Get Gl0016e Form

This guide provides clear and straightforward instructions for completing the Gl0016e form online, a critical document for life insurance claims. Follow these steps to ensure that you accurately fill out the form and submit it correctly.

Follow the steps to complete the Gl0016e form online.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with the initial sections of the form, specifying whether you are completing the plan member life claim or dependant life claim. Ensure you indicate the correct claim type by checking the appropriate option.
3. Proceed to complete the details required from the plan administrator. This includes filling in the plan contract number, class, division number, and plan sponsor's name. Make sure to provide all necessary identifiers clearly.
4. Next, input the details pertaining to the deceased plan member or dependant. Include their full name, job title, dates of employment, birth, and date of death.
5. For the section on beneficiary information, provide the beneficiary's full name and relationship to the deceased. Check the applicable benefits and specify the face amounts for each benefit.
6. If the death was accidental, ensure to fill in the corresponding details such as the date of the accident and details regarding the accident's location. Collect any necessary documentation required for accidental death claims.
7. Complete the claimant’s statement by filling in their details, including their mailing address, relationship to the deceased, and signing the certification form that verifies the truthfulness of the information provided.
8. For the attending physician's statement, include any required medical details about the deceased's health leading to death. This may include their medical history and the cause of death.
9. Once all fields are filled, review the entire form for accuracy. Ensure all signatures are included, particularly from the plan member or claimant, and that dates are properly filled.
10. After reviewing, you can save the form, download it, print it out, or share it through the provided options in the online editor.

Ensure your claims process is seamless by completing the Gl0016e form online today.