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 Application
01/01/2018 Download
Employer Information Change Form
01/01/2017 Download
Guaranteed Assoc Attestation Form
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Statement of Understanding
Download
Form Name Effective Date Download Form
Custodial Verification Form
Download
Employee Application
01/01/2018 Download
Employee Change Form
01/01/2018 Download
Employee Waiver Form
01/01/2018 Download
Handicapped Dependent Certification Form
Download
HIPAA Form - Spanish
Download
HIPAA Form
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Premium Only Plan
Download
Transition of Care Form - Spanish
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Transition of Care Form
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Transition of Care Policy
Download
Form Name Effective Date Download Form
2018 Medical HMO
CaliforniaCare Full HMO Network
Platinum HMO 10/10%/2000 - 300D
01/01/2018 Summary SBC
Gold HMO 25/20%/5500 - 304R
01/01/2018 Summary SBC
Gold HMO 40/20%/4500 - 301V
01/01/2018 Summary SBC
Gold HMO 500/20%/5000 - 2ZYU
01/01/2018 Summary SBC
Gold HMO 1000/30%/4000 - 305F
01/01/2018 Summary SBC
Silver HMO 1500/35%/7150 - 304Z
01/01/2018 Summary SBC
Silver HMO 2000/40%/7350 - 2ZZ2
01/01/2018 Summary SBC
Select HMO Network
Platinum Select HMO 10/10%/2000 - 3009
01/01/2018 Summary SBC
Gold Select HMO 25/20%/5500 - 304M
01/01/2018 Summary SBC
Gold Select HMO 40/20%/4500 - 301R
01/01/2018 Summary SBC
Gold Select HMO 500/20%/5000 - 2ZYQ
01/01/2018 Summary SBC
Gold Select HMO 1000/30%/4000 - 305K
01/01/2018 Summary SBC
Silver Select HMO 1500/35%/7150 - 304V
01/01/2018 Summary SBC
Silver Select HMO 2000/40%/7350 - 2ZYY
01/01/2018 Summary SBC
2018 Medical PPO
Prudent Buyer Full PPO Network
Platinum PPO 20/10%/3000 - 3057
01/01/2018 Summary SBC
Platinum PPO 200/10%/3000 - 3037
01/01/2018 Summary SBC
Gold PPO 20/30%/6500 - 302G
01/01/2018 Summary SBC
Gold PPO 500/20%/6500 - 302Q
01/01/2018 Summary SBC
Gold PPO 750/20%/6500 - 303P
01/01/2018 Summary SBC
Gold PPO 1000/20%/6000 - 303X
01/01/2018 Summary SBC
Gold PPO 2000/20%/4000 - 3024
01/01/2018 Summary SBC
Silver PPO 1250/40%/7350 - 3045
01/01/2018 Summary SBC
Silver PPO 1750/35%/7350 - 304H
01/01/2018 Summary SBC
Silver PPO 2000/40%/7350 - 303F
01/01/2018 Summary SBC
Silver PPO 2000/20%/6000 wHSA - RxC - 99A2 Employee Only Coverage
01/01/2018 Summary SBC
Silver PPO 2000/20%/6000 wHSA - RxC - 99AF Employee & Dependent Coverage
01/01/2018 Summary SBC
Bronze PPO 4000/40%/7350 - 305X
07/01/2018 Summary SBC
Bronze PPO 5000/30%/7350 - 301D
01/01/2018 Summary SBC
Bronze PPO 6000/35%/7350 - 3028
01/01/2018 Summary SBC
Bronze PPO 4500/35%/6550 wHSA - 3065
01/01/2018 Summary SBC
Bronze PPO 5000/35%/6550 wHSA - 2ZZN
01/01/2018 Summary SBC
Bronze PPO 6500/0%/6500 wHSA - 2ZZW
01/01/2018 Summary SBC
Select PPO Network
Platinum Select PPO 15/10%/3350 - 300Z
01/01/2018 Summary SBC
Platinum Select PPO 20/10%/3000 - 3053
01/01/2018 Summary SBC
Platinum Select PPO 200/10%/3000 - 303B
01/01/2018 Summary SBC
Gold Select PPO 20/30%/6500 - 302L
01/01/2018 Summary SBC
Gold Select PPO 25/20%/6000 - 300R
01/01/2018 Summary SBC
Gold Select PPO 500/20%/6500 - 302U
01/01/2018 Summary SBC
Gold Select PPO 750/20%/6500 - 303T
01/01/2018 Summary SBC
Gold Select PPO 1000/20%/6000 - 3041
01/01/2018 Summary SBC
Gold Select PPO 2000/20%/4000 - 301Z
01/01/2018 Summary SBC
Silver Select PPO 1250/40%/7350 - 3049
01/01/2018 Summary SBC
Silver Select PPO 1750/35%/7350 - 304D
01/01/2018 Summary SBC
Silver Select PPO 2000/20%/7000 - 3018
01/01/2018 Summary SBC
Silver Select PPO 2000/40%/7350 - 303K
01/01/2018 Summary SBC
Silver Select PPO 2000/20%/6000 wHSA - RxC - 999Y Employee Only Coverage
01/01/2018 Summary SBC
Silver Select PPO 2000/20%/6000 wHSA - RxC - 99AB Employee & Dependent Coverage
01/01/2018 Summary SBC
Bronze Select PPO 4000/40%/7350 - 3061
07/01/2018 Summary SBC
Bronze Select PPO 5000/30%/7350 - 301H
01/01/2018 Summary SBC
Bronze Select PPO 6000/35%/7350 - 302C
01/01/2018 Summary SBC
Bronze Select PPO 4500/35%/6550 w/HSA - 3069
01/01/2018 Summary SBC
Bronze Select PPO 4800/40%/6550 wHSA - 3013
01/01/2018 Summary SBC
Bronze Select PPO 5000/35%/6550 wHSA - 2ZZS
01/01/2018 Summary SBC
Bronze Select PPO 6500/0%/6500 wHSA - 3000
01/01/2018 Summary SBC
2017 Medical HMO
CaliforniaCare Full HMO Network
Platinum HMO 10/10%/2700 - 2EZG
01/01/2017 Summary SBC
Gold HMO 25/20%/6600 - 2EZU
01/01/2017 Summary SBC
Gold HMO 40/20%/6500 - 2EWB
01/01/2017 Summary SBC
Gold HMO 500/20%/6500 - 1ZPS
01/01/2017 Summary SBC
Silver HMO 1500/35%/7150 - 2F9C
01/01/2017 Summary SBC
Silver HMO 1750/40%/7150 - 2F9L
01/01/2017 Summary SBC
Silver HMO 2000/40%/7150 - 1ZQ3
01/01/2017 Summary SBC
Select HMO Network
Platinum Select HMO 10/10%/2700 - 1ZS0
01/01/2017 Summary SBC
Gold Select HMO 25/20%/6600 - 2EZQ
01/01/2017 Summary SBC
Gold Select HMO 40/20%/6500 - 2EW1
01/01/2017 Summary SBC
Gold Select HMO 500/20%/6500 - 1ZPN
01/01/2017 Summary SBC
Silver Select HMO 1500/35%/7150 - 2F98
01/01/2017 Summary SBC
Silver Select HMO 1750/40%/7150 - 2F9G
01/01/2017 Summary SBC
Silver Select HMO 2000/40%/7150 1ZQ0
01/01/2017 Summary SBC
2017 Medical PPO
Prudent Buyer Full PPO Network
Platinum PPO 20/10%/4000 - 2F9Q
01/01/2017 Summary SBC
Platinum PPO 200/10%/4000 - 2EXY
01/01/2017 Summary SBC
Gold PPO 20/30%/6500 - 2EXB
01/01/2017 Summary SBC
Gold PPO 500/20%/6500 - 2EXF
01/01/2017 Summary SBC
Gold PPO 700/20%/6600 - 2EXQ
01/01/2017 Summary SBC
Gold PPO 1000/20%/6000 - 2EXU
01/01/2017 Summary SBC
Gold PPO 2000/20%/4000 2EWH
01/01/2017 Summary SBC
Silver PPO 1250/40%/7150 - 2EY6
01/01/2017 Summary SBC
Silver PPO 1750/35%/7150 2EYE
01/01/2017 Summary SBC
Silver PPO 2000/35%/7150 - 2EY2
01/01/2017 Summary SBC
Silver PPO 2000_20%_5400 wHSA RxC CDHP - 9996 Employee Only Coverage
01/01/2017 Summary SBC
Silver PPO 2000/20%/5400 wHSA RxC CDHP - 999F Employee & Dependent Coverage
01/01/2017 Summary SBC
Bronze PPO 5000/30%/7150 - 2EVN
01/01/2017 Summary SBC
Bronze PPO 6000/35%/7150 - 2EWP
01/01/2017 Summary SBC
Bronze PPO 5000/35%/6550 wHSA - 1ZQQ
01/01/2017 Summary SBC
Bronze PPO 6500/0%/6500 wHSA - 1ZR2
01/01/2017 Summary SBC
Select PPO Network
Platinum Select PPO 15/10%/4000 - 1ZSK
01/01/2017 Summary SBC
Platinum Select PPO 20/10%/4000 - 2F90
01/01/2017 Summary SBC
Platinum Select PPO 200/10%/4000 - 2EZ4
01/01/2017 Summary SBC
Gold Select PPO 20/30%/6500 - 2EYS
01/01/2017 Summary SBC
Gold Select PPO 30/20%/6750 - 1ZSB
01/01/2017 Summary SBC
Gold Select PPO 500/20%/6500 - 2EYW
01/01/2017 Summary SBC
Gold Select PPO 700/20%/6600 - 2EZ0
01/01/2017 Summary SBC
Gold Select PPO 1000/20%/6000 - 2EYN
01/01/2017 Summary SBC
Gold Select PPO 2000/20%/4000 - 2EWD
01/01/2017 Summary SBC
Silver Select PPO 1250/40%/7150 2EZ8
01/01/2017 Summary SBC
Silver Select PPO 1750/35%/7150 2EYA
01/01/2017 Summary SBC
Silver Select PPO 2000/20%/6800 - 1ZSU
01/01/2017 Summary SBC
Silver Select PPO 2000/35%/7150 - 2EZC
01/01/2017 Summary SBC
Silver Select PPO 2000/20%/5400 wHSA RxC CDHP - 999B Employee Only Coverage
01/01/2017 Summary SBC
Silver Select PPO 2000/20%/5400 wHSA RxC CDHP - 999K Employee & Dependent Coverage
01/01/2017 Summary SBC
Bronze Select PPO 5000/30%/7150 - 2EVS
01/01/2017 Summary SBC
Bronze Select PPO 6000/35%/7150 2EWQ
01/01/2017 Summary SBC
Bronze Select PPO 4800/40%/6550 wHSA CDHP - 1ZSP
01/01/2017 Summary SBC
Bronze Select PPO 5000/35%/6550 wHSA CDHP - 1ZQU
01/01/2017 Summary SBC
Bronze Select PPO 6500/0%/6500 wHSA CDHP - 1ZR5
01/01/2017 Summary SBC
Dental
Vision
Form Name Effective Date Download Form
Anthem 2018 Specialty Bonus Program
02/01/2018 Download
Anthem Attestation Determining Group Size
01/01/2018 Download
Anthem Attestation Form
01/01/2018 Download
Anthem Contract Code List
01/01/2018 Download
Anthem HMO Network Comparison Guide
07/01/2017 Download
Anthem Mapping Grid
01/01/2018 Download
Anthem Q1 Rate Guide
01/01/2018 Download
Anthem RX Formulary
01/01/2018 Download
Anthem Small Group Guide
01/01/2018 Download
Infertility Flyer
Download
Premium Only Plan
Download
Preventative Services
Download
Provider Search
Download
Resource Advisor
Download
Travel Assist
Download
Web Overview
Download
PayForward FAQs
Download
Form Name Effective Date Download Form
Anthem Contact Sheet
Download