Get Nevada Quote Request Form - Anthem

This guide provides essential steps for users to accurately complete the Nevada Quote Request Form for Anthem online. Following these instructions will help ensure all necessary information is submitted correctly for timely processing.

Follow the steps to successfully complete the quote request form.

1. Click the ‘Get Form’ button to access the Nevada Quote Request Form and open it in your preferred editor.
2. Begin by filling in the broker information. Include your agency name, broker name, broker number, email address, phone number, and fax number. Ensure all fields are completed, as missing information may delay the quoting process.
3. Next, provide employer information. Fill in the group name, effective date, street address (note that P.O. boxes are not acceptable), contact name, city, state, ZIP code, SIC code, type of business, fax number, number of full-time employees, current carrier, and phone number. Accurate details in this section help streamline the quote request.
4. In the 'Please choose plan designs to quote' section, check all applicable boxes for the specific products you wish to include in your quote, or select 'PrintAll' for a comprehensive list.
5. Select the type of quote requested by choosing either 'Composite' or 'Age Rated.' Be sure to complete this section accurately as it impacts your final quote.
6. Fill out the census section with the details of employees. Provide each employee's name, date of birth or age, gender, and elected coverage. If additional space is needed, attach separate sheets.
7. Finally, review the entire form for any errors or omissions. Once completed, you can save your changes, download, print, or share the form as needed.

Complete your Nevada Quote Request Form online today for prompt assistance with your quote.