Anthem for SOCA Benefit Plan Sold Case Submission Checklist

Thank you for selecting Anthem Blue Cross and Blue Shield and the SOCA Benefit Plan. Following is a list of items necessary to enroll your Client’s business. To expedite the processing of your Client, please submit via FormFire the requested items below to your sales office at socabpnewcaseinstall@anthem.com (unless otherwise stated). Incomplete documents will be returned to you for completion and incomplete submissions will delay the effective date. We require a minimum of 15 days for processing a new case submission. The 15-day period begins when all checklist items are received in our office with no missing information.
 

Medical Sold Case submission requirements

• SOCA Benefit Plan Participation Agreement 
• SOCA Benefit Plan Participating Business Acknowledgement Employer Agreement 
• SOCA Benefit Plan Employer application (2020 version)
• SOCA Benefit Plan Employee applications with medical (2020 version)
• Signed rates and benefits
• Anthem excel census enrollment template (IM01), loaded and submitted via FormFire
• Proof of chamber membership (ONLY acceptable formats shown below) 
  • A letter from the Chamber of Commerce stating that the Employer is a member in good standing. The letter must be on letterhead that is specific to the Employer’s declared Chamber of Commerce.
  • An email from the Employer’s declared Chamber of Commerce stating that the Employer is a member is good standing. The email must specify the sender’s name and title, and must also show the sender’s email address, date, and time stamp. It is acceptable for the Broker to obtain this email from the Chamber of Commerce on behalf of the Client and to forward it to SOCA.
  • A copy of a cancelled check or credit card receipt that indicates payment of membership dues in the Employer’s declared Chamber of Commerce.
• SOCA Benefit Plan Electronic Funds Transfer (EFT) banking form and voided check (required) 
  — 1st months premium rate will be billed or withdrawn via EFT as applicable
• Annual Rate and Census Reconciliation Form
  
• SOLE PROPRIETORS ONLY:
  • Cover page for form with schedule C OR
  • Cover page for form 1040 with schedule F and a schedule SE

Dental Sold Case submission requirements

• BeneMod Form
• Dental enrollment template (IM01)
• Signed rates and benefits
• Proof of chamber membership
• SOCA Benefit Plan Electronic Funds Transfer (EFT) banking form and voided check (required)

 1st months premium rate will be billed or withdrawn via EFT as applicable

Vision Sold Case submission requirements

• Vision enrollment template (IM01)
• BeneMod Form
• Signed rates and benefits
• Proof of chamber membership
• SOCA Benefit Plan Electronic Funds Transfer (EFT) banking form and voided check (required)

 1st months premium rate will be billed or withdrawn via EFT as applicable

Life & Disability Sold Case submission requirements

• Life & Disability enrollment template (IM01)
• BeneMod Form
• Signed rates and benefits
• Proof of chamber membership
• SOCA Benefit Plan Electronic Funds Transfer (EFT) banking form and voided check (required)
• Hold Harmless Agreement

 1st months premium rate will be billed or withdrawn via EFT as applicable

Minimum 2 enrolled and no more than 50 total Employees on average during the preceding calendar year.