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2017 WI Anthem Employee Enrollment Application For 1-50 Employee Small Groups

2017 WI Anthem Employee Enrollment Application For 1-50 Employee Small Groups-2026

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The document is an Employee Enrollment Application for small groups (1-50 employees) in Wisconsin, requiring employees to provide personal and employment information to enroll in various insurance coverages including medical, dental, vision, life, and disability. It outlines the responsibilities of the employee to ensure accuracy and completeness of the application, details on coverage options, dependent information, and conditions for waiving coverage. Additionally, it includes terms and authorizations related to eligibility and compliance with federal laws.

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Click ‘Get Form’ to open it in the editor.
Begin with Section A: Employee Information. Fill in your last name, first name, middle initial, and Social Security number. Ensure all fields are completed accurately.
Continue by providing your home address, contact numbers, marital status, and employment details including date of hire and hours worked per week.
Move to Section B: Application Type. Select the appropriate enrollment type such as New Enrollment or Open Enrollment based on your situation.
In Section C: Type of Coverage, choose your desired medical, dental, and vision coverage options. Make sure to enter any required contract codes as advised by your employer.
Complete Sections D through G by providing dependent information, other group coverage details, waivers if applicable, and finally sign the application in Section G.

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Versions	Form popularity	Fillable & printable
2022	4.5 Satisfied (52 Votes)
2017	4.6 Satisfied (48 Votes)
2017	4.8 Satisfied (50 Votes)
2017	4.8 Satisfied (44 Votes)
2016	4 Satisfied (57 Votes)
2015	4 Satisfied (21 Votes)
2012	4 Satisfied (32 Votes)

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How many people does BCBS employ?

The BCBSA has around 1,000 employees. 9. BCBS affiliates employ more than 150,000 people nationwide, making it one of the top 20 employers in the United States.

Is Anthem bigger than United Healthcare?

UnitedHealthcare serves all 50 states and has almost 50 million health insurance customers. Anthem began operating in 2004 and has the distinction of being the biggest for-profit Blue Cross Blue Shield company and the second-largest American health insurance company. Anthem serves 40 million people in 14 states.

How many employees does Anthem Blue Cross Blue Shield have?

Description. Anthem is a public company headquartered in Indiana with an estimated 104,900 employees.

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Is Anthem Blue Cross in Wisconsin?

Whatever your health coverage needs, Anthem has a health plan in Wisconsin designed for you.

What is the phone number for Anthem Medicaid Wisconsin?

If you have questions, call us at 1-855-690-7800 (TTY 711).

2017 WI Anthem Employee Enrollment Application For 1-50 Employee Small Groups-2026

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How to use or fill out 2017 WI Anthem Employee Enrollment Application For 1-50 Employee Small Groups