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51+: Anthem Employer Application Updated

Apr 03, 2015

The Anthem Large Group Employer Application has been revised and ready to begin using!

The major changes to the form include:
  1. Dental Prime and Complete have been ADDED to the application!!! Continuing to meet the goal of making it easier to do business with Anthem. You will no longer need to have a separate form.
  2. Section 4 of this application:
      - Removed the ACO Flex and Advantage PPO plans from the dropdown selection (as those plans are no longer available)
      - Included HealthySupport HMO, HSA and PPO plans
      - Added a note under the ALL PRODUCTS SOLD OR MEDICAL ONLY Heading - If a waiting period with an asterisk is selected, Anthem will adjust the coverage effective date to ensure the waiting period between enrollees’ eligibility date and the effective date of their coverage does not exceed 90 days from date of hire. There are 2 instances under the waiting period dropdown when this applies:
          1st of the month following 2 months from date of hire*
          1st of the month following 60 days from date of hire*    
       (This waiting period note does not apply to Specialty Products waiting periods.)

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.

Here is a ​fillable version of the revised Employer Application.

All other versions of the Employer Application are considered ‘obsolete’ and this updated version is the only one that should be used.  Using a variety of different versions from over the years is problematic as expressed by Anthem's Legal team.

Please begin using the new form today!

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

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