Form | Download |
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Standalone Specialty Benefits Employer Application Dental, Vision & Life Insurance |
Download |
Conversion to Individual Coverage: Group Life | Download |
Beneficiary Affidavit & Assignment Form | Download |
Beneficiary Change Request | Download |
Waiver of Premium Claim Form: Group Life If a member becomes totally disabled, the life premium may be waived |
Download |
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Blue Shield of California
PO Box 272540
Chico, CA 95927-2540
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Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.