Get Tn Bcbst Go-01 2011-2025

Completing the TN BCBST GO-01 form online can streamline the process of establishing eligibility for dependent health care benefits. This guide provides clear, step-by-step instructions to help you navigate each section of the form effectively.

Follow the steps to successfully fill out the TN BCBST GO-01 form.

1. Press the ‘Get Form’ button to access the TN BCBST GO-01 form and open it for editing.
2. Begin by entering the subscriber's name, ID number, and group number in the designated fields at the top of the form.
3. In the dependent section, provide the dependent's name and status. For status, select from the options available: Natural Child, Step-Child, Adopted Child, Legal Guardianship, or Other, and include any necessary documentation as specified.
4. Indicate the dependent's marital status and whether they are a full-time student. If they are a student, be sure to include the name of the school.
5. Fill out the employment section detailing the dependent's employment status, whether full-time or part-time, and include details like how long they have been employed and their monthly earnings.
6. Provide information about the dependent's primary residence and whether they receive any other income or support. Be specific about the source and amount if applicable.
7. Complete the section regarding the support you provide for the dependent, indicating the percentage of support.
8. Answer questions about the dependent's capacity for self-support and attach any required physician statements if they have been incapable of self-support.
9. If applicable, indicate whether there is a divorce decree that mandates support for the dependent and attach the necessary documentation.
10. Finalize by signing and dating the form in the designated areas.
11. Once all fields are accurately completed, save your changes, and choose to download, print, or share the form as needed.

Complete the TN BCBST GO-01 form online today to ensure your dependent health care benefits are properly processed.