This form gives us information about any other health coverage our members may have that can affect how we pay benefits. This is also known as Coordination of Benefits (COB). And now, members can complete this form online!
In the past, you 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 My Health Toolkit®. It's easy to use and helps speed up claims processing. You can access both the Other Health Questionnaire, including Medicare, and the Other Dental Coverage Questionnaire.
If you'd still prefer a hard copy, you can get it here:
Other Health Coverage Questionnaire
Please complete and send this form to:
P.O. Box 6170
Columbia, SC 29260-6170