Get Anthem Extras California

This guide provides a clear and supportive walkthrough for users filling out the Anthem Extras California form online. Follow these steps to ensure a smooth and accurate application process.

Follow the steps to complete your Anthem Extras California application.

1. Click ‘Get Form’ button to access the Anthem Extras California form.
2. Begin by filling out Section A: Applicant Information. Provide your last name, first name, middle initial, sex, home address (not a P.O. Box), and contact details. Ensure to use black ink when filling out the form.
3. In Section B: Medicare Information, input your Medicare claim number and effective dates for Hospital (Part A) and Medical (Part B) coverage. Ensure you have your Medicare card handy for accurate information.
4. Section C: Plan Chosen requires you to select one of the available Medicare supplement plans. Ensure you check the correct box that corresponds to your age group (65 or over, or under 65 due to disability).
5. In Section D: Effective Date, provide your requested effective date. Remember that it can only be set for the first of the month following the approval of your application.
6. Section E: Billing and Payment Preference allows you to choose how frequently you would like to be billed. Options include monthly, quarterly, or annual billing.
7. In Section F: Preferred Language, fill out your preferred spoken and written languages by referring to the provided coding sheet.
8. Section G: Conditions of Application requires you to answer several health-related questions. Complete all fields truthfully and accurately since inaccuracies may affect your coverage.
9. Lastly, review all provided information, ensure it is correct, and complete Section J: Authorizations and Agreements by signing and dating the application.

Complete your Anthem Extras California document online today for efficient and timely processing.