South Carolina Document Library

North Carolina and South Carolina Documents
Carolinas Broker Guide (PDF) Case Submission Checklist (PDF) HIPAA letter (PDF) HIPAA Authorization (for claims inquiries) (PDF) CAF (PDF) PAF (PDF) Compensation Form Instructions (PDF) 1099 Letter.pdf (PDF)
South Carolina Documents
Group Master Data Sheet (PDF) Risk Appraisal Questionnaire (PDF) HMO/POS Member Enrollment Application (PDF) Family Medical History Questionnaire (PDF) Supplemental Medical Questionnaire (PDF) South Carolina Medical Claim Form (PDF) South Carolina Prescription Reimbursement Form (PDF) Enrollment/Change Form (PDF) Formulario de Inscripción / Cambio (Consolidado) (PDF)
South Carolina Benefit Summaries - January 2010
State Designed Basic HMO (PDF) State Designed Standard HMO (PDF) State Designed Basic Indemnity (PDF) State Designed Standard Indemnity (PDF)
South Carolina Benefit Summaries - No Longer Available January 1, 2010
Open Access CHMO Plan 4 (PDF) Open Access CHMO Plan 5 (PDF) Open Access CHMO Plan 6 (PDF) Open Access POS Plan 8 (PDF) Open Access POS Plan 9 (PDF) Open Access POS Plan 10 (PDF) Open Access POS Plan 11 (PDF) Open Access POS Plan 12 (PDF) Open Access POS Plan 13 (PDF) Open Access Plus Plan A (PDF) SC State Designed Basic CHMO Plan (PDF) SC State Designed Standard CHMO Plan (PDF) SC State Designed Basic Indemnity Plan (PDF) SC State Designed Standard Indemnity Plan (PDF) HDHP Plan 1: 90%/2000 (PDF) HDHP Plan 2: 90%/2500 (PDF) HDHP Plan 3: 90%/3000 (PDF) HDHP Plan 4: 100%/3000 (PDF) Open Access CHMO Plan Comparison for 8/1/06 plans (PDF) Open Access POS Plan Comparison Grid for 8/1/06 plans (PDF)