Get Conversion Of Dependent Form - Anthem

Filling out the Conversion Of Dependent Form - Anthem can streamline your transition from existing coverage to an individual policy. This guide will provide you with step-by-step instructions to ensure you complete the form accurately and efficiently.

Follow the steps to successfully complete the form.

1. Click the ‘Get Form’ button to obtain the form and open it for editing.
2. Begin with Section 1, where you will provide details about the dependent converting to a new policy. Input the dependent's last name, first name, middle initial, social security number, home address, city, state, zip, mailing address (if different), birthdate, email address, and telephone numbers.
3. Move to Section 2 to document the current primary policyholder's information. Fill in their last name, first name, middle initial, and identification number as displayed on the insurance ID card.
4. In Section 3, select the desired start date for the new policy, ensuring it is after the date the completed application is received.
5. In Section 4, choose whether to maintain your existing coverage or make changes. If selecting the option to maintain, simply check the appropriate box and proceed to Section 7. If opting to make changes, follow the prompts to fill out Sections 5 and/or 6.
6. If changes are desired, go to Section 5 to select any adjustments to policy deductibles and/or coinsurance. Indicate an amount that is higher than your current selections and remember: this form cannot be used to decrease deductibles.
7. In Section 6, add or delete optional coverages as needed. Review the qualifying events and check the boxes for any optional coverage changes you wish to make, ensuring you provide initials where required.
8. Proceed to Section 7, the Certification and Authorization section, and read the terms carefully. Sign and date where indicated to confirm your understanding and acceptance of the terms outlined.
9. Once all sections are completed, review the entire form for accuracy before submitting it. You may save changes, download, print, or share the completed form as necessary.

Start filling out your Conversion Of Dependent Form - Anthem online today to ensure a smooth transition to your new policy.