Survivor life insurance
Don't forget your beneficiaries!
If you are a member, you must complete and return the beneficiary designation form below if you want to designate a beneficiary to receive your $20,000 survivor benefit group term life insurance proceeds.
Coverage when you need it most
As a CAPE/Blue Shield of California medical plan member, you have survivor benefit group term life insurance with Blue Shield of California Life & Health Insurance Company included in your medical plan premium.

This life insurance can be continued after termination of your health plan through a conversion to an individual plan you pay for directly to Blue Shield.1

Life insurance is important. Prepare for the unexpected by making sure your beneficiaries receive benefits in the event of a tragic loss.
Benefits
Coverage. The CAPE survivor group term life insurance benefit amount is $20,000.2 The benefit will reduce to 65% of the original amount when you reach age 70, and will further reduce to 50% of the original amount at age 75. Coverage will terminate when you retire.

Accelerated death benefit. If you become terminally ill, you may elect an advanced payment of up to 50% of the death benefit.

For details, see the helpful documents below.
Who is eligible?
This life insurance is available only to active County employees enrolled in a CAPE/Blue Shield medical plan who are working a minimum of 30 hours per week with no underwriting requirements.

Note: Spouse and dependent coverage is not available.
Reminder: Don't forget your beneficiaries
If you are a member, you must complete and return the beneficiary designation form below if you want to designate a beneficiary to receive your $20,000 survivor benefit group term life insurance proceeds.

If we don’t receive your completed form, payment to the beneficiary may be delayed, and the proceeds will be paid out according to the schedule designated on the CAPE/Blue Shield of California policy. If you already returned the form, you do not need to complete another one unless you want to change beneficiaries.
Waiver of Premium
Your survivor benefit group term life insurance that is included with your medical plan will be continued and paid for by CAPE for the first 12 months that you are on leave for a disabling medical condition.

If you want to keep the life insurance after the 12 months, and you are still on leave for a disabling medical condition, you will need to apply for a Waiver of Premium.

Important: If you continue to be disabled or are totally disabled, you must apply for the Waiver of Premium before the end of the 12 months, when your life insurance coverage will end. You cannot apply for a Waiver of Premium after this 12-month period.

You can download the Waiver of Premium Claim Form by clicking on Helfpful document below. To start the waiver process, please complete your portion of the form. Your doctor and your Human Resources Department will also need to complete their respective parts of the form.

Once all sections of the Waiver of Premium Claim Form are filled out, submit the completed form to Blue Shield. We will review it and determine your eligibility for the Waiver of Premium.

If you have questions about how to complete the Waiver of Premium Claim Form, please call Blue Shield at (888) 800-2742, and press Option 3.
Have questions?
CAPE Benefit Trust Customer Service: (800) 487-3092
Representatives are available 7:30 a.m. to 5 p.m., Pacific time, Monday through Friday.

Blue Shield Life and Health Insurance: (888) 800-2742
Representatives are available 7 a.m. to 5 p.m., Pacific time, Monday through Friday.
1An individual life policy, known as a conversion policy, may be purchased at a higher cost without evidence of insurability if all or part of anyone’s life insurance terminates and that person has been covered continuously under the policy for at least five years. Please refer to the Group Life Insurance Policy for details regarding the conversion privilege.

2You should consult with a tax adviser to check if your combined pre-tax deducted personal and employer/CAPE paid life insurance is more than $50,000, as it may affect your tax return.