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Subscriber's Statement of Claim   Download

Statement of Claim: Blue Shield Life

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Authorization for Release of Personal and Health Information

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Pharmacy Reimbursement
 
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Blue Shield Global Core International Claim
 
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Proof of Death Form: Group Life
 
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Accelerated Death Benefit Claim Form: Group Life
 
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Dismemberment Claim Form: Group Life
 
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Dental Claim
 
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Vision Claim
 
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Waiver of Premium Claim Form: Group Life
If a member becomes totally disabled, the life premium may be waived.
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Conversion to Individual Coverage: Group Life   Download 
Beneficiary Affidavit (life insurance groups of 10 or more)  

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Beneficiary Change Request Form   Download
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Form
DOI
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DMHC
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*Translations temporarily unavailable.
**Underwritten by Blue Shield of California Life & Health Insurance Company.