Enrollment Kit - Anthem Blue Cross (Medical)
X
0
Forms Selected
Clear Selection
Form Name
Effective Date
Current As Of
"Current As Of" signifies the latest date on which a Word & Brown
Team Member confirmed that the Forms/Document available for download represents the most up-to-date and recently
revised version accessible.
Our goal is to process your new group enrollment easily and efficiently in order to provide you and your client with a quick approval. The following list outlines Anthem Blue Cross's case submission requirements:
- A copy of agent's quote (based on final enrollment)
- The most current Small Group Employer Application
- The most current applications from all employees enrolling
- Waivers from all employees not electing coverage
- Copy of company’s most recent Quarterly Wage Report
- Indicate on the document current employment status for each employee listed; example full-time, part-time or terminated
- Payroll may be required for new hires not listed on the Quarterly Wage Report
- An Eligibility Statement will be required for any officers/owners not on the Quarterly Wage Report. See California Underwriting Business Requirements for Sole Proprietors, Partners or Corporate Officers not appearing on the Quarterly Wage Report
- A copy of the prior carrier's last month's group premium statement
- COBRA/FMLA/Cal-Cobra questionnaire; the last billing statement listing COBRA/Cal-Cobra subscribers
- First month's premium
- A completed Electronic Enrollment Debit payment form for 100% of the first month's premium
- If electronic debit is not agreed to, a company check may be accepted, subject to additional processing time
- HSA Questionnaire required when the group is offering HSA- compatible plans and would like Anthem to administer the HSA bank account
- Completed Conditions of Enrollment for Start-Up Companies/PEO Spin-Off Groups. Payroll and additional business validation documentation may be required. Please refer to the underwriting guidelines
- If applicable, include a completed Premium Only Plan (POP) enrollment form and a separate check in the amount of $125 payable to Anthem Blue Cross
- Anthem will accept new group submissions for the following effective dates:
- 1st of the month - submit by the 5th working day of the month
- 15th of the month - submit by the 12th calendar day of the month
| After approval, prior carrier termination letter must be submitted by the employer or broker. |
For other useful for older documents, please refer to the Forms database.
Important Reminder: To help your client comply with ACA requirements, provide a copy of the appropriate Summary of Benefits and Coverage (SBC) to each employee at the Enrollment Meeting, via email or by posting on an internal company website. For the most recent information regarding Anthem Blue Cross SBCs, please go to the SBC Page or contact your Word & Brown Representative.