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Forms

Downloadable Forms

Download the forms you need to efficiently administer your ancillary products.

Critical Illness Claim Form
Critical Illness Claim Form - Spanish
Accident/Critical Illness Wellness Benefit Claim Form
Accident/Critical Illness Wellness Benefit Claim Form - Spanish
Accident Claim Form
Accident Claim Form - Spanish

Legal and Privacy

Dearborn Life Insurance Company’s group insurance products are offered as Specialty Benefits in cooperation with Blue Cross Blue Shield of Michigan.

Specialty Benefits group insurance products are issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148. Dearborn Life is a separate company and does not provide Blue Cross Blue Shield of Michigan products and is financially responsible for the products it issues.

Dearborn Life Insurance Company is an independent licensee of the Blue Cross and Blue Shield Association. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

© Copyright 2021 Dearborn Life Insurance Company. All Rights Reserved

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