Get the free Conversion of Dependent Form - Anthem
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Anthem Blue Cross and Blue Shield P. O. Box 14046 Roanoke, VA 24038-4046 Instructions 1. 2. 3. 4. 5. Print clearly and complete this application in ink. For each person to be covered, provide all
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What is conversion of dependent form?
Conversion of dependent form is a document that allows an individual to convert their dependent status to an independent status.
Who is required to file conversion of dependent form?
Individuals who wish to change their status from dependent to independent are required to file the conversion of dependent form.
How to fill out conversion of dependent form?
The conversion of dependent form can typically be filled out online or manually. It requires providing personal details and supporting documents to prove the eligibility for the conversion.
What is the purpose of conversion of dependent form?
The purpose of the conversion of dependent form is to allow individuals to change their status from dependent to independent for various legal and financial purposes.
What information must be reported on conversion of dependent form?
The conversion of dependent form typically requires personal information such as name, social security number, date of birth, current status, and supporting documents for proof of eligibility.
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