Get Indiana Insurability Information Request - Anthem

Filling out the Indiana Insurability Information Request is a crucial step in obtaining life and health insurance through Anthem. This guide provides a clear and supportive framework to assist you in completing the form accurately and efficiently, ensuring that you include all necessary information. Follow these instructions to navigate the process with confidence.

Follow the steps to complete the form easily and accurately.

1. Press the ‘Get Form’ button to access the Indiana Insurability Information Request form and open it for editing.
2. Begin with Section 1: General Information. Enter your last name, first name, middle initial, Social Security number, work and home phone numbers, and email address. Complete your address, including city, state, and ZIP code, as well as your date of birth and state of birth.
3. Proceed to Section 2: Dependent Information. If you have dependents to be covered, fill in their last name, first name, middle initial, date of birth, state of birth, sex, relationship to you, height, and weight for each dependent.
4. Move to Section 3: Medical and Activities Questionnaire. Answer all medical questions for yourself and your dependents, marking 'yes' or 'no' as applicable. Provide explanations for any 'yes' answers, and list any prescribed medications, diagnoses, or treatment details.
5. In Section 4: Notice of Exchange of Information, familiarize yourself with how your information will be treated and shared. This section informs you of confidentiality and your rights regarding insurability information.
6. Lastly, complete Section 5: Agreement and Authorization. Sign and date the form, ensuring to include signatures for any dependents to be covered. Review the information provided to confirm its accuracy before submission.
7. Once all sections are filled, you can save your changes, download the document, print it out, or share it as necessary.

Complete your documentation online to ensure proper management of your insurability needs.