South Carolina Health Insurance

Health Plan One	START BELOW OR CALL 877.56 PLANS (877)567-5267
Health Insurance for the Well Informed

Blue Cross Blue Shield of South Carolina

4% of South Carolina residents had individual health insurance in 2004. The percent change in the South Carolina population with individual insurance was 0.1% between 2000 and 2004 according to www.statehealthfacts.org.

In South Carolina, medical underwriting is allowed without restriction. There is a 12 month look back and exclusionary period for HMOs. There is an unlimited look back and 24 month exclusionary period for preexisting conditions for all other insurance companies.

South Carolina maintains a high risk pool called the South Carolina Health Insurance Pool. You may be eligible for this coverage due to your HIPAA rights or if you have been a resident of South Carolina for at least 30 days and you have been denied health coverage due to a medical reason. You may also be eligible if you have been offered health insurance with exclusions and limitations, or you have been offered health insurance at a rate that exceeds the high risk pool rate by 150%.

Coverage under the SC Health Insurance Pool includes doctor visits, prescription drugs, outpatient and in-hospital care, maternity, ambulance, labs and x-rays, skilled nursing care, hospice, home health visits, transplants, durable medical equipment, mental health and substance abuse, physical, speech and occupational therapy.

Uninsured in South Carolina

Between 2004 and 2005, the percent change of South Carolina’s uninsured population was 2.7%. South Carolina has a very large uninsured rate at 16%. The uninsured rate is 22% among adults between the ages of 19 and 64.

In 2004, only 50% of the population had employer-sponsored health insurance according to www.statehealthfacts.org. South Carolina ranked 46^th in percent of employees offered health insurance in 2005. Only 32% of small employers offered health insurance to their employees in 2005. Between 2000 and 2004, employer-sponsored health insurance decreased by 9%. The average monthly premium for a single in a small group in 2006 was $300 while for a family it was $786.

In South Carolina, medical underwriting is allowed with plus of minus 25% of the indexed rate based on the health status of the group. There is a 6 month look back and 12 month exclusionary period limit for preexisting conditions for those without prior health coverage.

South Carolina offers COBRA, the Consolidate Omnibus Budget Reconciliation Act of 1985. Many companies with 20 or more employees that offer health insurance are required to offer employees and their dependents continuation coverage for benefits that were lost due, for example, to job loss, reduction in hours worked, death, or divorce.

Medicaid is a state/federal program that pays for medical and long-term care services for low-income pregnant women, children, certain people on Medicare, disabled individuals and nursing home residents. These individuals must meet certain income and other requirements.

Children (ages 1-5-150% of the Federal Poverty Level
Children (Ages 6-19)-150% of the Federal Poverty Level

Pregnant Women and Infants

Pregnant Women-185% of the Federal Poverty Level
Infants (ages 0-1)-185% of the Federal Poverty Level

Non Working Parents- 49% of the Federal Poverty Level

Working Parents- 97% of the Federal Poverty Level

Supplemental Security Income Recipients- 74% of the Federal

Aged, blind, and disabled- 100% of the Federal Poverty Level

Inpatient and outpatient hospitalization, physicians’ services, early periodic screening diagnosis and treatment, vision care, dental, rural health clinic services, federally qualified health centers, family planning, laboratory and x-rays, durable medical equipment, pharmacy services, ambulance services, transportation, podiatry, home health services, therapy, mental health services, case management, hospice, and rehabilitation.

Co-payments vary. There are no co-payments if you are under 18, pregnant, living in a nursing home, or receiving family planning services.

You may learn more about South Carolina Medicaid at http://www.dhhs.state.sc.us/dhhsnew/medicaid.asp.

South Carolina offers the Partners for Healthy Children program for children up to the age of 19 whose family income is up to 150% of the Federal Poverty Level, who are residents of South Carolina, and who are U.S. citizens or legal residents. Please visit the Partners for Healthy Children website for more detailed information at http://www.workworld.org/wwwebhelp/medicaid_program_partners_for_healthy_children_south_carolina.htm.

“Health Access America Helps Hundreds of South Carolinians Obtain Health Insurance in Community Campaign”

“South lags in report care on health care”