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Nov 29, 2022
For consistency, and to meet state department of insurance requirements, we need to provide clients with current, approved applications for their life and disability plans from Anthem Life & Disability Insurance Company.
The current applications to use for your state are in the Forms Library. We will also continue to accept enrollments by Compassi Online Employer Self-Service, census, and EDI files.
Please contact your sales representative if you have any questions.
Life and Disability products are underwritten by Anthem Life & Disability Insurance Company, an affiliate of Empire HealthChoice Assurance, Inc. Independent licensees of the Blue Cross and Blue Shield Association. Anthem is a registered trademark of Anthem Insurance Companies, Inc. Life insurance benefits provided under Certificate Form Number LBO A NY 0105 C REV 0209. Disability insurance benefits provided under Certificate Form Number DLS A NY 1113 C. The expected benefit ratio for the Disability policies is 60% for groups of less than 50 lives, and 65% for groups of 50 or more lives. This ratio is the portion of future premiums which the company expects to return as benefits, when averaged over all people with this policy. This policy provides disability income insurance only. It does NOT provide basic hospital, basic medical or major medical insurance as defined by the New York State Department of Financial Services.
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