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Forms and Documents

State Health Plan

Health Claim Form

International Claim Form

Transition of Care Form/Continuity of Care Form

Dental Plus and Basic Dental

Dental Claim Form

Legal/Privacy

Authorization to Disclose Protected Health Information to a Third Party (HIPAA Authorization Form)

Confidential Communications Request

State Health Plan- Designation of Authorized Representative to Appeal Form

MUSC Plan- Designation of Authorized Representative to Appeal Form

Other Coverage

Other Health/Dental Coverage Questionnaire

Below are important documents related to your medical and dental benefits, as well as other information.

If you need to file a claim, you can either submit one of the forms below through mail, or online through My Health Toolkit.

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