Below you will find a list of commonly used forms for groups with Anthem Blue Cross Blue Shield of Wisconsin available for download. While we do the best we can to keep everything up to date, sometimes carrier websites change without our knowledge, which may mean step by step instructions may be out of date. If you notice anything doesn't work as intended, please bring it to our attention and we will correct it.
Please submit all completed forms to Shannon Herr:
Email: Shannon.Herr@hia-wi.com
Fax: 262-786-6731
Mail: Health Insurance Associates, Inc
Attn: Shannon Herr
19525 Janacek Ct STE 101
Brookfield, WI 53045
Type
Description
Form
Medical Enrollment Form
Used to enroll any employee and their dependents onto the medical plan.
Employee Termination Form
Can be used by any existing Anthem group to terminate coverage for an employee.
Medical Change Form
Can be used by any existing Anthem group to terminate an employee, spouse, and/or dependent from the medical policy, as well as make any change to an employees information.
Dental Enrollment Form
Used to enroll any employee and their dependents onto the dental plan.
Dental Change Form
Can be used by any existing Anthem group to terminate an employee, spouse, and/or dependent from the dental policy, as well as make any change to an employees information.
Provider Search (Current Member)
Instructions for current Anthem subscribers to look up providers, doctors, clinics and hospitals.
Provider Search (Guest)
Instructions for prospective Anthem subscribers and other guests to look up providers, doctors, clinics and hospitals.
Rx Choice Tiered Pharmacy Provider Search Instructions
Instructions to search for in network pharmacies for groups with the choice tiered pharmacy network. If you are unsure of your network, check with your employer or contact us.
Prescription Reimbursement Form
Used when a member pays for a prescription without using the insurance. This might be before ID cards are received or if they don't have their ID card when visiting the pharmacy. They submit this form, and whatever amount the insurance would have paid will be reimbursed to the employee.
Live Health Online
Have a health question? Feeling under the weather? With LiveHealth Online,
you don’t have to deal with scheduling an appointment or long wait times at the urgent care center. In fact, you don’t even have to leave your home or office. Using LiveHealth Online, you can see a doctor who can answer questions, make a diagnosis, and even prescribe basic medications, when needed.
Special Offers
Saving money is good. Saving money on things that are good for you — that’s even better. With SpecialOffers, you can get discounts on products and services that help promote better health and well-being.* It’s just one of the perks of being a member. Check out how much you can save.
Smart Shopper
Prices for the exact same quality medical services vary by hundreds or thousands of dollars in your area. Introducing SmartShopper, the consumer shopping and savings program for your medical care. As an Anthem member, you have access to SmartShopper, a valuable free service that lowers your out of pocket cost when you need a medical procedure or screening covered under the program. SmartShopper earns you a cash
reward just for choosing to have your procedure at a high-quality location that saves you money.