Get Enrollment Application - Anthem

Filling out the Enrollment Application for Anthem can be an easy and straightforward process when approached step-by-step. This guide is designed to help individuals complete the application accurately and efficiently for optimal benefit enrollment.

Follow the steps to complete your Enrollment Application with ease.

1. Click ‘Get Form’ button to obtain the Enrollment Application and open it in your preferred editor.
2. In Section 1, provide the employer and group information including the employer name, address, group number, and requested effective date. Ensure all details are accurate.
3. In Section 2, indicate the reason for application by selecting the appropriate option such as new enrollment or adding a dependent. If eligible, fill in the required fields.
4. If you checked ‘Add dependent’ in Section 2, complete Section 3 with the event date and the appropriate status change, such as marriage or birth. Attach legal documentation if necessary.
5. In Section 4, choose the type of coverage you desire for Medical, Dental, or Vision. Clearly indicate your selection and whether you wish to waive coverage.
6. Complete Section 5 with your personal details including your name, birth date, and contact information. Provide your Social Security number and employment details as required.
7. In Section 6, provide information about any dependents you wish to enroll. Ensure to complete all required fields and attach additional sheets if necessary.
8. Fill out Section 7 if applicable, detailing your income and any life or disability insurance coverage selected.
9. In Section 8, report any other health coverage you or your dependents currently have, including necessary details about prior coverage.
10. Carefully read through Section 9 which contains significant terms and conditions. Understand all provisions before signing.
11. Sign and date your application in Section 10 to certify the information provided is accurate and complete.
12. If waiving any coverage, complete Section 11 by checking applicable boxes and providing necessary reasons and signatures.
13. Once all sections are accurately filled, save your changes. You can choose to download, print, or share the completed application as needed.

Start filling out your Enrollment Application online today to ensure you have the coverage you need.