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Anthem Blue Cross Forms

Anthem Blue Cross health insurance forms and applications. Choose appropriate form below. If you cannot find appropriate form use contact page to contact us regarding a specific form. To apply for individual/family Anthem Blue Cross using paper application please see application below. Please follow instructions on the form on how to submit it. If you are filling out paper application for individual/family plan and would like to get a quote first click here. Only completed Individual/Family applications can be faxed to 800-376-4703.

California Forms

Individual and Family Plan Forms

Get a Quote and Apply Online

Individual and Family Application

TONIK Individual Enrollment Application

Authorization for Use of Protected Health Info (English/Spanish)

Supplement to Individual Enrollment Application

Change of Coverage Application

Credit Card Authorization Form

Member Claim Form

Prescription Drug Claim Form

HIPPA Brochure and Application

MRMIP Request Form

Small Group Health Plan Forms

Small Group Quote Request Form

Change of Coverage Application

Employee Addition Application (Existing Group)

Information Change Form

All Other States

Since we are Anthem Blue Cross Representatives in California to access forms for all other states please visit one of the appropriate links below.

Individual and Family Plan Resources

Please Visit Out Partner eHealthInsurance for Health Plan Forms and Options

Small Group Health Plan Resources

Please Visit Out Partner 2Insure4Less for Small Grour Quotes and Forms

Common Questions

All FAQs

Anthem.com, AnthemBlueCross.com, BlueCrossCa.com BlueCross.com, BlueCrossBlueShield.com, BlueShieldCA.com and BlueShield.com are the official websites of the Blue Cross and Blue Shield Association which is the trade association for the independent, locally operated Blue Cross and Blue Shield Plans. Copyright Health Coverage Insurance Services, Inc 2011, LC#0E75959, All Rights Reserved.