File your sickness claim form online 

Here are some helpful tips to guide you through the process of filing a sickness claim. You can also use this helpful checklist as well.

• All sections must be completed to ensure quicker processing
• Be sure to have the following information ready:
• Your name, date of birth, Social Security number (SSN) and address
• Claimant’s name, date of birth, SSN (if other than primary insured)
• Date symptoms and/or condition began
• Description of symptoms and/or condition
• Primary doctor information and treating doctor information (if different)
• Diagnosis from your doctor
• If there was a hospital stay, include hospital bill which includes Date/Time admitted and Date/Time discharged or the Hospital Confinement Rehabilitation Confinement Form
• If surgery or diagnostic procedure was performed, include bill with procedure code or the Surgery/Diagnostic Procedure Form

Then, before you know it, you can start receiving the benefits you need in less time than filing by paper!

For a paper form, download, print and fax the completed document to 1-800-880-9325 or mail to P.O. Box 100195, Columbia, SC 29202-3195.