Special Enrollment Period (SEP) Change Request Form

Certain life changes occurring during the SEP can affect coverage for our BlueEssentialsSM members. The life changes that can affect coverage, and therefore require change requests, include:

  • Adding a dependent or spouse (SEP documentation required)
  • Address change (SEP documentation required)
  • Change in coverage (SEP documentation required)
  • Voluntarily dropping a dependent or spouse (no documentation required, and cannot change coverage as a result)

If you need to make any of these changes, complete the Change Request Form and submit this form and proof that you are eligible for an SEP (if proof is required) directly to Marketplace Operations via:

  • Secure email: membership.SEP@bcbssc.com
  • Fax: 803-870-9439
  • Call: 855-404-6752 for assistance completing the form over the phone
  • Mail: BlueCross BlueShield of South Carolina, P.O. Box 100228, Columbia, SC 29202-3228

Download the Change Request Form.