Get Ky Anthem Health Plans Employee Enrollment Application For 51+ Employee Groups 2022-2025

Completing the KY Anthem Health Plans Employee Enrollment Application is essential for employees seeking coverage under the 51+ employee groups. This guide provides comprehensive steps to assist users in accurately filling out the form online.

Follow the steps to successfully complete your application.

1. Press the ‘Get Form’ button to access the application and open it in your chosen editor.
2. Enter your personal information in Section 1. This includes your last name, first name, birthdate, social security number, home address, sex, marital status, and primary phone number. Ensure all mandatory fields are filled out accurately.
3. Indicate your employment status, hire date, and provide the name and ID number of your primary care physician in Section 1.
4. In Section 2, specify the reason for your application by selecting one of the options provided, such as new enrollment or loss of prior coverage.
5. Proceed to Section 3 to select desired coverage types. Options include medical, dental, and vision coverage. Mark the relevant selections as per your needs.
6. Fill out Section 4 if you wish to add dependents under your coverage. Provide necessary information for each dependent including their relationship to you, birthdates, and PCP information.
7. In Section 5, provide information regarding any prior group coverage or Medicare eligibility pertaining to you or dependents.
8. Carefully read the terms, conditions, and authorizations outlined in Section 6. After understanding them, you will need to affirm your acceptance.
9. Sign and date your application in Section 7 to validate your enrollment request. Ensure that all information is accurate to avoid delays.
10. Once completed, you can choose to save your changes, download the document, print a copy, or share the form as necessary.

Begin your application now and secure your health coverage online.