Print a copy of the agreement.
Medicare Supplement members should send their Bank Draft Agreements to:
Consumer Products Business Unit
P.O. Box 100133
Columbia, SC 29202-3133
Here are the Health Insurance Portability and Accountability Act (HIPAA) compliance forms. They have also been translated into Spanish.
Authorization To Disclose Protected Health Information For Underwriting
Autorización Para Revelar Información Protegida De Salud Para Aseguramiento
Authorization To Disclose Protected Health Information To A Third Party
Autorización Para Revelar Información Protegida De Salud A Terceros
Businesses wishing to cover independent contractors must fill out the independent contractor coverage form. Once completed, please send the form to your Marketing Representative.
Blood Pressure Questionnaire