PLEASE NOTE: The links on this page open in a new window & the majority are PDFs.
Benefits Resource Center Flyer for Employees
Eligibility Information
To be eligible to enroll in your employer’s benefit plans, you must be a full time W-2 employee working 30 or more hours a week for the company and satisfy the new hire probation period.
Please refer to the Probation Calendar below and contact the person responsible at your employer for your company benefits. Also refer to the enrollment guidelines in the next section.
New Hire Benefit Waiting Period FOMA-60D
(Effective April 1st 2015)
Enrollment Guidelines
Please read the Enrollment Guidelines to learn when you can come on the plan, add dependents and make other changes.
Health Plan Enrollment Guidelines
Premium Charts
Payroll Deduction Chart 04-01-26
Monthly Premium, Allowance, PayDed 04-01-26
COBRA Center
Your Group is Subject to Federal COBRA
The Initial Notice should be provided to the employee AND spouse (if covered) within 90 days of becoming covered. One notice to the home is allowed if both live at the same address but it must be addressed to both parties.
Your employer outsources COBRA administration to EBA&M. Please contact
your HR department for more information.
Fed-COBRA Action Notice to EBA&M
Anthem Fed-COBRA Enrollment Form
Help & Support
| PLAN DEPARTMENTS | PHONE/MEMBER SERVICES | PLAN/POLICY # |
|---|---|---|
| Anthem California HMO Members | 1-833-913-2236 | U39464-CalifCare Network -Prefix JQK for IDs U39465-Select Network Prefix JQV for IDs |
| Anthem California PPO Members | 1-800-888-8288 | U39463 – Prefix JQU for IDs |
| 24/7 Registered Nurse Line | 1-800-977-0027 | |
| Billing Entity # U39462 | ||
| Dental Member Services | 1-844-729-1568 | U39466 |
| Vision Member Services | 1-855-333-9021 | U39467 |
| Principal Life & LTD Plan Members | 1-800-986-3343 | H9068-1 |
| Wayco Insurance Services, Inc. (Broker) | 1-951-699-6000 x10 | john@wayco.com |
Cafeteria Plan
Your Cafeteria “Section 125” Pre-Tax Premium plan allows payroll deductions to be taken “off the top line” before taxes are calculated ~ saving from 25% to 40% depending on your personal tax bracket.
Example of Cafeteria Plan Savings
Medical Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Health Plans @ A Glance 04-1-2026 | Anthem Enrollment / Change Form (fillable) (Save to your local drive first) | Anthem Website |
| Anthem HMO Plat Select | ||
| Anthem HMO Plat Calif Care | Anthem Waiver Form | |
| Anthem PPO Platinum | Anthem Domestic Partner Affidavit Form | Anthem Register Online for Members |
| SBCs Document Link | Anthem Employer Recap Form Employer Use | Anthem Mobile App Flyer |
| HMO Medical Group List
Pick from Calif Care or Select Networks |
||
| Anthem PPO EOC | Out of Network Claim Form | |
| Anthem HMO EOC | ||
| Anthem HMO Select EOC |
Dental Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Dental Plan At A Glance | Use Anthem Medical Forms | Anthem Website |
| Anthem Dental EOC 4-2025 | ||
| Using Anthem Provider Search Tool | ||
| Dental Network List 1-2020 All of California as of Jan 2020 sorted by county, then city and specialty. It is 936 pages. |
Vision Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Vision Plan Summary | Out of network claim form | Anthem Website |
Life Insurance
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Life Insurance Plan Highlights | Same form as Medical Plan (above) | Same website as Medical Plan (above) |
| Travel Assistance Flyer for those on the group life | Life Beneficiary Form (pdf) | |
| Anthem Life EOC Document |
Disability Insurance
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Disability Insurance Plan Highlights | New Member Enrollment Form | Principal Financial Website |
| Disability Plan Certificate | Changes and Termination Form (for Employer use) |
Retirement Plan
| BENEFIT SUMMARIES | FORMS LIBRARY | WEB SITE LINKS |
|---|---|---|
| Please see your employer for enrollment kit. |
