Health Insurance Forms
Application Guide and Instructions
A step-by-step guide for completing the applications and census
Click on the link above to download the 2023 IPEP Product Guide
Employer Group Enrollment Form
Application for the employer that must be completed by all groups regardless of how many are employed. All highlighted sections must be completely filled out in order to receive a quote.
A list of items needed to obtain a quote
Anthem Employee Application Form
Each employee must complete this application form for the 2-50 group. All highlighted sections must be completely filled out before Anthem can provide a quote.
The following columns must be completed to get a quote: Columns A, B, D, F, G, H, P, Q, S, T, U, Y, Z, and AA. Please note, there is a tab for dependents on the spreadsheet that must be completed. Please do not print the census, as it will print one line per page on 152 pages.