Forms related to your BCPSEA Benefits Program coverage

This section contains the forms related to your BCPSEA Benefits Program coverage. To access some of these forms, you will need Adobe® Acrobat® Reader® . You can download this software for free from Adobe’s web site if you do not have it already installed on your computer.

Life and AD&D Claims

For Life or AD&D claims, please contact your Benefits Administrator.


For the conversion of group insurance to (an) individual plan(s), the Benefits Administrator will provide you with a Notification of Conversion Form and Group Life Conversion Privilege Notification Form to advise you of which benefits you are eligible to convert and the time limits for converting each benefit. If you are eligible for Life conversion please contact Pacific Blue Cross for conversion information.

For AD&D conversion information please contact AIG Insurance Company of Canada. If you are eligible for extended health and dental coverage conversion, please use the conversion forms provided on this page.