ANTHEM - GROUP
www.anthem.com
Anthem Individual forms transfered to "Forms - Individual"
Health Care Reform
Health Care Reform Timeline 6/2/11
Health Care Reform Brochure - fully insured, large group 8/11
Health Care Reform Brochure - self-insured 8/15/11
Health Care Reform Brochure - small group with grandfathering 8/11
Health Care Reform Brochure - small group without grandfathering 9/11
360 & Wellness Materials
360 Solutions Time Well Spent
360 Health Programs at a Glance EMWsh1318A 1/08
360 Health Programs - fully insured notification
360 Employer Kit
360 Employer Overview
360 Employee Overview
360 24 Hr Nurseline
360 Complex Care
360 Condition Care
360 Condition Care FAQ
360 My Health at Anthem
360 Find My Health at Anthem
Preventative Services
Wellness in the Workplace
Wellness Services
6.0 Materials
All groups will change to Blue Access 6.0 at renewal starting with 10/1/11 renewals.
Comparison Grid 6.0
Product Guide 6.0 - PPO
Product Guide 6.0 - Lumenos HSA
5.0 Materials
Certificate Booklet (Lumenos) - Small Group 10/10
Certificate Booklet (PPO) - Small Group 10/10
Certificate Booklet (PPO) - Large Group 10/10
Product Grid PPO 5.0 5/11
Plan Comparison Guide - Current 4.0 vs Grandfathered 4.0 vs. Non-Grandfathered 5.0 - 10/10
4.0 Materials
Lumenos Plan Grid 6/9/10
Blue Access PPO Grid 5/30/10
Admin Guide (small group) HSA
Ancillary Producer Guide - see under Producer Guide - Ancillary
Admin Manual Midwest (group) P52 2010
Anthem Fact Sheet 8223 6/07
App - Addendum - Pre-Ex Notice Midwest 11/06
App - Addendum- Special Enroll Rights 3/06
Application EE - Helpful Hints A216
Application EE (grp 2-50) A216 7/09
Application - Missing Inforation Sheet
Application EE (grp 51+) A82 7/07
Application ER (grp 2-50) A100 7/09
Application ER (grp 2-50) A100 rev 7/09 WRITEABLE!
Application ER (grp 51+) A101
Application spreadsheet 51+
Application - 51+ funding form
1099 Group Guidelines
Application - quoting 51+ group - employer completes ERAF Employer Questionnaire 1/30/07
Benefits -How to maximize your benefits
Billing Process P32 12/04
Blue Ancillary Products
Blue Vision Exam Only Benefit Summary (opt 2 shown in sample)
Blue Vision Full Service Benefit Summary (opt 26 shown in sample)
Blue Vision Materials Only Benefit Summary (sample)
Blue Vision Voluntary Overview 11/08 (slick)
Blue Vision Voluntary Overiew - ER Brochure 10/08 (slick)
Change Form EE A78 7/09 (large group ASO only)
Change Form EE A83 7/09 (large and small group fully insured)
Common Ownership Form
Checklists
Downgrade checklist
New Business Checklist (grp 2-50) Rev 2/07
New Business Checklist - simplified and color 10/08 with early deadline
New Business Checklist (grp 51+) 5/02
Claim Forms (Prescription - see under WellPoint NextRx)
Claim Form (vision) non-network
Claim Form - life
Decare Dental
Application & Change Form - Employee (please use spreadsheet for original submission)
Application - Employer
Application - Employee Spreadsheet
Contact Sheet
EFT Form
Online User Form
Submission Checklist
Deductible Credit Form 11/06
Dental Flyer
Dental Highlights
Dental Product Grid
EFT Transfer Authorization (grp 2-50) P1095 11/06 (black & white)
EFT Transfer Authorization 11/06 (color)
EFT Transfer Authorization (grp 51+) 10/03
EMPLOYER ACCESS @ ANTHEM Overview 8/08
Employer Access Online User Guide 2/09
Express Scripts Claim Form
Express Scripts FAQ
Express Scripts Mail Order Forms 10/27/10
Healthy Solutions Brochure P341 2/04
Health Assessment - Employer Guide
Health Assessment - How to Prepare
Health Assessment - Rewards
Hospital Surgical PPO Benefits
Hospital Surgical Compare to Blue Access 3.0
HSA Admin Guide (see Admin Guide above)
Labs - Choosing a network lab
LICENSING - Anthem has a number of documents to complete - please refer to the INSTRUCTIONS re: the requirements
Appointment Instructions 9/09
Broker Agreement 10/09
Life Broker Contract
Pt D Broker Contract Addendum 9/25/08
Broker Relation Transfer Form 12/03
Business Associate Agreement 10/09
Direct Deposit Form
Producer Appointment Data 4/10
W-9
Commission Schedule
Life Conversion form 7/10
Life Evidence of Insurability Form (EOI)
LUMENOS
Lumenos EFT Form (only use for Lumenos)
Lumenos Gift Card Reward 9/23/10
Lumenos HSA Misc
Employer Brochure
FAQ
Using your HSA
Lumenos Product Grid - see under 4.0 Materials Excel format - HSA, HRA, HIA, etc. - smal, large and 100+
Lumenos Sales Brochure ERCEBRO.223
Lumenos - Mellon Fee Schedule 12/1/09
Lumenos - Mellon Bank Info EECESHT 287 10/06
Lumenos - Mellon Bank Trustee-to-Trustee Form
Lumenos - Mellon Small Group Funding Guide
Lumenos - Mellon Sample EOB (integrated)
Lumenos - Small Group Admin Guide (see Admin Guide above)
Medical Claim Form A4000 6/01
Medicare Secondary Payor EE Form 11/06
Medicare Secondary Payor ER Form 1/07
MyHealth@Anthem.com Brochure P73 10/04
Quoting for 51+ group - see Application quoting (above)...ERAF Employer Questionnaire
Prescription Claim Forms (see Express Scripts above)
Producer Guides - Ancillary 5/09
Product Grids Dual Choice (grp10-50) 7/05
Product Grids 4.0 see separate listing above
Product Grids - Lumenos - see separate listing above
Product Grid Specialty Business (2-50) 12/07
Product Grid Specialty Business 50+ 1/08
Product Grid Voluntary Specialty Business 10-50 12/07
Special Enrollment Rights (see above - App - Addendum - Special Enroll Rights)
Special Offers Brochure 10/13/10
Specialty Producer Guide - see producer guide - ancillary
Termination/PCP Change Form 4/08
Vision - Why Offer Vision Benefits?
Vision Flyer
Vision Highlights
Vision Plan Options
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