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Enrollment application anthem form 2025

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The document is an Employee Health Enrollment Application for groups of 15 or more, requiring completion in ink and submission to the employer. It includes sections for employer use, coverage options, reasons for application (such as marriage or new hire), employee and family information, details about other insurance coverage, Medicare coverage, and an employee certification statement. The application allows employees to select health plans and designate primary care physicians while providing necessary personal and dependent information.

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Versions	Form popularity	Fillable & printable
2015	4.8 Satisfied (117 Votes)
2005	4.3 Satisfied (98 Votes)

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