South Carolina Health Insurance Guide
South Carolina Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a resident of South Carolina you can choose from a variety of private health insurance plans including plans for individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for South Carolina State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
South Carolina is not a guarantee issue state. By law, private insurance companies that sell individual policies must medically underwrite them and are required to sell you an individual health insurance policy if you do not meet their criteria. You can be turned down for any number of reasons including your past or current health and lifestyle habits. In South Carolina, HMO plans for individuals are permitted a 12-month exclusionary period and a 12-month look-back period for pre-existing conditions. South Carolina does not impose a limitation on look-back periods for individual plans other than HMOs, but there is a maximum 24-month limit on exclusionary periods. Insurers are not required to give you credit for prior creditable coverage unless you are HIPAA-eligible. South Carolina also permits health insurance providers to issue Elimination Riders that exclude coverage for specific health conditions. Premiums, which are not regulated by the state, can be based on your health, your age and lifestyle factors. South Carolina does not require insurers to offer standardized policies for individuals.
South Carolina is a guarantee issue state for group health plans issued to small businesses. If your South Carolina health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. The insurer can impose a 12-month exclusionary period and a six-month look-back period for pre-existing medical conditions, but must give credit for prior creditable coverage. HMOs may impose a two-month waiting period, but you will not be required to pay premiums during that time. Your employer may impose a waiting period for eligibility for new hires, but it must be applied equally to all new hires. Premiums for small group health insurance may be underwritten and the insurer can charge a premium not to exceed 125% of the standard rate if your group has a history of unfavorable health.
South Carolina is a guaranteed renewal state. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status. Your policy can be canceled if your insurer discontinues a plan or no longer sells insurance in the state.
South Carolina Mandated Health Benefits
South Carolina laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Autism
- Bone Mass Measurement
- Breast Reconstruction
- Cervical Cancer and HPV Screening
- Cleft Palate
- Diabetic Supplies
- Emergency Services
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity Stays
- General and Parity Mental Health
- Off Label Drug Use
- Prostate Cancer Screening
- Coverage for newborns under their parent’s policy
- Coverage for adopted children under their parent’s policy
- Coverage for continuation/dependents under their parent’s policy
- Coverage for handicapped dependents under their parent’s policy
- Coverage for conversion to non-group
- Coverage for continuation/employees
Types Health Insurance Plans Available in South Carolina
The following major medical health insurance plans are generally available in South Carolina. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in South Carolina
South Carolina Health Insurance Pool
SCHIP is the state-sponsored high-risk pool that offers health insurance to state residents who have been unable to secure coverage from private insurers because of a pre-existing condition or certain other qualifiers, such as having exhausted your COBRA or State Continuation benefits. One plan is available, which has a $500 annual deductible and 20% coinsurance after plan deductible is met. Premiums may not exceed 200% of the established rates for similar individual plans. Plan benefits are not paid for pre-existing conditions during the first six months of coverage, but this can be waived under certain conditions.
South Carolina Partners for Healthy Children
SCPHC provides comprehensive low-cost health care for resident children up to age 19, whose families meet income requirements and other eligibility requirements. You can choose from a fee-for-service plan or a managed care plan. No premiums are charged for either plan.
Regulating Agency
The South Carolina Department of Insurance is responsible for regulating South Carolina’s health insurance industry.
Get access to South Carolina health insurance quotes from http://www.einsurance.com/health-insurance.
South Carolina Department of Insurance
PO Box 100105
Columbia, SC 29202
(803) 737-6160
http://www.doi.sc.gov
South Carolina Department of Health & Human Services
http://www.dhhs.state.sc.us/dhhsnew/insidedhhs/bureaus/bureauofeligibilityprocessing/phc.asp
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/