Get Anthem Employee Health Enrollment Application 2012-2026

This guide aims to provide clear and comprehensive instructions for completing the Anthem Employee Health Enrollment Application online. By following these steps, users will be able to navigate the form efficiently, ensuring that all necessary information is provided accurately.

Follow the steps to complete your enrollment application online.

1. Press the ‘Get Form’ button to obtain the Anthem Employee Health Enrollment Application and open it in the editor.
2. Begin by filling out the employer/group information section at the top of the form. This includes the group name, group number, date of hire, full-time hire date, hours worked per week, and your position/title.
3. Indicate your effective date and the date you are eligible for coverage, as well as your Social Security number.
4. In Section 1, check the appropriate box for the company and product that applies to your application, including options such as Anthem Blue Cross and Blue Shield or HealthKeepers, Inc.
5. In Section 2, check all relevant boxes for the reason for your application, providing dates where required for events such as marriage or birth of a child.
6. Select your type of coverage in Section 3, indicating whether you are enrolling for Employee Only, Employee and Spouse, Employee and Children, or Employee and Family.
7. Fill out your personal information in Section 4, including your Social Security number, date of birth, sex, last name, first name, and contact details.
8. If applicable, provide information for family members applying for coverage in Section 5, including their relationship to you, Social Security numbers, and dates of birth.
9. Complete Section 6 about other insurance coverage, providing the name of the other carrier, ID number, and effective dates.
10. If applicable, fill out Section 7 regarding any Medicare coverage you or your dependents might have.
11. In Section 8, certify that the information provided is complete and true. Sign and date the application. This section may require you to authorize the sharing of Health Savings Account information if applicable.
12. Review all provided information for accuracy and completeness before finalizing the application.
13. Once complete, save your changes, and you may choose to download, print, or share the application as needed.

Complete your Anthem Employee Health Enrollment Application online today to ensure your health coverage needs are met.