Certification of Dependency - BCBST 2026

1. Click ‘Get Form’ to open the Certification of Dependency - BCBST in the editor.
2. Begin by entering the Subscriber Name, ID No., and Group No. in the designated fields at the top of the form.
3. In Section 1, provide the Dependent Name and select their status from options such as Natural Child, Step-Child, or Adopted Child. If applicable, attach necessary documents for adopted children or legal guardianship.
4. Section 3 requires you to indicate the dependent's marital status and whether they are a full-time student. If they are employed, fill in details about their employment status and earnings.
5. Complete Section 4 by stating what percentage of support you provide for the dependent if they receive income from other sources.
6. Finally, sign and date the form at the bottom. If a physician's certification is needed, ensure that section is completed as well.

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