Form analysis 11 forms found in the DOM
Name: simpleSearch — GET /search
<form role="search" action="/search" method="get" name="simpleSearch" novalidate="novalidate">
<label for="q-tablet">Search</label>
<input type="text" id="q-tablet" role="combobox" aria-owns="search-suggestions" aria-autocomplete="both" aria-label="search" name="q" value="" placeholder="SEARCH" autocomplete="off" aria-expanded="false">
<input type="submit" value="Submit" class="submit">
<img class="header-search-icon" alt="" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dwc78b1424/images/header/search-icon.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dwc78b1424/images/header/search-icon.png?yocs=1_5_" data-yo-loaded="true">
</form>POST https://www.eyeconic.com/sign-in
<form action="https://www.eyeconic.com/sign-in" method="post" id="headerLoginForm" novalidate="novalidate">
<input type="hidden" value="" id="rememberEmail">
<input type="hidden" name="headerLogin" value="true" id="headerLogin">
<div class="form-row email-input email-div required " data-required-text="Please enter your e-mail address" aria-required="true">
<label for="dwfrm_login_username">
<span> Email Address </span>
<span class="required-indicator" aria-hidden="true">*</span>
</label>
<input class="input-text email-input email required" id="dwfrm_login_username" type="email" name="dwfrm_login_username" placeholder="" value="" "="" data-required-text=" Please enter your e-mail address" maxlength="2147483647"
aria-required="true">
<span class="form-caption d-none"></span>
</div>
<a id="password-reset" class="password-reset" href="/pwdresetdialog" title="Forgot Password?" data-dlg-action="{"test":100}" data-dlg-options="{"width":700,"height":250}">
Forgot Password?
</a>
<div class="password-box">
<div class="form-row password-input password-div required " data-required-text="Please enter your password" aria-required="true">
<label for="dwfrm_login_password">
<span> Password </span>
<span class="required-indicator" aria-hidden="true">*</span>
</label>
<input class="input-text password-input password required" id="dwfrm_login_password" type="password" name="dwfrm_login_password" placeholder="" value="" "="" data-required-text=" Please enter your password" maxlength="2147483647"
autocomplete="off" aria-required="true">
<span class="form-caption d-none"></span>
</div>
<div class="form-row form-row-button mx-0 d-block">
<div class="form-row label-inline login-rememberme ">
<input class="input-checkbox " type="checkbox" checked="checked" name="dwfrm_login_rememberme" id="dwfrm_login_rememberme" value="true">
<label for="dwfrm_login_rememberme"> Keep me signed in </label>
</div>
<button type="submit" class="btn btn-block btn-primary" value="Sign In" name="dwfrm_login_login"> Sign In </button>
</div>
<input type="hidden" name="dwfrm_login_securekey" value="1753724862">
</div>
</form>GET https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/AccountRegister-Register
<form action="https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/AccountRegister-Register" method="GET" id="createAccountLink" novalidate="novalidate">
<div class="form-row form-row-button mx-0 d-block">
<button type="submit" class="btn btn-block btn-secondary" value="Create An Account" name="register"> Create an account </button>
</div>
</form>Name: simpleSearch — GET https://www.eyeconic.com/search
<form role="search" action="https://www.eyeconic.com/search" method="get" name="simpleSearch" novalidate="novalidate">
<label for="q">Search</label>
<input type="text" id="q" name="q" value="" role="combobox" aria-owns="search-suggestions" aria-autocomplete="both" aria-label="search" aria-expanded="false" placeholder="SEARCH" aria-haspopup="listbox" aria-controls="search-suggestions"
autocomplete="off" aria-invalid="false" class="valid">
<input type="submit" value="Submit" class="submit" title="Click to Search">
<img class="header-search-icon" alt="" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/-/Sites-eyeconic-Library/default/dw4e3bb926/images/search-icon.png?yocs=1_5_" data-yo-delaytype="lazy"
data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/-/Sites-eyeconic-Library/default/dw4e3bb926/images/search-icon.png?yocs=1_5_" data-yo-loaded="true">
</form>Name: simpleSearch — GET /search
<form role="search" action="/search" method="get" name="simpleSearch" novalidate="novalidate">
<label for="q-mobile">Search</label>
<input type="text" id="q-mobile" role="combobox" aria-owns="search-suggestions" aria-autocomplete="both" aria-label="search" name="q" value="" placeholder="SEARCH" autocomplete="off" aria-expanded="false">
<input type="submit" value="Submit" class="submit">
<img class="header-search-icon" alt="" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dwc78b1424/images/header/search-icon.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dwc78b1424/images/header/search-icon.png?yocs=1_5_" data-yo-loaded="true">
</form>POST https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/Subscription-NewsLetter
<form action="https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/Subscription-NewsLetter" id="subscribeform" method="POST" novalidate="novalidate"><label class="sign-up-heading text-uppercase" for="subscribe">Receive News and
Offers</label> <input class="email-addr" id="subscribe" maxlength="50" name="email-address" placeholder="EMAIL ADDRESS" type="text" value="">
<div><button aria-label="Submit" class="email-button" name="email-address-arrow" type="submit" value=""></button></div>
<p class="message"> </p>
</form><form id="selectInsuranceForm" novalidate="novalidate">
<fieldset>
<legend>Select My Insurance</legend>
<div class="mt-3">
<div class="radio">
<input type="radio" id="vsp" name="selectInsuranceRadio" value="VSP" checked="">
<label for="vsp">VSP Vision</label>
</div>
<div class="radio mt-3">
<input type="radio" id="metlife" name="selectInsuranceRadio" value="MetLife">
<label for="metlife">MetLife - VSP Choice</label>
</div>
<div class="radio mt-3">
<input type="radio" id="cigna" name="selectInsuranceRadio" value="Cigna">
<label for="cigna">Cigna Vision</label>
</div>
</div>
</fieldset>
</form><form id="lookupBenefitsForm" class="needs-validation suppress lookupInsuranceForm ignoreGlobalValidator" novalidate="" data-action="https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/OOSMember-Search">
<div class="member-details-inputs">
<div class="input-group form-label-group col-11 mx-auto">
<input type="text" class="d-none" id="policyHolderInfo-carrier" name="carrier">
</div>
<div class="input-group form-label-group col-11 mx-auto">
<input type="text" class="form-input form-control w-100" id="policyHolderInfo-firstName" name="firstName" placeholder="First Name" required="">
<label for="policyHolderInfo-firstName">First Name</label>
<div class="ml-1 invalid-feedback">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-3">Enter First Name</p>
</div>
</div>
<div class="input-group form-label-group col-11 mx-auto">
<input type="text" class="form-input form-control w-100" id="policyHolderInfo-lastName" name="lastName" placeholder="Last Name" required="">
<label for="policyHolderInfo-lastName">Last Name</label>
<div class="ml-1 invalid-feedback">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-3">Enter Last Name</p>
</div>
</div>
<div class="input-group form-label-group col-11 mx-auto">
<div class="w-100 js-dob-datepicker-container row">
<input type="text" class="js-mobile-datepicker form-control dateOfBirth-field w-100 form-input form-control bg-white" name="mobileDob1" id="mobileDob1" placeholder="Date of Birth (mm/dd/yyyy)"
pattern="(((0)[0-9])|((1)[0-2]))(\/)([0-2][0-9]|(3)[0-1])(\/)\d{4}" data-missing-error="Error: Enter date of birth" data-pattern-mismatch="Error: Enter a valid date of birth (mm/dd/yyyy)"
data-futuredate-error="Error: Date of Birth cannot be a future date." data-olddate-error="Error: Date of Birth cannot be so far in the past." encoding="off" autocomplete="bday">
<label for="mobileDob1" class="dob-mobile-label">Date of Birth (mm/dd/yyyy)</label>
<input type="hidden" name="mobileDob" class="mobileDob" required="">
<div class="ml-1 invalid-feedback">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-3">Enter Date of Birth</p>
</div>
<div class="ml-1 invalid-future-dob-feedback-datepicker" style="display: none;">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left text-left ml-3">Date of birth selected is for a future date. Please enter a valid date of birth.</p>
</div>
</div>
</div>
<div class="input-group form-label-group col-11 mx-auto">
<input type="text" class="form-input form-control w-100" id="policyHolderInfo-last4" name="last4" placeholder="Enter Last 4 SSN or Member ID" pattern="^[a-zA-Z0-9]*$" maxlength="30" minlength="2" required="">
<label for="policyHolderInfo-last4">Primary's Last 4 SSN/Policy or Full Member ID</label>
<div class="ml-2 invalid-feedback">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-3">Enter Last 4 SSN or Member ID</p>
</div>
<span class="float-left position-absolute last4-tooltip">
<button class="tooltip-button p-0" aria-labelledby="tooltip-label" type="button">
<img alt="icon help" id="vision-insurance-tooltip" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw4e45912b/images/cart/last4TooltipIcon.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw4e45912b/images/cart/last4TooltipIcon.png?yocs=1_5_"
data-yo-loaded="true">
</button>
<span class="tooltip" role="status" id="tooltip-label" tabindex="-1">
<span class="d-inline-block text-left font-weight-bold">Information needed to use your benefits on Eyeconic can vary based on your insurance plan. One of these options may work for you:</span>
<span class="d-inline-block text-left">1. The last four digits of the primary member's Social Security Number.</span>
<span class="d-inline-block text-left">2. The full unique Member ID given to the primary policyholder by an employer or health plan.</span>
<span class="d-inline-block text-left">3. The primary policyholder's Policy ID (a 9-digit number or Social Security Number)</span>
<span class="d-inline-block text-left">4. The last 4 digits of the primary policyholder's Policy ID.</span>
<span class="tip-outer"></span>
<span class="tip-inner"></span>
</span>
</span>
</div>
</div>
<div id="serviceErrorContainer" class="row">
<div class="col-11 text-left mx-auto">
<span id="serviceError" class="error d-none"></span>
</div>
</div>
<div class="justify-content-center">
<input id="submitPolicyHolderInfo" type="submit" class="col mx-auto modal-button modal-confirm-button text-white text-capitalize" value="Continue">
</div>
<div id="orSignInWithVSP" class="row text-center">
<input id="signInWithVSP" type="button" class="col text-nostyle bg-white" value="Sign in with VSP.com account">
</div>
</form><form id="selectPolicyHolderForm" class="needs-validation suppress" data-action="https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/OOSVB-GetSnapshot" novalidate="novalidate">
<div class="row policy-dropdown">
<div class="col">
<div class="input-group form-label-group">
<select class="form-input form-control w-100" id="selectPolicyHolderDropdown">
</select>
<div class="invalid-feedback">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-1">Choose the person you want to shop for.</p>
</div>
</div>
</div>
</div>
<div class="row policy-continue">
<div class="col">
<div class="policy-continue-btn">
<button type="button" id="selectPolicyHolderContinue" title="Shopping Cart|Order Summary|Use my vision insurance" class="btn w-100 text-capitalize text-white modal-button modal-confirm-button promo-data"> Continue </button>
</div>
</div>
</div>
<div class="row footer">
<div class="col">
<div class="d-none js-addDependentLink" id="addDependentLink">
<p class="text-center"> Don't see your eligible dependents? <span class="ml-2 link"> Add them </span>
</p>
</div>
<div class="js-callDependentLink">
<p class="dependent vsp d-none text-center"> Don’t see your eligible dependents? <br> Please call VSP at <a href="tel:8008777195">800.877.7195</a>
</p>
<p class="dependent cigna d-none text-center"> Don’t see your eligible dependents? <br> Please call Cigna at <a href="tel:8774787557">877.478.7557</a>
</p>
</div>
</div>
</div>
</form><form id="selectMemberToShopForForm" class="needs-validation suppress" novalidate="novalidate">
<div class="row mb-3">
<div class="col-7 mx-auto">
<div class="input-group form-label-group">
<div class="invalid-feedback ml-1">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-1">Choose the person you want to shop for.</p>
</div>
</div>
</div>
</div>
<div class="row mb-4">
<div class="col-7 mx-auto">
<button type="button" id="selectMemberToShopForContinue" class="btn w-100 text-capitalize text-white modal-button modal-confirm-button"> Connect </button>
</div>
</div>
</form>https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/OOSBenefits-AddDependent
<form class="needs-validation suppress" novalidate="novalidate" id="addQualifiedDependentForm" action="https://www.eyeconic.com/on/demandware.store/Sites-eyeconic-Site/default/OOSBenefits-AddDependent">
<input hidden="" id="qualifiedDependent-encryptedMemberId" name="qualifiedDependentEncryptedMemberId" value="" class="js-qualifiedDependent-encryptedMemberId">
<div class="row">
<div class="col-8 m-auto">
<div class="modal-body">
<div class="row">
<div class="col text-center pb-3">
<span id="connectBenefitsModalHeader" class="modal-heading font-weight-bold"> Add a Qualified Dependent </span>
</div>
</div>
<div class="row m-auto text-center fit-content-center">
<span class="ml-md-1">Enter the Qualified Dependent Information.</span>
</div>
<div class="row">
<div class="input-group form-label-group col-12">
<input type="text" id="qualifiedDependent-firstName" name="qualifiedDependentFirstName" class="form-input form-control mt-2 w-100" placeholder="First Name" required="" aria-required="true">
<label for="qualifiedDependent-firstName">First Name</label>
<div class="invalid-feedback ml-1">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-1">Enter First Name</p>
</div>
</div>
<div class="input-group form-label-group col-12">
<input type="text" id="qualifiedDependent-lastName" name="qualifiedDependentLastName" class="form-input form-control mt-2 w-100" placeholder="Last Name" required="" aria-required="true">
<label for="qualifiedDependent-lastName">Last Name</label>
<div class="invalid-feedback ml-1">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-1">Enter Last Name</p>
</div>
</div>
<div class="input-group form-label-group js-qualifiedDependent-dob col-12" id="qualifiedDependent-dob">
<div class="w-100 js-dob-datepicker-container row">
<input type="text" class="js-mobile-datepicker form-control dateOfBirth-field w-100 form-input form-control bg-white" name="mobileDob1" id="qualifiedDependent" placeholder="Date of Birth (mm/dd/yyyy)"
pattern="(((0)[0-9])|((1)[0-2]))(\/)([0-2][0-9]|(3)[0-1])(\/)\d{4}" data-missing-error="Error: Enter date of birth" data-pattern-mismatch="Error: Enter a valid date of birth (mm/dd/yyyy)"
data-futuredate-error="Error: Date of Birth cannot be a future date." data-olddate-error="Error: Date of Birth cannot be so far in the past." encoding="off" autocomplete="bday" aria-required="true">
<label for="qualifiedDependent" class="dob-mobile-label">Date of Birth (mm/dd/yyyy)</label>
<input type="hidden" name="mobileDob" class="mobileDob" required="" aria-required="true">
<div class="ml-1 invalid-feedback">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-3">Enter Date of Birth</p>
</div>
<div class="ml-1 invalid-future-dob-feedback-datepicker" style="display: none;">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left text-left ml-3">Date of birth selected is for a future date. Please enter a valid date of birth.</p>
</div>
</div>
</div>
<div class="input-group col-12">
<select id="qualifiedDependent-relationship" name="qualifiedDependentRelationship" class="form-input form-control mt-2 w-100 js-qualifiedDependent-relationship">
</select>
<div class="invalid-feedback ml-1">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-1">Enter Relationship</p>
</div>
</div>
</div>
<div class="row">
<div class="form-group col-12">
<div class="form-check mt-3">
<input class="form-check-input form-control" type="checkbox" id="qualifiedDependentAgreementCheckbox" value="" required="" aria-required="true">
<label class="form-check-label" for="qualifiedDependentAgreementCheckbox"> I declare that the person I am adding is eligible as my legal dependent for my vision insurance benefits. If you are unsure whether your legal dependents are
eligible under your vision insurance plan, please check your benefit information. </label>
<div class="invalid-feedback mt-3 mb-5">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="float-left ml-4">You must acknowledge the accuracy of information in order to continue.</p>
</div>
</div>
</div>
</div>
</div>
</div>
<div class="col-8 mx-auto mb-4 d-none js-addDependentGenericError add-dependent-error" id="addDependentGenericError">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="text-red ml-4">Sorry, there was a problem adding your dependent. Please try again.</p>
</div>
<div class="col-8 mx-auto mb-4 d-none js-addDependentDOBError add-dependent-error" id="addDependentDOBError">
<img alt="Error Sign" class="float-left" src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-delaytype="lazy" data-yo-src="https://cdn-fsly.yottaa.net/5dc48d35d9314072a73dc69c/www.eyeconic.com/v~4b.eef/on/demandware.static/Sites-eyeconic-Site/-/default/dw96de252e/images/common/errorExclamation.png?yocs=1_5_"
data-yo-loaded="true">
<p class="text-red ml-4"></p>
</div>
</div>
<div class="row mb-4">
<div class="col">
<div class="text-center">
<a href="https://www.eyeconic.com/removebenefits">
<button type="submit" class="btn text-white text-capitalize modal-button modal-confirm-button" id="addQualifiedDependentButton">Add Dependent</button>
</a>
</div>
</div>
</div>
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Success! You've added your dependent.
Hi, there!
Use your eligible member insurance benefits on Eyeconic to see savings (up to
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WELCOME! MEMBER
NOTE: USE THE PRIMARY MEMBER'S INFORMATION FOR THE SOCIAL SECURITY NUMBER (SSN),
POLICY, OR FULL MEMBER ID.
First Name
Enter First Name
Last Name
Enter Last Name
Date of Birth (mm/dd/yyyy)
Enter Date of Birth
Date of birth selected is for a future date. Please enter a valid date of birth.
Primary's Last 4 SSN/Policy or Full Member ID
Enter Last 4 SSN or Member ID
Information needed to use your benefits on Eyeconic can vary based on your
insurance plan. One of these options may work for you: 1. The last four digits
of the primary member's Social Security Number. 2. The full unique Member ID
given to the primary policyholder by an employer or health plan. 3. The primary
policyholder's Policy ID (a 9-digit number or Social Security Number) 4. The
last 4 digits of the primary policyholder's Policy ID.
Need Help? Contact us | Terms of Service
WHO ARE YOU SHOPPING FOR?
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Continue
Don't see your eligible dependents? Add them
Don’t see your eligible dependents?
Please call VSP at 800.877.7195
Don’t see your eligible dependents?
Please call Cigna at 877.478.7557
Choose the person you want to shop for.
Connect
Add a Qualified Dependent
Enter the Qualified Dependent Information.
First Name
Enter First Name
Last Name
Enter Last Name
Date of Birth (mm/dd/yyyy)
Enter Date of Birth
Date of birth selected is for a future date. Please enter a valid date of birth.
Enter Relationship
I declare that the person I am adding is eligible as my legal dependent for my
vision insurance benefits. If you are unsure whether your legal dependents are
eligible under your vision insurance plan, please check your benefit
information.
You must acknowledge the accuracy of information in order to continue.
Sorry, there was a problem adding your dependent. Please try again.
Add Dependent
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PLEASE USE YOUR VSP.COM LOGIN AND PASSWORD TO CONNECT YOUR BENEFITS.
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Forgot your VSP.com username or password? Contact us
If you need to add additional dependents, please contact us at 1-855-EYECONIC
(855-393-2664) If you need to add additional dependents, please contact us at
1-855-EYECONIC (855-393-2664)
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