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South Carolina Health Insurance
Health insurance is an inevitable option that cannot be avoided at any costs. Purchasing appropriate health insurance coverage for your family is costly that requires a good evaluation of all future risks and its impact on your finances. More than 47 million Americans are uninsured, majority of whom are working families. These working families, especially children, suffer financially due to the lack of proper health coverage and the medical expenses associated with them. However, for those families who are not covered by their employers’ health group plan, there are low-priced state sponsored health insurance programs.
South Carolina is ranked at 48th position on the healthiest states list as surveyed by the United Health Foundation’s 2008 Health Rankings. The healthcare system of the state has been declining as it fell six places from it 42nd position in 2007. The major weak points of South Carolina’s health system include high violent crime rate, high infant mortality rate, high rate of uninsured population and high percentage of children under 18 in poverty. The state of South Carolina, having the population of more than four million people, offers both private-market and public health insurance alternatives. The private-market health insurance consists of various types of health plans including family, Medicare supplemental, short-term, student, group and dental. In addition, the state and federal government sponsored programs provide subsidized health coverage to the uninsurable residents of South Carolina who meet specific eligibility requirements.
The South Carolina Department of Insurance protects the insurance consumers against unfair practices by regulating all kinds of insurance sold through private-market health insurers as well as public health coverage programs. However, despite of moderate public health funding, nearly 16.2% of the state residents are uninsured. Approximately, 34.4% uninsured South Carolina citizens come under the above 200% FPL bracket, according to the Censor Bureau’s 2007 and 2008 Current Population Survey.
When shopping for health coverage, get in touch with a South Carolina-based licensed health insurance agent/broker to avail the benefits of health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of South Carolina. These regulations apply to all insurance companies offering individual or family health insurance in South Carolina:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 24 months |
Look Back Period | No Limit |
Look Back Standard | Prudent person |
Mandatory Benefits | Cancer screening for women including breast cancer screening and cervical cancer screening, mastectomy stay of 48 hours, reconstructive surgery after mastectomy, direct access to OB/GYNs |
Market Rate Restrictions | None |
Guaranteed Issue Options | None |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of South Carolina. These regulations apply to all insurance companies offering small group health insurance in South Carolina:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must work for at least 6 months out of the year, and work 20 hours per week |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate bands |
Rate Adjustment Factors | 25% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as Individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of South Carolina. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | Yes |
Eligible Group Sizes | 2-19 |
Extension of Benefits Period - Standard | 6 months |
Extension of Benefits Period - Disabled | 6 months |
Maximum Premium Increase | 100% |
State Legislation Reference | South Carolina Continuation Law |
Additional Notes | To qualify, you must have been continuously covered under the group policy for six months and termination of your prior group plan must have occurred for a reason other than nonpayment of your required contribution. In addition, you must not be eligible for Federal COBRA continuation coverage, similar group coverage or Medicare benefits. |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of South Carolina to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of South Carolina is summarized in the chart below:
| Plan Name | South Carolina Health Insurance Pool (SCHIP) |
Website | |
Phone Number | 800-868-2500, ext. 46401 |
HIPPA Eligibility Required? | Yes |
Available Carriers | Blue Cross Blue Shield of South Carolina |
Pre-Existing Condition Waiting Period | 6 months |
Enrollment Periods | Currently Open to New Enrollment |
Premium Limits | Between 150% to 200% of standard rate |
Lifetime Maximum Benefit | $1 million |
Special Notes | To be eligible, you must be a South Carolina resident for at least 30 days; you must have been accepted for private health insurance, but have had a pre-existing condition exclusion placed on your coverage for more than 12 months; you must have been accepted for private health insurance and are paying an insurance premium that is higher than 150% of the premium amount charged by SCHIP |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of South Carolina provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | The Partners for Healthy Children program (PHC) |
Website | http://www.dhhs.state.sc.us/dhhsnew/InsideDHHS/Bureaus/BureauofEligibilityProcessing/phc.asp |
Phone Number | 877-552-4642 |
Apply Online | Yes |
Age Limits | Under 19 |
Insurance Carrier | NA |
Length of Coverage | Subject to Periodic Eligibility Review |
Residency Requirements | South Carolina resident, U.S. citizen, legal immigrant |
Other Eligibility Requirements | Household Income should be at or below 150% of FPL |
Pre-Existing Condition Exclusions | None |
Cost | $0 or minimal cost of share |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of South Carolina:
| Governing Agency | South Carolina Department of Health and Human Services |
Website | |
Phone Number | 888-549-0820 |
Residency Requirements | South Carolina resident and U.S. citizen |
Federal Poverty Line Income Limits | Pregnant women and infants age 0-1: 185% FPL; |
Additional Resources
South Carolina Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines South Carolina’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
South Carolina: At-A-Glance
Provides exclusive health data of the South Carolina state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
