Training Materials
Contents
1. i toun RM inania ee Piense note thet all Passwords are case sensaive Password Rules New Password Email j Z3Qadmin com Reo Enter New Password Soot Ld was the name of your Srst your frst dog Sect Queston Anona Note You wil bo asked for the antwer lo your secret question nrieatag a Requires Field EAAS you frgmt your password nine gt Coes tone Online User Manual Provider Finder Provider Finder is your online resource for finding doctors hospitals and other health card professionals that participate in your current plan or a different Anthem Blue Cross and Blue Shield plan Follow the step by step instructions to find providers that match your custom search criteria Anthem 29 Basin Search Retine Search ProviderFinder Search By Location Leu Ex Name Previder Finder Hei Find Providers Near a Location Select a Plan tone Selected m eimen Select Printa Type Wesen tC Indicates Required Field EmployerAccess Anthem 9 Anthem Blue Cross and Blue Shield is the trade name of Rocky Mountain Hospital and Medical Service Inc Life insurance products are underwritten by Anthem Life Insurance Company Independent licensees of the Blue Cross and Blue Shield Association ANTHEM is a registered trademark of Anthem Insurance Companies Inc The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association 07 02. Lite and Disability Tests Acibity Report Many of your employees may be enrolled in or are Our online reports give vou fast access 10 current and tongideneg enrcmaet i Life andior Disobinty pati enrollment information Provider Peter Cwr enhanced search tool allows you to quickly and easily locate participating doctors hospitals and Other heal care providers within the network EmployerAccess Reports Employee Roster Here you can view an alphabetical list of all employees in your group Anthem 29 EmployerAccess Welcome UPI Administrator cus Finder Dele E Log out Reports Employee Roster Employee Roster Group Name ABC CO OrupNumbe 123456 Number of members for group 344888 is 157 123456709 ANTHEM SO 500 80 Select SMTHJOMN 113496789 ANTHEM SO 1000 80 ANTHEM 0 GOLDPREMIUM Select SMTH JOHN 123456700 ANTHEM 20 500 00 ANTHEM 80 OOLDPREMIUM Select SMITH JOMN 122456709 ANTHEM SO 500 90 ANTHEM 80 GOLDPREMIUM Salact SMTH JOMN 122456709 ANTHEM 9G OOLDPREMIUM Select SMTH JOHN 123455789 ANTHEM SG 500 80 Select SMITH JOHN 123456789 ANTHEM 86 1000 60 Select SMITH JOHN 123456708 ANTHEM 66 GOLDPREMIUM Select SMTH JOHN 123456709 ANTHEM 90 2500 70 ANTHEM 96 GOLDPREMIUM Satoct SMTHM JOMN 123450709 ANTHEM 86 GOLDPREMIUM Setoct SMTH J MN 123498780 UFE Salect SMTHJOMN 123456709 ANTHEM SO 1000 80 ANTHEM 6 GOLDPREMIUM Select SMTHJOHN 123456700 AN
3. ANTHEM SG GOL DOS MILIM 75 qoesoo name Shi Gender JOHH SMITH Ade Male Subsciber 05 49 1948 PuorEnrolment Information JANE SMITH Ade Female Spouse 0311 1952 1201 2005 ANTPLS2t Prior Enrolrment lotermation ANTHEM SG Vision Namu us ter Rulasonstip Online User Manual Membership Employees Add Dependents Complete the Add Dependents event information including event reason and date EmployerAccess Anthem Welcome UPI Administrater Provider Poder Help E Log out Membership nent Member ship Enpleyoe Dependent Detalhs f Add Dependents immatr t 3 n Gondor Male Female Number p Indude Oependent p Totally Disabled pm full Time Student Indicates a Required Field Jat ter Depandan EJ Eo Contin gt EmployerAccess Membership Employees Assign Coverage for Dependents To add coverage for listed dependents simply check the Cover this Member box It s that simple EmployerAccess Anthem Weicome UPI Administrator Si Provider Finder Help E Log out more Wang Membership Employee Dependent D tadis Add Dependents J Assign Coverage for Add Dependants Assign Coverage SButscriber Nome JANE SMITH Group Meme ABCCO Member ID 123456799 Group Number 123456 ANTHEM SG 500 80 116100 Subscriber Female JOHN SMITH Spouse Male 10025970 1103 2005 ANTPLSH pm JOE SMITH Chig Mie 120988 1201 2008 e I
4. Group Name ABC COMPANY Billing Entity Current Period Current Invoice Amount 423456 June 2006 123456789C 23 423 13 Billed Amount 23 423 13 Amount Due May 2006 123456789C 33 523 40 Billed Amount 33 523 40 Amount Due 230 Case G Pay using a Single Account Pay using Multiple Accounts Find Provider Help ContactUs Logout Online User Manual Billing Scheduling Payments EmployerAccess Scheduled Payment s To Schedule a payment Enter the payment date in the First Payment Date field in a MM DD YYYY sequence AND Select a payment frequency Click Continue Note Recurring monthly payments can be set for a specific number of months or with no end date established On the following pages the schedule can be set to be a fixed amount each month or allow the system to determine the payment amount based upon invoices open at the time of each payment Please note A payment thou be schede at beast Gays Detore Mi dur Cate Payment of iess than the tetai amourt ovemd or ate payment may negatively aflect your cover age Please rater te the terms and condibans of your Contr act fee further FerwPaymenmOwe gm Wem he Lat y st Pha manh a rnbered thus manthiy payment ell ata he the beet dior bay of aaia month Pomet Frequency C meem y calendar di no end oste C Monthly by calendar dior mentes dicio w 9m O One tme or n LIT EmployerAccess Billing Payment Fr
5. New Subscriber Use this box to add a new employee subscriber by entering the member ID number in the blank box And don t forget to check the Open Enrollment Mode box at the top of the page to automatically apply the same enrollment effective date for everyone you enroll that day This function will only be available during your group s open enrollment period Anthem U EmployerAccess Welcome UPI Administratet QU Pender Finder tp Leg out Membership ELTE 0 EmployerAccess wW Welcome to EmnployerAccess our Stite Of Tot arl benefits manapement system Pending Activity Meenbur BET crither Manne iD Chye Log Mtoe ation 123456789 JOHN SMITH Add JSMITH123 Resume Coverage Qata y 123458789 JOHN SMITH Add JSMITH123 Rosine View Change Coverage Qelete Subscriber information 1234586780 JOHN SMITH Re JSMITH123 Besume Enroliment Delete Member ID 123456709 JOHN SMITHO Change JOMITH123 Resunet E Coverage Delete Add New Subscriber m Ld mos Member i Chiat Dettnption Manbo Srami LALJ ANTHEM 0 500 00 0401 2004 MED View Details T 65 ANTHEM 6 1000 80 04 01 2004 MED View T16a ANTHEM 6 2000 80 04 01 7004 MED View Qetaits TI73 ANTHEM 3G 2500 70 04 01 2004 MED View Qetails 1759 ANTHEM SG 04 01 2004 MED View 1000HIOED Qetails EmployerAccess Membership Enrollment Member Information for Enrollment Enrolling employees online can save t
6. View Emater Details View Group Banene Benett Detans Group Name aac co Plan Name BCBS SG 5009 90 Group Number 123458 Emetwe 04132006 Back To Group Banents Getiet ad Pyovtiont Applicable Provider Metwork Benefit Lever Maximum Age Lima Preesisting Period Prior Efectve Date a Month s 12 Month s 15 Months i l Sotoma Level Payment Participating Provider Oop Met Parscipating Provider Seton Laval Payment Participating Provider Oop Mat Non Parstipahing Provider EE PINE AO EI Participating Provider Second Level Payment Non Parscipating Provider Oop Non Par cipating Provider we Indrasus Out Of Pocket Participating Provider Indivigust Out Of Pocket Non Pardcipating Provider Participating j i i nos onm p gp rss s gu 83 1 EmployerAccess Billing Manage Employer s Bank Account s If you ve set up one or more bank accounts for online payments you can manage them here as well as pay bills online modify or delete account information and even add additional accounts EmployerAccess Anthem V Welcome FirstName LastName S Provider Finder S Help E Log out Membership Employer Billing Entities Open invoices Select Payment Amount ont Select Accounts Group Number 123456 Group Name ABC COMPANY June 2006 123456789C 23 423 13 Billed Amount 23 423 13 Amount Due May 2006 123456789C 33 523 40 Billed Amount 33 523 40 Amount Due
7. terunt 5 Pending ACLVIL i uiii e dicii ce e reed lr 5 Billing Entities eese nennen aaa 5 Change Login Information essere 5 View Change Subscriber Information sss 5 Add New Subscriber tentes 5 Membership Enrollment cernere rennen tenens 6 Member Information for Enrollment eene 6 Select Coverage us etaed sr gan v Po Ier pod 7 Assign CoVerage ii soe de doute b ete tippen 8 Other Goyera g Ca dicen Sepe rem prn d has aeta pee 9 Enrollment Verification essere 10 Add Coverage Confirmation sss 11 Membership Employees eese nennen rnnt 12 Employee Dependent Details sees 12 Add Dependents sss eren nnne nnne 13 Assign Coverage for Dependents ssiri 14 Other Coverage for Dependent 15 Verifica tigh 16 Cancel COVerage oae eritis i uec nda 17 Member Information for Re enrollment 18 Request ID Cards or Materials eene 19 dung 20 View Employer Details seen 20 Benefit Details seen trennen testante tenis 21 BINNE PED 22 Manage Employer s Bank Account s sss 22 Billing Entities eene rennen tnnt rantes 23 Select Payment Select Amount Aut
8. 0051 Rev 12 09
9. 4233 04 BA Ce G Pay using a Single Account Pay using Multiple Accounts EIE Online User Manual Billing Billing Entities Here you can view all open invoices for each billing location only one billing location per group if applicable Click an invoice number to pull up the Invoice Details screen EmployerAccess Anthem U Welcome FirstName LastName Si Provider Finder Sh Help E Log out Forms Reports Profile gt Pay Online Now Billing Entities CENI gt Dovenload Self Bill Coa ana Group Number 123456789 cone Group Name ABC COMPANY Manage Billing Email Addresses 122456001 ABC Laboratories June 2006 123456789C 38 401 18 May 2006 1234567890 23 423 13 Total Amount Due 151 075 33 The functionality of the Invoice Details screen Anthem includes the following EmployerAccess Welcome FirstName LastName Sl Provder Finder Help E Log out Bill Summary Shows the amount due for the current month as well as a summary from the Membership Employer forms Reports Profile Billin Entities Open invoices invoice Details 2M Invoice Details Membership Details Features a breakdown of Select Billing Period Invoice July 2005 23456789012 i Billing Entity Number 123456 Invoice amp 123456789012 the charges for each subscriber for the current raed Fc snp nan billing period Date Billed 06 21 2005 Payment Due Date 07 01 2005 Billed Adjustments Shows any adjustments such as lat
10. 6000000103 5 941 76 etats 1 Paid 0000000102 203287 Uetsis 02782008 123456 Paid 0000000101 1 328 33 tins 02 10 2006 122456 Paid 0000000100 1 975 26 petas EmployerAccess Forms At any point you can click the Forms tab The system displays the following links to downloadable PDFs Employee Information Change Form Small Group Dental Application Small Group Employer Application COBRA State Continuation Form Affidavit of Common Law Marriage Small Group Benefit Modification Inquiry Small Group Employee Application Colorado Uniform Application Group Administrator Manual HIPAA Privacy Practices HIPAA Authorization Form Online User Manual Reports You ll enjoy instant access to current and past enrollment information as well as functionality for your life and disability coverage if applicable such as Initiating claims Calculating entered claims Downloading conversion and portability forms EmployerAccess Anthem Wolorme UPI Administrater S Provider Finder f Help E Log out Memberane tnmeseyer Bing Crewe Name ABCCO Oroua Number 123456 Activity Reporte Otis Reports Pending Activine Employes Roster This i list of work such as new enrodments or This report enables you 10 quickly view al employees changes that you have started but have not completed by group and sort tha ordar of P s Infeemation for Al iotomelete work is Sutomatcsiy Saved In Pending qxomele by Heatncare ID
11. 7 59PM Resume Qelete T 323450789 JOHN SMITH NewEnroliment J MITHI23 08 11 2005 G21857PM Bense Delete T 12356700 JOHN SMITH NewEnraliment JSMMHI23 00 11 2005 022144PM Remene Delete F 123456789 JOHN SMITH NewEnrolment JSMITHI23 09 1 2005 0237 54PM Resume Delete F 123456789 JOHN SMITH NewEnroliment JSMITHI23 0947005 1229 225M Resume Delete F 123456788 JOHN SMITH NewEnroliment JSMITH123 10 20 2005 021537PM Resme Delete FT 123456788 JOHN SMITH NewEnrolmont J6MITHI23 10 28 2005 050441PM Besame Delete F 123456788 JOHN SMITH NewEnrolment JSMITHT23 11 01 2005 O314 02PM Basmi Delete T 123456789 JOHN SMITH NewEnroment JEMITHY23 11012005 0334 06 PM Resume Delete T 123488789 JOHN SMITH NewEnroliment J MITHI23 11 04 2008 OSIFOOPM Resena Delete F 3123450789 JOHN SMITH New Enrollment JGMITHIZ3 1109 005 032442PM Resume Delete T 123450789 JIM HARDEN NewEnroliment JEMITHI23 11 222005 024115PM Reseme Delete T 123458709 TOUCHKEXECUTE Change Coverage JSMITH122 02 10 2000 012029PM Remene Delete seca T ns at Dt EmployerAccess Profile Change Login Information You can change your login information including your password e mail address and secret question Note If you forget your password you ll be asked for your e mail address and to answer your secret question on the Login screen EmployerAccess Anthem Welcome Jeie Sith Provider Finder Bl Help E Log out Membership Employer Siling
12. Online User Manual Introduction We value your time and want to make doing business with Anthem Blue Cross and Blue Shield easy for you We re proud to introduce EmployerAccess your benefits management website where online enrollment membership and billing functions are just a point and a click away EmployerAccess helps you perform benefit functions quickly and accurately in real time That means no delays in transmitting data you get the same information that s available on our system And once your data is keyed in it s available immediately and you won t need to enter it elsewhere no duplicating work In addition EmployerAccess offers you more control over employee eligibility information and accuracy of information Error messages signal when required information is either missing or incomplete while electronic prompts guide you from screen to screen and from one step to the next EmployerAccess uses the speed and convenience of the Internet so there are no special software requirements All you need is Internet Explorer 6 0 or later a mouse and keyboard to electronically enroll review and maintain your Anthem employee benefits EmployerAccess is just one example of what we re doing to serve you better and give you more control of your employee health care benefits Online User Manual Table of Contents Getting Started iere iier etae tune tonne 4 Ripe 4 MemberShip neisuna
13. T Saturday 1200 am CST te 4 00 prm CST Sunday Holidays Closed incheates s Required Fiet Support Number 0017 42 2505 Tip Because the Login box is embedded in the Anthem Employer page save it to your Favorites or Bookmarks after you click the Employer tab That way you can navigate there directly the next time you need to log on s Online User Manual Membership Overview With the variety of at a glance features on the Overview page you can start the enrollment process access pending activity and search for or add a new member Pending Activity Any incomplete work will appear in this space You ll have the option of resuming work or deleting the recent action For quick reference the Type header describes the nature of the activity If you don t have any work in progress the Pending Activity chart will be empty Billing Entities Here you can view all open invoices for each billing location only one billing location per group Change Login Information Click here to change your login information including password e mail address and secret question Note If you forget your password you ll be asked for your e mail address and to answer your secret question on the Login screen View Change Subscriber Information To access information for current subscribers make changes to their information or alter benefits enter their member ID number in the blank box and then click Search Add
14. THEM SO GOLDPREMIUM Select SMTH JOHN 123458709 UFE Select SMTH JOHN 122456799 UF amp Salect Note If you have multiple groups in your company i e billing locations you must access them separately through their specific group account information Online User Manual Reports Pending Activity Any incomplete work will appear in this space You ll have the option of resuming work or deleting the recent action For quick reference the Type header describes the nature of the activity If you leave before a task is completed your work is automatically saved When you return you can either continue or delete the activity by choosing the desired link If you have work in progress the grid on this page is linked to the Membership Overview page and your activity is displayed there If there is no work in progress the Membership Overview page won t show the link and the grid on this page will be empty so you ll know there is no pending activity Anthem 29 EmployerAccess Wekome UP Administrator Provider Finder S Holp E Log out Forms Raparts Pending Activity Pending Activity Croup Name AIK CO Group Nandor 123456 Pending Activity Vere Al Datum 123456789 JOHN SMITH A33 Coverage J9MITH123 0507 2005 034029 PM Resse Delete E F 123488789 JOHN SMITH Ada Coverage J MITH123 07 19 2008 111934AM pesana Dalita 123458788 JOHN SMITH Change Coverage JEMITHI23 08 08 2008 092
15. e or reinstatement fees COBRA Lists COBRA or State Continuation subscribers Anthem Blue Cross and Blue Shield Print Remittance Sheet Prim Bill Summary Downoad 88 Summary Plan Name 776 538 59 765 533 00 10 000 59 Workers Compensation Shows the monthly i Plan Name 778 453 13 769 253 13 9 200 00 installment premium due any renewal fees Subtotal 1 554 991 71 1 535 791 13 19 200 59 and deposit premium required and the policy Pla Nang REND Sones period and policy number Plan Name 778 453 13 920 00 Subtotal 1 554 991 71 19 200 59 Overage Dependents Lists any dependents who are approaching the maximum age for the policy Eligibility Changes Highlights retroactive adjustments on a subscriber or dependent level Note If you have multiple groups in your company i e billing locations you must access them separately through their individual group account information EmployerAccess Billing Select Payment Select Amount Authorize Payment With the pay online option you can cover multiple invoices with one payment Select the desired payment amount and the account to pay from and then confirm your information on the authorization screen EmployerAccess Anthem V Wolcome FirstName LastName S Providar Finder Help E Log out Membership Employer Billing Entities Open Invoices Select Payment Amount Select Payment Amount E gt Select ARGUS Authorize oes Group Number 123456
16. equency amp Amount EmployerAccess Select Payment Amount Monthly frequency First Payment Date and Payment Frequency are carried forward to the Select Payment Amount page Select Payment Amount Entry Method Have system determine amount Select this method to have the system determine the payment amount based on all open invoices as of each payment date Note This selection pays for all open invoices as of the scheduled payment date Invoices with future dates will be included if they have been generated Scheduling a payment using the Have system determine amount option will result in an additional payment being made if your next month s invoice has been generated Enter amount Select this method to enter a fixed amount for each month Hove system determine amourt MOTE The retecines payt tor ot epee mesi af of e pheduled payment ate messer mmm Pos dun dates antl be shaded an mei d they have booe geneusted O Enter amount s Online User Manual Billing View Past Payments Here you ll view 12 rolling months of processed invoices Click the Details link and you can view more details Note Pending payments won t appear until they re processed iss Anthem Welcome John Smith Grover roo E Help Broo Billing Entities Open fnvelces View Past Payments Biting Entity Number 123456 Biling Entity Name ABC CO 1 23456 Paid 104 1 5536 Dotais Qar30 2006 123456 Paid
17. ffered and selects a PPO plan his or her dependent can t select an HMO plan EmployerAccess Anthem gt 90 Welcome UPI Adimisisti atot E Prowser Einder Hep Leg eut frepioyer ning Merke ship Mertber Inforimation Setect Cover ape Lite Coverage Assign Coverage Assign Coverage for Enrollment Tip EED SD ea Check the Coverage Assignment Options SubscriberName JOHN SMITH Group Name ABCCO Member ID 123456709 Group Number 123456 box highlighted by the red box in the example on this page to enroll all dependents in these benefits If the individual dependents should be enrolled in a specific benefit plan simply click pm the corresponding check box to select ANLEM SG 2800 70 1173 coverage for that member yn preva JOHN SMTH Subscriber Male 01 0151970 04 01 2006 74 JANE SMITH Spouse Female 0216201971 04 01 2006 r JESSE SMITH Crud Wale 0303 2000 04 1 2006 r ACTEM SG COL DONS MEM 25 PORN REN Hame f ecabonstup Emei Dule JOHN SMITH Subscriber Wale 0911970 0491 2006 F JANE SMITH Spouse Female 0302971 0401 2008 r JESSE EMITH Chid Male 03632000 0401 2006 r ANTHEM 86 Lii PRODUCT NMBT 64 01 2006 ANTHEM 96 SUPP LIFE PRODUCT PD78 94 1 2006 CS Save ans Enit rancet tareaton corci Online User Manual Membership Enrollment Other Coverage Answer yes or no to the questions about other prior and Medicare coverage If you answered yes to any questions on th
18. horize Payment 24 Scheduling Payments 25 Payment Frequency amp Amount sse 26 View Past Payments sse nennen nnns 21 uds M 28 ROPOIUS PPP 29 Employee RosSter eese eene niente anrea tantas 30 Pending Activity eese ene nnerer teretes tennis 31 dinili tws DDR 32 Change Login Information senes 32 Provider Findet eren doen ra ara cria cuni 33 EmployerAccess Getting Started Log on to EmployerAccess Go to anthem com click the Employer tab and select your state Then above the orange Login button select Groups of 1 50 and click Login Login Enter your existing user ID and case sensitive password and then click Login EmployerAccess Anthem B Provider Finder B Hele We have made some changes to the Acity Report his feature resides underthe Login Reports hyperlink For more detaits please reser to page 20 of the internet Enrollment User Manual which Is located via me help hypartink Fanar You Login formation User ld I Forgot Your User ID 0t Password Click Here To Reset Password Password f Click Here To Retrieve User IO Case Senstve Are You an Esmpleyer That Needs Access Note Atar 15 minutes of inactivity the system Reames Fe Emotover Access wil log you Out automatically and require that Hears of Operation you log back In Monday Friday 7 30 am CST te 5 00 pm CS
19. ime and reduce errors To start the enrollment process find the Add New Subscriber box highlighted by the red box in Figure 1 on the right side of the Overview page and then enter the new employee s member ID number Figure 1 ioniene Anthem 4 amp 9 Wecome UP Advamtiate cesse nie Blogo Member ID Member ID Figure 1 mue 0339 niai L3 Me i j Denger Cu femi o M T Member Information for Enrollment Figure 2 From here fill in the required fields including covet i rt employee s name address birth date hire and on e ominta gt Kaiet Ont signature dates and probation type if applicable s lt Note If you only have one probationary period the wee coverage effective date is calculated based on the Pal CULA Diis eons ens deseo ty Publ ip Code date entered in the Hire Date field If you have multiple mema Coco probationary periods i e exempt employees are eligible for coverage on the first day of the month after their date of hire and non exempt employees are eligible for coverage on the first day of the month after the date they complete piles MONT ser TOMANA Employees must meet eligibility requirements and satisfy their waiting employment click the drop down box for Probation sae eters to as the BERG UN period as defined in your E Type to select the appropriate type The employee s Administrator Manual Fig
20. is screen please provide additional information about other and additional coverages where requested EmployerAccess Walcome UPI Adwinismate E Provider Finder E Heip E Log cut tengteyer Miting Membership Member Information Select Coverage Lite Coverage Ansim Covet aas Car Coverage Other Coverage for Enrollment Subscriber Name JOHN SMITH Group Name ABC CO Member ID 123456739 Group Number 172456 Eo eines die lili Does any meri being added have other coverage Cyes No Dots any meritar being added have prior coverage C Yes C No Does am member being added hawo Medicare coverage C Yes C No indicates Required Fiend EmployerAccess Membership Enrollment Enrollment Verification To complete the enrollment process for a new member review your selections and click the Submit button To make changes use the Previous button at the bottom of the page rather than your browser s back function EmployerAccess Anthem U Welcome UPI Administrar BE Prysor rese o E Log out Mesuberstip Meruber Rtomatior J Select Cover ape Life Cover ape Assia Coverage Offer Coverage Enroliment Veetication Enrollment Verification Sudgen Name JOHN SMITH Grow Name ABC CO MemberID 123455729 Group Number 123456 Subscriber JANG SMITH Spouts Female 02 02 971 04 01 2006 Chis ANTHEM SG GOLUPREMIUM 25 9 Life Cives ape Basic ANTHEM 86 LIFE PRODUCT NMBT Supplementa
21. ive Ow JOHN SMITH Subscriber 03 01 2006 ANTHEM SG VISION S 80 1 165 Nene Watatonitg Cancellation nerts om JOMN SMITH Subscriber 63 01 2008 EmployerAccess Membership Employees Member Information for Re enrollment For the re enrollment process you ll take the same steps as for the initial enrollment process following the flags on the screen below highlighted by the red box Select Coverage Life Coverage Assign Coverage Other Coverage Verification EmployerAccess Weieome UPI Administrator S Provider Finder E Help E Log ot Signature eum C GR ew RE Stoot wan STREET me Oty gt Geneon Probation Type iSelect One E State P F amom EAE indicates a Required Field p Actual City and State names are determined by US Postal Zip Cose Last Name 5mm Birth Date 02027971 FirstName JANE mewhonshp Spouse x Gender C Male Female Kj inchide Dependent Totally Disabled Fell Time Student gt Indiestes a Required Naig Acts Dependent EECIILLI IEZH Online User Manual Membership Employees Request ID Cards or Materials Choose the item you want to request an ID card or certificate If you re requesting a certificate choose which product Please note that life and disability products don t have ID cards Then select a mailing option and click the Submit button A confirmation screen will let
22. l ANTHEM SG SUPP LIFE PRODUCT PD78 0401 2006 Online User Manual Membership Enrollment Add Coverage Confirmation After you ve submitted your enrollment information a confirmation line appears on the Membership Overview page informing you that your Add coverage has been successfully completed EmployerAccess Anthem U Welcome John Smith S Provider Fide Hep E Log out Pending Activity 123456709 123456708 123456789 123456788 Group View Benefits View Detaes vas5 ANTHEMS 1000 04017005 MED View Detats vas ANTHEM SO 7000 04 1 2005 MED View Dstats vaso ANTHEM 902500 04 1 2005 MED View Detame vati ANTHEM SO 1000 0401 2005 MED VienDetals EmployerAccess Membership Employees Employee Dependent Details The Employee Dependent Details page gives you complete access to an employee s benefits Changing subscriber information or requesting an ID card is easy You start by clicking one of the blue buttons Or you can simply scroll down to review contract and coverage information EmployerAccess Anthem V Vekoma UPI Administ mot BY Provider Finder E Male E Log out Membership E22 7 Subscriber Name JOHN SMITH Group Name ABCCO Birth Date Active JANE SMITH Active female Spouse 03110952 12 01 2005 ANTPLS21 Prot Eneoimest imatan JOMM SATH Ae Male Child 06101933 12 01 2005 ANTPLS21 Prior Encplment JOAN SMTH Aio female Crid 06101993 12 01 2005 ANTPLS21
23. member far Oliver Coverage 6 Cmo A If Yes enter the information below Number Group iD CE Cartier Name feces Poroy i manza Effective Date oao12006 a gt Indicates a Required Field on e EmployerAccess Membership Employees Verification You ll be asked to review your information or make changes by clicking the Previous button at the bottom of the page If your information is accurate click the Submit button and your dependent information will be submitted Anthem 9 EmployerAccess Welcome UP Administrator S Provider Finder S Hulp E Log ot Employer Bilin Menpe ship J Merber Wntormeaten f Select Covet que J Ll Covet one J Appian Covert as f Other Coverage f Enrolment Vertcaton Subscriber Name JOHN SMITH Group Name ABC C Member ID 122456709 Group Number 123456 00 HGH DED 1 759 Reteborsten ANTIE M SG COl DPR MILIM 75 PARN cane Rulations Vatic ANTHEM SO LFE PRODUCT NME 0491 2006 Supplementi ANTHEM 90 SUPP UFE PRODUCT PO70 049912008 mo Canest Transaction siama J Online User Manual Membership Employees Cancel Coverage To cancel this employee s dependent s coverage enter the cancellation date and reason Also select the coverage to be canceled Review your cancellation on the EmployerAccess Anthem Verification screen before you Vimicome UPI Administrator Prowd a complete the termination and LL c o ten click the Submit bu
24. ndicates a Required Field Subscriber JOHN A SMITH Spouse Male 10021970 11 03 2005 Chis JOE SMITH indicalus a Required Field Online User Manual Membership Employees Other Coverage for Dependents Here you ll indicate other coverage including prior coverage and health care benefits received from Medicare for the listed member dependent If you answered yes to any questions on this screen please provide additional information about other and additional coverages where requested Welcome UPI Adininistrat t BY Prowder Feder B Help E Log ot 1 Add Depondents A231 Cover auo fot Ad4 Depamdents Members Omer Coverage for Add Dependents Other Coverage EPI Subscriber Name JANE SMITH Group Nama MK CO Member ID 123456789 Group Number 123456 Oller Covet age Does any member being added have other coverage Yes C No Does any member being added have prior coverage amp Yes C No Does any member being added have Medicare coverage Yes No indicates a Required Fieid Hew Dependent Information Nome JOE SMITH Gender Mate Relationship Child Birth Date 12201988 This member has had prior coverage This member has Medicare coverage Ee Yes C No C Yes 8 No If Yes enter the information below M Yes please check the fo owing Begin Date 0170172001 Pana C Yes 8 No fetigaryyy End Date aXX m raay Pata C vos No Prior Carrier Name Efectve Date This
25. tton to Member siio Empiovee Depermlen Dtaiis f Cancel Coverage complete your transaction Cancel Subscriber Coverage Note Coverage is canceled on TEUER ees oues ane the first of the month after the Member D 123456789 Group Number 123456 qualifying event date You can t cancel a member retroactively Quatitcaton Date Cancenabon Reason Select Reason ATES SG C006 SS iT Nye Beisbonshio JOSIN SMITH Subscriber Actus 08 01 2005 e JANE SMITH Spouse Actvo cen JOAN SMITH Chig Acto 09m EmployerAccess Anthem y Vroicome UPI Administr ater g ANTHEM SG DENTAL CH1000 80 1 165 Membership E27 7 2E Forms Reporte Profile Nene LL UJ Meinbership Ermeteyee Dependent Details Cancel Coverage Declination Cancel Coverage Vertication JOHN SMITH Subscriber Acie 0s Cancel Subscriber Coverage Verification Subscriber Nome JOHN SMITH Group Nome asc co tj Lu U ANTHEM SG VISION CH1000 80 1165 Member ID 123456789 Group Number 123456 Nama Rannap JOMN SMITH Subscriber Ace oan ANTHEM SG CH1000 80 1165 Neme Cancellason Ciecive Osie JOHN SMITH Subscnber 03 01 2006 Basic Life ANTHEM LIFE PROOUCT NM6700 Status Acte JANE SMITH Spo 0301 2006 Effective Date 05 01 2003 Spouse 01 2 iG Su ODUCT POTE Supplemental Lite ANTHEM SG SUPP LIFE PRODUCT PD78 JOAN SMITH Child 0 01 2006 Status Ach Effective Osie 05 01 2002 ANTHEM SG DENTAL CH1000 80 1465 Nime Cencotason Efoct
26. ure 2 coverage effective date will be calculated based on the date entered in the Hire Date field and the information selected in the Probation Type field Tips The flags highlighted by the red box in Figure 2 tell you where you are in the enrollment process You must complete all steps in the process before an employee is enrolled If you don t fill in all required fields an error message will appear telling you which fields need to be completed You ll need to complete those fields before you can move to the next screen Online User Manual Membership Enrollment Select Coverage Next select from among the different coverages available for your group With EmployerAccess you can enroll your employees in health dental vision life long term disability and short term disability coverage from Anthem all in one place To save even more time only those coverages you offer to employees will be shown EmployerAccess Anthem Wwicemne UPI Admins atee eode Fede Hep Blog ot EmployerAccess Membership Enrollment Assign Coverage You can now assign coverage and enter the provider number The information on this page is based on the products the employee has chosen If the products require a provider you ll need to make a selection Otherwise provider fields won t appear Note A dependent can only enroll in a plan that s offered to and selected by the employee For example if the employee is o
27. you know your request has been received EmployerAccess Anthem U Welcome UPI Administrates GE Provider Finder Hep E Log out Memba sbin Employees Paperjet Detalis Request ID Card or Materials Request ID Card or Materials Subscriber Namo JOHN SMITH Growp Name Anc C Member ID 123456789 Group Number 123456 Matesbals fleqaestex Select Ali Applicable ems Which Products FID Card V Medical T Evidence of Coverage F dents Loo M Mail To Address Subscriber 6 Group EmployerAccess Employer View Employer Details Here you ll review your company s information including enrollment dates new hire employees probation types group details and contact information EmployerAccess Anthem U Weicome Jobe Sani B Provider Finder E Help Log out LL M Enwdeyet Erdeyet View Employer Details View Employer Details Group Name ABCCO ee ECLTITCN ot Care OF MIC CO Contact information Name Prone Namimi CONTACT ONG 999 777 6666 JSMITH ABRC COM Yes CONATCT TWO 123 456 7890 No _ Give Cross Dlue Sibolt Cordact L Name Online User Manual Employer Benefit Details In this plan specific page you can view your group s medical benefit summary i e information under the General Provisions Applicable Provider Network and Benefit Level headings Anthem EmployerAccess Wetcome Jem Sanith GI Provder Finder Help E Log ot
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