Common Forms
This page includes only standard versions of our most-used forms. Many forms are specific to your policy or plan and aren't listed here. If you don't see what you need, please contact us or your benefits administrator.
Former Anthem Life customers should log in to get their claim forms.
| Title | Purpose | Action |
|---|---|---|
| Anthem Life (Formerly) Claim Forms | Former Anthem Life customers should log in to get claim forms and use the Claims Service Center to file their life and disability insurance claims. |
Log In |
| EFT Setup for Long Term Disability Claim Payments (All states except NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
| EFT Setup for Long Term Disability Claim Payments (NY) | Used to request the electronic funds transfer (EFT) of Long Term Disability claim payments. |
Download |
| Long Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Long Term Disability plan issued outside of the state of New York. |
Download |
| Long Term Disability Claim Packet (NY) | Use this packet to file a claim for a Long Term Disability plan issued in the state of New York. |
Download |
| Short Term Disability Claim Packet (All states except NY) | Use this packet to file a claim for a Short Term Disability plan issued outside of the states of New York. |
Download |
| Short Term Disability Claim Packet (NY) | Use this packet to file a claim for a Short Term Disability plan issued in the state of New York. |
Download |