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Este documento es una solicitud para la inscripción o cambio del seguro de salud individual de Anthem. Permite a los individuos inscribirse, realizar cambios en su plan, o agregar o eliminar dependientes.
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How to fill out Anthem Individual Enrollment/Change Application

01
Obtain the Anthem Individual Enrollment/Change Application form.
02
Fill in your personal information, including name, address, and contact details.
03
Indicate whether you are applying for new coverage or making changes to existing coverage.
04
Provide information about your desired plan, including any specific options or riders.
05
Complete the health history section honestly, answering all questions about medical conditions.
06
Review the terms and conditions of the plan thoroughly.
07
Sign and date the application.
08
Submit the application via mail, fax, or online as instructed.

Who needs Anthem Individual Enrollment/Change Application?

01
Individuals seeking health insurance coverage.
02
Those needing to make changes to their existing Anthem health insurance plans.
03
People who have experienced life changes such as marriage, moving, or changes in employment.
04
Those eligible for Medicare or other government programs needing to enroll.
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People Also Ask about

Prior to June 2022, Elevance Health was named Anthem, Inc.
Anthem Blue Cross is the trade name of Blue Cross of California. Anthem Blue Cross and Blue Cross of California Partnership Plan, Inc. are independent licensees of the Blue Cross Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc.
For help, call us at the number listed on your ID card or 1-866-346-7198. For more help all the CA Department of Insurance at 1-800-927-4357.
Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.
Case Management support is available 24/7 through Anthem Blue Cross Cal MediConnect Plan Customer Care at 1-855-817-5786.

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The Anthem Individual Enrollment/Change Application is a form used by individuals to enroll in or make changes to their health insurance plans offered by Anthem.
Individuals who wish to enroll in an Anthem health insurance plan, as well as those who need to make changes to their existing coverage, are required to file this application.
To fill out the Anthem Individual Enrollment/Change Application, individuals should provide personal information, select the desired plan, indicate any changes needed, and sign the application.
The purpose of the Anthem Individual Enrollment/Change Application is to facilitate the enrollment process for new members and to allow existing members to update their information or change their plans.
The application must report personal information such as name, address, date of birth, social security number, health coverage selections, and any changes to existing coverage.
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