FOR MATERNITY: Although maternity services do not require a pre-authorization, the related inpatient 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin with Section A: PATIENT INFORMATION. Fill in your name, policy number, GBG ID, employer, date of birth, address, postal code, country, phone number, fax number, and email.
3. Proceed to Section B: MATERNITY INFORMATION. Indicate your anticipated type of delivery (Vaginal or Cesarean Section) and provide the expected delivery date and date of last menstrual period.
4. Answer questions regarding any history of fertility treatments and whether this pregnancy is a result of such treatments. Provide details if applicable.
5. In Section C: DOCTOR/FACILITY INFORMATION, enter the name and contact details of your healthcare provider.
6. Finally, complete Section D: AUTHORIZATION by typing your name as an electronic signature and confirming the accuracy of your information.

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