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Commonly Used Forms

These following insurance forms are available for the use of the GBA members who participate in the GBA Insurance Trust insurance programs.

• GBAIT Request for Change

• GBAIT HMO/POS Change Form

• GBAIT Death Beneficiary Claim Form

• GBAIT Medical Questionnaire (Late Enrollee for Dependent Life Insurance)

• GBAIT Evidence of Insurability (Late Enrollee for Long Term Disability Insurance)

• New Enrollment Cards:

  • Full-time

  • Part-time

• Leave of Absence Form

• Long-Term Disability Claim Form

• GBAIT Notice of Employee Termination

Please mail all completed forms to the attention of Susan Kelley at:

GBA Insurance Trust
50 Hurt Plaza, Suite 1050
Atlanta, Georgia 30303

Insurance Trust Staff
 

Dan Thomason
Susan Kelley
Lee Belaus
Courtney Rowland
 

Marketing & Service
Holmes/Shaw Agency

Bruce Shaw
David Holmes
Rad Downey
Skip Hill
Guy Whidby
Noel Williams