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51-125: New Employee Application Available
Oct 29, 2015
Anthem is pleased to announce that the Large Group Member Enrollment forms have been revised (both English and Spanish).
Some of the revisions include:
- Section 1 – Anthem added the Elements choice EQ plans and removed Advantage PPO and ACO Flex plan options. Updated the Dental choices to be in line with CA Large Group options.
- Section 3 – Anthem replaced Subscriber’s “street” address with “mailing” address (as members sometimes receive mail other than at a residence).
- Section 4 – updated the Declination Acknowledgment text.
- Section 10 – simplified the W-9 Certification Language per IRS requirement.
Here are pdfs of the forms:
All other versions of the Employee Application are considered "obsolete" and this updated version is the only one that should be used by statewide sales and brokers.
For questions, please contact a member of your b&p Sales Team - 888.722.3373.