Get Anthem Blue Cross Enrollment Form 2008-2025

Filling out the Anthem Blue Cross Enrollment Form online is an important step towards accessing your healthcare benefits. This guide will support you in completing each section accurately and efficiently, ensuring that you don't miss any necessary information.

Follow the steps to complete your enrollment form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin by selecting the type of coverage you desire from the options provided in Section 1. This might include medical, dental, or vision coverage, among others. Make sure to choose only from the options available through your employer.
3. Proceed to Section 2 to enter the applicant's personal information. Fill in your last name, first name, middle initial, and marital status. Ensure to provide the correct social security number, street address, and contact details.
4. In Section 3, list yourself and any eligible family members you wish to enroll. Provide details such as sex, birthdate, and other specific codes for your designated health providers or plans.
5. Section 4 is crucial if you need to decline coverage for yourself or any dependents. Check the applicable boxes and provide the reason for declining.
6. If enrolling in COBRA or Cal-COBRA, complete Section 5 to detail the qualifying events and coverage dates.
7. Section 6 requires you to disclose any existing coverage that you or your dependents may have. Answer the questions truthfully to help avoid issues later.
8. If applicable, fill out Section 7 for Medicare coverage information, providing the necessary details of any Medicare plans you or a dependent might have.
9. Complete Section 9 by designating beneficiaries for life insurance. List names and the relationship to you, ensuring to allocate percentages if there are multiple beneficiaries.
10. Finally, read carefully through Section 10, and provide your signature and date to confirm the information is accurate. This is also where you authorize any required deductions from your wages.
11. After completing the form, you can save your changes, download, print, or share the completed form as necessary.

Complete your enrollment form online today to secure your health benefits.