Submission Requirements & Applications

Health Insurance Forms

Download 2020 IPEP Product Guide

Click on the link above to download the 2020 IPEP Product Guide

Quoting Check List

A list of items needed to obtain a quote

Application Guide and Instructions

A step-by-step guide for completing the applications and census

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.

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.

Employee and Dependent Census

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.

Are you eligible for membership?

Quick Links



Toll Free 800.382.8837

Phone 765.457.9161

Fax 765.868.3310


Mailing Address

PO Box 1247

Kokomo, IN 46903

Contact Us


IPEP is an Indiana not-for-profit corporation organized in December 1989. Its purpose is to operate a self-funded group program for the purpose of satisfying the obligations of the members under the Indiana Workers' Compensation Act, the Indiana Workers' Occupational Diseases Act and the Indiana Employers' Liability Act. Membership in IPEP is limited to political subdivisions and governmental entities of the State of Indiana.

Toll Free: 800-382-8837

Phone: 765-457-9161

P.O. Box 1247

Kokomo, IN 46903-1247

Anthem Blue Cross and Blue Shield is the trade name of Anthem Insurance Companies, Inc. Independent licensee 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.

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