Anthem Spotlight
At Anthem Life, our mission is to provide the people we serve with financial protection and security.

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Group Coverage @ Anthem Life
Provide competitive employee benefits that fit your budget, with our group life and disability coverage.

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Voluntary Coverage @ Anthem Life
Let employees choose their own coverage with voluntary life and disability insurance from Anthem Life.

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Evidence of Insurability Forms

PW_M010906
An Evidence of Insurability form (proof of good health) may be required in certain situations. If an applicant has properly completed an Anthem Life Medical Application, this form is not required.  
An Evidence of Insurability form should be used if an individual has applied for coverage using an application form that did not contain medical questions (Anthem Life Non-Medical Application) and it is later determined that evidence of insurability is needed to approve or deny coverage.  
Print and complete the Evidence of Insurability form. The form must be dated and signed. It may be mailed or faxed to us. Our address and fax number are listed on the form.  
 
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Anthem Blue Cross and Blue Shield is the trade name of: In Colorado Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc. In Connecticut: Anthem Health Plans, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky, Inc. In Maine: Anthem Health Plans of Maine, Inc. In Missouri (excluding 30 counties in the Kansas City area): RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. HMO products underwritten by HMO Colorado, Inc., dba HMO Nevada. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Com pany. In Virginia: Anthem Health Plans of Virginia, Inc. trades as Anthem Blue Cross and Blue Shield in Virginia, and its service area is all of Virginia except for the City of Fairfax, the Town of Vienna, and the area east of State Route 123. In Wisconsin: Blue Cross Blue Shield of Wisconsin ("BCBSWi"), which underwrites or administers the PPO and indemnity policies; Compcare Health Services Insurance Corporation ("Compcare"), which underwrites or administers the HMO policies; and Compcare and BCBSWi collectively, which underwrite or administer the POS policies. Independent licensees of the Blue Cross and Blue Shield Association. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association. Use of the Anthem Web sites constitutes your agreement with our Terms of Use