If your group would like to move forward with the proposed plan from their renewal, they will not need to do anything. Anthem will move the group from their current 2022 plan to the proposed 2023 plan automatically. Download documents below.
Medical Benefit Change
- Admin and Benefit Change Form
- Schedule B premium rate grid
- If the group will be offering more than one plan, a list of subscribers to be enrolled in each plan should be included with the benefits change.
Ancillary Adds
Dental/Vision
- Signed Rates
- Benefit Modification Form
- Admin and Benefit Change Form
- Enrollment Census
Life and/or Disability
- Signed Rates
- Benefit Modification Form
- Admin and Benefit Change Form
- Enrollment Census
- Hold Harmless
Download documents here:
ACA Medical Benefit Change Forms
ACA Ancillary Add – Life.Dis Forms
ACA Ancillary Add – Dental.Vis Forms
