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Commonwealth of Virginia and The Local Choice Forms

PW_M009236
Some of the links on this page can only be viewed using Adobe Acrobat Reader. If you don't have Adobe Acrobat Reader, you can download a free copy by clicking HERE. 
For More Information:
Anthem Claim Form Use for medical, dental and vision claims.

State Active Employees Enrollment Form

State Retirees Enrollment Form

State Extended Coverage Enrollees Enrollment Form

The Local Choice Enrollment Form

Anthem Individual Authorization Form

Blue View Vision Out-of-Network Claim Form
 
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