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51-125: New Employer Application Available

Aug 31, 2015

Another way Anthem is making it easier to do business with Anthem!

The Large Group Employer application (form # SC10683) has been updated to include a new section 6, whereby an employer can grant an agent/broker/producer/GA access to the group’s information through EmployerAccess. 
Here is a ​fillable version of the revised Employer Application. 

Here is the new text:

SECTION 6: ELECTRONIC ACCESS OF GROUP INFORMATION BY AGENT/PRODUCER/BROKER/GENERAL AGENT

We, the employer, hereby authorize the agent/producer/broker/general agent whose name is attached to this application to use the EmployerAccess system of Anthem Blue Cross or Anthem Blue Cross Life and Health Insurance Company to access the group’s information, such as but not limited to enrollees, plan selections, and bills/invoices. Such agent/ producer/broker/general agent is also hereby authorized to use the EmployerAccess system of Anthem Blue Cross or Anthem Blue Cross Life and Health Insurance Company to make changes to the group’s information on behalf of the group, such as but not limited to adding/deleting plans, adding/deleting employees, and or changing employee demographic information. These authorizations shall terminate if the group’s designated agent/producer/broker/general agent changes.
___Check this box ONLY if the group elects to opt-out of authorizing the agent/producer/broker/general agent to access and change the group’s information on behalf of the group.
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All other versions of the Employer Application are considered "obsolete" and this updated version is the only one that should be used by statewide sales and brokers.

Please note: the signature fields are not fillable, as Anthem does not have capability to capture signatures yet. You will need to save and print the filled-in form; get signatures and submit.

For questions, please ​contact a member of your b&p Sales Team - 888.722.3373.

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