Common Forms
This page includes only standard versions of our most-used forms. Many forms are specific to your policy or plan and aren't listed here. If you don't see what you need, please contact us or your benefits administrator.
Former Anthem Life customers should log in to get their claim forms.
| Title | Purpose | Action |
|---|---|---|
| Colorado Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Colorado Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Colorado Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Colorado Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Colorado Paid Family and Medical Leave for your own serious health condition. |
Download |
| Colorado Paid Family and Medical Leave Safe Leave Attestation | Used to attest the need for Safe Leave, as defined on the form, when submitting a request for CO PFML Safe Leave benefits. |
Download |
| Colorado Request for Paid Family and Medical Leave | Complete this packet to apply for Colorado Paid Family and Medical Leave Safe Leave benefits. |
Download |
| Connecticut Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Connecticut Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Connecticut Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Connecticut Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Connecticut Paid Family and Medical Leave for your own serious health condition. |
Download |
| Delaware Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Delaware Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Delaware Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Delaware Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Delaware Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Delaware Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Delaware Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Delaware Paid Family and Medical Leave for your own serious health condition. |
Download |
| Massachusetts Paid Family and Medical Leave Bonding Leave Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Massachusetts Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Massachusetts Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Massachusetts Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Massachusetts Paid Family and Medical Leave for your own serious health condition. |
Download |
| Minnesota Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Minnesota Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Minnesota Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Minnesota Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Minnesota Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Minnesota Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Minnesota Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Minnesota Paid Family and Medical Leave for your own serious health condition. |
Download |
| Oregon Paid Family and Medical Leave Bonding Packet | Complete this packet to apply for Oregon Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Oregon Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Oregon Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Oregon Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Oregon Paid Family and Medical Leave for your own serious health condition. |
Download |
| Washington Paid Family and Medical Leave Bonding Leave Packet | Complete this packet to apply for Washington Paid Family and Medical Leave to bond with a newborn, a newly adopted or fostered child. |
Download |
| Washington Paid Family and Medical Leave Care of Family Member Packet | Complete this packet to apply for Washington Paid Family and Medical Leave to care for a family member with a serious health condition. |
Download |
| Washington Paid Family and Medical Leave Military Leave Packet | Complete this packet to apply for Washington Paid Family and Medical Leave to assist family members due to another family member’s active military duty or impending active duty abroad. |
Download |
| Washington Paid Family and Medical Leave Own Serious Health Condition Packet | Complete this packet to apply for Washington Paid Family and Medical Leave for your own serious health condition. |
Download |