Life Insurance Claim Form - Blue Cross and Blue Shield of 2025

1. Click ‘Get Form’ to open the Life Insurance Claim Form in the editor.
2. Begin with Part 1, where the Employer/Administrator must fill in their information, including Group Name, Group Number, and contact details. Ensure all fields are completed accurately.
3. Next, provide Employee Information such as Last Name, First Name, Birth Date, and Date of Death. This section is crucial for identifying the insured individual.
4. In Part 2, beneficiaries must complete their respective sections. Each beneficiary should provide their personal details and relationship to the deceased.
5. Finally, ensure that all required documentation is attached as per the checklist provided. This includes a certified copy of the Death Certificate if applicable.

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