Anthem Life Insurance Beneficiary Form

September 17, 2021

Make sure the details you fill in insurance beneficiary is updated and accurate. 1303130 53967gamenggl life beneficiary designation prt fr 06 15 greater georgia life insurance company the employer must keep this form on file.

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Page 2 of 2 beneficiary designations definitions:

Anthem life insurance beneficiary form. The purpose of designating beneficiaries for this policy is to tell anthem life insurance company exactly how you wish the proceeds of your policy/certificate to be paid upon your death. If a covered employee or dependent passes away, the beneficiary will need to complete a claimant's statement. An anthem $50,000 life insurance plan is provided for all district benefit eligible employees, during their active employment.

Complete this portion only if spouse is not the sole primary beneficiary if you are currently married and are naming someone other than your spouse as your beneficiary, your spouse must sign this beneficiary designation form. Name address name address name address date of birth date of birth date of birth social security no. If you fax or email the

Person or persons who will receive the life insurance proceeds upon your death. If multiple primary beneficiaries are listed, death benefits are divided equally among all the living primary beneficiaries, unless otherwise stated. Therefore, please take a moment to read the examples below:

Complete electronically, or in blue or Anthem life & disability insurance company life claims service center p.o. Activate the wizard mode in the top toolbar to get additional tips.

The employer must keep this form on file. Name of policyholder (if different) social security no. I understand that anthem life insurance company reserves the right to accept or decline this application and that no right whatsoever is created by this application.

The access advantage program allows the insurance proceeds to be placed in a competitive interest bearing. Secure employer access to claims; Your beneficiary designation will automatically be deemed revoked upon certain changes in marital status.

Trustee under insured’s will (if choosing this option do not enter additional names in the primary beneficiary field.) please send completed form to anthem blue cross life and health insurance company. Name of employer/group (if applicable) effective date designation policy/certification no. Life and disability products underwritten by anthem life & disability insurance company.

Name of policyowner (if different) social security no. I represent that the answers given to all The employer must keep this form on file.

Life insurance beneficiary claim forms. Page 2 of 2 beneficiary designations definitions: Typing, drawing, or capturing one.

This form should only be used for disability waiver of premium policies. If you are cancelling coverage for a dependent or changing a name, please provide a reason in the designated sections. Anthem life resources anthem life resources.

Dental prime and complete login; Name of insured social security no. Please submit both forms with a copy of the death certificate to voya life for processing.

Person or persons to receive the life insurance proceeds upon the death of the insured. Anthem life insurance company p.o. The purpose of designating beneficiaries for this policy is to tell anthem blue cross life and health insurance company exactly how you wish the proceeds of your policy/certificate to be paid upon your death.

Select the get form button to start modifying. Therefore, please take a moment to read the examples below: Form/beneficiary designation, beneficiary claim form(s) and death certificate to:

The agency hr representative needs to complete the death claim for group life plans form. General information name of employer/group (if applicable) policy/certification no. When the amount payable to any one beneficiary is $10,000 or more, we will pay the claim under our anthem access advantage program unless the beneficiary asks us to do otherwise or the employee chose a different payment option before their death.

® anthem is a registered trademark of anthem insurance companies, inc. Relationship to insured % to be paid to beneficiary social security no. Include the date to the record using the date tool.

There are 3 available alternatives; The purpose of designating beneficiaries for this policy is to instruct anthem life insurance company (anthem life) exactly how you wish the proceeds of your policy/certificate to be paid upon your death. Payment amounts of $10,000 or more:

Please type or print your responses below. Anthem life insurance has a particular way to disperse life insurance when necessary to the beneficiary. Name of policyowner (if different) social security no.

Street address city state zip code street address city state zip code The purpose of designating beneficiaries for this policy is to instruct anthem life insurance company (anthem life) exactly how you wish the proceeds of your policy/certificate to be paid upon your death. Access advantage is their standard method of paying life insurance claims of $10,000 or more according to their website's faq section.

® anthem is a registered trademark of anthem insurance companies, inc. The employer must keep this form on file. Beneficiary information is captured during the open enrollment process.

I acknowledge that i have read the foregoing provisions and i expressly accept such provisions as a condition of coverage. Life and disability products underwritten by anthem life insurance company. This allows the life insurance proceeds to be put into an interest bearing account that is competitive and successful.

Relationship to insured % to be paid to beneficiary social security no. The employer must keep this form on file. Complete the anthem enrollment application instead of this form.

Therefore, please take a moment to read the. Name of employer/group (if applicable) effective date designation policy/certification no.

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