State Health Plan Comprehensive Benefits Claim Form Page 2

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Please send this form to:
Blue Cross and Blue Shield of South Carolina
P.O. Box 100605
Columbia, SC 29260-0605
In Columbia: 803-736-1576
In S.C. and Nationwide: 800-868-2520
Before you mail your claim form, please remember to:
1. Include the insured’s Social Security number;
2. Sign and date the form; and
3. Attach copies of itemized bills for services.

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