The information on this page is meant to be an easy reference and summary of plans. For additional information on any of the plans, please visit the South Carolina Employee Insurance Program's website at http://www.eip.sc.gov
General Information
Eligibility Requirements
- Employees - permanent, full-time faculty and staff employees who work at least 30 hours a week are eligible for insurance benefits.
- Eligible Dependents - you may cover your lawful spouse, or a former spouse required to be covered by a divorce decree or court order, but not both. If a spouse is also an employee of a South Carolina state-covered entity, the spouse cannot be covered as a dependent and must carry their own coverage, and only one of you may carry coverage for dependent children.
- Children - you may cover an unmarried child under 19 years of age (or under age 25 if a full-time student) and who is principally dependent upon you for maintenance and support, provided the child is:
- the natural or adopted child, stepchild, foster child or child for whom the subscriber has legal custody and who resides in the subscriber's home in a parent-child relationship; or
- for whom the subscriber provides support and maintenance due to a court order.
- Other children - An incapacitated unmarried child who is incapable of self-sustaining employment because of a disability and who is principally dependent on you for support (incapacity must be established prior to age 19) may also be covered.
Effective Dates
Coverage begins on the first day of the month the employee commences active employment if the employee commences active employment on the first working day of the month. Otherwise, coverage commences on the first day of the following month.
Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA)
If you lose health and/or dental coverage due to termination of employment or reduction in hours, or your dependents are no longer eligible for coverage, coverage for you and/or your dependents may be continued under COBRA. A spouse or dependent of an active or retired employee may continue coverage if the termination of coverage falls within COBRA guidelines. You will receive information on COBRA when you initially enroll in a health and/or dental plan.
Certificate of Creditable Coverage
Terminated subscribers will receive a certificate of creditable coverage unless they are eligible for coverage in another classification such as transferring to another state-coverage entity. This certificate may be used to reduce the preexisting period of your next employer's health insurance plan. If you and/or your dependents are enrolling in a state health plan for the first time, you are responsible for obtaining and submitting a certificate of creditable coverage with your enrollment form.
Preexisting Condition Definition Use by Plans
Health: Any medical condition, regardless of the cause of the condition, for which medical advice, diagnosis, care or treatment was recommended or received by a licensed health care provider or practitioner in the six months preceding the covered person's enrollment date under the plan. Benefits for the preexisting condition ar payable only for treatment rendered 12 months (18 months for a late entrant) after the enrollment date of a covered person. If you have been insured previously, you may reduce the preexisting condition period by providing certification of prior health insurance coverage provided the break in coverage is 62 days or less.
Basic Long Term Disability (BLTD): An injury, physical disease, mental disorder or pregnancy for which you consulted a doctor, received medical treatment or took prescribed drugs during the six-month period before your effective date.
Supplemental Long Term Disability (SLTD): An injury, physical disease, mental disorder or pregnancy for which you consulted a doctor, received medical treatment or took prescribed drugs during the six-month period before your effective date.
Enrollment Changes
Eligible employees have 31 days from your date of hire to enroll yourself and eligible dependents in the College's insurance plans. After 31 days from your hire date, you may make changes only on the following occasions:
- Qualified Events: You may make certain changes throughout the year within 31 days of a qualified event. Qualified events include: marriage, birth, adoption or placement, loss of group health plan coverage, divorce/legal separation, death of the covered employee, loss of dependent's eligibility for coverage, etc. Documentation is required for certain events.
- Annual Enrollment: Every year during the month of October, you may change from one health plan to another, enroll in or cancel the MoneyPlu$ premium feature. You must also enroll or re-enroll in the MoneyPlu$ Medical Spending Account or the MoneyPlu$ Dependent Care Spending Account. Changes made during the annual enrollment period are effective January 1 of the following year.
- Open Enrollment: Open Enrollment is held during October in odd years (2007, 2009, etc.) In addition to the changes allowed during annual enrollment, you may make these changes:
- enroll yourself and/or eligible dependents in a health plan without providing medical evidence of good health, subject to an 18-month pre-existing condition waiting period;
- drop health coverage for yourself or dependents;
- enroll or drop dental coverage for yourself or dependents.
Changes made during Open Enrollment are effective January 1 of the following year.
Health Insurance
PLAN COMPARISON CHART
PLAN SUMMARIES:
State Health Plan:
The two available State Health Plan options are the Health Savings Plan and the Standard Plan. Both plans offer comprehensive coverage with preventive care features and the most participating providers in the state.
Medi-Call-Medi-call is the State Health Plan’s utilization review program. Medi-Call makes sure you and your covered family members receive appropriate medical care in the most beneficial, cost-effective manner. Precertification is required for: all hospital admissions; pregnancy (must call within first trimester); any non-emergency surgical procedure performed in a hospital, freestanding clinic or ambulatory surgical center; any non-emergency surgical procedure on the foot or knee performed in a physician’s office; all admissions for obstetrical and neonatal (sick newborn) services; hospitalization that exceeds a length-of-stay limitation previously authorized by Medi-Call; extended care services (hospice, home health care, skilled nursing facility, durable medical equipment); any medical service or procedure involving inpatient physical therapy, second surgical opinion and extended care; any InVitro Fertilization procedure; inpatient rehabilitative services and related outpatient physical, speech and occupational therapies; and, organ transplant, bone marrow transplant or other stem cell rescuer or tissue transplant for which benefits are provided.
Failure to obtain admission review (precertification for elective surgery or 48 hours after an emergency) or maternity management services will result in a $200 penalty. The costs incurred during the hospitalization, treatment or extended benefit program will not contribute to the out-of-pocket limit.
Provider Networks-Preferred Provider Organization (PPO)-The SHP is a preferred provider organization that has arrangements with doctors, hospitals and other providers of care who have agreed to accept the Plan's allowable charges for covered medical services as payment in full and will not balance bill you. Balance billing occurs when a non-network provider chooses to charge more for his services than the Plan allows. The difference between what the provider actually charges and what the Plan allows is called the balance bill. If you use a Network provider, you will not have to pay balance bills.
The BlueCard Program-You have access to doctors and hospitals almost everywhere with the BlueCard Program administered by BlueCross and BlueShield of South Carolina. This program, which applies to your medical benefits, gives you access to BlueCross BlueShield provider networks throughout the United States and around the world through BlueCard Worldwide. Please refer to the Mental Health and Substance Abuse section on how those benefits are handled.
The Mental Health And Substance Abuse Network-If you need to see a mental health care provider, simply call toll-free 1-800-221-8699 and you will be directed to a national network of providers. The Mental Health and Substance Abuse provider network operates just like the State Health Plan Physician network except that no benefits are paid if you use a hospital or provider that does not participate in the network and hospital admissions are not covered if they are not precertified.
The Mental Health and Substance Abuse provider network is responsible for submitting claims for these services so there are no claims for you to file. Remember, if you choose to use a non-participating provider, no benefits will be paid. The State Health Plan’s Mental Health and Substance Abuse provider network information is also available on the Internet at www.apshealthcare.com (password = “statesc”).
Free & Clear®-An innovative tobacco cessation program, is now available at no charge to State Health Plan subscribers and dependents. It is offered through APS Healthcare.
Preventive Benefits-The SHP has benefits and programs that can help make staying healthy easier for you and your family and help guide you through the health care process when you become ill. They include Prevention Partners, Early Detection Benefits such as Mammography testing, pap tests and maternity management programs. The SHP also has a Well Child Care Benefit.
The savings plan offers even more preventive benefits, including an annual physical, an annual flu shot, and access to a nurseline and self-care guide.
Health Maintenance Organizations (HMOs)
An alternative to State Health Plan coverage is offered through HMOs. HMOs generally use a gatekeeper approach to medical care. Each covered member must select a primary care physician (PCP) from the HMO's list of qualified physicians to provide all medical care and referrals. If the PCP is unable to treat you and feels that specialty care is needed, a referral can be made from the HMO's list of qualified physicians. The HMO's available in our area are: BlueChoice HMO and CIGNA HMO.
Dental
The State Dental Plan is provided to active employees at no cost. You may add your eligible dependents for an additional premium. You and your dependents do not have to be enrolled in a health plan to enroll in the State Dental Plan.
Dental Plus is a supplemental dental program that provides a higher level of dental coverage for the same services covered under the State Dental Plan (except orthodontia) at affordable rates. Dental Plus subscribers are required to carry the same level of coverage that they are enrolled in under the State Dental Plan. Dental Plus premiums are paid entirely by you with no contribution from the state. Dental Plus premiums are in addition to State Dental Plan premiums.
Rates:
| |
State
Dental Plan |
Dental Plus |
| Employee |
$ 0.00 |
$ 20.60 |
| Emp/Spouse |
$ 7.64 |
$ 39.00 |
| Emp/Child |
$13.72 |
$ 42.56 |
| Family |
$21.34 |
$ 60.96 |
Life Insurance
Basic Life Insurance-The employer provides $3,000 group term life and accidental death and dismemberment coverage at no cost if you are enrolled in a health plan offered by the state.
Optional Life Insurance-New employees can elect coverage in $10,000 increments up to three times your basic annual earnings without providing medical evidence of good health. You can select a higher benefits level in increments of $10,000 up to a maximum of $500,000 by providing medical evidence of good health. Insurance rates are based on your age as of each January 1. The state's Optional Life Insurance rates are on the following website: http://www.eip.sc.gov/publications/2007OLRates.pdf
State Farm Life-You may also elect State Farm life insurance offered by The College. The amount of coverage is two times your current annual salary and the premiums are based on your current annual salary. Accidental Death & Dismemberment or Loss of Sight Benefits are included.
State Farm Table of Charges:
| Salary Ranges |
Your Monthly Cost |
| $1 to $10,000 |
$4.00 |
| $10,001 to $12,500 |
$5.00 |
| $12,501 to $15,000 |
$6.00 |
| $15,001 to $17,500 |
$7.00 |
| $17,501 to $20,000 |
$8.00 |
| $20,001 to $25,000 |
$9.00 |
| $25,001 to $30,000 |
$10.00 |
| $30,001 to $35,000 |
$11.00 |
| $35,001 to $40,000 |
$12.00 |
| $40,001 to $50,000 |
$13.00 |
| $50,001 and up |
$14.00 |
Dependent Life Spouse-If you are currently enrolled in Optional Life, you may cover your spouse in increments of $10,000 for up to 50 percent of your Optional Life coverage or $100,000, whichever is less. Medical evidence of good health is required for coverage amounts greater than $20,000. If you are not enrolled in Optional Life, you may cover your spouse for $10,000 or $20,000. Premiums are the same as the Optional Life premiums, based on the employee’s age.
http://www.eip.sc.gov/publications/2007OLRates.pdf
Dependent Life Child-You can cover your eligible dependent children for $10,000. Medical evidence is not required for child coverage even if late entrant. The monthly premium is $1.24 regardless of the number of children covered.
Long Term Disability:
Basic Long Term Disability (BLTD) is provided at no cost when you are enrolled in the state group health plan of your choice. If approved, 90 days from the onset of a disability BLTD provides a benefit of 62.5 percent of monthly base earnings, less certain offsets, up to a maximum benefit of $800 per month. Taxable benefits are payable for 24 months if you are unable to perform the duties of your own job and to age 65 if you are unable to perform the duties of any and all jobs for which you are eligible through education, training or experience. There is a two-year limit for mental/dependency disabilities.
Supplemental Long Term Disability (SLTD) is a voluntary, employee-pays-all program. This benefit pays 65 percent of gross monthly salary, with certain offsets, up to a monthly maximum of $8,000. If offsets exceed 65 percent of monthly income, the plan will pay a minimum of $100 per month. Non-taxable benefits are payable for 24 months if you are unable to perform the duties of your own job and up to age 65 if you are unable to perform the duties of any and all jobs for which you are eligible through education, training and experience. There is a two-year limit for mental/dependency disabilities. You may choose either a 90-day or 180-day benefits waiting period at enrollment. Premiums are based on age and salary using the chart below:
AGE |
90-DAY |
180 DAY |
| <31 |
0.00065 |
0.00050 |
| 31-40 |
0.00089 |
0.00069 |
| 41-50 |
0.00179 |
0.00137 |
| 51-60 |
0.00360 |
0.00277 |
| 61-65 |
0.00433 |
0.00333 |
| >65 |
0.00528 |
0.00406 |
STEPS TO CALCULATE SLTD MONTHLY PREMIUM
- Always select floating decimal (F) on your calculator.
- Divide gross annual salary by 12 to determine monthly salary.
- Multiply monthly salary by rate factor from table.
- Drop digits to right of 2 decimal places; do not round.
- If number is even, this is the monthly premium.
- If number is odd, add .01, this is the monthly premium.
Long Term Care (LTC)
Long-term care is the help or supervision provided for someone with severe cognitive impairment or the inability to perform the activities of daily living: bathing, dressing, eating, toileting, transferring, and continence. Services may be provided at home or in a facility--and care may be provided by a professional or informal caregiver, such as a friend or family member. As a new, actively-at-work full-time permanent employee, if you enroll in long term care insurance within 31 days of your date of hire, you will be guaranteed coverage without having to provide your medical history. The LTC program is provided by The Prudential Insurance Company of America. Learn more about Prudential LTC: Visit www.prudential.com/gltcweb Group Name: eipltc Access Code: carolina. Call 1-877-214-6588 8 a.m. to 8 p.m. ET, Monday through Friday.
MoneyPlu$
You can get more out of your paycheck with MoneyPlu$, a flexible benefits program.
Pretax Group Insurance Premium Feature-You pay your health plan, dental plan and Optional Life (for coverage up to $50,000) premiums before taxes are taken out of your paycheck. This means you do not have to pay taxes on the dollars you use to pay these premiums. The monthly administrative fee for deducting medical, dental and Optional Life premiums before taxes is $0.28, which is deducted from your paycheck before taxes are deducted.
Dependent Care Spending Account-This allows you to pay for dependent-care expenses with your pretax income. You may set aside up to $5,000 annually to pay your dependent-care expenses. The monthly administrative fee is $3.50, which is deducted from your paycheck before taxes are deducted. You may enroll within 31 days of your date of hire. You must, however, re-enroll during the enrollment period (October 1-31) to continue for the next plan year.
Medical Spending Account-To be eligible for the Medical Spending Account, you must have completed one year of continuous state service by January 1 following an enrollment period. With this feature, you may set aside up to $5,000 annually to pay for your and your family’s out-of-pocket medical and dental expenses. The monthly administrative fee is $3.50, which is deducted from your paycheck before taxes are deducted. Enrollment and re-enrollment must be done during the enrollment period (October 1-31) for the next plan year.
Health Savings Account-The HSA is available to subscribers enrolled in the SHP Savings Plan and can be used to pay healthcare expenses. Unlike money in a MoneyPlu$ Medical Spending Account, the funds do not have to be spent in the year they are deposited. Money in the account accumulates tax free, so the funds can be used to pay qualified medical expenses in the future. An important advantage of the HSA is that you own it. If you leave your job, you can take the account with you and continue to use it for qualified medical expenses. The monthly administrative fee is $1.00, which is deducted from your paycheck before taxes. See the following link for more information http://www.eip.sc.gov/publications/MoneyPlus_HSA_flyer.pdf
and
http://www.eip.sc.gov/publications/takecontrol.pdf
For more information on these MoneyPlu$ programs, visit the EIP website:
http://www.eip.sc.gov/publications/2009_MoneyPlus_Guide.pdf
Vision Care Program
Anyone enrolled in the South Carolina Health Plan or an HMO may take advantage of this program; however, you do not have to subscribe to the SHP or HMO to take advantage of discounted vision care services. Participating ophthalmologists and optometrists throughout the state have agreed to charge no more than $60 for a routine, comprehensive eye examination.
If you are fitted for contact lenses, you may have to pay additional charges. The fitting of contact lenses usually requires additional services.
Participating providers, including opticians, have agreed to give a 20 percent discount on all eyewear. The discount does not apply to disposable contact lenses.
Participating providers are listed in the Vision Care Program Directory available on the EIP website at http://www.eip.sc.gov/vision Click on the Vision Care link.
The Vision Care program is not associated with any state group health coverage. There are no claims to file and no reimbursement of fees.
Other Insurance that can be payroll deducted
AFLAC Personal Short-Term Disability, Personal Cancer Protector Plan, Personal Recover Plus, and Personal Long Term Care Plan
Contact: Patricia Osti 843-509-3135 or Cissy Ehlen 843-303-4869
website: www.aflac.com
American Amicable Life Insurance
Contact: Sharon Brown, 1-843-345-0976
Colonial Life-Medical Bridge - Cancer Insurance, Accident Insurance, Short Term Disability Income Protection Insurance, Universal Life Insurance, and Juvenile Universal Life Insurance
Contact: Shelley Kirk, 1-800-863-3500 or 1-803-750-9222
Website: www.coloniallife.com
Jefferson Pilot, Disability Insurance
Contact: Jeff Anderson, 1-843-571-4301
Merastar Unitrid direct Insurance Company-group discount plan for Auto,Boat,Home/Renters/Condo, and Personal Excess Liability insurance
Contact:1-800-637-2782
Website: http://www.UDpreferred.com (sign-in: College of Charleston, Offer Code = PLP) for an on-line quote
