Blue Shield of California and Blue Shield of California 2026

1. Click ‘Get Form’ to open the Blue Shield of California Life Insurance Plan in the editor.
2. Begin by selecting the reason for application. Check the appropriate box for 'New hire', 'Rehire', 'Loss of coverage', 'Open enrollment', 'Late enrollment', or 'Other qualifying event'. Fill in the date if applicable.
3. In Section 1, review the important enrollment guidelines for Specialty Benefits coverage. Ensure you understand the requirements for Basic and Supplemental Life insurance.
4. Proceed to Section 2 and select your desired plan(s) by checking the corresponding boxes for Basic group term life/AD&D insurance, Dependent basic life insurance, Supplemental Life insurance, or Supplemental AD&D insurance.
5. Fill out Section 3 with your personal information including Social Security number, employment status, job title, home address, and contact preferences.
6. Complete Section 4 if enrolling dependents. Provide their information as required and indicate if they are refusing coverage.
7. In Section 5, designate your primary and contingent beneficiaries by filling in their names, relationships, and percentage of benefits.
8. Finally, sign and date Section 6 to authorize your application. Ensure all information is accurate before submitting.

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