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. PEBA has added an informative "Navigating Your Benefits" section.

General Information

Detailed information and rates about plans covered by PEBA Insurance can be found in the Insurance Benefits Guide

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: An eligible spouse is defined as a spouse by South Carolina law. *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. 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.
- For Children age 19 and older, according to the Patient Protection and Affordable Care Act, as amended by the Health Care and Education Reconciliation Act of 2010, a child age 19-25 does not need to be certified as a full-time student or an incapacitate child to be covered under his parent’s health, dental or vision insurance. This includes a child who is eligible for state coverage on his own because he works for an employer that participates in PEBA Insurance Benefits. However, if the child is covered under his parent’s insurance he is only eligible for benefits offered to children.
- 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, dental, and/or vision plan.

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.

Open Enrollment: Open Enrollment is offered every October at which point you may:

Change health plans
Add or drop health plan coverage for yourself and for eligible spouse and/or children
Eligible members of the military community may add or drop TRICARE Supplemental Plan coverage for themselves and for their eligible dependents
Add or drop State Vision Plan coverage for yourself and for eligible spouse and/or children
Add or drop State Dental Plan and Dental Plus coverage ONLY DURING OPEN ENROLLMENT IN OCTOBER OF ODD-NUMBERED YEARS, or within 31 days of a special eligibility situation.

Changes made during Open Enrollment are effective January 1 of the following year.

Health Insurance

Plan Comparison Chart (see page 31 of Insurance Benefits Guide)
Premium Comparison

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 State Health Plan (SHP) consists of the Standard Plan and the Savings Plan. Both plans offer comprehensive coverage with preventive care features and the most participating providers in the state.

As a preferred provider organization, the State Health Plan has networks, groups of doctors, hospitals and other providers, that accept the plan’s allowed amount as payment in full. The allowed amount is the most a plan allows for a covered service, procedure or supply. Network providers also file subscribers’ claims.

Under both the Standard Plan and the Savings Plan, prescription drugs are covered only if they are purchased at a network pharmacy. A subscriber may use any doctor, hospital or mental health/substance abuse provider he chooses. However, a higher percentage of his health care costs will be paid if he receives care from an out-of-network provider.

The annual deductibles for the Standard Plan are lower than for the Savings Plan, but the premiums are higher. Standard Plan subscribers also pay copayments for each office visit and for outpatient facility services and emergency care before the plan begins to pay a percentage of the cost of the services. These copayments do not apply toward the annual deductible and continue after the deductible is met. Neither do they apply to the coinsurance maximum, and they continue after the coinsurance maximum is met.

Prescription drugs at network pharmacies are available for a copayment, a fixed total amount for each prescription. The copayment applies to the member's prescription drug copayment maximum but not to the annual deductible.

Savings Plan premiums are lower, but the annual deductibles are higher. Savings Plan subscribers pay the full allowed amount for medical and mental health/substance abuse services and prescription drugs. The allowed amount is the most the plan allows for a covered service. Unlike the Standard Plan drug copayments, the allowed amount for prescription drugs under the Savings Plan is applied to the annual deductible. The Savings Plan offers more preventive benefits than the Standard Plan. An important advantage of the plan is that a subscriber can save for medical expenses with a tax-free Health Savings Account.

Patient-Centered Medical Home (PCMH)

TRICARE Supplement Plan – TRICARE is the Department of Defense health benefit program for the military community. The AMRA TRICARE Supplement Plan is designed for TRICARE-eligible employees and their eligible family members until they become eligible for TRICARE for Life, a Medicare supplement.

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.

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.

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 PEBA Insurance Premiums.

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 spouse's age.

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 $1.26 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 this chart.

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, dental plus, vision 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.

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 $2.14, 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 – With this feature, you may set aside up to $2700 annually to pay for you and your family's out-of-pocket medical and dental expenses. The monthly administrative fee is $2.14, 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.

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.

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: 1.800.256.7004

Jefferson Pilot, Disability Insurance
Contact: Jeff Anderson, 843.571.4301