A new law became effective January 1, 2009 (SB853). This California mandate requires a Language Assistance Regulatory Notice be provided with each Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company, health-related document vital to our members. As an agent or representative requesting a form, application or other vital documents from Anthem Blue Cross and Anthem Blue Cross Life and Health Insurance Company, you must ensure a Language Assistance Regulatory Notice is included with the distribution of every vital document intended for an employee.

Department of Managed Health Care (DMHC) Notice of Language Assistance

California Department of Insurance (CDI) Notice of Language Assistance

360 Health - Your Total Health Solution

Employee Application

Employee Application (Spanish)

Employee Application (Chinese)

Employee Application (Korean)

Employee Application (Tagalog)

Employee Application (Vietnamese)

2-50 Employee Waiver Form

MemberAccess

Employee Information Change Form

HIPAA Authorization Form

HIPAA Instructions

Domestic Partner Affidavit

Custodial Parent Form

Life Change Request Form

Exceptions to Standard Enrollment/ Translator's Statement

Preventive Care Benefits - This document provides an overview of the preventive care benefits covered in your Anthem Blue Cross health plan.

Preventive Care Benefits (Spanish Version)

For Dental Prime and Dental Complete Plans: Diabetes Extra Cleaning Sign-Up Form

For Dental Prime and Dental Complete Plans: Pregnancy Extra Cleaning Sign-Up Form

Non-Dental Prime and Dental Complete Plans: Diabetes Extra Cleaning Sign-Up Form

Non-Dental Prime and Dental Complete Plans: Pregnancy Extra Cleaning Sign-Up Form

Pharmacy Forms and Documents

Four Tier Formulary Prescription Drug List

Member Claim Form

Patient Claim Form

Prescription Drug Claim Form

Home Delivery Form

New Patient Home Delivery Form

New Patient Home Delivery Form (Spanish)