Common Forms
This page includes only standard versions of our most-used forms. Many forms are specific to your policy or plan and aren't listed here. If you don't see what you need, please contact us or your benefits administrator.
Former Anthem Life customers should log in to get their claim forms.
| Title | Purpose | Action |
|---|---|---|
| Accident Benefit Claim Form (All states except NY) | Use this form to file an Accident insurance claim by mail, email or fax. Or log in to file this claim online. |
Download |
| Accident Benefit Claim Form (NY) | Use this form to file an Accident insurance claim in New York by mail, email or fax. Or log in to file this claim online. |
Download |
| Health Maintenance Screening Benefit Claim Form (All states except NY) | Use this form to file a Health Maintenance Screening claim by mail, email or fax. Or log in to file this claim online. |
Download |
| Health Maintenance Screening Benefit Claim Form (NY) | Use this form to file a Health Maintenance Screening claim in New York by mail, email or fax. Or log in to file this claim online. |
Download |
| Specified Disease Benefit Claim Form (NY) | Use this form to file a Specified Disease insurance claim in New York by mail, email or fax. Or log in to file this claim online. |
Download |
| Specified Disease Benefit Claim Form (VT) | Use this form to file a Specified Disease insurance claim in Vermont by mail, email or fax. Or log in to file this claim online. |
Download |