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 Anthem Change Form 2011

Anthem Change Form 2011

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COVERAGE FOR SELF OR DEPENDENT S Employees cancelling coverage for themselves or their dependent s MUST COMPLETE Sections 2 and 4 of the Employee Application in compliance with California State Law AB 1672. Please attach the completed application declining coverage to this form. Note Federal COBRA-eligible dependent MUST COMPLETE an application to enroll on Federal COBRA. 2-50 Small Group Employee Information Change Form Note Credit for deletions will appear on a subsequent billing. Please...
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This video will walk you through the anthem Blue Cross application we would recommend that you positive step to make it easier to follow along we still encourage everyone to call Member Services on the toll-free numbers shown on your papers so that one of our service representatives can take you through the application one on one an application that is completely filled out will sales for processing and your policy will be issued faster please keep in mind that following this video for completion will take longer than a one-on-one session simply because of the more detailed explanations and deposits to the video remember you can pause or backup this video at any time okay let's go ahead and get started if you open up the blue folder with all the papers inside you will find two applications held like paper clips on the left-hand side each one will have a cover sheet that will show the various marks that appear on the pages of the application that will need your attention, so you should

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