BlueChoice HealthPlan

providers

Online Other Health Coverage Questionnaire

(You will need the Adobe Acrobat Reader to view or print some of the items on this page.)

This form gives us information about any other health coverage our members may have that can affect how we pay benefits. And now, members can complete it online! 

In the past, members could only mail or fax us completed questionnaires. This took time and could delay payment for services. Now, members can access the form by logging into the Member My Insurance Manager. It's easy to use and helps speed up claims processing. Members can access both the Other Health Questionnaire, including Medicare, and the Other Dental Coverage Questionnaire.

If members still prefer a hard copy, they can get it here:

Other Health Coverage Questionnaire

Members should complete and send this form to:

BlueChoice HealthPlan
P.O. Box 6170
Columbia, SC 29260-6170



Copyright © 2007, BlueChoice HealthPlan. All rights reserved.
BlueChoice HealthPlan is a wholly owned subsidiary of BlueCross BlueShield of South Carolina. Both are independent licensees of the Blue Cross and Blue Shield Association.
® Registered Marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans.
sm Service mark of BlueChoice HealthPlan of South Carolina, Inc.