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Get Anthem Blue Cross - Cobra Enrollment Form (pdf) - Meba
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How to fill out the Anthem Blue Cross - Cobra Enrollment Form (PDF) - MEBA online
Completing the Anthem Blue Cross - Cobra Enrollment Form is an essential step for individuals seeking to continue their health insurance coverage under COBRA. This guide provides clear and comprehensive instructions to help you navigate each section of the form effectively and online.
Follow the steps to fill out the form accurately.
- Click ‘Get Form’ button to obtain the Anthem Blue Cross - Cobra Enrollment Form and open it in an editor.
- In the 'Applicant’s Personal Information' section, fill in your last name, first name, middle initial, street address, city, state, zip code, telephone number, department number, and email address. Indicate your preferred language for receiving information.
- If applicable, indicate whether you or your dependents have other health care coverage. Provide the name and address of the other insurance carrier.
- Review the 'Continuation of Group Health Coverage' section carefully, sign the form, and date it. Ensure that all pertinent information is accurate and complete.
Complete your documents online today to secure your health coverage.
You'll get one for each healthcare service claim you or your provider sends to your plan. That may include a doctor, hospital, lab, or clinic claim. Your health plan sends you an EOB after it receives your provider's bill.
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