Blue Cross Blue Shield (previously Dearborn National) is the provider for the basic and voluntary life insurance benefits. Because Dearborn National continues to administer benefits on behalf of Blue Cross Blue Shield, you may see either one, or both, of these entities listed on the life insurance documents and forms. Basic life insurance of $10,000 is provided to members who participate in the Egyptian Trust health insurance program. Additional voluntary term life insurance coverage is also available at very reasonable rates. Employees of participating districts may purchase up to $100,000 of additional term life insurance on a guaranteed issue basis (no medical underwriting) if purchased at the time the employee is first eligible for benefits. A delayed effective date will apply for any employee who is not actively at work on their original benefit effective date. Check with your local district representative to inquire about the supplemental/optional life insurance program. The below documents explain these life insurance benefits in more detail:
Life Insurance Certificate
Basic Life Insurance Highlights
Optional Life Insurance Brochure
How to Enroll: The New Employee Enrollment Form is used to enroll in all benefits, including life insurance plans, when the employee is first eligible for benefits.
The Enrollment Change Form is used when an employee wishes to change their life insurance volume after initial eligibility (see Evidence of Insurability below) or update beneficiary information. The Beneficiary Designation Form can also be used to update beneficiary information on file. Employers should retain a copy of the beneficiary information in the employee’s personnel file as it will be required at time of claim.
Enrollment Change Form
Beneficiary Designation Form
Evidence of Insurability: The Evidence of Insurability (EOI) form is to be completed when an Employee or Spouse is enrolling for more than the guaranteed issue amount at initial enrollment. Guaranteed Issue amount is $100,000 for new Employees under age 60 when enrolling within 31 days of their date of hire. Guaranteed Issue amount for a Spouse is 50% of the Employee’s election up to $37,500 when enrolling within 31 days of the Employees date of hire. After the initial enrollment window, if the Employee or Spouse is enrolling in any amount, EOI is required. The form is completed by both the employer (page 1) and employee (pages 2-5) and mailed to the address listed on the form.
If You Become Disabled: Employees who become totally disabled prior to age 60 without interruption from last day worked for at least six months should apply for Waiver of Premium. This will allow the employee to continue coverage for the duration of their disability without having to pay premium, as defined in the BCBS Life Insurance Certificate and Policy.
Portability: The Portability Provision allows employees, spouses and children to port Supplemental/ Voluntary Life and Dependent Life Insurance when coverage terminates for reasons other than disability, retirement, sickness and injury. In addition, Eligibility Requirements must be satisfied. This provision offers a rate that is less expensive than the Conversion Provision. The application is completed by both the employer and employee and mailed to the address listed on form with the first premium payment. Premium rates are listed on page 2 of the application form. You must apply for portability continuation within 31 days of termination of coverage. See the Life Insurance Certificate for full details regarding Portability.
Conversion: The Conversion Provision is available upon becoming ineligible for group Basic or Supplemental/Voluntary Life insurance due to termination of employment or losing eligibility for this benefit, such as a dependent child turning age 26. Employees or dependents may convert all or any portion of the in force Group Life Insurance amount to an Individual Whole Life Insurance policy. The application is completed by both the employer and employee and mailed to the address listed on form with the first premium payment. Premium rates are listed on page 3 of the application form. You must apply for conversion within 31 days of termination of coverage. See the Life Insurance Certificate for full details regarding Conversion.
Filing a Life Claim: In the event of death, a life claim form must be completed by the employer and employee or beneficiary. The employee’s enrollment or change form, proof of payroll deductions (for voluntary life), a copy of certified death certificate and beneficiary designation form must accompany the completed claim form. In certain circumstances additional information may be required.
Life Claim Form
How to File a Life Claim
Beneficiary Resource Services: When a loved one dies, families often face complex issues ranging from estate planning, legal questions, funeral planning, coping with grief and financial uncertainties. That’s why we offer Beneficiary Resource Services, a program that combines family wellness and security at the most difficult of times. Services include grief and financial counseling, funeral planning, legal support, as well as online will preparation.
Travel Resource Services: As a participating member in the Blue Cross Blue Shield Life Insurance program you are extended Travel Resource Services. This service offers around-the-clock emergency and information services to help you access emergency assistance when you are traveling 100 or more miles away from home. Help is there when a crisis strikes. More than 850,000 multilingual service professionals stand ready to assist you in more than 200 countries and territories worldwide.