Indiana Insurance Group Forms

The Health and Dental insurance forms listed below are for your convenience. Simply click on the appropriate form and the information can be printed or saved to your computer for future reference. When necessary simply fill out the necessary information, print, and fax to our office at your convenience. You may also e-mail the completed form to info@indianainsurancegroup.com.

Our fax number is (317) 842-2243 or you can contact our office if you have any questions or need any help, just call (317)-842-2210 or Toll Free 1-866-742-4800.

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Group application forms:
Group Census Form
Anthem Employer Application
Anthem 2-50 Small Group Employee Application

Active Group Forms:
Anthem New Employee Enrollment Form
Anthem Change of Coverage Form
Anthem Employee Termination Form

Health Applications:
Anthem All in One Application
Assurant Health Individual Application
Medical Mutual of Ohio Individual Application
United Healthcare Individual Application

Dental Insurance Applications:
Anthem Dental Application
Brokers National Application