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Ation. PART ONE (Please PRINT IN INK) Fax: 803-264-0225 SECTION A - APPLICANT INFORMATION Requested Effective Date: / / P.O. Box 100118, Columbia, SC 29202-3118 www.SouthCarolinaBlues.com As of the requested effective date, will you be a resident of South Carolina? (Only South Carolina residents are eligible for coverage.) (Effective dates must be either the 1st or the 15th of the month.) First Name: / / Social Security Number: Telephone Number: Home/Cell: ( - No Are you a United Sta.

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To add a dependent, an employee must complete and submit the Subscriber Change Request form. Important: HMO and POS members must select a Personal Physician for each dependent.

Had a baby, adopted a child, or began fostering a child The entire family can use the special enrollment period to enroll in coverage.

Common life events that may qualify for special enrollment include job loss, early retirement, loss of dependent status, marriage, divorce, birth or adoption of a child or a move. You'll need to enroll within the required time frame — usually within 60 days of the life event.

A change in your situation — like getting married, having a baby, or losing health coverage — that can make you eligible for a Special Enrollment Period, allowing you to enroll in health insurance outside the yearly Open Enrollment Period.

Private health insurance — also known as qualified health plans or QHPs — is coverage offered by private insurance companies on the MNsure marketplace. This table shows some key features of Medical Assistance, MinnesotaCare and private coverage.

With a PPO plan, you have the flexibility to receive covered services from providers that are not in your plan's network, but your costs will be significantly higher because we do not have negotiated rates with those providers. And, in some instances, services provided by a non-network provider are not covered.

Qualifying Life Events Gaining a dependent or becoming a dependent through birth or adoption. Getting married. Applicant or dependent lost minimum essential coverage due to termination or change in employment status. Cessation of an employer's contribution toward an employee or dependents coverage.

Claims should be submitted to Blue Shield of California via the Real-Time Claims web tool or electronically using Electronic Data Interchange, though they can also be submitted by mail.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232