Claim Forms

Dental Claim Form

Download and print form here

To submit form, mail to:
BlueCross BlueShield of South Carolina, Attn: Dental Claims Department, P.O. Box 100300, Columbia, South Carolina 29202-3300

Dependent Care Reimbursement Claim Form

Download and print form here

To submit form:
Fax the completed form to 800-726-9982 or 704-335-0818 in the Charlotte area.
Or mail the completed form to: Claims Processing, P.O. Box 31397, Charlotte, NC 28231-1397

Employee Past Service Credit Request Form

Download and print form here

To submit form, send through inner-office mail to McLeod Health Human Resources or via email to livingwell@mcleodhealth.org.

McLeod Pharmacy Prescription Delivery Form

Download and print form here

To submit form, fax to: 843-777-2187

Questions? Call the delivery technician at 843-777-3864

Medical Claim Form

Download and print form here

To submit form, mail to:
BlueCross BlueShield of South Carolina, Claims Processing Center, P.O. Box 100300, Columbia, South Carolina 29202-3300

Physicians Eyecare Claim Form

Download and print form here

To submit form, you may:

Mail to: Physicians Eyecare Plan, Attn: Claims Department, 48 Courtenay Drive, Charleston, SC 29403

Fax to: 843-577-5895

Email to: memberservices@physicianseyecareplan.com

VOYA Accident Claim Form

Download and print form here

To submit form, mail to:
VOYA Claims, P.O. Box 320, Minneapolis, Minnesota 55440

VOYA Critical Illness Claim Form

Download and print form here

To submit form, mail to:
VOYA Claims, P.O. Box 320, Minneapolis, Minnesota 55440

VOYA Wellness Claim Form

Download and print form here

To submit form, mail to:
VOYA Claims, P.O. Box 320, Minneapolis, Minnesota 55440

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