Specialty Benefits

Specialty Benefits

Form Download
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

Contact Us

  • Producer Services (800) 559-5905

    Employer Services (800) 325-5166

  • Blue Shield of California

    PO Box 272540

    Chico, CA 95927-2540

© California Physicians’ Service DBA Blue Shield of California 1999-2022. All rights reserved. California Physicians’ Service DBA Blue Shield of California is an independent member of the Blue Shield Association.

Health insurance products are offered by Blue Shield of California Life & Health Insurance Company. Health plans are offered by Blue Shield of California.