Medical

Health Benefits Claim Form
State Health Plan Comprehensive Benefits Claim Form
 

Dental

If your plan includes coverage for dental services, use these forms to file claims:

Dental Services Claim Form
Dental Services Claim Form for State Dental Plan

Vision

If your plan includes coverage for vision services, you may need one of these forms to file your claims:

Vision Benefits Claim Form - Columbia Service Center
Vision Benefits Claim Form - Greenville Service Center
Healthy Vision Out-of-Network Claim Form

Prescription Drug

Many of our plans include pharmacy and prescription drug benefits. If yours does, you’ll save money at the point of purchase when you use a network pharmacy.

There may be times when you need to file a claim. Examples include:

• You paid 100 percent for a covered medication.
• You didn’t show your member ID when you filled a prescription.
• You filled a prescription for a covered medication at a non-participating pharmacy.

In these cases, use the Prescription Drug Claim Form.

If you regularly take medication, you may also want to look into our mail-order service. With this benefit, you can order up to a 90-day supply of your prescriptions. Use the Prescription Drug Mail Service Form.

Medicare Supplement

When filing a Medicare Supplement claim, follow these steps:

1. Write your BlueCross BlueShield of South Carolina ID number on your Medicare Summary Notice.
2. Make a copy of all pages and mail them to us at:

BlueCross BlueShield of South Carolina
Consumer Products, AF-525
P.O. Box 100133
Columbia, SC 29202-3133

Medicare prescription drug claims

If your Medicare Supplement policy has prescription drug coverage (Plans H and I), please send us copies of your drug receipts or a printout from your pharmacy. Include your BlueCross ID number. Mail these items to us at the above address.