The State Health Plan (PPO) - 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 annual deductibles are lower than the Savings Plan, but the premiums are higher. Summary of Benefits and Coverage.
The premiums are lower than for the Savings Plan, but the annual deductibles are higher. Summary of Benefits and Coverage. The Savings Plan offers more preventative benefits than the Standard Plan.
Designed for TRICARE — eligible employees and retirees and their eligible family members until they become eligible for TRICARE for Life, a Medicare supplement.
Health Services:
Available through Express Scripts, each plan includes prescription drug benefits if you use a pharmacy within the plan's network or the plan's mail-order pharmacy. For most drugs you pay a copayment. Copayments are lower for generic and preferred-brand drugs. Under the Savings Plan, you pay the full allowed amount for prescription drugs, and it is applied to your deductible.
One-on-one coaching and health management programs are available at no cost to State Health Plan primary members.
There is no cost to the employee for this plan. There is a premium for spouse and/or child(ren). The yearly maximum is $1,000.00 per person. There are four classes of dental coverage:
| Class I | Preventive Services: 100% of Allowable Charges |
| Class II | Basic Services: 80% of Allowable Charges after $25 deductible |
| Class III | Prosthodontics: 50% of Allowable Charge after $25 deductible (implants are covered beginning 2013 based on the allowable) |
| Class IV | Orthodontics: 50% of Allowable Charge, $1000 Lifetime Benefit (only dependents under age 19 are eligible) |
Dental Plus is a supplemental plan to provide a higher level of dental coverage for you and your family. Dental Plus is applied to the level of coverage carried under the Basic State Dental Plan but subscribers must pay an additional premium and can only be added or dropped in October of the odd years, effective January 1st of the following year.
The State vision plan offers benefits for a comprehensive vision exam every year, eyeglass lenses or contact
lenses every year and frames every two years. A discount of 15% on the retail price
and 5% on a promotional price is offered on LASIK and PRK vision correction through
the U.S. Laser Network.
EyeMed Vision Care
This program is offered at no cost to full and part-time employees, retirees, survivors, COBRA subscribers and their dependents. Participating providers agree to charge no more than $60 for a routine eye examination and offer a 20% discount on eye wear, except contact lenses. You do not need to be enrolled in a health plan, but may need to provide employer related identification to be eligible for benefits.
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
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.
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.
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.
More details can be found on the PEBA website. A plan summary, including monthly premiums, is available in the Group Term Life Insurance document.
Underwritten by MetLife.
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% 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.
is a voluntary, employee-pays-all program. This benefit pays 65% of gross monthly salary, with certain offsets, up to a monthly maximum of $8,000. 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. If interested, please contact one of the Benefits Administrators for a calculation of your monthly premium.
You must be eligible for state group insurance benefits to participate in MoneyPlus. However, you are not required to be enrolled in an insurance program in order to participate in MoneyPlus.
*Enrollment in one of these pre-tax spending accounts incurs an administrative fee of $2.32 each month from your pay.
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.
A Dependent Care Spending Account (DCSA) allows you to pay for daycare costs for children and adults with pretax income. It cannot be used to pay for dependent medical care. You submit cliams for reimbursements as you have eligible expenses. The funds can be used only for expenses incurred during the plan year. If you have money left in your account on December 31st, you have until March 15th to spend funds deposited during the plan year. You have until March 31st to request reimbursement from your previous year's funds for expenses incurred on or before March 15th. You forfeit funds left in your account after the reimbursement deadline. You must re-enroll in DCSA each year during the enrollment period (October 1st-31st) to continue for the next plan year.
A Medical Spending Account (MSA) allows you to pay eligible medical expenses with pretax income. This includes copayments and coinsurance. MSAs offer the ASIFlex Card, which functions like a debit card. You can use this card to spend funds as an alternative to submitting claims for reimbursement. If you have money left in your account on December 31st, you can carry over up to $500 of those funds into the next plan year. You will have until March 31st to request reimbursement from your previous year's funds for expenses incurred on or before December 31st.
Once you sign up for an MSA and decide how much to contribute, the entire amount is available on January 1st. You do not have to wait for funds to accumulate in your account before being reimbursed for eligible medical expenses. You must re-enroll each year. Enrollment and re-enrollment must be done during the enrollment period (October 1st-31st) for the next plan year.
The HSA is available to subscribers enrolled in the SHP Savings Plan and can be used to pay healthcare expenses. Unlike money in a MoneyPlus 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. There is no monthly administrative fee for this account. Our HSA vendor, Central Bank, charges a $1.25 per month fee directly from your health savings account.
Participants enrolled in a Health Savings Account may also participate in a Limited-Use MSA for expenses not covered by the SHP Savings Plan, including dental and vision care expenses. It cannot be used for deductibles, coinsurance, co-payments and other out-of-pocket medical expenses. Except for the restriction on what kinds of expenses are reimbursable, a MoneyPlus Limited-Use MSA works the same way as a Medical Spending Account.
Consolidated Omnibus Budget Reconciliation Act of 1985
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.
Changes to your benefits can be made within 31 days of a qualifying event or special eligibility situation. Examples of the most common types of events or situations are:
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If no special eligibility event exists, changes can be made during open enrollment in October every year.
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MyBenefits website allows you to:
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South Carolina Blues website allows you to view:
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To find network providers, please visit the PEBA Online Directory.
Winthrop University will offer health care coverage to eligible non-permanent employees. Eligible employees will be offered health care, dental, and vision coverage. Non-permanent employees will be classified as one of the following types:
How to Enroll In or Decline Insurance Benefits:
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