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Anthem Blue Cross Blue Shield Health Insurance  
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MyAnthem Producer - Secure Web Registration Form

To protect your information, you must complete this registration form on behalf of yourself. If you are not an Anthem appointed producer, authorization from your agency principal will be secured by Anthem Producer Relations prior to a login being assigned.

required field Indicates a required field

 

1.   Requester Name (Name of individual who needs access into the portal):
required field First Name:  
required field Last Name:  
 
2. Role:
required field  Appointed Producer Other (service representitive)
 
3. Agency Name:
required field 
 
4.   required fieldFor what state(s) are you requesting access?
  spacer image(Agency# - this is the number Anthem assigns to the agency)
spacer image CT Agency #:  
spacer image ME Agency #:  
spacer image NH Agency #:  
 
5. Agency Tax ID:
required field 
 
6. Mailing Address:
required field Street 1: 
Street 2: 
required field City: 
required field State: 
required field Zip Code: 
 
7. Telephone Number:
required field Area Code: (  ) required field Phone:  - Ext: 
 
8. E-mail Address (Format: john.doe@abc.com):
required field 
 

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®Registered marks Blue Cross and Blue Shield Association
©2005 copyright of Anthem Insurance Companies, Inc.


Health insurance

for individuals, families & employers. Find Anthem Blue Cross Blue Shield health and medical insurance information for visitors, members, individuals & families, employers, brokers & producers. Learn about group health insurance plans, family & individual insurance options, health insurance savings accounts, obtain a health insurance quote.

Anthem Blue Cross and Blue Shield

is the trade name for the following: In Connecticut: Anthem Health Plans, Inc. In Colorado, Rocky Mountain Hospital and Medical Service, Inc. In Indiana: Anthem Insurance Companies, Inc. In Kentucky: Anthem Health Plans of Kentucky. In Maine: Anthem Health Plans of Maine, Inc. In Missouri: RightCHOICE Managed Care, Inc. (RIT), Healthy Alliance Life Insurance Company (HALIC) and HMO Missouri, Inc. In Nevada: Rocky Mountain Hospital and Medical Service, Inc. In New Hampshire: Anthem Health Plans of New Hampshire, Inc. In Ohio: Community Insurance Company. In Virginia: Anthem Health Plans of Virginia, Inc. In Wisconsin: Blue Cross Blue Shield of Wisconsin (BCBSWi) and Compcare Health Services Insurance Corporation (Compcare). Independent licensees of the Blue Cross and Blue Shield Association. Serving residents and businesses in Indiana, Kentucky, Missouri, Ohio, Wisconsin, Colorado, Nevada, Connecticut, Maine, New Hampshire and Virginia (excluding the city of Fairfax, the town of Vienna and the area east of State Route 123). Use of the Anthem Web sites constitutes your agreement with our Terms of Use.

Investor relations – information on WellPoint, Inc., formerly Anthem, Inc.