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Use this form if you have a BlueEssentialsSM policy and experience certain life changes outside the annual Open Enrollment Period. These life changes can affect coverage, and therefore require you to submit a Change Request form:

• Adding a dependent or spouse*

• Moving to or within South Carolina*

• Voluntarily dropping a dependent or spouse from your policy

Download the Change Request form.


*These changes also require documentation to show that you’re eligible for a Special Enrollment Period.

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