BlueCross BlueShield of Georgia

Greater Georgia Life & Health Spotlight

At Greater Georgia Life our mission is to provide the people we serve with financial protection and security.


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Group Coverage @ Greater Georgia Life

Provide competitive employee benefits that fit your budget, with our group life and disability coverage.


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Voluntary Coverage @ Greater Georgia Life

Let employees choose their own coverage with voluntary life and disability insurance from Greater Georgia Life.


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Enrollment Forms

Employee Life Application

Employee Life Application with Medical Questionnaire

Georgia Insurability Information Request

Individual Life Application

Claim Forms

Accelerated Death Benefit Claim Form

Accelerated Death Benefit Attending Physician’s Statement

Accelerated Death Benefit Disclosure Statement

Accidental Dismemberment or Loss of Sight Claim Form

Beneficiary Designation Form

Life Claim Form

Life Claim Form - Spanish

Life Waiver of Premium or Continuation of Benefits Claim Form

Living Benefit Claim Form

Long-term Disability Claim Form

Short-term Disability Claim Form

Portability & Conversion Forms

Portability Benefit Request Form

Request for Group Life Conversion Information

Other Forms

Cancellation Authorization Form (for Small Groups)

Cancellation Authorization Form (for Large Groups)

Change of Beneficiary/Name Form

Life Beneficiary Claim Form

Member Enrollment Change Form

Request for Change Form

Waiver of Coverage Authorization Form

Waiver of Coverage Authorization Form (Self-Administered Groups)

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Life and Disability products underwritten by Greater Georgia Life Insurance Company, an independent licensee of the Blue Cross and Blue Shield Association. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross and Blue Shield Association.