Anthem extras packages senior enrollment application form 2025

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The document is an application form for Anthem Extras Packages, specifically designed for seniors aged 65 and older in various states including Ohio, Kentucky, and others. It includes sections for applicant information, coverage options, billing details, and agreement signatures. The form outlines the necessary steps to apply for health insurance coverage through Anthem Blue Cross and Blue Shield.

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Click ‘Get Form’ to open the anthem extras packages senior enrollment application form in the editor.
Begin with Section A – Applicant Information. Fill in your last name, first name, middle initial, and social security number. Ensure your home address is complete, as P.O. Boxes are not acceptable.
Continue by providing your contact details including daytime and evening phone numbers, and email address. If you have existing coverage with Anthem, include your member identification number and relevant dates.
Move to Section B – Coverage Information. Select your desired effective date for coverage and choose from the available package options: Standard, Premium, or Premium Plus.
In Section C – Billing Information, select your preferred payment frequency and indicate whether you will pay via automatic bank draft or check. If using a bank draft, attach a voided check.
Finally, sign in Section D to confirm the information provided is accurate. If applicable, have your agent complete Section E for certification.

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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

Can I buy soap and shampoo with my OTC card?

OTC items are not eligible for reimbursement if they are normally used for general health, are not used to treat a medical condition (e.g. toothpaste, mouthwash, lotion, shampoo) or are cosmetic in nature (e.g. teeth whitening products, wrinkle reducers). See additional examples in the OTC Chart.

Does Walmart accept Anthem benefits prepaid card?

Please note: Your Benefits Prepaid Card is not accepted at online retailers like Walmart.com, but in-store purchases are accepted.

Is there a difference between Anthem and Anthem Blue Cross?

Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.

Is Anthem dental insurance worth it?

The best dental insurance companies are Anthem and Guardian, ing to our analysis of large dental insurers. Anthems Essential Choice PPO Platinum plan received five out of five stars in our evaluation.

How do I use my OTC card at Walmart?

You can create a Walmart.com account and add your OTC Network card to your wallet or enter your OTC Network card as a payment method during check-out.

What is the timely filing limit for Anthem senior advantage?

Anthem will consider reimbursement for the initial claim, when received and accepted within timely filing requirements, in compliance with federal, and/or state mandates. Anthem follows the standard of: 90 days for participating providers and facilities.

Can I use my Anthem OTC card at Walmart?

You can use your Anthem OTC card to purchase eligible items at participating stores. You can find participating stores via your online portal. *Note that you can use your Anthem OTC card at participating Walmart stores, but you cannot use the card on the Walmart website.

What stores can I use my OTC card at?

You can use your Healthfirst OTC card at locations such as: Retailers like Duane Reade, Walgreens, CVS, Rite Aid, Family Dollar, CTown, Walmart, StopShop, Rite Aid, Duane Reade by Walgreens, ShopRite, Dollar General, Hannaford, GrowNYC, and Western Beef. Many local independent pharmacies.

Anthem extras packages senior enrollment application form 2025

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