Medical Forms:
Anthem Claim Form
Formulario de Reclamación de Reembolso de Medicamentos Recetados

Dental Forms:
Anthem Dental Claim Form

Vision Forms:
Anthem Vision Claim Form

Disability Claim Forms:
Employer Statement  
Short Term Disability and Long Term Disability Claimant Statement
Attending Physician’s Statement
Medical Authorization
EFT Authorization

Life & AD&D Forms:
Beneficiary Statement – For All Other Employer Contracts
<Formulario de Reclamo de accidente de Unum
Formulario de Reclamo de seguro de vida de Unum

FSA Forms:
Formulario de Reclamo de Cuenta de Gastos Flexible (FSA)
Formulario de Reclamo de Cuenta de Gastos Flexible (FSA) con Transit

CERTIFICATION OF HEALTH CARE PROVIDER FOR California Family Rights Act (CFRA) or Family and Medical Leave Act (FMLA)

CERTIFICATION OF HEALTH CARE PROVIDER – CT

CERTIFICATION OF HEALTH CARE PROVIDER – NJ

CERTIFICATION OF HEALTH CARE PROVIDER FOR EMPLOYEE’S SERIOUS HEALTH CONDITION (Family and Medical Leave Act)

CERTIFICATION FOR MILITARY FAMILY LEAVE FOR QUALIFYING EXIGENCY (Family and Medical Leave Act)

CERTIFICATION OF HEALTH CARE PROVIDER FOR FAMILY MEMBER’S SERIOUS HEALTH CONDITION (Family and Medical Leave Act)

CERTIFICATION SERIOUS INJURY OR ILLNESS OF A CURRENT SERVICEMEMBER FOR MILITARY CAREGIVER LEAVE (Family and Medical Leave Act)

CERTIFICATION FOR SERIOUS INJURY OR ILLNESS OF A VETERAN FOR MILITARY CAREGIVER LEAVE (Family and Medical Leave Act)

CERTIFICATION OF HEALTH CARE PROVIDER – OR (Family and Medical Leave Act (FMLA) and/or the Oregon Family Leave Act (OFLA)

AUTHORIZATION TO RELEASE AND OBTAIN INFORMATION

AUTHORIZATION TO RETURN TO WORK

Consentimiento Para Recibir Avisos Electrónicos 
Solicitud declaración de reclamo por el beneficio de vida Prudential
Solicitud de Asegurabilidad Prudential

Declaración Jurada Para Examen Físico Anual