Anthem Blue Cross

At Anthem Blue Cross we understand our health connects us to each other. What we all do impacts those around us. So Anthem is dedicated to delivering better care to our members, providing greater value to our customers and helping improve the health of our communities.

Provider Finder 

Form Name Effective Date Download Form
Attestation Form
01/01/2017 Download
Conditions of Enrollment Start Up Companies PEO Spin Offs
Download
Electronic Debit Payment/Recurring Payment Option
01/01/2017 Download
Proprietor/Partner/Corporate Officer Eligibility Statement
01/01/2017 Download
Employer Enrollment Application
07/01/2017 Download
Employer Enrollment Application
01/01/2017 Download
Employer Information Change Form
01/01/2017 Download
Guaranteed Assoc Attestation Form
Download
Statement of Understanding
Download
Form Name Effective Date Download Form
Custodial Verification Form
Download
Employee Application Form
01/01/2017 Download
Employee Change Form
01/01/2017 Download
Employee Waiver Form
Download
Handicapped Dependent Certification Form
Download
HIPAA Form - Spanish
Download
HIPAA Form
Download
Premium Only Plan
Download
Transition of Care Form - Spanish
Download
Transition of Care Form
Download
Transition of Care Policy
Download
Form Name Effective Date Download Form
Medical HMO
Anthem Platinum HMO 10/10%/2700 2EZG
01/01/2017 Summary SBC
Anthem Platinum Select HMO 10/10%/2700 1ZS0
01/01/2017 Summary SBC
Anthem Gold HMO 25/20%/6600 2EZU
01/01/2017 Summary SBC
Anthem Gold HMO 40/20%/6500 2EWB
01/01/2017 Summary SBC
Anthem Gold HMO 500/20%/6500 1ZPS
01/01/2017 Summary SBC
Anthem Gold Select HMO 25/20%/6600 2EZQ
01/01/2017 Summary SBC
Anthem Gold Select HMO 40/20%/6500 2EW1
01/01/2017 Summary SBC
Anthem Gold Select HMO 500/20%/6500 1ZPN
01/01/2017 Summary SBC
Anthem Silver HMO 1500/35%/7150 2F9C
01/01/2017 Summary SBC
Anthem Silver HMO 1750/40%/7150 2F9L
01/01/2017 Summary SBC
Anthem Silver HMO 2000/40%/7150 1ZQ3
01/01/2017 Summary SBC
Anthem Silver Select HMO 1500/35%/7150 2F98
01/01/2017 Summary SBC
Anthem Silver Select HMO 1750/40%/7150 2F9G
01/01/2017 Summary SBC
Anthem Silver Select HMO 2000/40%/7150 1ZQ0
01/01/2017 Summary SBC
Medical PPO
Anthem Platinum PPO 20/10%/4000 2F9Q
01/01/2017 Summary SBC
Anthem Platinum PPO 200/10%/4000 2EXY
01/01/2017 Summary SBC
Anthem Platinum Select PPO 15/10%/4000 1ZSK
01/01/2017 Summary SBC
Anthem Platinum Select PPO 20/10%/4000 2F90
01/01/2017 Summary SBC
Anthem Platinum Select PPO 200/10%/4000 2EZ4
01/01/2017 Summary SBC
Anthem Gold PPO 20/30%/6500 2EXB
01/01/2017 Summary SBC
Anthem Gold PPO 500/20%/6500 2EXF
01/01/2017 Summary SBC
Anthem Gold PPO 700/20%/6600 2EXQ
01/01/2017 Summary SBC
Anthem Gold PPO 1000/20%/6000 2EXU
01/01/2017 Summary SBC
Anthem Gold PPO 2000/20%/4000 2EWH
01/01/2017 Summary SBC
Anthem Gold Select PPO 20/30%/6500 2EYS
01/01/2017 Summary SBC
Anthem Gold Select PPO 30/20%/6750 1ZSB
01/01/2017 Summary SBC
Anthem Gold Select PPO 500/20%/6500 2EYW
01/01/2017 Summary SBC
Anthem Gold Select PPO 700/20%/6600 2EZ0
01/01/2017 Summary SBC
Anthem Gold Select PPO 1000/20%/6000 2EYN
01/01/2017 Summary SBC
Anthem Gold Select PPO 2000/20%/4000 2EWD
01/01/2017 Summary SBC
Anthem Silver PPO 1250/40%/7150 2EY6
01/01/2017 Summary SBC
Anthem Silver PPO 2000/20%/5400 wHSA RxC CDHP 999F
01/01/2017 Summary SBC
Anthem Silver PPO 2000_20%_5400 wHSA RxC CDHP 9996
01/01/2017 Summary SBC
Anthem Silver PPO 2000/35%/7150 2EY2
01/01/2017 Summary SBC
Anthem Silver PPO 1750/35%/7150 2EYE
01/01/2017 Summary SBC
Anthem Silver Select PPO 1250/40%/7150 2EZ8
01/01/2017 Summary SBC
Anthem Silver Select PPO 1750/35%/7150 2EYA
01/01/2017 Summary SBC
Anthem Silver Select PPO 2000/20%/5400 wHSA RxC CDHP 999B
01/01/2017 Summary SBC
Anthem Silver Select PPO 2000/20%/5400 wHSA RxC CDHP 999K
01/01/2017 Summary SBC
Anthem Silver Select PPO 2000/20%/6800 1ZSU
01/01/2017 Summary SBC
Anthem Silver Select PPO 2000/35%/7150 2EZC
01/01/2017 Summary SBC
Anthem Bronze PPO 5000/30%/7150 2EVN
01/01/2017 Summary SBC
Anthem Bronze PPO 5000/35%/6550 wHSA 1ZQQ
01/01/2017 Summary SBC
Anthem Bronze PPO 6000/35%/7150 2EWP
01/01/2017 Summary SBC
Anthem Bronze PPO 6500/0%/6500 wHSA 1ZR2
01/01/2017 Summary SBC
Anthem Bronze Select PPO 4800/40%/6550 wHSA CDHP 1ZSP
01/01/2017 Summary SBC
Anthem Bronze Select PPO 5000/30%/7150 2EVS
01/01/2017 Summary SBC
Anthem Bronze Select PPO 5000/35%/6550 wHSA CDHP 1ZQU
01/01/2017 Summary SBC
Anthem Bronze Select PPO 6000/35%/7150 2EWQ
01/01/2017 Summary SBC
Anthem Bronze Select PPO 6500/0%/6500 wHSA CDHP 1ZR5
01/01/2017 Summary SBC
Dental
Dental Classic Complete CA-2AX
Summary
Dental Classic Complete CA-2CV
Summary
Dental Enhanced Complete CA-3AZ
Summary
Dental Voluntary Complete CA-4H
Summary
Dental Voluntary Complete CA-4R
Summary
Enhanced CA-3A
Summary
Enhanced CA-3B
Summary
Enhanced CA-3BA
Summary
Enhanced CA-3BZ
Summary
Enhanced CA-3C
Summary
Enhanced CA-3D
Summary
Enhanced CA-3E
Summary
Voluntary Basic Plan CA-4H 26ZW
Summary
Voluntary Basic Plan CA-4R 270A
Summary
Vision
Summary
Blue View Full Service Plan A1
Summary
Blue View Full Service Plan A2
Summary
Blue View Full Service Plan A3
Summary
Blue View Full Service Plan A4
Summary
Blue View Full Service Plan A5
Summary
Blue View Full Service Plan A6
Summary
Blue View Full Service Plan B1
Summary
Blue View Full Service Plan B2
Summary
Blue View Full Service Plan B3
Summary
Blue View Full Service Plan B4
Summary
Blue View Full Service Plan B5
Summary
Blue View Full Service Plan B6
Summary
Blue View Full Service Plan C1
Summary
Blue View Full Service Plan C2
Summary
Blue View Full Service Plan C3
Summary
Blue View Full Service Plan C4
Summary
Blue View Full Service Plan C5
Summary
Blue View Full Service Plan C6
Summary
Blue View Full Service Plan C7
Summary
Blue View Full Service Plan C8
Summary
Blue View Full Service Plan C9
Summary
Blue View Material Only Plan MO1
Summary
Blue View Material Only Plan MO2
Summary
Blue View Material Only Plan MO3
Summary
Blue View Material Only Plan MO4
Summary
Blue View Material Only Plan MO5
Summary
Blue View Material Only Plan MO6
Summary
Form Name Effective Date Download Form
Infertility Flyer
Download
Premium Only Plan
Download
Preventative Services
Download
Resource Advisor
Download
Travel Assist
Download
Web Overview
Download
Form Name Effective Date Download Form
Anthem Contact Sheet
Download