{{ navigationCurrentPage.title }}

Use this form if you have a Individual and Family 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 2020 Change Request form.

Download the 2021 Change Request Form.


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

Complementary Content