Below you will find the most recent information pertaining to COVID-19 and your State Health Plan and MoneyPlus benefits.
For the latest information on COVID-19, please visit the South Carolina Department of Health and Environmental Control (DHEC) website at www.scdhec.gov and the Centers for Disease Control and Prevention (CDC) website at www.cdc.gov.
PEBA, BlueCross BlueShield of South Carolina and Express Scripts are continuing to monitor information about the COVID-19 vaccines. The State Health Plan will cover the COVID-19 vaccination as recommended by the CDC at no member cost. For vaccines that require more than one dose, the Plan will cover each required dose at no member cost.
Medicare covers the cost of the COVID-19 vaccine under Medicare Part B. Express Scripts Medicare members need to present their Medicare card a network pharmacy for COVID vaccine coverage. Additional information is available at www.express-scripts.com/home/covid19.
More information about the distribution of the vaccine is available on DHEC’s website. Members who have questions about the safety and effectiveness of the vaccines or other clinical aspects, such as potential side effects, should visit the CDC and DHEC websites.
The State Health Plan adheres to the testing guidelines set forth by the CDC. As this is a rapidly changing situation, adjustments to plan provisions will continue to be made as needed. Currently, testing for COVID-19 is covered by the Plan as follows:
- Diagnostic tests. Commonly known as COVID-19 PCR test or simply PCR, the State Health Plan covers this test at no member cost when prescribed by a healthcare provider for individuals who are symptomatic and for those who have been exposed to COVID-19 and are concerned about infection, for the purpose of identifying and treating the disease. In this situation, other services related to the administration of the diagnostic test are also covered at no member cost.
- Antibody tests. Sometimes referred to as a serology or immunity test, the State Health Plan covers this test at no member cost when medically appropriate as determined and ordered by a healthcare provider. In this situation, other services related to the administration of the diagnostic test are also covered at no member cost. It is important to note that the World Health Organization, the Infectious Diseases Society of America, and the CDC do not recommend using antibody testing as the sole method of diagnosing COVID-19 or confirming immunity as this type of test currently has too many variables and unknown performance characteristics.
- Return to work/school tests. Currently, the CDC does not recommend return to work/school testing, and therefore is not covered by the State Health Plan for this purpose.
Reimbursement for at-home tests
Every household in the United States is eligible to order four free at-home COVID-19 tests at www.COVIDtests.gov.
State Health Plan primary members are also eligible to request reimbursement for over-the-counter COVID-19 tests authorized by the U.S. Food and Drug Administration. Reimbursements are limited to eight tests per covered member in a 30-day period.
Effective January 28, 2022, claims will be processed under the Plan’s pharmacy benefit through Express Scripts. Here is how the process works:
- Call your local network pharmacy to see if they have over-the-counter COVID-19 tests available.
- At your local network pharmacy, take the COVID-19 test to the pharmacy counter just like you would when filling a prescription. Do not use the regular checkout lane.
- Show them your Express Scripts identification card.
- Your over-the-counter COVID-19 test should automatically ring up at no cost to you, which means you do not need to file a claim.
To find a network pharmacy near you, log in to your Express Scripts account online or log in to the Express Scripts mobile app and select Find a Pharmacy.
If you purchase an over-the-counter COVID-19 test at an out-of-network pharmacy or regular checkout lane, you can submit your receipt for reimbursement of up to $12 per test. Download the Prescription Drug Reimbursement form or submit your claim online through your Express Scripts account. After you log in, select Claims & Balances from the Prescriptions menu. Then, select the Prescription claims & history tab and click Request Reimbursement.
If you have questions about reimbursement of at-home tests, contact Express Scripts at 855.612.3128.
In response to the COVID-19 pandemic, Blue Cross is expanding reimbursement for all services delivered through telehealth that meet the coverage criteria in the policy. The expansion supports the diagnosis and treatment of COVID-19 as well as minimizes unnecessary exposure to individuals needing medical care for other conditions.
The expansion of telehealth services will continue to be allowed until further notice. Ongoing coverage will be continually assessed during the pandemic. Telehealth delivered via non-HIPAA-compliant technologies will remain noncovered.
Services delivered over the phone to existing patients will be covered. Providers offering these services must already be credentialed in the BlueCross system.
Telehealth services will be covered at the same benefit level as office visits. This means the visit is subject to copayments, deductibles and coinsurance. The benefit includes telehealth visits as a new patient or as a current patient with providers already credentialed by BlueCross to offer telehealth services.
Members are encouraged to call their doctor and ask for a virtual visit. These virtual visits must be medically necessary and meet qualifying criteria.
For the latest information, visit bcbs.sc/covid-19.
MUSC Health Virtual Care
MUSC Health Virtual Care is another telehealth option available at no cost to State Health Plan members, including Medicare primary members. Members ages 18 and older can create an account. Visits for dependent children younger than age 18 must be completed by a parent. You do not need to be a South Carolina resident; however, you must be in the state at the time of the visit. To start a visit:
- Go to www.MUSChealth.org/virtual-care.
- Click Get Care Now, then Create Account.
- Select State Health Plan, then Continue.
Flexible spending accounts
COVID-19 Relief Bill
On December 27, 2020, President Trump signed the COVID-19 Relief Bill, which allows for changes to flexible spending accounts. Below is a summary of the applicable provisions of the bill.
- Increases the MSA and Limited-use MSA carryover for 2020 and 2021 to the full unused amount.
- Extends the DCSA grace period for 2020 and 2021 to December 31 of each following year.
View the COVID-19 summary for FSAs in 2021 document for more details about the changes.
Use PEBA's online resources to submit transactions
We encourage you to use PEBA’s online resources to submit your transactions. Doing so will ensure your transactions are processed in a timely manner. If you submit transactions using paper forms, processing time will be delayed as we continue to deal with the effects of the pandemic.
MyBenefits is the fastest, most convenient way for subscribers covered by PEBA-administered insurance programs to manage their benefits. You can use My Benefits to:
- Make changes to benefits due to birth, marriage, divorce or adoption.
- Complete new hire enrollment elections after your employer initiates the process.
- Upload any required documentation.
- Update beneficiary information for Basic Life and Optional Life insurance.
- Change your address and contact information.
Member Access is the online resource that allows you to view and update the personal information on file for your retirement account.
You can use Member Access to:
- Update active member beneficiary information.
- Apply for service retirement.
- Apply for a refund.
- Change your address and contact information.
- Create benefit estimates.
- Submit service purchase requests.
Retired members can use Member Access to:
- Update contact information;
- Change their tax withholdings;
- View and print a 1099-R form;
- View and print a benefit verification letter;
- View their current payment method and history;
- Change their payment method from paper check to direct deposit; and
- Modify an existing direct deposit account or add an additional direct deposit account.