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Wyoming Educators' Benefit Trust
Managed by Willis Towers Watson
415 W. 17th Street
Suite 140
Cheyenne, WY 82001
(307) 634-5566

Blue Cross Blue Shield of Wyoming 1-800-210-6642
Group Forms

Group Contact Information

PHI Authorization Form

Life Beneficiary Form

Life Claim Form

Supply Request

LTD Claim Form

Life Conversion Form

Transaction Transmittal Form

All group level forms must be completed at the employer group level and submitted through the Willis Towers Watson office.

Wyoming Educators' Benefit Trust
Managed by Willis Towers Watson
415 W. 17th Street
Suite 140
Cheyenne, WY 82001
(307) 634-5566
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