PACKARD GENERAL AGENCY
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ANTHEM
GROUP
Plan Designs, Applications, and Other Needed Forms
*Plan Designs and Details are provided in the quotes we provide.
Document Library
Name
Description
Group EFT Form
EFT Form - Save $25 Billing Fee
Large Group Risk Assessment
Form needed to obtain large group quotes
HSA Fees
Mellon Bank Fees
Employee Application
Small Group - Under 50 Employees
Employer Application
Small Group - Under 50 Employees
Large Group Employee
Application 51+
Large Group Employer
Application 51+
Employee Change Form
Change Form
Rx Mail Order
Form
Group Dental Options
Benefit Detail
