training materials
Contents
1. Loss of SighyDismembermont C Lite or Dependent Lite e C Arcelersted Death Benet C Accidentat Deam C Life Waiver of Premium Group Function Employer Review preferences group benefits and other general information with this tab The Groups Benefits screen displays a listing of groups within the current case To view the medical benefits simply click on the View Benefits link Billing This tab allows you to view summary information for all open invoices Additionally this functionality provides details on monthly activity invoice number and total amount due Forms This tab includes the Logon Agreement form Reports You can use this tab to view your Pending Activity generate Subscriber Dependent Listings or Activity Reports You can also access the Life and Disability Tools and help employees find physicians using our Provider Finder link Profile Use this tab to change your e mail address password and or your secret question EmployerAccess Wolcome John Smith B Pronder Finder E Help Bg Log out Metibership B1 7 20 7 7 eo O Em Access ployer Welcome to EmpioyerAccess our state of e arl benefits management system Pending Activity Ibscriber Humber 123456789 larre f SMITH JOHN New JSMITHDU1 Enrollment Resimire Delete Billing Entities Billing En ty Number 12352010001 2 070 00 Total Arnourd Due 12 070 00 Anthem amp2. Reoree Change Department Clock Claim Category andlor Claim Reporting EZIBEIIJEZLIZJ o Cancel Coverage On the Employee Dependent Details page click the Cancel Subscriber Coverage button to cancel the subscriber coverage or click the Cancel Dependent Coverage button to cancel dependent coverage The appropriate Cancel Coverage screen will appear Key inthe cancellation effective date Under Cancellation Reason select a reason from the drop down menu Be sure you check the box next to all affected benefits Q Click the Submit button to complete the transaction Note The cancellation effective date is the first day the employee department will no longer be covered by the employer sponsored plan For example if the employee s last day of coverage is July 31 the cancellation effective date would be August 1 If the employee s last day of employment is July 13 and you cover employees through the end of the month the cancellation effective date will be August 1 EmployerAccess Welcome Jehn Sanih Gl Proveder Finder Help Log out Membership Cancel Subscriber Coverage indicates a Required Field Moric ad Cover aye ANTHEM ALUE CROSS HMO 123456H001 NIMM Date 02 15 2006 r Access AX ANTHEM BLUE CROSS HMO 123456H001 Efecto Cate 0255 70606 r ANTHEM BLUE CROSS LIFE amp HEALTH BLUE VIEW 123456V001 Efectve Lia Coverage Bait Lif
3. SMITH JOHN New Enrollment T 123458789 SMITH JOHN New Enrollment Select A Deselect Al Delete Log out JSMITH123 JSMITH1 23 JSMITH173 J MITH123 JSMITH123 J8MITH123 JEMITH123 JSMITH123 JSMITH1 23 JSMITHI 23 JSMITH123 JSMITHI 23 0407 2006 04 10 2006 141172006 04n1 2006 04 11 2006 047 2006 0417 2008 04 18 2006 04 24 2006 04 24 2006 05 08 2006 05 10 2006 Anthem LL Reports PELCO 1021 31 AM 0110510 PM 1001 53 AM 11 06 32 PM 11 10 01 PM 01 57 13 PM 05 51 05 PM 02 00 16 AM 0343 06 PM 034624 PM 01 36 38 PM 110315 AM Resume Qeleto Resume Delete Resume Delete Resume Delete Resume Delete Resume Delete Resume Delete Resume Delete Resume Delete Resume Delete Group Billing TIP Billing Entities also provides access to invoices and their details Group Billing Transaction Selection Select the group number from the Billing Entities page Billing home page to access a number of transactions on the Open Invoices page Q Click on an invoice number to view details Q Using the links on the left side of the screen you can pay your bills online manage billing e mail addresses and more Note You can also access some of the above functions using the buttons on the screen Activities ope ty Pane Onne How Billing Entities in ae gt Downtoad Ses fall Lorrmats and Tutoriaty Case Number 144230 Preferences Case Name Wyle Laboratories Addresses
4. Ferme Reports Profile o O Case Name ABC CO Case 123456 Number Change Legin hnfermation View Change Member information ID Number Last Name First Name Please enter full first name Add New Subscriber 1D Number Pending Activity This example shows how your Pending Activity folder might look Clicking Delete ona transaction on this page allows you to cancel the transaction that was in process and saved It does not cancel any existing coverage for the subscriber dependent If Delete is selected on the bottom of the page an entry is required to be selected by the ID number Note To ensure full access to subscriber information and accurate records please be aware of pending activity and process or delete transactions in a timely manner EmployerAccess Welcome John Smith y Provide Finder amp Holp Membership impioyer Bing Raports Pending Activity Pending Activity Case Name ABCCO Case Number 123456 Pending Activity ym hier Fr 1214567899 New Enrollment FT 123456789 SMITH JOHN New Enrollment FT 123456788 SMITH JOHN New Eneollment F 123490789 SMITH JOHN Add Coverage F 122456709 SMITH JOHN Add Coverage T 123456789 SMITH JOHN New Encolimont FT 122456780 SMITH JOHN New Envoliment m 123456700 GMITH JOHN New Ervollment FT 123458789 SMITH JOHN New Enrollment UT 123458700 SMITH JOHN New Encollment m 123456789
5. Serves tyes fou past Nene JOHN SMITH Relationship Subscriber This mambar has prier coverage C Yes C No Af Yeo enter ihe jotormabon beiow Begin Date z mnidateeyy End Ome meiden indicates a Required Field Case Name Case Number Anthem Log out Membership EZ 128 57 Fome Reports Profile Mamar shin Mambaa Information J Select Coverage Dapt amp Clock intcamatien Ute Cover nae Assin Cosmas Anc co 123456 Gondor Male Binn Ds 01011970 This mambar has Medicare coverage C Yes C No IT Yes piede check the fo owing Pana C Yes C No Pate C Yee C Ne Ertoctre Dato mentary Li Effectiee Date anasa Medx are ifanitifc stian Number How to Correct an Incorrect ID Number If you notice an error in the ID number while you are on the Member Information page you can Click Change ID Number on the Member Information page Enter the correct ID number in the blank field on the Change ID page not shown and click Submit You will return to the Member Information screen for continued work You can access the Change ID Number hyperlink only through this screen Note You can only change the ID number during the enrollment process You cannot change an ID Number once the new enrollment has been confirmed on the verification screen and submitted EmployerAccess Welcome John Smith GB Provider Finder Heip E Log out Mem
6. Hano Match Search FirstName e 77 tatame e ooo e Beth D cameeveris Ic o New Enrollment TIP Steps are numbered to tell you where you are in the enrollment process All steps must be com pleted before an employee is enrolled If at any time you click Save and Exit your work will be saved in Pending Activity Once you ve completed the steps a message bar will appear on the Overview page letting you know you have successfully completed the transaction Step 1 Member Information This is the beginning page to start the enrollment process EmployerAccess Wuicome Jotm Sinith Prowder Finder E Help Lag ou Meniberuip Member information Member Information for Enrollment Select Dept amp Clock ELT information To enroll an employee subscriber enter the requested information into each blank box or field Fields with red arrows gt gt beside them indicate required information cowie n Respon mas Saitisciiber bdor uation o9 If the employee has dependents to enroll click Add Dependent S ema ey Hire Date Moddle intial E 1 nem dd ryr otial Sec I 0 Q if there are no dependents cede Cu Crm emo 1 i 1 n one mier to enroll click Continue adii ed LL Street 1 Oty P onj Probabon Type mene Salectad State r Dp Code eC 4 Dirth Cate o imadyyyy Indicates Required Firid P Actual City and State names
7. Subscriber Address is the default 2 Select members for whom you d like to request a card Q Click Submit A confirmation screen will let you know the card is on its way EmployerAccess Welcome John Smith B Proveder Finder Help Log out Membership E277 238 7 Metnber ship Request ID Card Anthem amp Request ID Card Subscenber Name JOHN SMITH Case Name ID Number 123456709 Case Number Delivery iforinateen Mall To Address Subscriber Address Group Bill Address Sebect Members ABC CO 123456 ember Name ember r o Entire Family r JOHN SMITH 6 JANE SMITH JOE SMITH Life and Disability To initiate a claim click Life and Disability on the Employee Dependent Details page Click Initiate Life and Disability Claim on the Claims Tools page There are several different kinds of claims you can initiate Note The Life and Disability option is available on the Employee Dependent Details page only if a member has elected the Life coverage EmployerAccess Welcome John Smith Elerovcer Finer Grew Logat Membership ET 7 E 17 Mentes ship Claims Tools Claims Tools liate Claim Initiate a We or disability claim online and download necessary forms Initiate Claim You can initiate a life and or disability claim for your employees here Fill in the required information and select a claim at t
8. are determined by US Postal Dp Code En ns T ancat masacsos Last Name LI Signanjre Date z 9 o Anthem Forma Reporta Profile Aad Dependent TIP If you did not complete all required information an error message will appear telling you which field needs to be completed You won t be able to continue to the next screen until completing the required fields Member Information EmployerAccess Antonin Entering a Probationary Period v e A Ft s E bambes sie 7 Member Informason eo If you have only one probationary period Member Information for Enrollment the effective date of coverage is calculated based on the date entered in the Hire Date field Dept amp Clock reformation ID Number 123456709 Cate Name ABC co Ghana Ko Numbet Cane Number 1722456 o If you have multiple probationary periods sts tenen i e an exempt employee is eligible for wem fT seem e coverage on the first day of the month M Hre Oaia following date of hire and a non exempt Le g Li www o employee is eligible for coverage on the AN 1 first day of the month following dg H e eme O completion of three months of continuous aw employment see note below click cee M the drop down box for Probation Type sanw 77 and select the appropriate type The S indeaion a iewied Faid sy ue Poutulzp Coe employee s effective date of coverage Sac crm wi
9. at the login page This means that no usernames or passwords pass across the Internet in clear text Do you use Secure Socket Layer SSL e Yes 128 bit SSL certificates are installed on the server supporting the Web site ensuring an encrypted channel is established between a customer s browser and our Web site The vendor we use is VeriSign Health care plans provided by Anthem Blue Cross Insurance plans provided by Anthem Blue Cross Life and Health Insurance Company Anthem Blue Cross is the trade name of Blue Cross of California Independent licensees of the Blue Cross Association ANTHEM is a registered trademark The Blue Cross name and symbol are registered marks of the Blue Cross Association ECAHB0832C 5 08
10. 0 Q Resume or delete pending activity using the hyperlinks to the right of the specific activity All incomplete work is automatically saved in Pending Activity Note You can also access pending activity from the Reports tab O To access benefit information or make changes to a current employee s benefits enter the Member ID number typically the Social Security Number in the blank box under View Change Member Information then click Submit You can also reach the information by entering the last name and the first name then clicking Submit Q To add a new employee enter the Member ID number typically the Social Security Number in the blank box under Add New Subscriber then click Submit The first page in the new enrollment process Member Information will appear EmployerAccess Overview Note This screen is displayed if the ID Number entered on the EmployerAccess Overview page under Add New Subscriber exists under a different employer in the Blue Cross database i e member had coverage with a different employer Q9 Type the requested information Q click Search If a complete match is found you will be prompted to continue with the enrollment process If a complete match is not found contact your Enrollment and Billing representative Employer Anthem Wolcoene John Smith BY Proeder Finder E Holp E Log out Membership KOTTE Member iip Nama Math Name Match
11. 01 darne Ma teoers hop JOHN SMITH Subscriber Male 9101 1870 04 05 2000 C PMPA a zA o Q This screen displays the C Adi Pick PMOAPA employee s benefit selections JANE GMITH Spouse Female OMS OM06i2008 C pwoaa ef If you missed something or Auto FIck PNGAPA selected the wrong benefit plan you can go back by clicking Previous va Relaaonahip Gender DENTAL 2000 SERES 1234560001 JOHN SMITH Subscriber Male 01011970 04 6 7006 Dental F f everything looks right iaa click Continue inim Covet oe ANTHEM VISION 123456V001 Nama JOHN SwTH Subscriber 2 Life Coverage BasiciDependent BASIC LFE TERM 1234560017 065 2006 Lite Accidontat ADO 1234560018 04 05 2006 Death and Dismemberment Supplementa SUPP UFE TERM 1234560022 04 06 2006 Supplemertat SUPP ADD 1234550024 0408 2006 Actidantal Death and Dismambermant indicates a Required Fist o Step 5a Assign Coverage The following screen appears if provider information is required e g for HMO medical and dental plans A Enrolls subscriber and all dependents in selected coverage B Enrolls subscriber and all dependents with the same medical Primary Medical Group PMG Independent Physicians Association IPA C Allows the system to pick a medical PMG IPA for all members Q Enter a provider for each member Note To help employees find provider information you may select
12. 144230001 Wyte aborniories 1 June 2006 200176333 2 70 401 10 May 2008 09091703330 2242212 Total Amount Due 151 075 33 1306420001 Communication Tech ins a2 June 2006 0001537858 pene May 2006 0901537950 Machine ele June 2006 0001537954 NN May 2006 0001537858 Woreneet 12 245 45 Sutbmined Total Amount Due 12 345 45 1452 1SEAP 1 Thomas Dodge of ParkARC Submit Set BN Lite Worksheet Invoice Details After selecting an invoice number to review a number of options are available This screen displays your Current invoices and the total amount due All the information on this page appears on your statement Note The Outstanding Adjustments section of the invoice is now conveniently located on the Open Invoices page EmployerAccess Welcome John Smith Provider Finder Help E Log out Membership Umpleyer Ville Cotitees Open breetces invoke Detats Invoice Details Pa One ow Pret tt T omnim t Select Billing Portos Invoice Apri 2007 0008888806 Ding Entty Number qoum Baling Enbty Name Geoup Contact CONTACT GROUP Invoice 0009999596 Premium Specialat SPECIALIST PREMIUM Biling Period 04 01 2007 65012007 Teng Pn DU Date 0401 2007 T elophone Number 199 999 9999 Lived j Git edut Membesi p Died icogea Saue Chatty Summary Summary Qetaits Adiistineras Dependens Changes ANTHEM BLUE CROSS T Prior Bill Amount Amount Paid MBR D
13. ACCO lent Care Spending Account o 1234560015 FLEX DEPENDENT SPENDING A Basic Depondent Lite Coverage 1234560017 BASIC LIFE TERM Accidental Death and Dismemberment Coverage 1234560018 ADO Supplemental Lite Coverage as 1234560023 SUPP LIFE TERM Supplemental Accidental Deam and Dismemberment pu Coverage 1234560024 SUPP ADD Step 4 Life Coverage If you have selected Life coverage you will be directed to the following screen Select Benefit Values and or enter Subscriber Annual Salary When finished click Continue EmployerAccess Welcome John Smh E Provider Finder E Heip E Lag owt Assign Other Coverage Coverage Bubscemer Name JOHN SMITH Case name ABE CO Number 123455709 Case Number 1723456 Me a nn oOo ee Selected Coverage Subscribes Aeeual Salary UPL WITH DOP ACTPIVE 123456002 1 Subscriber Spouse Childiren Value Danst Benet Value 1000 5000 10 000 Minimum Benefit Amt PCT Maximum Benedi Amt PCT 30 300 000 Any beneti smoart over 100 000 wf require evidence ofinsursbilty A famiy member s amount of insurance may eot exceed 40 of ee subscribers amount of coverage Accent al Death amd Orsmemberment Setocted Coverage Subscriber Areal Salary ADD ACTIVE 1234560018 o Subscriber Beneni Vaise 1 000 Minimum Benefit Amt PCT Maximum Benefit Amt PCT LI 200 000 Any benefi amount Geer 100 000 wit require evidence of insurabiit
14. ETAIL SUB TOTAL 420 00 55 370 00 Total Amount Due ANTHEM DLUE CROSS IS COLLECTING PREMIUM DOLLARS ON BEHALF OF ANTHEM BC LIFE amp HEALTH Invoice Membership Details Here you can view each employee within your group by clicking on the Membership Details link You can view additional information about an invoice by clicking on the additional links in the Invoice Details section 111222333 RC MURRAY MGLEEWORTM 04 15 2005 222222444 RC PECCIANT BRUCE E 05 15 2005 233444555 RO CRAWFORD RONALDA 05 15 2005 414555688 RO NEWTON GARY J 0505 2005 555060777 RE PETERSON TERRY L 05 15 2005 660777000 RE TORTORICH FRANKL 05 15 2005 777099999 RE WILLERT GaRYM 05 15 2005 989999000 Rf AKEN ROSSO 051572005 999000111 Rf CABAI ELAINE L 05 15 2005 000111222 RF GARCIA NICK 0515 2005 Subtotal for Department 2123456789 1234567890 000799888 RF JACKSON ANMEL 0556005 993850777 Rf VOSS BEVERLYJ 05152005 000777665 SA DAXTER JOFFREY C 05 2 2005 777000555 SA DURNS USAR 0515 2005 656555444 SA STEVENA 05 15 2005 555444333 SA CHAPIN PINOTTL ELIZABETH 05 15 2005 411333222 SA DUTRA DAMOL 0515 2005 333222111 SA FRY RANDALL 06 4 2005 222111000 SA HUNTER CHARLEEN 0515 2005 111000909 SA MNOBELAUCH PATRICIAAN 05 15 2005 Subtotal for Department 2123456789 Legend S Subscriber Only 2P Two Party Contract FAM Famity Contract DEP One Dependent DEP S Two or More Dependents S DEP Subscriber 1 Dependent No Spo
15. Internet Enrollment User Manual Table of Contents Introduction to EmployerAccess page 3 Getting Started page 4 EmplyerAccess Overview page 7 Enrollment page 9 Entering a Probationary Period page 10 Add Dependents page 11 Select Coverage page 12 Department and Clock Information page 13 Life Coverage page 14 Assign Coverage page 15 Other Coverage page 17 How to Correct an ID page 18 Existing Member Maintenance page 19 Employee Dependent Details page 20 Add or Re Enroll Dependent s page 21 Add Coverage page 22 Change Coverage page 23 Cancel Coverage page 24 Re Enrollment page 25 Change Life Benefits page 26 Reinstate page 27 Edit Personal Information page 28 Request ID Card page 29 Life and Disability page 30 Initiate Claim page 31 Group Function page 32 Pending Activity page 33 Group Billing page 34 Invoice Details page 35 Invoice Membership Details page 36 Pay Online page 37 Helpful Tips for Adding New Employees and Dependents and Enrolling in Life Products page 38 Helpful Tips for Changing Life Benefits page 40 Frequently Asked Questions page 41 Introduction EmployerAccess at anthem com ca employeraccess Ig your one stop health management Web portal Anthem Blue Cross is making it easier for you to do business with us In addition to the helpful resources already available at anthem com ca our online transaction service EmployerAccess has been updated to provide e Enhanced content e Ability to pay bill
16. MUEEN 1745000 74 Ware tiewcted Aricent g Sutur uu Ae Uns ra ca om Crac Raset Desens Add or Re Enroll Dependent s Simply click on Add Dependent on the Employee Dependent Details page to access this screen On this page you can add or re enroll dependents to an enrolled employee s subscriber s coverage Select the event reason Q Enter the event date Ifyou wish to add a new dependent complete the New Dependent Information section New spouses and newborn dependents may be added through EmployerAccess within 31 days of marriage or birth A dependent spouse and or child ren not due to a marriage or birth may only be added during the group s open enrollment period Loss of a dependent s coverage cannot be completed online Whether you re enroll a dependent or add a new dependent make sure the box next to Include Dependent is checked and make sure to uncheck Include Dependent box es on any blank dependent information Clickthe Continue button Anthem amp EmployerAccess Welcome Jen Smith Gy Provider Finder ep E Log o Menit sti Add Dependents Add Dependents Subscriber Name JOHN SMITH Case Name ABC CO ID Number 123456709 Cate Number 13456 Foret norma ventRwascn Other x Event Date Ld 36 tv O indcotes a Requhod Field Cuncent Mambor e JOHN SMITH Eubscriber Malo oworne7o JANE SMITH Btudent Female 01 02 1383 tarita Depondt
17. arday 7 90am to 4 00pm Sunday Holidays Closed ineicates Requeed Fiala Ul Please click here if you are an existing mydcclink user and have not already re registered EmployerAccess Overview The Membership main page is called EmployerAccess Overview Think of it as homebase Here you can start the enrollment process for new employees subscribers access pending activity perform a search for a current subscriber or navigate easily using the tabs at the top Tabs to Employer Details Billing Anthem Forms Reports and Profile are EE n Bical o embedded at the top They give you UN ad Alas c quick access to any of these screens M um 141 Cate N me ABCCO Q To automatically enroll an employee oce case tH H ver vie iber with the Open Enrollment effective HN date that appears on the overview emus page click on the box This open enrollment feature appears only during your group s open enrollment period Pending Activity Open Enrollment Mode 2 V Use open enrotiment date of 04 01 2000 Number n Last Neme 173458789 SMITH JOHN New JSMITMOO Resumo Delete EmployerAccess Overview displays Ervolenent O Fest Name all your pending activity To view all incomplete work items click the View All tab on the right Please enter full fret name Add New Subscriber Number ig Billing Entities Diling Enta Nurmde gt 4 Total amp mount Due 12 070 0
18. ber stip Member Information Dept amp Clock Information ID Number 123456789 Case Name Change ID tanbor eo Case Number Subscriber Information Last Name Signature Dato mentityyvy First Name B Hire Dale Middle Initial mr di rvrern Social Secunty Gander C male C Female Number Cere Of dg Phone Number Extension Streat Cry a Probation Type State gt EHI Dp Code Birth Date rrentieyyyy Indicates a Required Field ie Actual City and State names are determined by US Postal Zip Code mn oo Anthem forms Reports Profile Add Dependent Existing Member Maintenance Member Search To perform maintenance on a specific employee and or dependent first search for the employee in EmployerAccess There are two ways to search O Enter the employee s ID Number Social Security Number or HCID Health Card Identification and click Submit You can also search by entering the employee s last name and first name Your search will bring up an Employee Dependent Details page from which you can view specific information about an employee and easily initiate member update transactions by using the buttons displayed Employer Anthem Welcome John Smith Bl Prowder Finder Holp E Log out Case Name ABCCO EmployerAccess Case 123456 Overview Number Welcome to Employerhccess our Cate Of he art benefes management stem Pending Activil
19. bonshin L ione Selected zl Midde iniiai 7 Sander Dependent Status None Selected z C Male C Female Social Security Number 9 xlude Dependent Totally Disabled Full Time Student RS Dependent Indicates 9 Required Field 4 Last Name Smith Birth Date 7 btas yyy First Name A z elationship hid 3 wesemmas Dender C Male C Female Depende Sue Pone Selected 3 Social Security Number fH iude Dependent f Totally Disabled Full Time Student RE Dependent Indicates a Requitod Field La Add Anathar Dependent o e Step 2 Select Coverage Use this screen to select coverage for employees subscribers and if applicable dependents To complete this step simply click the drop down arrow and select the appropriate Medical Dental Vision Flexible Spending Account Dependent Care Spending Account and or Life coverage o9 If your plan uses department or clock numbers you will enter that information in this section Note If the Apply to All Cover ages box is unchecked you will proceed to Step 3 Department and Clock Information When finished click Continue Note Step 3 Department and Clock Information and Step 4 Life Coverage of the enrollment process are optional depending upon your selection on the Select Coverage page EmployerAccess Wokome John Smith Pyowder Finder Hel
20. e UFE WITH DEPENDENTS 1734560021 Effective Dato 0215 2006 Accideetal ACCIDENTAL DEATHIDISMEMBERMENT 1234560020 Deam and Ertectve Date 0215 2006 Diememberment D amp D Supplemental SUPPLEMENTAL UFE TERM 1234560022 Life Efecte Date 02 15 2006 Supplemental SUPPLEMENTAL DeattVDismemberment 1224560023 Death and amp ffectve Data 02 15 2006 Dismemberment ADD EE Members ECO 017 foma Reporta Profile 5 Cancel Subscriber Coverage Subscriber Harme JOHN SMITH Case Name Anc co ID Number 123456789 Caso Number 123456 Canceliation Reason Cancetahon Date Cancellation Reason 1 Select Reason o Geay o o Anthem Re Enrollment Employer Anthem Welcome John Sanith B Provider Finder Bret E Log out To re enroll a member whose coverage has been cancelled select Re Enroll from the Employee Dependent Details Member Information for Re Enrollment page Re enrollment follows wild d e ck d the same process as new z enrollment Subscriber Name JOHN SMITH Case Name noc co ID Number 122456789 Case Number 122456 forms Reports Profile To re enroll an employee Last Name Ew Signature Date gt subscriber enter the onne p orn n x r Dai E requested information into wm 7 o9 sas Social Secunty each blank box or field Gense mle C Female abe x we CE one Number Fields with red arrows gt gt TOT Bris
21. e employee pays a portion of the costs he she must elect life benefit within 31 days of his her eligibility date Late Enrollment If the employee elects the contributory Life benefit after the initial 31 days from the eligibility date the employee must complete and submit an Evidence of Insurability to Blue Cross Increase in benefit other than due to salary change may be done only within 31 days of the eligibility date Decrease in benefit may be processed ay any time as long as the effective date of change is within the 90 day retro guideline Additionally if the effective date of change is a future date the effective date of change can only be up to six months of the current date Non Contributory the benefit is free to employees and the employer pays the entire premium Guarantee Issue Amount Coverage guaranteed to a certain amount for any amount above the guarantee issue the subscriber employee must submit an Evidence of Insurability Helpful Tips for Changing Life Benefits Increase Coverage Change from Basic Life to Dependent Life Add Supplemental Life or Supplemental AD amp D Change to a higher selected value amount selection or multiplier Increase benefit due to salary change Change to another life coverage resulting in a higher benefit amount Decrease Coverage Change from Dependent Life to Basic Life Delete Supplemental Life or Supplemental AD amp D Change to a lower selected value amount selection o
22. elcome John Sima E Provider Finder E Help Log out Memberstup KO OTT U Membership Edit Personal information Edit Personal Information Subtcnber Name JOHN SMITH Case Namo ABC CO ID Number 123456789 Case Number 23456 LastName MTH Binh Date Cenei yyy First Naene jore Hire Debe Middle Initial venie Social Secunty Gander Male C Female Number Cu p 3 PM Midi Street roo MAN ST Extension CN P ANDOA PARI State P Lo 51304 Indicates a Required Field i Actual City and Stato names are determined by UB Postal Zip Code Dependent itortnation Last Name Retatonship First Nama B AMES Social Secunty Number Middle Initial C Gander Maw Female Birth Date 2uuxxo 7 T Totaly Disabled Ful Time Student indicates a Required Field a i Ml Last Name Li miM Relatonship First Nome STEPHEN Social Security Middle Inibal C BEN Gender Male C Fomale Birth Dale nosme ot omabled T Pu Time Stugent indicates a Required Field EZIETTGETIL3 Forms Anthem Reperta Prote 0101 1970 m Chic IRS Depencent IRS Dependent Request ID Card Requesting ID cards is quick and easy Simply click Request ID Cards on the Employee Dependent Details page Select a Mail To option The ID card can be mailed to the group or the employee s home address The
23. enefits elected the Life coverage CUNEO Paras as I0 Number 123450002 Cate Number 125456 Complete the following change Det data fields ewe e Effective Date man pann g required field TTE e Signature Date VENT RR is RN s NNNM me Gu Quse IOO 7 Change This Coverage automatically defaults acer NEN SUM aewCewaps fepe Annisti GOD to today s date cii LE Stree come to Seemepeen rr E Minimum Benefit e Reason Select eii Reason from the cs RII o i tequire evideec e ot inturabhty drop down menu family member s amount of insurance may nol exceed 50 of me Subscriber s amount of coverage Q Select the Change This sider Ovem nd AGODA HABE change Mie Coverage Coverage option eed Ba Subscriber Coverape 40 000 Annu Sam Fon Effoctiee Data 0901 2005 Subscriber Seloctod 09 Prat Value fi Ti zj value Minimum Genet Amur ct Note Change Life Benefits is not Manmum Berent AmUPet 200 000 available in Open Enrollment Mode Any benef amount over 100 000 wit t quita evisenza ef incurabinty A faenidy members amount of insurance may not exceed 40 of me Subscriber s amount of coverage vor ww nns ut J Caves cto Reinstate To reinstate a member with no lapse in coverage select Reinstate from the Employee Dependent Details page 7o reinstate an employee and dependents check the box marked Reinstate Member Be sure to check all applicable benefit boxes Cl
24. eps in the new enrollment process outlined on pages 12 17 for the subscriber level and pages 15 17 for the de pendent level Anthem EmployerAccess Weicome Jen Smith B Provider Finder Help Log out Membership Pir EE 707 forma Reports Profile Membership Add Coverage Subscriber Name JOHNSMITH Case Name ADCCO ID Number 123456709 CaseNumber 123456 You are C Adding new subscriber level coverage C Adding new dependent level coverage Efechve Date 02017006 SipmahaeDale z o indicates a Required Field ei e Note The Signature Date entry field is not applicable in Open Enrollment Mode If Open Enrollment Mode is selected the group s Open Enrollment Effective Date will be pre populated Change Coverage Simply click the Change Coverage button on the Employee Dependent Details page to make changes to existing benefit coverage Changes can also be made to enroll an active subscriber to COBRA or a Retiree plan and update department or clock numbers Select Type of Change Q Click Continue EmployerAccess Welcome Jolin Senith A Pronte Finder Help Log out Membership E27 24 5 7 terms Reperts i Metnlrer ship Change Coverage Change Coverage hange Cover age Change Pians Dept amp Clock informatio Assign Coverage Subscriber Name JOHN SMITH Case Name Apc co ID Number 122456780 Case Number 123456 JOB I E C CREE Ace COBRA
25. he bottom Life Claims e Life or Dependent Life e Accelerated Death Benefit e Accidental Death Life Waiver of Premium Once you have completed your online entries you will be able to print the claims form for signature and completion Short term disability claims are handled over the phone EmployerAocess Anthem Wekome John Sma Gy troverfince Brew Boo formes Reports Profite Membership Kir E Life amp Disability Chair Tools J Inibate Chaim Submit Claim AS th Case Administrator you can initiate Life and or Disability Claims for your employees here For all claims other an Snort Term Disability once you have completed your on line entries you will be able to print the claims form for signature and tompleson You will need to print the claims form for signature and completion e Itwill Gti be necessary for you or the membat to GUN completed and signed paper form and all documentason for the claim to be paid For Short Term Disability claims your entries will be submited to our claims department for processing and followup Now wil walk you through the claim by asking you senes of questons C onp Information Case Number 123456 Case Name ABC CO Erngdoyee formation Employee First Name Employee Last Name Number 122456709 indicates a Required Field Type of Claim What type of claim is this Life Claims Disability Chris Shor Tern Disabaty C Long Term Disabilty
26. hiiumaa Last Name Sum Birin Date x 1 197 Urtutdd hepovy firstname sane Retabonshe pouse z Midde nial Genda Mio Fema Dopendert Stats Select Ore Bocial Security Number m Totslly Disables p Full Time Stusent p IRS Dependent fs intlute Dependent Insicstes a Requires Pista Mow Dependent bitospmatin LastName SMITH Arm Date a rmkkvyyyy FirstName 9 Retationstep iSelect Ova gt widdemnai 7 Oendee C male C Female Dependort Staus comm Ora E Social Secunty Number r Totali Disabled m Fume Student M IRBDependont f incluse Dependerg Indicates a Required Field cerere Save and Eat Ff Cancel tramaxtion Aat ruber Dezentent e Note You can only re enroll a dependent on this page if they are not active in any other products If active in another product the Add Coverage Dependent Level option is used Note A separate transaction is required when re enrolling and adding new dependents Add Coverage Simply click Add Coverage on the Employee Dependent Details page and access this screen to add coverage to an employee s subscriber s benefits Benefits can be added within 60 days of the current calendar date To Add Coverage Click on the appropriate button for who is adding coverage subscriber or dependent Enter the Signature Date Click Continue The remaining steps of the Add Coverage enrollment process mirror the st
27. ick Submit Note No dependents can be reinstated on cancelled contracts unless the employee subscriber is reinstated Only dependents with the same cancel date as the employee can be reinstated on cancelled contracts EmployerAccess Welcome Jehn Sani Gl Pronder Finder E Halip E Log out Membe stip E a Subscriber Name JOHN SMITH Case Name ABE co Number 123456799 Cate Number 12456 Medie al pan PRUDENT BUYER INCENTIVE 127344463008 Anthem amp LUCY SMITH Not Ache Femae Crid 02 02 1990 02 01 2008 0301 2006 AMY SMITH Not Actwe Femate Crid 03 02 2004 05012004 1200172005 Not Actre Mee Subscrber 01 01 1970 12 01 2005 LUCY SMITH Not Actve Ferme Chi d 02 02 1990 05 01 2005 03 01 2006 ANY SMITH Not Acte Femwe Crid 03 03 2004 0501 2003 1201 2005 Not Actve Mole Subscriber 01 01 1970 05 01 2005 AMY SMITH Not Acbve Female Child 03 032004 05 01 2005 12 01 2005 BasiciDependant Life BASIC UFE TERM 1234560017 Accidental Death and ACCIDENTAL DEATHIDISMEMBERMENT Dismemberment 1234660018 scome Savant Cee raat o Edit Personal Information Simply click Edit Personal Information on the Employee Dependent Details page to access the option to change employee subscriber and dependent personal information such as address phone number etc Note Be sure to verify your changes before submitting the new information EmployerAccess W
28. ll be calculated based on the Hire Date and the Probation Type If the employee has dependents to enroll click Add Dependent o If the employee does not have dependents to enroll click Continue o Note Employees must meet eligibility requirements and satisfy their waiting period referred to as probationary period as defined in your Group Master Application Member Information AXI Add Dependents EmployerAccess This step is applicable only if you want to add dependents to the employee s benefits Wekome Jahn Smith Bl Provide Finder Bl Heo Bl Log out Membership ECL 7 Foma Repone Prorie Memniberster Member Informabon Member Information for Enrollment Solect Dept amp Clock Ute informaten i Zr Lover age Fields requesting dependent information appear below the employee information Complete aM ME wane the information and click Add eem treet eee s First Nama s aaa Hire e Satbscribor idormation Migdia Initia O presasaryyy T n iat Secur Q Otherwise click Continue Ca Ch ex s Care Of 4 Phone Number Strast 5 _ J Extension e gt EE Probaton Type Monn Selected Birth Date gt ic 1 nettyy yy indicates a Required Field p Actual City aed State names are qetemined by US Postel Zip Code _ Deporte eee eh M E Latt Name Smith Birth Doe rreneiityyy Fire Name f Rela
29. loyerAccess Please contact your Blue Cross Enrollment and Billing representative to correct the wrong date e Employees can make provider changes at the Blue Cross Member Services site at anthem com ca The employee can also make the change by calling Customer Service at the toll free number located on the member ID card e After you Submit the transaction you will receive a message saying the transmission was successful if Blue Cross received the information You will receive an error message if Blue Cross did not receive the information The Processing Date is the date that Blue Cross successfully receives the information Dependent e You cannot enroll disabled dependents through EmployerAccess Please complete the Disabled Dependent Certification form and submit it to Blue Cross for processing e To enroll a dependent only in COBRA you must submit a completed paper enrollment form to Blue Cross e To enroll a dependent due to adoption or loss of coverage outside open enrollment you must submit a completed paper enrollment form to Blue Cross Medical Dental e During Open Enrollment you may make eligibility changes outside the 60 day timeframe for New Enrollment Add Coverage Add Dependent s Change Coverage Re Enroll e Retroactive additions allow a 60 day window to process The 60 day period is based upon the current date Changes beyond this timeframe must be submitted to Blue Cross Provider Selection e ifan em
30. ment process Indicate Yes or No by clicking the corresponding circle o Clicking No to this question will automatically activate No in the corresponding check boxes below Clicking Yes to this question prompts you to complete the necessary Prior Coverage information Q Enter the appropriate begin and end date for each member who had prior coverage If no prior coverage information is provided enter the hire date as the prior coverage begin date and leave the end date blank This does not apply if you are processing in the Open Enrollment mode or if the employee has chosen an HMO plan Note Clicking No to this question Does any member being added have Medicare coverage will automatically activate No in the corresponding check boxes below Clicking Yes to this question prompts you to complete the necessary information below which is used to document Medicare information Q This is the last step in the enrollment process Click Submit to complete the enrollment process EmployerAccess Welcome Jobe Sant S Peosder Finder E Mey Other Coverage Other Coverage for Enrollment Gubseride Nama JOHN SMITH ID Number 12356789 Cher Carved age Does any member deing added Neve other coverage e C Yes C No Does any member being added have prior coverage 2 C Yes C No Dots amy member doira added Nave Medicare coverage C Yes C No indicates a Required Fits
31. ownload training materials e Power Point presentation and a Quick Reference Guide e Learn more and view FAQs e Visit anthem com ca To get started select the Login button Anthem 6 close window Announcing EmployerAccess Y n Y Huey t Puegester Take Better Control of Your Employees Health Plans mme tara e Easier to Use Pius mow you can manage all of your employees dens al vision amd Me plans afi in ome seuntess celna experience Thare right manage benerke comprehensively with C SS your One stop health Management web portal EmployerArccess has ligttning fact navigabon and ts packed with me saving tools including celine onroliment contact maintenance benefits inquiry heip you do the rest of your job even beter Check oul the inks below lo learn more about EmployerAccess More information About EmployerAccess Getting Started TIP Save this page in your favorites list so you can access this information quickly Login Page Enter your valid User ID Password Q Select Login Sater Vow Lag ttecnnaton Anthem User i e m Forgot Your Password eo Chich Here to Reset Password Password Are You an Eenployer That Needs Access Case Sensiree t Mote Aner 15 minutes of inactiity me syetem Benista tor Employer Acces will 10g you Gut automatically and reauire that Hours of Operation you log back in Monday Frida 7am to 720pm Suh
32. p Log out Mentes ship Memes Information Sect Coverage Select Coverage for Enrollment anf ee mation SubscriberName JOHN SMITH 1D Number 1234070 Case Name Case Number Cone age infor ration Department Number Clock Number Efecive Date 0466 2006 03662006 rc m Apot TOAN Coverages F Signature Date Select c I dae Meaca Coverage Mune Selected Dental Cover o Mone Selected Vision Cover lt 5 BasiuDepensent Life Coveray Mone Selected Supplemental Life Cover pens Saocto S Accidental Death and Doo membeemoent Coverage Mone Selected Supplemental Accidental Death and Dismemberment Cover e o Step 3 Department and Clock Information Q9 On this page you can enter a different Department Number Clock Number for each selected coverage EmployerAccess Weome John Smith Si Provider Finder Help E Log out Membersiip E 2 7 Mernber stip Hambar formation Select Coverage Dest Clock Information Department amp Clock Information Assign Coverage Subscriber Nome JOHN SMITH Cage nome ABC CO IO Number 100505175 Case Number 123456 Department Number a Clock Number Apply To All Coverages r Medical Coverage I 123456H001 BLUE CROSS HMO mum 6 1234560001 DENTAL NET 2000 SERIES Plo CORDON pue 123456V00 BLUE VIEW BC LEM Fiexinie Spending Account as 1294560016 FLEX HEALTH SPENDING
33. ployee s choice of primary care physician creates an error message saying the physician is no longer accepting patients but the employee is an existing patient of the physician a paper enrollment form needs to be completed and sent to Blue Cross e You may choose to have the system pick a primary care physician for an employee by typing PIC immediately after the Independent Physicians Association IPA code e g ODFPIC e fyou receive an error message saying PMG or IPA Missing or Invalid please check that you are entering a numeral 0 instead of the letter O as the first character of your PMG Primary Medical Group or IPA Independent Physicians Association code Life Products e Life products are not available for selection in Open enrollment Mode e Select Basic Life when enrolling an employee only in a life product s e Select Life with Dependents when enrolling an employee and his or her dependent in a life product s e Dependent s information is not required when enrolling in life product s e There might be a reduction in benefit amount for employees ages 65 and older e Evidence of Insurability is required if the calculated benefit amount is over the guaranteed amount e Only employees are eligible for Supplemental Life and AD amp D e Employees subscribers must enroll in Basic Life to enroll in Supplemental Life Definitions Contributory employee pays a portion or all of the cost Since th
34. process the eligibility e Yes We require a written request from the group if they use the services of a third party to act on their behalf Blue Cross will need to approve the use of this third party administrator The Internet Eligibility Agreement and the Third Party Agreement will need to be signed by the group If the client has multiple entities can the group administrator process eligibility for all groups e Yes The system is designed to use the case number to determine what groups will be viewable to the client What is the turnaround time once a group administrator has processed activity through EmployerAccess e Once the group administrator receives the message that the requested action was successfully completed the information is in the Blue Cross database Are groups required to submit membership forms i e enrollment change etc once activities are processed through EmployerAccess e No The group is responsible for maintaining the eligibility documentation This is noted in the Internet Eligibility Agreement under Section IV Part A Establishment and Retention of Membership Information Does Anthem Blue Cross have a minimum browser requirement Yes Internet Explorer 6 0 or higher Does Anthem Blue Cross use passwords e Yes A User ID and PIN are assigned for each of our customers as they register to use the Web site What is your encryption process e Anthem Blue Cross uses 128 bit encryption starting
35. r multiplier Decrease due to salary change Change to another life coverage resulting in a lower benefit amount Go to Option Change Coverage Add Coverage Change Life Benefits Change Life Benefits Change Coverage Go to Option Change Coverage Cancel Subscriber Coverage Change Life Benefits Change Life Benefits Change Coverage Coverage amount change for contributory and non contributory products cannot be process in one transaction You must process the change one transaction at a time If a subscriber employee elects to change from Basic Life to Dependent Life due to a qualifying event or vice versa a completed paper enrollment form needs to be sent to Blue Cross Increase or reduction in benefit for non contributory life products whose effective dates are beyond the ninety day guideline need to be sent to Blue Cross for processing Retroactive benefit changes with effective date that is less than the current benefit effective date should be sent to Blue Cross Change Life Benefits is not available in Open Enrollment Mode Frequently Asked Questions Can there be more than one administrator in a group who can process eligibility on EmployerAccess e Yes Each administrator requesting access to EmployerAccess needs to complete the Logon ID Policy and Usage Agreement Each administrator will receive their own User ID and PIN allowing them access to EmployerAccess Can a group s third party administrator
36. s lt P Steet rao wan STREET beside them indicate re ine ae Probaton Tye Nane Seaca E quired information State r E Dp Code ha If the employee has amom suns dependents to re enroll incite a Required Field p Actual City and State fames are Satermimads by US Postal Zio Code check the box next to u Dependesa intosmatmon Include Dependent PN m 77777 ed penna 7 4 First Name mg FF Q Click Continue aint 7 meus ON i Dependent Status Select One ender C Male Female FR ME tial Sec i Number The remaining steps of o9 Include Dependent f Tes Disabled Ful Time Stent IRS Depencent the re enrollment process Indicates a Regores Field mirror the steps in the new m enrollment process outlined tasnama Sa mex as on pages 12 17 Pes MEE Retatonsp Ses x Lj Dependent Status GSeiect o z Gender C mae Female Social Secunty I Note A separate transaction Include Dependent Totally Disabled Full Time Student IRS Dependent is required when adding indicates a megored Field new dependents ns annt and Endt Canca Transact on Change Life Benefits Employer Anthem amp Welcome John Smith BP Pronder Finder Hele E Log ow On the Employee Dependent Details page click the Change Life Benefits button to update Membership Change Lite Dantis Life Benefits if a member has Change Life B
37. s online e Schedule payments e Anda clean new look Plus we are adding easier security administration password administration and authentication which will make it easier to find forgotten passwords and change passwords We ve added Life and Disability management which allows you to manage your life claims information The new EmployerAccess offers you even more control over employee eligibility and information accuracy Error messages signal missing or incomplete information and electronic prompts guide you from one step to the next This manual offers step by step instructions on how to use EmployerAccess effectively If you have specific questions refer to the Table of Contents or the helpful tips located throughout the manual Getting Started Visit anthem com ca and click the Employers tab Welcome to Q Select Groups of 51 Mambece Agem sA okers Q Click the orange Login button Wonders 1 Login Find a Doctor tipetel ML MyHealth Anthem Special Offers Learn More Employers Spotlight e rta Halte Updated company news put c and media resources Abed is laus Same da did A Aether it naneda Me The Nue Cras faa aod fytbdi ate pitidos fata ef the Bae Corr A sacafbos DI Arita Mus Oort Disce Getting Started View the valuable information on the Announcing EmployerAccess screen to help you get started Here you ll find links to help you e Login e D
38. the Provider Finder link located on this page eo Coverage Assiymmen Options Anthem EmployerAccess VWieicome John Smith e Provider Finder gr Log out Membership B2 C Forma Reports Prole Mamba ship Member Information Select Coverage Dept amp Clock information Lite Coverage Assign Coverage Assign Coverage for Enrollment Subscriber Name JOHN SMITH Case Name ABC CO ID Number 123456789 Case Number 123456 T Enron s members in coverage selected Samo modical PMGAPA for 38 members PMGAPA a j Eronder Finger Auto Pick PMOTPA for all members Same dental office for all members Dental Office Providur Finder Medic M Coverage HMO 12345611001 Name R JOHN SMITH Subscriber Mate 017099670 04 06 2006 C PMORPA Ayto Pick PMGIPA JANE SMITH Spouse Female 02 02 97 04 08 2006 C PMGRPA i nuto PIck PMGNPA JOHN SMITH Subscriber Male 01 01 1970 04 2005 Dental F Vision Cove age ANTHEM VISION 173456V001 JOHN SMITH Subscriber 010011970 04 06 2008 pz Basic Dependent BASIC LIFE TERM 1234560017 04 06 2006 Ute Accidental ADD 1234560018 04 06 2006 Desh and Dismemberment Supplemental SUPP LIFE TERM 1234560022 04 06 2006 Supplemeetal SUPP ADD 1234560024 04 06 2006 Accidental Dest and Oismomberment Indicates o Required Field Step 6 Other Coverage This is the final screen in the new enroll
39. to pay as billed Choose to pay using a single account or multiple accounts Click Continue Next you will be able to select a bank account and authorize your payment You ll receive confirmation that the payment is being sent to the bank Note You are still required to pay all invoices in a timely manner in accordance with the terms of your group contract Case Number 144230M001 Care Name Wyle Laboratories June 2006 ooosvass3c z Pay 30 401 10 Billed Amount 38 401 18 Amount Due May 2006 0001763200 Pay 23 423 13 Billed Amount 23 423 13 Amount Due 1206420001 dune 2006 99001537054 O Pay 12 345 45 Billed Amount 12 345 45 Amount Due May 2006 0901237950 O Pay 12 345 45 Self Biled Amount 12 345 45 Amount Due 12925 18141 June 2006 900153795 Suet Sen en May 2006 0001527050 E Pay 12 345 45 Sel Biled Amount 112 345 45 Amount Due 1452700 AP 1 Suit Sen Oil Life Workdhest May 2006 v Pay 12 345 45 Se Billud Amoun 512 345 45 Amount Due Pay using a Single Account CO Pay using Multiple Accounts o e Helpful Tips for Adding New Employees and Dependents and Enrolling in Life Products Enrollment General e An Open Enrollment effective date is automatically assigned if the box under Open Enrollment Mode is selected on the EmployerAccess Overview page e Anincorrect date of hire may produce a wrong eligibility effective date You cannot correct this error through Emp
40. use S DEPS Subscriber 2 or More Dependents No Spouse CIL LI T3HRC A PRPC s 1 40298 tINRO A PUPC s 1 0090 T3480 A PRC 7 2 76 amp 55 T33MRF A PRPC s 1 408 98 1334RE A PPC 8 1 40098 134RE R Pec P d 2 qne 1334RE R Porc 2 2 pan 1234RE R Pope 2 2 nan 1T14RE R PRC m 2 VaN TERES R Pha 1 oii 134RE R PEC 8 1 40098 URF R PC Pd 2 1290 TIURI R Pc s 1 sN 1224RF R PUPC P 2 11290 2112 58 1334R8F R roec 2 2 712 90 1334RF R rore 2P 2 712 90 122454 A Pore FAM 3 91729 1334RE A PRPC pid 2 739 72 134RE POPC 2P 2 739 72 1324RF POPC t 409 99 TIMURE A PBPC 5 1 40098 133494 A Pore FAM 5 017 29 133454 PAPO FAM 3 01729 13348A A PRPC FAM 4 91728 122494 A POPO FAM 91729 133484 A PBPC FAM 3 917 29 133424 A Porc 2P 2 917 29 133494 A POPC 2P 2 91729 9080 26 Pror Next oz LSUB Life Subscriber LSPS Life Spouse LCHD Life Child LDEP Ute spouse Child ren 3 Rate Per 10 2 Rate Per 100 3 Rate Per 1000 4 Fist Rate 5 Refer to Group Policy TIP You have the option to pay online from almost any screen in the Billing section Look for the Pay Online Now button Pay Online EmployerAccess offers you the convenience and flexibility of paying your monthly bill s online You have the option to pay multiple invoices at one time Check the box marked Pay for each invoice you choose Note When selecting to pay an invoice you will be required
41. y 123450729 SMITH JOHN New JSMITHOOT Bosne Detete Enrotenert iD ber D Billing Entities Last Name Diling Entity Number Amount Due First Name o 251009 Pleuse enter full rst name 1234501001 Total Amoun Due 7 070 00 Add New Subscriber ID Number E 3 Employee Dependent Details Employee Dependent Details offers a quick overview of employee and dependent information including coverage name s address birthdate s relationship code for dependents effective cancellation dates and provider information if applicable This screen displays a list of enrolled members and their benefits e New ID Number Option allows you to view another employee s information without having to return to the Overview page e You can easily access prior enrollment information by clicking on the Prior Enrollment link located below the member s name Anthem EmployerAccess Wakes Mn Sel BP redeo Blog ot OSS LFE AHEAL TO nma sate fictio am Speneng ieot F IDOBUE REALM SPENDING ACCOUNT 1724550119 Ec ve Date CIMCO Prist Decortt Cotes autos fas ee Cancri Outer BASK LEE TERM C 22444001 7 Sieur future Acton SUPFLEMENTA LF E TERM CIHO4530027 Apene Coverage Amcurt Moo Son piteeat a Lo Suh Fun Actos Ase SaNctag Vacant qoo Crise Basati Detto Ctectve Date 021 7096 Curent Pene Dfectve Dote DET 2006 eppderenta cocina SUPTLEMENTA ACCIDENTAL Death asst DRA Desay
42. y Saptanan Selected Coverage SUPP LIFE TERM ACTIVE 1224560023 Guesenber Vae 10 00 Any denet amount over 100 000 wf require evidence of ineurabiity Supplemental Acchtertal Death am Dasenecitred nett Geteeted Coverage SUPP ADO AC TIVE 1234560024 Beneft 10 000 Any benedi amount over 100 000 wit requim evidence of insurabilty Indicates a Required Field cans Tc Pres Seo ant Cnet LO Step 5 Assign Coverage p g g EmployerA Anthem amp Viekome sin Smh E Provider mater E Help Log out The following screen appears if provider information is not eroe Aia term Reperts Prote required e g for PPO medical Merneerstip berber Bdesriion elect ayet ane Dept amp Leech Mrfotimation Ute Coverage Asian Coverage and dental plans Assign Coverage for Enrollment Other Coverage You have two options when enrolling a ase an employee s dependents Subscriber Name JOHN SMITH Case name ADE CO ID Number 123456709 Case Number 123456 Coverage Assignar Options Either check the box to enroll all Enrol at members in coverage sedacia eo n in ver PR F Same medical FMGAPA for all members dependents in selected coverage Aane C Auto Pick PMOIPA for al members Q Or if individual dependents Same dentat oc fora menter should be enrolled in a specific apt LT edis coverage simply check the Medical Comage corresponding box to select coverage for that member HMO 12345610
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