Get 8669592864

Filling out the 8669592864 form online can streamline your premium payment for Medicare Supplement plans with Anthem Blue Cross and Blue Shield. This guide offers clear and detailed instructions to assist you through each section of the form.

Follow the steps to complete the form accurately.

1. Click the ‘Get Form’ button to access the form and open it in the online editor.
2. Begin by entering your full name in the designated field. Ensure your name is printed clearly to avoid processing delays.
3. Provide your phone number for contact purposes. It is important to use a number where you can be reached easily.
4. Input your mailing address, including apartment number if applicable. This information helps Anthem to maintain accurate records.
5. Fill in your city, state, and ZIP code. Ensure all data is correct to avoid any issues with your payment setup.
6. If your billing address differs from your mailing address, enter the necessary information in the corresponding fields.
7. Indicate whether you are an existing member changing to Automatic Bank Draft or a new applicant submitting your initial application.
8. If you are an existing member, enter your Anthem identification number as shown on your ID card.
9. For new applicants, state the initial premium amount for your chosen coverage.
10. Select the appropriate option for how you wish to deduct the premium: either monthly drafts or a different payment method.
11. Complete the bank information section by selecting whether the account is checking or savings, and indicate if it is a business account.
12. Fill out the start date for the Automatic Bank Draft and provide your account holder name, financial institution name, routing number, and account number.
13. Sign and date the form where indicated, ensuring your signature matches the one on your bank account.
14. Carefully review all the information you have entered for accuracy before submitting the form.
15. Once completed, save your changes, and choose to download, print, or share the form as needed.

Complete your 8669592864 form online today for a seamless premium payment experience.