Our fax number is (317) 842-2243 or you can contact our office if you have any questions or need any help, just call (317)-842-2210 or Toll Free 1-866-742-4800.

Group application forms:

Group Census Form

Anthem Employer Application

Anthem 2-50 Small Group Employee Application

Active Group Forms:

Anthem New Employee Enrollment Form

Anthem Change of Coverage Form

Anthem Employee Termination Form

Health Applications: 

Anthem All in One Application

Assurant Health Individual Application

Consumers Life Individual Application

Unicare Individual Application

Dental Insurance Applications:

Anthem Dental Application

Brokers National Application