Medical Insurance
Your medical insurance is provided by BCBS of South Carolina. All employees have the option to participate in the medical benefits. The medical plan is open access, which means you do not have to first receive a referral from your Primary Care Provider (PCP) before scheduling an appointment with an in-network Specialist. We always recommend you use in-network providers. If you choose to seek care from an out-of-network provider, you will have to pay more out of pocket towards these services. To locate an in-network provider call (800) 922-1185 ext 21144 or visit them at www.southcarolinablues.com.
The information contained in this presentation is an overview of your benefits. If you have specific questions regarding a provider or procedure, please call BCBS customer service at the number listed on the back of your medical ID card. If you do not have an ID card, please call (800) 922-1185 ext 21144 or refer to the Medical SPD.
BCBS of SC Medical Benefits
|
|
In-Network (BCBS Providers) |
Out-of-Network (Non-BCBS Providers) |
|
Deductible |
||
|
Single |
$2,000 |
$10,000 |
|
Family |
$4,000 |
$20,000 |
|
Lifetime Maximum |
Unlimited on mandated essential benefits |
Unlimited on mandated essential benefits |
|
Coinsurance (Plan/Member) |
70% / 30% |
50% / 50% |
|
Max Out-of-Pocket (Excluding Deductible) |
||
|
Single |
$2,000 |
$10,000 |
|
Family |
$4,000 |
$20,000 |
|
Hospital Facility Services |
||
|
Inpatient |
Deductible + 30% |
$100 copay, Deductible + 50% |
|
Outpatient |
Deductible + 30% |
Deductible + 50% |
|
Emergency Room |
Deductible + 30% |
Deductible + 30% + Balance Billing |
|
Physician Office Visits |
||
|
Preventive Care |
Covered at 100% |
Not Covered |
|
Primary Care |
$25 Copay |
Deductible + 50% |
|
Specialist |
$25 Copay |
Deductible + 50% |
|
Prescription Drug Coverage |
||
|
Generic Tier |
$15 Copay |
$15 copay, Member pays 50% |
|
Preferred Brand Tier |
$40 Copay |
$40 copay, Member pays 50% |
|
Non-Preferred Tier |
$70 Copay |
$70 copay, Member pays 50% |
|
Mail Order |
$25/$90/$175 Copay |
Not Covered |
HRA
How does the HRA work:
- Member incurs claim
- Provider files claim with Blue Cross Blue Shield (BCBS)
- Member is responsible for deductible
- BCBS processes claim, applies network discounts, mails EOB to employee. Benefit Coordinator sends payment to in-network provider. (Instructions for Benefit Coordinator's portal are included in the Benefit Guide.) If your provider is out-of-network, payment will be mailed to employee and employee will pay provider with reimbursement.
Medical Plan Payroll Deductions
| Semi-Monthly | No Surcharge | Smoking Surcharge | Spouse Surcharge | Spouse & Smoking Surcharge |
| Employee Only | $59.37 | $81.03 | $59.37 | $81.03 |
| Employee + Spouse | $160.84 | $182.50 | $210.84 | $232.50 |
| Employee + Child(ren) | $129.56 | $151.22 | $129.56 | $151.22 |
| Family | $199.74 | $221.41 | $249.74 | $271.41 |
Finding Providers
How do you find a BCBS Medical provider?
It's easy! There are several ways!!
- Contact your provider and ask:
"Do you participate in the Blue Cross Blue Shield Blue Medical HMO, Open Access HMO or PPO Network?" - Contact BCBSGA at the toll-free number:
1 (800) 441 - CARE (2273) - Visit them on the Internet at:
www.southcarolinablues.com