Individual Forms

Individual Health & Dental Forms (VA only):

• Anthem Off-Exchange Application
• Anthem Off-Exchange Benefit Snapshot
• Anthem HSA Flyer
• Anthem Prescription Formulary 2014
• Anthem Dental Prime Application
• Anthem Dental Prime Brochure
• Optima Off-Exchange Vantage Application
• Optima Off-Exchange Vantage Benefit Summary

Age 65+ Forms (VA only):

• Anthem Extras Packages Brochure
• Anthem Extras Packages Application

All Forms may be faxed to 540.313.9014 for processing