Home
Forms Library
Anthem enrollment form

Enrollment application anthem form 2026

anthem enrollment form Preview on Page 1

See details

4.3 out of 5

98 votes

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 information, 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 provide necessary personal and dependent information.

Here's how it works

01. Edit your anthem enrollment form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out enrollment application anthem form with our platform

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open the enrollment application anthem form in the editor.
Begin by filling out the employer/group information, including Group Name, Group Number, and Date of Hire. This section is crucial for your employer's records.
In Section 1, check the applicable company and write in the product that applies to your application. Ensure you select the correct coverage option based on your needs.
For Section 2, indicate your reason for application by checking all that apply. This helps in processing your request efficiently.
Complete Section 4 with your personal information, including Social Security Number and contact details. If required, list your Primary Care Physician (PCP) details.
If you have dependents applying for coverage, fill out Section 5 with their information. Be sure to include relationships and any necessary documentation.
Finally, review all sections for accuracy before signing and dating the Employee Certification at the end of the form.

Start using our platform today to fill out your enrollment application anthem form easily and for free!

See more enrollment application anthem form versions

We've got more versions of the enrollment application anthem form form. Select the right enrollment application anthem form version from the list and start editing it straight away!

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

be ready to get more

Complete this form in 5 minutes or less

Get form

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.

How can I sign my enrollment application anthem form without printing?

Electronic signatures are a perfect alternative to traditional signing, as they save time, effort, and money people spend on printing, scanning, and paper delivery. You can electronically sign your enrollment application anthem form utilizing a reliable and powerful online document management services like DocHub. It complies with primary eSignature policies (ESIGN and UETA), so all documents approved there are legally binding and have the same validity as manually signed ones.

How do you edit enrollment application anthem form on iOS?

You can easily edit and complete your enrollment application anthem form on any iOS gadget. Open an internet browser of your choice, go to the DocHub website, authorize or create a new account, upload your file for editing, and make your required adjustments. Our service is mobile-friendly, so utilizing its features on your phone will be a no-brainer, even on the first try.