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• 2-50 Small Group Employer Application
  
• 2-50 Small Group Employee Application
  
• 2-50 Existing Small Group Employee Addition Application
  
• Small Group Change of Coverage Application
  
• Dental Coverage Employee Application
  
• Small Group Benefit Modification Inquiry
  
• Prescription Drug Claim Form
  
• Small Group Remittance Report
  Use this form to report termination of employees and/or dependents, address  change for covered employees, or  COBRA/Cal COBRA notifications.
  
• Standard Enrollment/Translator's Statement
  When completing the Small Group Employee Application and a translator assists you, the translator must complete this form and attach it to the application.
  
• Patient Claim Form
  When an employee receives services from a health care provider, the health care provider submits the claim directly to Anthem blue cross. However, in certain circumstances the employee may be required to submit a claim form. See page 1 of this form for instructions.
  
• Affidavit of Domestic Partnership
  If an employer offers the domestic partner eligibility option to their employees, and an employee wishes to add their domestic partner to their plan, the employee must complete and submit this form along with an Employee Application requesting enrollment.
  
• Cal-COBRA/COBRA and Medicare Survey
  In order to ensure compliance with state and federal laws, you are required to update Anthem blue cross annually with your company's Cal-COBRA or COBRA and Medicare eligibility for the upcoming year.
  
• Small Group Required Information Checklist
  
• Accelerated Death Benefit Attending Physician's Statement
  
• Claim for Personal Accelerated Death Benefit
  
• Beneficiary Claim Form & Group Policyholder's Statement
  
• Absolute Assignment
  
• Change of Beneficiary and/or Name
  
• Statement of Attending Physician (Dismemberment)