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You can make sure that your Anthem Life & Disability Insurance Company supplies are always current by using this website to identify or download the materials you need.

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Group Term Life Coverage
When faced with a loss, employees want to know that they can count on prompt, convenient benefit payments. But our life insurance plans provide more than just a benefit check.

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Group Disability Coverage
No one plans on experiencing a disabling illness or injury. But illnesses and accidents do happen, and our disability insurance plans provide more than just income replacement in case of disability. Our plans also provide the kind of support employees need to help them get back to health, back to work and back to life.

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Online Forms

Employee Applications 
Life Insurance Applications

Employee Disability & Life Application

Employee Disability & Life Application with Medical Questionnaire (use when underwriting is required)

Employer Applications 
Disability & Life Employer Group Application
Claim Forms 
Accidental Dismemberment or Loss of Sight Claim Form
Beneficiary Designation Form
Life Insurance Claim Form
Life Insurance Claim Form – Spanish
Life Waiver of Premium Claim Form
Living Benefit Claim Form
Long-term Disability (LTD) Claim Form
Short-term Disability (STD) Claim Form
Privacy Notes 
Privacy Note
Other Forms 
New York Evidence of Insurability Form
Group Life Conversion Information
®Registered marks Blue Cross and Blue Shield Association ©2016 Copyright of Anthem Insurance Companies, Inc. Life and Disability products are underwritten by Anthem Life & Disability Insurance Company. ® ANTHEM is a registered trademark of Anthem Insurance Companies, Inc.
Health products are underwritten by Empire HealthChoice HMO, Inc. and/or Empire HealthChoice Assurance, Inc., licensees of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield Plans, serving residents and businesses in the 28 eastern and southeastern counties of New York State. All external sites will open in a new browser window. Please view our Website Privacy Policy and Terms of Use for more information.