NWtech Member Forms Library

The following forms are provided for your assistance in submitting claims for your coverage under NWtech. For enrollment/disenrollment, waivers and deductible credit forms, please consult your employer.

Form Description	Form
Life/AD&D Claim Form Use this form when a filing a Life or AD&D (Accidental Death and Dismemberment) claim.	Click Here
Spousal Consent Form Use this form for Employees who do not wish to list their spouse as the named beneficiary on the group life plan.	Click Here
Life Insurance Conversion Form	Click Here
Dismemberment Claim Form	Click Here
Accelerated Death Form	Click Here
Affidavit of Domestic Partnership Employees that wish to add their domestic partners for insurance coverage whose partnership is not registered in the domestic partner registry of any state, should complete the appropriate form which should be retained by the employer for his/her records. The employee should also submit an employee application indicating the addition to BSI.	Click Here
Statement of Termination of Domestic Partnership Employees that wish to delete their domestic partner from their insurance coverage because the domestic partnership has been terminated should complete this form which should be retained by the employer for his/her records.	Click Here
Domestic Partner Q&A's Domestic Partner Q&A's.	Click Here