Forms needed for New Employee Enrollment are marked with a *.

Contact Numbers
Anthem Enrollment and Change Form*
To be used for all new enrollments;
changes, adding and deleting family members.
Pre-authorization
1 800-555-1212
Anthem Claim Form
Claims
1 800-555-1213
Prescription Drug Mail-order Form*
Coverage Questions
1 800-555-1214
Family Health Statement*
Additional Forms....  
 
Unum Enrollment Form - Disability*  
Evidence of Insurability  
   
 
MetLife Enrollment Form - Dental*  
MetLife Dental Claim  

All forms require Adobe Acrobat Reader.

 
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This does not constitute your health plan or insurance policy. It is only a general description of your employee benefits program. Please refer to plan documents for exclusions and limitations under the program.