Serving those who serve South Carolina

Value-based benefits

These value-based initiatives are offered at no cost to State Health Plan primary members at network providers and pharmacies.

  • Adult checkup for Savings Plan participants

    Savings Plan participants age 19 and older may receive an annual checkup at an in-network provider's office at no cost.

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    The annual physical includes:

    • A preventive, comprehensive examination
    • A complete urinalysis, if coded as a preventive screening
    • A preventive EKG
    • A fecal occult blood test, if coded as a preventive screening
    • A general health laboratory panel blood work, if coded as a preventive screening - this benefit does not include a more comprehensive executive blood panel test
    • A lipid panel once every five years for testing cholesterol and triglycerides.

     

    If your network provider sends tests to a non-network physician or lab, the tests will not be covered.

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    Adult vaccinations

    Adult vaccination rates remain low in the US, despite the widespread availability of safe and effective vaccines. As recommended by the Center for Disease Control (CDC), the State Health Plan covers all adult vaccinations within specified age parameters at no cost to the member.

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    If a member receives the shot in a network doctor's office, the vaccine and the administration fee will be paid in full; any associated office visit charges will be processed according to regular Plan coverage rules. State Health Plan members and Medicare-primary members can learn more about how this benefit coordinates with their coverage in the Insurance Benefits Guide.

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    Mammography

    If you meet eligibility requirements and visit a network provider, routine mammograms are covered at 100 percent.

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    Mammography benefits include:

    • One base-line mammogram (four views) for women age 35 through 39; and
    • One routine mammogram (four views) every year for women over age 40.

     

    Routine, preventive mammogram benefits are in addition to benefits for diagnostic mammograms. Any charges for additional mammograms beyond the preventive mammogram are subject to copayments, deductibles and coinsurance.

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    No-Pay Copay

    The No-Pay Copay program gives State Health Plan primary members, including employees, retirees, COBRA subscribers, survivors and their covered spouses, with high blood pressure, high cholesterol, congestive heart failure, cardiovascular disease, coronary artery disease, or diabetes a copayment waiver for generic drugs that treat these conditions. The program encourages members to be more engaged in their health — and saves them money. Participants qualify for the program on a quarterly basis. By completing certain activities in one quarter, they are able to receive certain generic drugs at no cost the next quarter.

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    Members are identified for one of the qualifying conditions automatically by BlueCross. BlueCross notifies members of eligibility and directs them to register for the Rally® online platform. For detailed information about the No-Pay Copay program, go to StateSC.SouthCarolinaBlues.com or call BlueCross Customer Service at 800.868.2520. If you think you qualify for the program but have not been notified of your eligibility, call 855.838.5897. BlueCross administers the program, but you may call Express Scripts, the pharmacy benefits manager, at 855.612.3128 for more information about eligible generic prescriptions.

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    Pap test benefits

    Each calendar year, the Plan covers the cost of the lab work associated with a Pap test for covered women ages 18 through 65.

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    It is advised that you contact the provider before attending an office visit to determine the cost of the exam and related services. Before you receive this service, please consider the following:

    • The cost of the portion of the office visit associated with the Pap test is covered.
    • Costs for the portion of the office visit not associated with the Pap test, charges associated with a pelvic exam, breast exam or a complete or mini-physical exam and any other laboratory tests, procedure or services associated with receiving the Pap test benefit are not covered and are the member’s responsibility.

     

    Savings Plan members older than 18 are entitled to a routine annual exam. They may receive a routine annual exam or an exam performed in conjunction with the Pap test, but not both. If both are performed in the same year, the first one filed will be allowed.

     

    Based on the recommendation of the United States Preventive Services Task Force, the Standard Plan and Savings Plan both cover the human papillomavirus (HPV) test every five years in conjunction with a Pap test at no cost to eligible women ages 30 through 65.

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    Preventive screening

    This benefit is provided at no cost to employees, retirees, COBRA subscribers and their covered spouses if their primary coverage is the Standard Plan or the Savings Plan. The screening includes blood work, a health risk appraisal, height and weight measurements, blood pressure and lipid panels. After the screening, you will receive a confidential report with your results and recommendations for improving your health. Taking this report to your doctor may eliminate the need for tests.

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    There are three ways to take advantage of this benefit:

    1. Attend a  preventive worksite screening. To find out when a screening is offered at your worksite, contact your benefits office. Any worksite with a minimum of 20 participants can host a screening. If your worksite doesn't meet the minimum requirement for participants, consider planning a joint screening day with other agencies or organizations or contacting eligible retirees from your worksite. Complete and email the Preventive Worksite Screening Request Form to wellness@peba.sc.gov to get started.
    2. Attend a regional preventive screening. If your worksite doesn’t offer a screening, or if you missed it, you can register for a regional screening. Regional screenings can be found on our Calendar page.
    3. Visit a participating screening provider. Visit one of our participating screening providers. Print this voucher and take it when you visit for a screening.

     

    No matter how you take advantage of this benefit, there are required tests and appraisals that will be included in your confidential report. Some screening providers may, however, provide additional results above the minimum requirements.

     

    In addition to the required tests and appraisals, participating screening providers may offer optional tests for an additional fee. You may contact the screening provider about out-of-pocket expenses associated with these tests. Please note, optional tests may vary based on screening provider.

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    Well child benefits

    Well child care benefits, including checkups and immunizations, aim to promote good health and both early detection and prevention of illness in children enrolled in the State Health Plan. Covered children are eligible for well child care exams until they turn age 19. When services are received from a network provider, benefits will be paid at 100 percent of the allowed amount.

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    Well child exams

    The plan pays 100 percent of the allowed amount for approved routine exams, Centers for Disease Control-recommended immunizations, American Academy of Pediatrics-recommended services specific to certain ages and lab tests when an in-network doctor provides these checkups:

    • Younger than 1 year old (up to six visits);
    • 1 year old (up to three visits);
    • 2 years old (up to two visits);
    • 3 years old until he turns 19 years old (one visit a year).

     

    The well child care exam must occur after the child’s birthday.

     

    Immunizations

    Benefits are provided for all immunizations at the appropriate ages that the American Academy of Pediatrics recommends for children through age 18. To ensure that the immunization will be covered, the child must have reached the age at which the AAP schedule says the immunization should be given. If your covered child has delayed or missed receiving immunizations at the recommended times, the Plan will pay for immunizations through age 18, for the vaccines listed, subject to the age limitations. Please contact your pediatrician for the most up-to-date information about immunizing your child.

 

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Columbia, SC 29223

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