Get Anthem Blue Cross Blue Shield Size 2 14 Fillable Form

This guide provides clear, step-by-step instructions for filling out the Anthem Blue Cross Blue Shield Size 2 14 Fillable Form online. By following these directions, users will ensure that all necessary information is accurately provided.

Follow the steps to fill out the form correctly:

1. Press the ‘Get Form’ button to acquire the Anthem Blue Cross Blue Shield Size 2 14 Fillable Form and open it in your chosen editor.
2. Begin by entering the group size in the appropriate section. Choose from the options provided: 2-14 small business, 15-50 community, or 51-99 mid-size.
3. Fill in the account code and group numbers in the designated fields. If your group is also enrolled in an Anthem HealthKeepers product, indicate this by checking 'Yes' or 'No' and provide the HealthKeepers group numbers if applicable.
4. Enter the company name as it should appear on official documents. Also, include the operational year, street address, city, county, and zip code.
5. If the billing address differs from the main address, provide the billing city and zip code.
6. Fill in the contact information for the group administrator, including their title, phone number, email address, and fax number.
7. Provide the company executive details, ensuring to include their title.
8. Complete the health benefits effective date, indicating the month and day.
9. Select your preferred billing frequency from the options given — whether once every year or every few months.
10. Review the list of health benefits available for groups with 2-99 enrolled employees and select the appropriate plans you wish to apply for.
11. Indicate whether you would like Anthem to facilitate the opening of a Health Savings Account and remember that checking 'Yes' requires completion of additional documentation.
12. Proceed to the coverage history section, providing details about your current carrier and whether you were enrolled with Anthem in the last 12 months.
13. In the group information section, specify the type of organization and, if applicable, the SIC code.
14. Complete the eligibility information, including the percentage of premium your company contributes and any waiting period required for new employees.
15. Attach the necessary employee applications as required in the enrollment information section.
16. Finally, review all information provided, ensure accuracy, and save your changes. You may print, download, or share the completed form as needed.

Get started on your online document management by completing your Anthem Blue Cross Blue Shield Size 2 14 Fillable Form today!