Forms

Below are some forms you may need:
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SWSCHP
Young Adult Children Coverage
In-Network claims (services rendered by Participating BCBS provider) should be filed directly with the provider’s local BCBS (by your provider).
Out-of-Network Claims for Active and Retiree < 65 should be filed using the Alicare claim form below.
Determining UCR
Medicare Primary Claim Form
Medicare Part D Reimbursement
SWSCHP Accident Verification Form
HIPPA
International Claim Form

Contact a Care Navigator

Monday through Thursday: 8:00am - 8:00pm ET

Friday: 8:00am - 6:00pm ET

Saturday: 9:00am - 2:00pm ET

1-888 P-SWSCHP1-888 779-7247