SRS - Retiree Benefits

11/08/2023

Retiree Benefits
Forms

Medical Forms		Return completed forms to:
5-200	Health Care Programs Enrollment Change (if PDF doesn't open in browser, right click and choose "save link as")	SRNS Service Center Bldg 730-1B Aiken, SC 29808
5-340	Medical Claim Form	Claims Processing Center P.O. Box 100300, Columbia, SC 29202
--	Pharmacy Claim Form	OptumRx Claims Department P.O. Box 29044, Hot Springs, AR 71903
--	Mail Service Order Form	OptumRx P.O. Box 2975, Mission, KS 66201
Dental Forms		Return completed forms to:
5-200	Health Care Programs Enrollment Change (if PDF doesn't open in browser, right click and choose "save link as")	SRNS Service Center Bldg 730-1B Aiken, SC 29808
5-342	Dental Claim Form	Claims Processing Center P.O. Box 100300, Columbia, SC 29202
Any Benefits content questions contact the Benefits Solutions Service Center at 803-725-7772 or 800-368-7333 or via email at service-center@srs.gov