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Get Indiana Insurability Information Request - Anthem

Company Life Underwriting Unit PO Box 4510 Woodland Hills, CA 91365 Anthem Life Insurance Company PO Box 182361 Columbus, OH 43218-2361 Phone 800-551-7265 Fax 614-433-8880 This evidence is provided for: Late entrant Change of benefits SECTION 1: GENERAL INFORMATION Last name An effective date under a new group First name Social Security no. Work phone no. Employee address City Name of employer M.I. Home phone no. State A post group effective date addition Date of bi.

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