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Health, Dental, Vision Benefits

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 PEBA Insurance Benefits website.

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 spouse – you may cover your lawful spouse, or a former spouse required to be covered by a divorce decree or court order, but not both. *Documentation will be required. If a spouse is eligible for coverage as an employee of any participating South Carolina state covered entity, they may not be covered as a spouse under any plan.
Eligible Children – you may cover your child younger than age 26. They must not be eligible for a group health plan sponsored by an employer (either as an employee or as a spouse). The child must be the subscriber’s natural child, adopted child, (including child placed for legal adoption), step-child, foster child, or a child for whom the subscriber has legal custody. *Documentation will be required.
- If you and your spouse are both eligible for coverage, only one of you can cover your children under any one plan. However, one parent can cover the children under health, and the other can cover the children under dental.
- Note: For Dependent Life Child coverage, a child between age 19-24 must be certified as a full-time student or certified by EIP as an incapacitated child.

* Required Documentation for dependent coverage

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, dental and/or vision 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 fewer.

Pregnancy is not considered a pre-existing condition. Rule excluding coverage of pre-existing conditions do not apply to a covered person age 18 and younger.

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 and 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 (2013, 2015, 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, 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

Tobacco-Use Surcharge (applies to all health plans): If you are a subscriber with single coverage and you use tobacco, you will pay a $40 monthly surcharge. If you have subscriber/spouse, subscriber/children or full-family coverage and anyone you cover uses tobacco, the surcharge will be $60 monthly.

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 - Medically necessary mental health and substance abuse services are covered when rendered by network and out-of-network providers. Just like benefits for medical services, a higher percentage of the cost of your care is covered if you use network services. For customer service and information about claims for mental health and/or substance abuse care, call BlueCross BlueShield of South Carolina at 1.800.868.2520.

Quit For Life® Program – The research-based Quit For Life® Program is brought to you by the American Cancer Society® and Alere Wellbeing. It is available at no charge to SHP subscribers, their spouses and covered dependents age 13 or older. Call 866-QUIT-4-LIFE (866.784.8454) or visit Quit for Life® to enroll in the Quit For Life® Program. After your eligibility is verified, you will be transferred to a Quit Coach for your first call.

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 a HMO. 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 available in our area is BlueChoice HMO.

OTHER INSURANCE

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	$ 22.60
Emp/Spouse	$ 7.64	$ 45.66
Emp/Child	$13.72	$ 52.64
Family	$21.34	$ 68.24

State Vision Plan

The State Vision Plan is available to eligible active employees and their dependents.

The program covers comprehensive eye examinations, frames, lenses and lens options, and contact lens service and materials. It also offers discounts on additional pairs of eyeglasses and contact lenses. A discount of 15 percent on the retail price and a 5 percent discount on a promotiional price is offered on LASIK and PRK vision correction through the U.S. Laser Network. Medical related treatment of your eyes is covered by your health plan. See Vision Benefits at a Glance for more information.

Vision Care Discount Program

This program offers 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 Discount Program Directory available at EIP Vision.

Full-time and part-time employees, as well as their dependents are eligible. You do not have to be enrolled in a health plan. You may need to provide an employment related identification to prove you are eligible for the program. The Vision Care Discount program is not associated with any state group health coverage. There are no claims to file and no reimbursement of fees.

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 available at EIP Premiums.

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. Rates are available at EIP.

Dependent Life Child – You can cover your eligible dependent children for $15,000. 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	0.00050	0.00039
31-40	0.00069	0.00053
41-50	0.00138	0.00105
51-60	0.00277	0.00213
61-65	0.00333	0.00256
>65	0.00407	0.00313

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 two 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: Group Name: eipltc Access Code: carolina. Call 1-877-214-6588 8:00 a.m. to 8:00 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 $3.14, 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 $2500 annually to pay for you and your family's out-of-pocket medical and dental expenses. The monthly administrative fee is $3.14, 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 $1.50, which is deducted from your paycheck before taxes. Learn more about Health Savings Account.

Other Insurance That May 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

American Amicable Life Insurance
Contact: Sharon Brown, 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: Robin L Harris, 803.358.0761 or rwj29072@yahoo.com

Jefferson Pilot, Disability Insurance
Contact: Jeff Anderson, 843.571.4301

Kemper Select Insurance Company
Group Discount Plan for Auto,Boat,Home/Renters/Condo, and Personal Excess Liability insurance
Contact: 800.637.2782
Kemper Select will be happy to offer on-line quotes (sign-in: College of Charleston, Offer Code = PLP)