Now that you have filled out the appropriate application, if you answered YES to any of the following medical conditions listed below, click the appropriate questionnaire, print and complete it. Please complete all that apply. If none of the questionnaires apply to you, proceed to step 3.
First, select the payment option that best suits your needs:
Bank Draft: It's easy and convenient, saving you time and postage. Just fill out Section 10 on the application and be sure to include your initial payment with your application.
Credit Card: Simply fill out the Credit Card Section on the application and send in your application, following the steps below.
Check: You can fax a copy of your check, along with the application to 1-800-336-2429. Then, just send us the check in the mail with a copy of the first page of your application. Or, you can mail your check and application to the address below.
Send Your Application
Now that you've chosen your initial payment method, you're ready to send in your application.
Fax: Faxing your application can save you time and postage--we'll start processing your application right away. Just fax your application and initial payment to 1-800-336-2429.
Mail: You can also mail your initial premium and application to:
Anthem Blue Cross and Blue Shield
P. O. Box 14046
Roanoke, VA 24038-4046
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