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Click ‘Get Form’ to open the bcbs of tx evidence of insurability form in the editor.
Begin by filling out Section A, Employee Information. Enter your name, Social Security Number (SSN), gender, personal email address, birth date, and contact details including home and cell phone numbers.
In Section B, Insurance Details, indicate if you are completing this form due to a Family Status Change. Fill in the desired coverage amounts and current amounts for both Employee and Spouse Supplemental Life insurance.
Proceed to Section C for Spouse Information. Provide your spouse's details including name, SSN, contact information, and health practitioner details if applicable.
In Section D, answer all health questions for both yourself and your spouse. Ensure that you provide accurate responses as these will impact your coverage eligibility.
Finally, review Section E for Authorization and Acknowledgment. Read through the terms carefully before signing and dating the form to confirm accuracy.

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