Get Enrollment Application Group Size 2-99 Eligible Employees - Anthem

Filling out the Enrollment Application Group Size 2-99 Eligible Employees - Anthem online is a crucial step in securing health coverage for you and your dependents. This guide provides a detailed, step-by-step approach to completing each section of the form effectively.

Follow the steps to complete your enrollment application with ease.

1. Click 'Get Form' button to obtain the Enrollment Application Group Size 2-99 Eligible Employees - Anthem and open it in the editor.
2. Begin with Section 1, where you will select the type of coverage requested. Options include employee only, employee + spouse, employee + child(ren), family, life only, and no coverage. Make your selection clearly.
3. Move to Section 2, Enrollment Information. Here, you must provide details for yourself and any dependents enrolling. Include names, dates of birth, Social Security numbers, sex, age, height, weight, tobacco use, and disability status. Ensure each section is filled out completely.
4. Proceed to Section 3, Medical Information. Carefully answer the questions regarding medication, surgeries, pregnancy, and previous diagnoses. If you respond 'Yes' to any question, provide additional details in the space provided or on an extra sheet if necessary.
5. In Section 4, Reason for Application, specify if this enrollment is due to a qualifying event such as marriage, divorce, birth of a child, or other reasons. Include the effective date for the event.
6. Complete Section 5, Group Information, by providing your group's name, address, status, and other relevant information regarding your employment.
7. Section 6 pertains to Coverage Selection. Choose the types of medical, dental, and vision coverage you or your dependents are applying for. This section can vary based on your employer's offerings.
8. Full details regarding any life and disability insurance selections must be filled out in Section 7. Indicate any desired coverage levels and provide beneficiary information.
9. If you or your dependents are waiving medical, vision, dental, or life coverage, complete Section 8. Indicate the coverage declined and the reason.
10. In Section 9, Other Health Insurance Information, disclose any additional health insurance coverage you or family members have. Include details for policies and Medicare, if relevant.
11. Finally, review Section 10 for significant terms, conditions, and authorizations. Read this carefully, sign the application, and include the date.
12. Once you have completed all sections, save changes, download, print, or share the form as necessary to submit it as required.

Complete your Enrollment Application Group Size 2-99 Eligible Employees - Anthem online to ensure health coverage for you and your dependents.