Member Handbooks and Forms
Member Handbook
Forms
- Primary Care Provider (PCP) Form (PDF)
- Grievance Form (PDF) Effective 05/16/2023
- Appeal Form (PDF) Effective 05/16/2023
- Appointment of Authorized Representative Form (PDF)
- Notification of Pregnancy Member Form (PDF)
- Authorization to Use and/or Disclose Health Information - English (PDF)
- Authorization to Use and/or Disclose Health Information - Spanish (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information - English (PDF)
- Revocation of Authorization to Use and/or Disclose Health Information - Spanish (PDF)
- SCDHHS Form 1716 - Request for Medicaid ID Number - Infant (PDF)
- Prescription Claim Reimbursement Form (PDF)
Provider and Pharmacy Directory
Resources
- South Carolina Healthy Connections Choices
- South Carolina Department of Public Health
- Social Security
- Women, Infants and Children (WIC)
- South Carolina Department of Insurance (SCDOI)
- SNAP (Supplemental Nutrition Assistance Program)
- Big Brothers Big Sisters
- National Hospice and Palliative Care Organization
- Preventive Guidelines
*Links on this page lead to third-party websites. Those parties are solely responsible for the privacy policies and contents on their sites.