Browse commonly requested Anthem forms to find and download the one you need for various topics including pharmacy, enrollment, claims and more.

The current Anthem Identification Number should only be completed if you are changing, updating or terminating an existing policy. You will not have an Anthem ID Number if this is a new enrollment.

Please read these instructions before filling out the attached Member Enrollment/Member Change Form. Here’s what you need to fill out, so we can enroll you without delay.

Ø The PMF is an online form used to request demographic and practice profile changes to Anthem contracted physician, practitioner, and professional provider records.

Complete this form to change your PCP. For urgent requests, please call Member Services toll free at 1-855-690-7800.

Instructions: Please complete this form ONLY if you are making changes to your existing coverage. If you are APPLYING for coverage or ADDING a dependent(s), complete the Anthem “Enrollment …

If you want to request a new in-network PCP, complete this form and fax it to 1-866-840-4993. Please allow 24 to 72 hours for processing. For urgent requests, please call Member Services toll free at 1 …

Use this form to change personal data, cancel coverage or remove a dependent(s) All other changes must be done using the enrollment form

Please complete this form ONLY if you are making changes to your existing coverage. If you are APPLYING for coverage or ADDING a dependent(s), complete the Anthem Blue Cross and Blue …

This is not an application. A new employee must complete an enrollment application. Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Virginia, Inc. 170006 Anthem …