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Health Insurance Forms

Submission Requirements & Applications

Application Guide and Instructions

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

2023 IPEP Product Guide

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.

Quoting Check List

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.

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.

Quick Links
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Who is Eligible?
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How to Apply
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