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

360 Health - Your Total Health Solution

Employee Application

California Department of Insurance (CDI) Notice of Language Assistance

MemberAccess

Employee Renewal/Change Application

Chase Application/Group Participant Enrollment

HIPAA Authorization Form

HIPAA Instructions

Domestic Partner Affidavit

Custodial Parent Form

Patient Claim Form

Life Change Request Form

Exceptions to Standard Enrollment/ Translator's Statement