As we mentioned previously, via an announcement from Blue Cross Blue Shield of South Carolina, Roper St. Francis Hospital system of Charleston was expected to be in the Bluechoice South Carolina marketplace network for 2015.
As predicted, Bluechoice just publicly announced this network addition via email. Text below:
Great news! Starting January 1, 2015, Blue Option individual members will have access to the Roper St. Francis network. This includes hospitals, diagnostic centers, urgent care centers and doctors in the Lowcountry. We have once again expanded our Health Insurance Marketplace (HIM) network throughout the state. As a reminder, Spartanburg Regional Hospital joined the network earlier this year.
If you have any questions, please contact us today!
CLICK HERE to view South Carolina marketplace plans and rates,
Breaking News: SC DOI releases 2015 South Carolina ACA marketplace rates!
The SC Department of Insurance on Friday, October 17, 2014 released sample rates for health insurance plans available on the Health Insurance Marketplace for 2015. The sample 2015 South Carolina ACA marketplace rates were for a 40 year old South Carolina resident and rates were given for 5 major metro areas in South Carolina: Charleston, Horry, Greenville, Richland, and York counties. Sample rates were also provided for both smokers and non-smokers, as the Affordable Care Act does allow insurance companies to charge more for tobacco use.
Open enrollment for 2015 SC Health Plans begins November 15, 2014!
Although we do not yet have a complete set of rates for 2015 South Carolina marketplace plans, the sample information provided by the South Carolina DOI provides a number of insights into what we may see for the 2015 Open Enrollment, beginning November 15, 2014. Let’s break it down by insurer:
Blue Cross Blue Shield of South Carolina
For 2015, it looks like BCBS marketplace rates will actually be LOWER in 2015 for certain regions, notably the coastal areas and the midlands. For example, in Charleston county, the average BCBS Silver plan price for 2015 is $294.88 versus an average 2014 price of $318.10 for a silver plan in Charleston county. This is great news, especially in light of the recent network expansion announcement by BCBS-SC. Last week, we broke a story that Roper St. Francis healthcare system will be in network for marketplace plans in 2015. CLICK HERE for details on the BCBS network expansion. In addition, we have been informed that pediatric dental coverage will not be included in BCBS marketplace plans for 2015 – similar to other marketplace carriers. Eliminating this benefit (you can still buy a standalone pediatric dental policy on the marketplace) makes the Blue companies much more competitive for 2015!
Bluechoice of South Carolina
Similar to BCBS, for 2015 it appears that Bluechoice marketplace rates will actually be LOWER in 2015 for certain regions, notable the coastal areas and the midlands. Rates in Greenville, as illustrated by the SCDOI, look to be flat to slightly lower for most plans in 2015. For example, in Richland county, the average Bluechoice Silver plan price for 2015 is $314.60 versus an average 2014 price of $336.65. This is great news, especially in light of the recent network expansion announcement by Bluechoice. Last week, we broke a story that Roper St. Francis healthcare system will be in network for Bluecross marketplace plans in 2015 – we expect the same in network treatment for Bluechoice, as the 2 insurers essentially share the same network. CLICK HERE for details on the Bluechoice network expansion. Similar to BCBS, Bluechoice will also eliminate the pediatric dental benefit for on exchange policies for 2015, according to our sources.
Consumers Choice Health Plan
Consumers Choice Health Plan was the overall winner for market share for the 2014 open enrollment in South Carolina, so we have been anxious to see what 2015 would look like. For 2014, CCHP was the low price leader in the majority (though certainly not all) South Carolina counties. In the few counties where CCHP was not the low price leader in 2014, we expect CCHP to be the low price leader for 2015, as they have made some network changes in rural areas that should significantly reduce their premiums. Most notably, Newberry county is one of the areas we expect to be affected by an overall price decrease for 2015. Overall, it appears CCHP is getting a slight increase in rates for 2015. Also, it appears CCHP will retain top position as the low price leader among silver plans for the 5 metro area samples provided. It is important to note, however, that rates are getting very close in the upstate among CCHP, Bluecross, Bluechoice and Coventry. In Greenville county for 2015, there is only a $2 difference in price between CCHP and Bluechoice! Hooray for competition!
Coventry Health Care of the Carolinas, Inc.
Although not available in all South Carolina counties for 2014, Coventry enrolled a respectable number of South Carolinians due to having access to both MUSC and Roper St. Francis for 2014 marketplace plans using a tiered network model. For 2015, we noticed a few interesting points for Coventry. First, it appears that Coventry is getting a rate increase across the board for 2015, though the amount of increase varies across plans. It appears in most areas, Bronze plans were least affected by increases. It appears Coventry’s Gold plans were hit with an increase of approximately 10% in most areas. Second, it appears Coventry is expanding their Silver plan options from 1 plan in 2014 to 2 plans in 2015. We hope to have more information about this new plan offering by next week, and will update with the latest. Finally, it appears that Coventry will be newly offering plans on the marketplace in York, Lancaster, and Newberry counties for 2015! It is currently rumored that Carolinas Medical Center will be the preferred network provider for the new marketplace product in York & Lancaster.
Time Insurance – Assurant Health
Last, but certainly not least, is Assurant Health, marketed by Time Insurance. Assurant will be a new entrant into the marketplace for 2014 in South Carolina. As the 2015 South Carolina ACA marketplace rates released by the SCDOI indicate, Assurant will be the highest priced option available on the marketplace for 2015. However, we must note, that Assurant will be the ONLY plan available with a broad, quality PPO network on the marketplace. In addition, Assurant will be the only company offering Platinum plans on the marketplace in South Carolina for 2015! Assurant will be a great option for SC residents who demand a wide PPO network (Aetna Signature network), out of network benefits and an open formulary!
If you have questions about anything mentioned above, leave a comment, call or email us!
On November 15th, 2014, South Carolina residents can visit our homepage, click “enroll now” and view 2015 South Carolina ACA marketplace rates, apply for tax credits and enroll quickly!
UPDATE: October 25, 2014 – South Carolina Department has released additional sample rate data for ages 25 and 60!
We just received word from Bluecross Blueshield of SC that Roper St Francis hospital system in Charleston county will be IN NETWORK for 2015 individual healthplans on the marketplace. We assume this will apply to Bluechoice SC as well, as this is a shared network.
Starting January 1, 2015, BlueEssentials members will have access to the Roper St. Francis network of hospitals, diagnostic centers, urgent care centers and doctors in the Lowcountry.
We will list Roper St. Francis on the 2015 BlueEssentials Hospital and Doctor Finder starting November 15. At this time, you can view the 2015 BlueEssentials network on the Shop 2015 (presently the Shop 2014 page).
Of course, you can always view current rates for Bluecross and Bluechoice South Carolina plans on our plan finder.
On Friday, October 10, 2014, the South Carolina Department of Insurance released a summary of 2015 South Carolina health insurance rate increases for each insurer in South Carolina. Overall, it appears that the average increase across all South Carolina health plans will be approximately 1%, as reported by Charleston’s Post & Courier. At the surface, it appears this is very good news for South Carolina residents fearing a big rate increase for 2015.
2015 South Carolina Health Insurance Rate Increases: A Deeper look.
Of course, the 1% overall increase doesn’t tell the entire story. Currently, the SC Department Of Insurance has not released detailed rate information, however, as your #1 South Carolina Obamacare Agent, SChealthconnector has been tracking these rate increases very closely. Using data we have collected in addition to rate filing information released by the SC DOI we would like to provide our readers with as much rate data as possible. Before we get started, it is important to note that in South Carolina, insurers can charge different amounts via county and via plan. For example, an insurer could raise a Gold plan rate in Orangeburg, while also lowering Silver plan rates in Orangeburg. Rate increases and decreases are very specific and many insurers have numerous plans in each metal category (Bronze, Silver, Gold)!
The first thing that caught our eye on the DOI rate release was the wide variation in rates with Consumers Choice Healthplan rate decrease minimum of -35.00% and rate increase maximums of 38.50%. I suspect the -35% rate DECREASES to affect South Carolina counties where Consumers Choice was renting the Medcost network for 2014. Renting provider networks is a very pricey proposition. Time/Assurant is another insurer that rents their provider network, and as we can see in the SC DOI rate information, it is reflected in rate increases of 7%-35% for Assurant. The average increase for Assurant was 21%, according to the published figures.
One bright spot of the 2015 South Carolina health insurance rate increase data are actually a couple of DECREASES! Overall, the SCDOI is reporting an average DECREASE of -2.11% for Bluechoice and -2.34% for Bluecross. We have also been told that both companies will offer family plans for 2015. For 2014, Bluecross and Bluechoice only offered individual plans, much to our dismay. I will also note that I am expecting another major announcement from Bluecross and Bluechoice shortly regarding network expansion for 2015. Unfortunately, I cannot say anything further – stay tuned, or drop me and email, call or tweet to find out more.
Regarding Coventry, the 2015 SC health insurance rate increase summary indicates an average increase of 5.3% for Coventry Health Care. The biggest news for Coventry in South Carolina was the addition of marketplace plans in a few counties that only had Coventry plans available OFF MARKETPLACE for 2014. It appears York county and Lancaster county will now have Coventry plans offered on the marketplace, along with a few others.
York county will have new health plan options on the marketplace for 2015!
Coventry was the first insurer to begin sending out rate change letters to South Carolina residents for 2015. Based on what I have seen so far, it appears that in the lowcountry, Coventry’s Gold plans are running approximately 10.81% and Coventry’s lowest price Bronze plan option appears to be running approximately 3.87% higher based on renewal data we have collected so far. Based on detailed plan information we have been able to view so far, we do not anticipate major benefits changes for 2015, though Coventry has indicated the are making changes to their most popular plans (Silver and Bronze).
If you have questions about any of this, please drop us a line, call tweet, or like us on facebook.
Over the course of the last year, we have received many inquiries from clients wanting to know when a South Carolina newborn can get insurance coverage through the health insurance marketplace. As many people may be aware, most marketplace enrollments are effective the 1st day of the month following the date of enrollment.
However, for South Carolina newborn children who need insurance coverage, a Special Enrollment Period or SEP is available that will provide coverage effective on the date of birth! This is great news for new parents worried about the hassle of getting a newly born child insured.
What is a a Special Enrollment Period? A special enrollment period is when you have a qualifying life event that allows you to enroll in coverage on or off of the marketplace, outside of open enrollment. Of course, giving birth to a child is one of the many life events that would qualify you for a Special Enrollment Period.
Below is the specific guidance, directly from CMS, that details how Special Enrollment Periods for South Carolina newborn insurance coverage work:
Per 45 CFR §155.420, Special Enrollment Periods (SEPs) constitute periods outside the initial or annual
open enrollment when a QI may enroll in a QHP and QDP or a QI can elect to change a current QHP and
QDP selection as a result of a triggering event, such as birth/adoption, relocation, death, or loss of MEC.
It is the responsibility of the FFMs to determine whether a QI meets eligibility requirements for a SEP.
The FFMs determine eligibility for SEPs, which are described by regulation at 45 CFR §155.420(d). In the
individual market FFMs, Special Enrollment Periods generally last 60 days from the triggering event, per
45 CFR §155.420(c). In SHOPs, including FF-SHOPs, Special Enrollment Periods generally last 30 days
from the triggering event, although there are two exceptions, when an enrollee loses Medicaid or CHIP
coverage and when an enrollee becomes eligible for Medicaid or CHIP coverage For the Medicaid and
CHIP exceptions the SEP is 60 days. The start date of an SEP is based on the date of the triggering event. Although certain SEPs adhere to the standard effective dates described earlier in section 1.2, there are exceptions to this rule. For example, for birth, adoption, placement for adoption, or placement in foster care, coverage is retroactive to the date of birth, adoption, placement for adoption, or placement in foster care.
South Carolina Newborn Health Insurance Coverage enrollment example:
Example : An enrollee contacts the Marketplace on 04/25/2014 to inform the Marketplace of the birth of
twins on 04/01/2014. The Marketplace does a redetermination of the enrollment group. The Marketplace sends
an 834 change transaction to the selected Qualified Health Plan adding the newborn children with a coverage effective date 04/01/2014.
Do you need help with South Carolina newborn insurance coverage?
Of course, if all of this sounds complicated, please call (843.882.7062) or email us directly. or leave a comment. We can HELP!