Submission Requirements & Applications
Health Insurance Forms
Click on the link above to download the 2019 IPEP Product Guide.
A list of items needed to get a quote.
A step-by-step guide for completing the applications and census.
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.
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.
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.