Info/Forms

Find the Form/Application/Brochure you are looking for here.

ISMA Health Brochure Pages: 6Describes the unique advantages of the ISMA/Anthem group medical, life and dental insurance program and describes plans and benefits.
Medicare Carve-Out Brochure Pages: 6Describes the ISMA/Anthem Medicare Carve-out policy, which serves as a supplement to Medicare.
Group Health Renewal Info for 7/1/07 Pages: 2Newsletter for groups regarding 7/1/07 benefit and rate changes for ISMA/Anthem health insurance, how to access information about your policy, benefits, and claims, and where to get discounts on eyeglasses and other products and services.
Individual Health Renewal Info for 7/1/07 Pages: 2Newsletter for individuals regarding 7/1/07 benefit and rate changes for ISMA/Anthem health insurance, how to access information about your policy, benefits, and claims, and where to get discounts on eyeglasses and other products and services.
Requesting Changes to Anthem Policies. Pages: 5Instructions for requesting changes to an ISMA/Anthem policy including adding or deleting dependents, requesting a plan upgrade, requesting a review of risk class, changing a name, or changing a life insurance beneficiary.
Anthem Effective Date Finder for Groups Pages: 7Use this tool to take the guesswork out of when ISMA/Anthem health insurance will begin for a new physician or employee.
Anthem Enrollment Application for Groups Pages: 4Physicians and Employees in Groups insured with ISMA/Anthem use this form to apply for new policies or to request changes to existing policies.
Anthem Enrollment Application for Individuals Pages: 4Physicians and Employees insured with ISMA/Anthem as individuals use this form to apply for new policies or to request changes to existing policies.
Anthem Medical Claim Form Pages: 2Use this form to file a medical claim with Anthem if your provider's office will not file a claim for you.
Anthem Dental Claim Form Pages: 2Use this form to file a dental claim with Anthem if you have the optional Dental plan and your dentist's office will not file a claim for you.
AnthemRx 90-day Rx Order Form Pages: Use this form if your ISMA/Anthem includes a 90-day prescription drug mail order option to place an order for a new prescription.
AnthemRx Claim Form Pages: 2Use this form to file a prescription drug claim if you purchase a prescription from a pharmacy that does not submit the charge electronically to Anthem at the time of purchase or if a pharmacy is unable to access your Anthem benefits.
Overview of HSA PPO 2500-5000 plan Pages: 1 A high-level look at how a Health Savings Account works, when paired with the ISMA/Anthem HSA 2500 or HSA 5000 high deductible health plan.
Overview of HSA PPO 3000-6000 plan Pages: 1 A high-level look at how a Health Savings Account works, when paired with the ISMA/Anthem HSA 3000 or HSA 6000 high deductible health plan.
Anthem worldwide coverage brochure Pages: 2Did you know your ISMA/Anthem policy provides benefits worldwide? Find more information in this helpful brochure.
Group Health Employer ApplicationPages: 1
Overview of Lumenos HSA PPO 3000-6000 plan Pages: 1

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