Get Ky Anthem Health Plans Employee Enrollment Application For 51+ Employee Groups 2017-2025

Completing the KY Anthem Health Plans Employee Enrollment Application is a crucial step for employees in 51+ groups. This guide provides a clear framework to assist you in accurately filling out the application online, ensuring that all necessary information is provided for enrollment.

Follow the steps to successfully complete your enrollment application.

1. Click ‘Get Form’ button to access the enrollment application and open it in your preferred form editor.
2. In Section 1, provide the company name, address, group number, subgroup number, and requested effective date. Ensure accuracy as this information is essential for processing your enrollment.
3. In Section 2, indicate the reason for application by checking the appropriate box, such as 'New enrollment' or 'Add dependent'. If adding a dependent, be prepared to fill in the details in Section 3.
4. If you opted to add a dependent in Section 2, complete Section 3 by providing the event date and details of the status change, such as marriage, birth, or adoption.
5. In Section 4, select the type of coverage desired (medical, dental, vision, or life). Indicate your preference for coverage and ensure to write down any plan numbers if multiple options are available.
6. In Section 5, fill out your personal information including name, birth date, Social Security number, and contact information. Be accurate as this section is required.
7. Complete Section 6 by providing information about dependents. Only list those you wish to enroll, and attach additional sheets if necessary.
8. If applicable, provide details in Section 7 regarding any life and disability insurance coverage you desire.
9. Complete Section 8 by detailing any other health coverage you or your dependents have, including policy numbers and effective dates.
10. Carefully read Section 9 to understand the significant terms and conditions before signing the application in Section 10.
11. Finally, review your application for accuracy, then submit it to your employer, saving any necessary changes. You may choose to download or print a copy for your records.

Start filling out your KY Anthem Health Plans Employee Enrollment Application online today to ensure you have the coverage you need.