Get Anthem 27248caeenabc 2015-2025

This guide provides a comprehensive overview of how to accurately complete the Anthem 27248CAEENABC form online for authorizing debit or credit transactions for premiums or administrative fees by phone. Follow the steps carefully to ensure all necessary information is entered correctly.

Follow the steps to fill out the Anthem 27248CAEENABC form online

1. Press the ‘Get Form’ button to access the Anthem 27248CAEENABC form and open it in your online editor.
2. Enter your employer information in Section 1, including the employer name, group or case number, legal company name, street address, city, state, ZIP code, and contact person’s details such as phone number, fax number, and email address.
3. In Section 2, input the financial institution information. This includes the name and address of the institution, the transit routing number (9-digit ABA routing number), the city, the account number, and the type of bank account you are designating (personal or business checking/savings).
4. Read the authorization terms carefully. Ensure you understand that the authorization takes effect once Anthem Blue Cross receives it and remains effective until you provide written notice of termination.
5. Complete the signature section by providing the printed name and signature of the authorized signer, along with the date of signing.
6. If you are terminating the agreement, fill out Section 3 by providing the printed name, signature, and date of the authorized signer who is listed in the Anthem Blue Cross database.
7. After filling out the form, review all entries for accuracy. Save your changes, and download, print, or share the completed form as needed.

Complete your Anthem 27248CAEENABC form online today for efficient processing.