Health Insurance Plans
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Forms
- BC/BS Medical Expense Claim Form
- BC/BS Prescription Drug Claim Form
- LGHIP Automatic Payments-COBRA
- LGHIP Preauthorized Payment Service Agreement-Units
- LGHIP Enrollment Form
- LGHIP Change Form
- LGHIP Cancellation Form
- LGHIP Declination of Coverage Form
- LGHIP General Information Form
- Medicare Part D Creditable Coverage Notice
- Southland National Voluntary Plan Enrollment Form
- Southland National Voluntary Plan Change Form
- Southland National Voluntary Plan Cancellation Form
- Southland Dental Claim
- Southland Vision Claim
201 South Union Street, Suite 200 Montgomery, AL 36104
P.O. Box 304900 Montgomery, AL 36130
