Anthem Vision Dental Employer Application for Group Insurance 2026

1. Click ‘Get Form’ to open the Anthem Vision Dental Employer Application in the editor.
2. Begin by filling out the 'Employer Information' section. Provide the legal name of the employer, DBA name if applicable, and contact details including physical and billing addresses.
3. In Section 2, indicate the vision and dental coverage applied for. Specify plan designs, copayments, and number of eligible and enrolled employees. Attach any required documents as instructed.
4. Complete Section 3 regarding eligibility criteria for employees. Clearly state the minimum hours required for eligibility and any classifications that may be restricted.
5. Fill out Section 4 on contribution and enrollment requirements, ensuring you meet participation guidelines based on your group size.
6. Provide information about dependents in Section 5, followed by effective date policies in Section 6.
7. Review Sections 7 through 10 for prior coverage details, general agreements, and ensure all signatures are obtained before submission.

Start using our platform today to easily complete your Anthem Vision Dental Employer Application for free!