California anthem blue cross form 2025

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The document is an enrollment form for Anthem Blue Cross, detailing the process for employees to enroll in various health insurance plans offered by their employer. It includes sections for selecting coverage types (medical, dental, vision, life insurance), providing personal information, and designating beneficiaries. The form also outlines the procedures for declining coverage, COBRA/Cal-COBRA options, and requirements for binding arbitration. Employees are instructed to return the completed form to their employer.

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Click ‘Get Form’ to open the California Anthem Blue Cross enrollment form in the editor.
Begin by selecting the type of coverage you need in Section 1. Choose from options like Medical, Dental, and Vision based on what your employer offers.
In Section 2, fill out your personal information including your Social Security number, name, marital status, and contact details. Ensure accuracy as this information is crucial for processing.
Proceed to Section 3 to list yourself and any eligible family members. Include their Social Security numbers and other required details such as birthdates and relationship to you.
If you are declining any coverage, complete Section 4 by indicating which coverage you are opting out of and providing a reason.
Review all sections for completeness before submitting. Use our platform’s features to save your progress or make edits easily.

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Versions	Form popularity	Fillable & printable
2017	4.8 Satisfied (81 Votes)
2014	4.3 Satisfied (114 Votes)
2013	4 Satisfied (54 Votes)
2012	4 Satisfied (28 Votes)

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Is Anthem leaving California?

Anthem Blue Cross has announced that they will leave many counties in California starting Jan 2018. Lets look at the message detail and most importantly Well look at the alternative options if youre affected.

Is Blue Cross of California the same as Anthem?

Anthem Blue Cross is the trade name of In California: Blue Cross of California, Anthem Blue Cross Partnership Plan, Anthem BC Health Insurance Company and Anthem Blue Cross Life and Health Insurance Company are independent licensees of the Blue Cross Association.

What is Blue Cross Blue Shield called now?

Anthem Blue Cross HMO/POS has earned an Excellent Accreditation status from the National Committee for Quality Assurance (NCQA). Anthem Blue Cross PPO is the first and continues to be the only PPO in California to have earned Full Accreditation from the NCQA5.

How to contact Anthem Blue Cross California?

Case Management for Anthem Blue Cross Cal MediConnect Plan Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

Is Anthem Blue Cross the same as Blue Cross of California?

As of January 1, 2024, the Empire BlueCross BlueShield and Empire BlueCross names are Anthem Blue Cross and Blue Shield and Anthem Blue Cross.

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Is Anthem Blue Cross Blue Shield the same as Empire Blue Cross Blue Shield?

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