BCBS of South Carolina and BlueChoice HealthPlan
BlueCross BlueShield of South Carolina’s COVID-19 website
BlueChoice HealthPlan’s COVID-19 website
MEDICAL SPECIAL ENROLLMENT AND COVERAGE EXPANSION
To better serve their members during the COVID-19 crisis, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan will waive all out-of-pocket costs related to in-network COVID-19 medical treatment.
For more details and to view the formal announcement, click here.
Updates as of March 2020
As noted in the recent agent newsletter from President Scott Graves, BlueCross and BlueChoice are continuing to find unquie solutions for advisors and their customers. To view that letter, click here. Decisions regarding eligibility and re-hire waiting periods are considered and as soon as updates are made available, The Cason Group will be sure to pass along.
Updates as of April 6, 2020
Effective through May 31, 2020, BlueCross and BlueChoice will deem an employee to be actively at work, for eligibility purposes, so long as the employer:
- considers the employee to be “employed”,
- is collecting contributions toward insurance, unless 100% company paid
- is paying the insurance premiums for that employee in a timely manner.
Returning Employees, rehired or returning to full time status, on or before May 31, 2020 will not be subject to a waiting period.
Pertaining to group size, effective through May 31, 2020 the group will remain active with BlueCross or BlueChoice, as long as:
- at least two full-time employees remain on the group policy,
- the group is collecting contributions toward insurance, unless 100% company paid, and
- is paying the insurance premiums to BlueCross for those employees in a timely manner
Click here for more details.
BlueChoice HealthPlan: For New Groups now through 7/1/2020 effective dates, BlueChoice HealthPlan will consider individual policies as a valid waiver. In addition, BlueChoice HealthPlan of South Carolina has compiled a Frequently Asked Questions (FAQs) document to help you navigate your small group customers during this time. Topics include:
- Eligibility
- Business Rules and Practices
- Telehealth
- Care Management
BlueCross BlueShield and BlueChoice HealthPlan: Effective March 31, 2020, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan members have an additional telehealth option available to them.
Members can now have a live video visit at no cost to them with a Doctors Care provider using Doctors Care Anywhere, available via https://doctorscare.com/anywhere/ or by downloading the app from the App Store or Google Play. Promotional materials can be found here for BlueCross members and here for BlueChoice® members.
BlueCross BlueShield and BlueChoice HealthPlan have created webpages where members can go to access telehealth.
For BlueCross members, this information can be found here.
For BlueChoice members, this information can be found here.
Updates as of May 19th, 2020
Group Eligibility Guidelines Extended Through July 31, 2020, Due to COVID-19 Pandemic
As a result of the impact the COVID-19 pandemic is having on the workplace, BlueCross BlueShield of South Carolina (BlueCross) and BlueChoice HealthPlan of South Carolina, Inc. (BlueChoice®) provided this update on Group Eligibility Rules and Guidelines for their Fully Insured Group Lines of Business.
BCBS and BCHP are extending their group eligibility guidelines due to the COVID-19 pandemic through July 31, 2020.
Actively At Work
BlueCross and BlueChoice understand that employers may need to displace workers and amend work schedules during this crisis. Effective through July 31, 2020, BlueCross and BlueChoice will deem an employee to be actively at work, for eligibility purposes, so long as the employer:
- considers the employee to be “employed,”
- is collecting contributions toward insurance, unless 100 percent company paid, and is paying the insurance premiums for that employee in a timely manner
Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees and employee contributions must be no greater than those in effect immediately prior to March 1, 2020.
Group Size
BlueCross and BlueChoice understand that some groups may lay off workers or downsize. Effective through July 31, 2020, the group will remain active with BlueCross or BlueChoice at the group’s current premium structure and/or rating methodology unless and until the group’s renewal as long as:
- at least two full-time employees remain on the group policy,
- the group is collecting contributions toward insurance, unless 100 percent company paid, and
- is paying the insurance premiums to BlueCross or BlueChoice for those employees in a timely manner.
Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees and employee contributions must be no greater than those in effect immediately prior to March 1, 2020.
Renewals
BlueCross and BlueChoice will continue to meet market and regulatory provisions for offering timely renewals. Unless any temporary impacts to group size are sufficiently significant and anticipated to be permanent, or the group’s average number of employees on business days in 2019 changed by a sufficiently significant amount from 2018 to cause the group’s market segment to change (from large to small), the group will be renewed under the rating methodology in place at the time of the last renewal.
COBRA and Continuation
Generally, employers with greater than 20 lives will qualify to offer COBRA coverage to displaced employees while employers with fewer than 20 lives may qualify for state continuation coverage. Additionally, BlueCross and BlueChoice can offer individual coverage options to displaced workers. Please contact your marketing representative to review options.
Returning Employees
Employees rehired or returning to full time status on or before July 31, 2020, will not be subject to a waiting period.
Helping Employees Find Other Insurance Coverage
If individuals lose coverage due to a loss of eligibility, BlueCross and BlueChoice will work with agents and employers to assist with transitions to other types of coverage. BCBS and BCHP can help assess options and eligibility for Medicare, Medicaid, individual coverage or even short-term products.
Updates as of October 5, 2020
BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina COVID-19 Pandemic Group Eligibility Guidelines Extended Through Dec. 31
As the COVID-19 pandemic continues to impact the workplace, BlueCross BlueShield of South Carolina and BlueChoice HealthPlan of South Carolina have extended the end dates of the Group Eligibility Rules and Guidelines for our Fully Insured Group lines of business.
While many questions can be addressed by our respective standard Premium Billing & Payment guidelines, we understand the need to remain flexible during this extraordinary time. As we have demonstrated during this pandemic and previous natural disasters, we will continue to work alongside our customers to keep individuals insured. Should local or federal authorities provide new or “emergency” guidelines or provisions, we will amend our policies consistent with such guidance.
Most inquiries continue to be related to eligibility and the “actively at work” provisions of our contracts. To clarify how we are determining eligibility during this time, we offer this guidance:
ACTIVELY AT WORK
BlueCross and BlueChoice® understand that employers may need to displace workers and amend work schedules during this crisis. Effective through Dec. 31, 2020, BlueCross and BlueChoice will deem an employee to be actively at work, for eligibility purposes, so long as the employer:
- Considers the employee to be “employed.”
- Is collecting contributions toward insurance, unless 100 percent company paid.
- Is paying the insurance premiums for that employee in a timely manner.
Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees, and employee contributions must be no greater than those in effect immediately before March 1, 2020.
GROUP SIZE
BlueCross and BlueChoice understand that some groups may downsize or lay off workers. Effective thorough Dec. 31, 2020, the group will remain active with BlueCross or BlueChoice at the group’s current premium structure and/or rating methodology until the group’s renewal as long as:
- At least two full-time employees remain on the group policy.
- The group is collecting contributions toward insurance, unless 100 percent company paid.
- The company is paying insurance premiums in a timely manner.
Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees, and employee contributions must be no greater than those in effect immediately before March 1, 2020.
RENEWALS
BlueCross and BlueChoice will continue to meet market and regulatory provisions for offering timely renewals. Unless any temporary impacts to group size are sufficiently significant and anticipated to be permanent, or the group’s average number of employees on business days in 2020 changed by a sufficiently significant amount from 2019 to cause the group’s market segment to change (from large to small), the group will be renewed under the rating methodology in place at the time of the last renewal.
COBRA AND CONTINUATION
Generally, employers with greater than 20 lives will qualify to offer COBRA coverage to displaced employees, while employers with fewer than 20 lives may qualify for state continuation coverage. BlueCross and BlueChoice also can offer individual coverage options to displaced workers. Please contact your marketing representative to review options.
RETURNING EMPLOYEES
Employees rehired or returning to full-time status on or before Dec. 31, 2020, will not be subject to a waiting period.
HELPING EMPLOYEES FIND OTHER INSURANCE COVERAGE
If individuals lose coverage due to a loss of eligibility, BlueCross and BlueChoice will work with agents and employers to assist with transitions to other types of coverage. We can help assess options and eligibility for Medicare, Medicaid, individual coverage or even short-term products.
Please continue to remind your customers who are our members that updated information regarding COVID-19 and any related changes in their coverage can be found on our websites.
BlueCross members: www.bcbs.sc/covid-19
BlueChoice members: www.BlueChoiceSC.com/COVID-19
