Tobacco Use Attestation Form
The Office of Insurance recently mailed the Tobacco Use Attestation Form to all active employees, non-Medicare retirees, and COBRA participants. Please return your completed form to Mandy Cain at the Central Office, NOT to Blue Cross & Blue Shield of Mississippi. Only non-Medicare retirees and COBRA participants should return their completed forms to Blue Cross & Blue Shield of Mississippi.
Please send your forms in a sealed envelope via the inner office mail box located in your school's office.
If you do not have the State & School Employees Health Insurance, you will not receive a form & there is nothing you need to do.
Employee's written request for FMLA
New Health Insurance Marketplace Coverage Options & Your Health Coverage
Verification of Previous Experience Form