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| Underwriting Health Questionnaires | Call 1-866-508-0618 | ||
| When filling out your Individual Health Statement for Anthem health insurance, you will be required to fill out a questionnaire form if you answered "YES" to any of the questions numbers below. Filling these forms out will help you get health insurance with Anthem. | |||
| Check your health statement to see if you answered yes to the Question numbers below. | |||
| Application Area | Question Numbers | Health Condition | Questionnaire Form Required. Click for form. |
| Part C | 1 | Disability | Disability Form |
| Part D | 1a | Cardiac/Hypertension | Hypertension Form |
| 1a | Heart Murmur/Mitral Valve | Heart Murmur / Mitro Valve Prolapse Form | |
| 1b | Tumor/Cyst/Cancer | Tumor/Cyst/Skin Cancer Form | |
| 1d | Mental Health | Mental Health Form | |
| Attention Deficit Disorder Form | |||
| 1e | Seizure/Epilepsy | Seizure/Epilepsy Form | |
| 1f | Alcohol /Drug | Alcohol & Drug Form | |
| 1h | Abnormal Pap Smear | Abnormal Pap Smear Form | |
| Endometriosis Form | |||
| 1i | Spinal |
Spinal Form | |
| Fibromyalgia | Fibromyalgia Form | ||
| Arthritis | Arthritis Form | ||
| Gout | Gout Form | ||
| 1k | Digestive | Digestive Form | |
| Ulcer | Ulcer Form | ||
| Colitis / Irritable Bowl Syndrome | Colitis/ Irritable Bowl Syndrome Form | ||
| 1l | Asthma | Asthma Allergy Form | |
| 1m | Kidney / Urinary | Kidney/ Urinary Disorder Form | |
| 1o | Thyroid | Thyroid Form | |
| Part E | A | Asthma | Asthma Allergy Form |
| C | Chiropractic Care | Spinal Form | |
| F | Headaches / Migraines | Migraine Form | |
| I | Skin Problems / Allergies | Allergy Form | |
| Other | Newborn | Newborn Form | |
| Other | Domestic Partner Form | Domestic Partner Form | |
| How to Apply for Anthem Health Insurance | Back to Anthem Menu | ||
