Author Archives: jtdickerson

Ambetter South Carolina – Additional Benefits – My Health Pays

30 Oct , 2018,
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Updated October 14, 2020

Ambetter is expanding in South Carolina for 2020! Ambetter is also IMPROVING the MY HEALTH PAYS program by increasing the maximum member reward to $500!

New for 2019!Ambetter by Absolute Total Care will be offering plans on the Federal Health Insurance Marketplace for South Carolina residents living in Charleston County.

Ambetter will offer 5 Plans in Charleston County, South Carolina: 1 Bronze, 3 Silver and 1 Gold plan for 2019.

One of the Value Added features that sets Ambetter Plans apart from other Marketplace plans in South Carolina is the “My Health Pays” value added benefit!

Ambetter South Carolina

WHAT IS “MY HEALTH PAYS Rewards”? My Health Pays is a Wellness program that rewards members for healthy behavior. The program uses a My Health Pays Visa card. Member can earn reward dollars for healthy behavior such as a Well Being Survey (worth $50), an annual Well Visit ($50) and getting a flu shot in the Fall ($25). The annual Well Visit will be at no cost to the member, provided that the member visits an in-network provider. Rewards will be loaded onto the My Health Pays Visa card upon completion of the healthy actions & members can earn up to $125 each year!

HOW DO I USE “MY HEALTH PAYS” Rewards? My Health Rewards are loaded onto the Ambetter My Health Pays Visa card & may be spent on eligible expenses. Eligible expenses include: Monthly Ambetter Premium payments, deductibles, coinsurance and copays!

CLICK HERE to get a quote on an Ambetter South Carolina Marketplace Health Plan


Introducing: Challenges and Power-Ups.
Challenges help Ambetter members set and reach certain goals at their own pace. Power-Ups are activities they can do in a shorter amount of time. As they complete Challenges and Power-Ups, rewards will keep adding up!
And they can continue to be rewarded for activities like completing an annual wellness exam and getting a flu vaccine!
Members can redeem points their way!
Ambetter members can use their points to shop for special items at the online My Health Pays Rewards Store or convert them into dollars to spend on healthcare-related costs, such as doctor copays*, deductibles and coinsurance. It’s their choice!

Beginning 1/1/2020, My Health Pays reward dollars cannot be used at Walmart.

Ambetter by Absolute Total Care (Centene) coming to Marketplace in Charleston County for 2019!

8 Oct , 2018,
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UPDATE 10/29/2018 – These plans will be marketed under the Ambetter brand and we now have 2019 rates available on our quote platform – CLICK HERE to view 2019 rates! We have finally managed to access the provider directory, and it appears that the Medical University of South Carolina (MUSC) is the only in-network hospital in Charleston County. We are currently finding 807 Primary Care Providers within 200 miles of Charleston County. Stay tuned for more details!


Big news concerning marketplace health insurance in South Carolina for 2019! As reported by the Charleston Post & Courier, Absolute Total Care (a subsidiary of Centene) will be offering plans on the health insurance marketplace in South Carolina – however, these plans will only be available in Charleston County for plan year 2019.  Currently we have very limited information on plan details, however stay tuned to this page for breaking news on 2019 Absolute Total Care South Carolina plan information.

The following are sample average rate comparisons for 2019 from the SC Department of Insurance:

25 Year Old (No Tobacco Use) Shopping on Healthcare.gov

40 Year Old (No Tobacco Use) Shopping on Healthcare.gov

60 Year Old (No Tobacco Use) Shopping on Healthcare.gov

Update – 10/12/2018 – A number of sites, including Kaiser Health NewsFierceHealthcare.com and The Wall Street Journal also reports Centene (Absolute Total Care) is expanding into the South Carolina health insurance marketplace! Although fiercehealthcare.com notes the expansion is under the Allwell brand, we are assuming this is a typo based on information provided by the SC Department of Insurance. Stay tuned for more!



Health Insurance for as Low as $0 Per Month!

3 Oct , 2018,
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Do You Qualify? Click Here to Find Out!

Many South Carolina residents may qualify for a premium as low as $0 per month in 2019 BCBS-SC Bronze 4 plan, based on the amount of tax credit, also known as the APTC or Advanced Premium Tax Credit (i.e., financial assistance toward your monthly premium) they’re eligible for. Eligibility for tax credits is based on estimated 2019 income, see below for more details!

If your annual income is below the amounts shown below, you will likely qualify for a subsidy. We can also help determine your eligibility. CLICK this link or call us at 843-882-7062 to find out if you qualify! We would love to help!

Persons in Household         Max. Annual Income
1                                  $36,420
2                                  $49,380
3                                  $62,340
4                                  $75,300
5                                  $88,260
  6                                  $101,220
Source: http://familiesusa.org/product/federal-poverty-guidelines

Bronze 4 Benefits
The BlueCross BlueShield of South Carolina Bronze 4 Plan offers these benefits for 2019:

$0 preventive screenings
$0 immunizations
$15 copay for telehealth visits
$25 copay on primary care doctor visits
$50 copay on specialist visits
$12 on tier 1 or low cost generic prescription drugs


Stay tuned for more information!

BCBS-SC Medicare Select Network Update

7 Jun , 2018,
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Palmetto Health Tuomey, located in Sumter, was recently added to the Blue Select®Network Hospital Directory. This brings up the network total to 41 hospitals, expanding access for our members. The Blue Select Network is a network of providers used for the BlueCross BlueShield of South Carolina Medicare Select supplement products. These products reduce the cost of supplemental medicare coverage by limiting members to using an exclusive network of providers.

Hospitals must be Medicare certified as well as licensed by the Department of Health and Environmental Control (DHEC) and meet all applicable state laws and regulations.

Click here to View the updated Medicare Select Network Hospital Directory.

HHS issues 2019 Notice of Benefit and Payment Parameters

11 Apr , 2018,
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On Monday, April 9, 2018, the Department of Health and Human Services issued final regulations for Plan Year 2019!

Why is this important? Every year, changes to parameters that govern health insurance issuers are updated as required by the Affordable Care Act – HHS is in charge of updating and implementing these parameters.

Below is some of the notable changes for 2019:

2019 out-of-pocket (OOP) maximums:
The 2019 OOP maximums increase to $7,900 for individual coverage and $15,800 for family coverage. These coverage limits apply to all non-grandfathered plans, regardless of size or funding type.

Marketplace regulations 
The final rule also includes a number of provisions (effective Jan. 1, 2019) intended to strengthen the Health Insurance Marketplace, including:

  • Deferring the network adequacy reviews for qualified health plan (QHP) certification to the states
  • Loosening the audit process for agents, brokers and issuers who participate in the direct enrollment process
  • Updating the risk adjustment model for insurers with high-cost enrollees
  • Modifying the requirements for Marketplaces to verify eligibility for, and enrollment in, qualifying employer-sponsored coverage
  • Not specifying 2019 standardized plan options (known as simple choice plans)
  • Updating special enrollment period (SEP) rules for coverage effective dates specific to SEPs that allow adding or changing dependents
  • Adding a new SEP for pregnant women who were receiving coverage through the Children’s Health Insurance Program (CHIP) but lose that access
  • Allowing Marketplaces to determine individual affordability exemptions based on affordability of the lowest-cost metal level plan available
  • Allowing enrollees to request same-day termination of coverage
  • Removing several Small Business Health Options Program (SHOP) requirements for online enrollment
  • Other market reforms
    In addition to Marketplace updates, the final rules also modify other ACA provisions, including:

Streamlining the rate review process for states and issuers, including when rates are posted by the states, increasing the threshold at which rate increases require review from 10% to 15%, and establishing a process for states to request a higher threshold
Modifying the Medical Loss Ratio (MLR) rules, including simplifying quality improvement activity reporting requirements for issuers and establishing a process for states to use to request adjustments to the 80% MLR standard in the individual market

BlueChoice Blue Option South Carolina 2018 Pharmacy Benefits!

28 Nov , 2017,
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Blue Option plans by BlueChoice Healthplan provide members with a wide array of plans with multiple pharmacy options. Most Blue Option members will NOT have a separate pharmacy deductible for 2018. BlueChoice is building members’ pharmacy charges into the deductible or applying them to the maximum out-of-pocket expenses, depending on the plan selection. One plan (Silver 4002) does include a separate pharmacy deductible for 2018!

Pharmacy benefits – Tiers
For 2018 Blue Option members will continue to have six-tier copayment/coinsurance levels for their prescription drugs. This approach provides more flexibility in managing high-cost and specialty medications, regardless of whether a drug is generic or a brand. BlueChoice has taken steps to ensure members have all classes of drugs covered and spread across six tiers for better affordability. You can review the BlueChoice  Covered Drug List online to see on which tier a specific drug is located.


Have Questions? Call us today at 843-882-7062 for more information about Blue Option plans available outside the marketplace!


2018 Adjustments to age ratings

20 Oct , 2017,
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2018 Age-Rating Adjustment for Individual & Group Health Insurance Plans
For 2018 BlueEssentials and Business BlueEssentials plans, Blue Cross Blue Shield of South Carolina will be implementing an age-rating adjustment as a result of the 2018 Notice of Benefit and Payment Parameters Final Rule, which was passed by the Centers for Medicare and Medicaid Services (CMS).

What’s is Changing for 2018?

Prior to this ruling, CMS required a single age band be applied to the rate for members from birth through age 20. Under the 2018 CMS final rule, beginning on Jan. 1, 2018:
One age-rating band will apply to members from birth through age 14.

Separate, one-year age bands will apply to members ages 15 through 20.

The purpose of this change is to provide a more gradual transition from a child to an adult age rating.

Questions? Feel free to call us directly at 843-882-7062. Or CLICK HERE to shop and enroll in health plans!


2018 Open Enrollment for Employers: Checklist

28 Sep , 2017,
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Currently, the Affordable Care Act is still the law of the land (pending action this week by Congress, of course). As such, we wanted to pass along this handy checklist for employers provided by our carrier partner, CIGNA. This is a very informative checklist of things ALL employer sponsored health plans must abide by in order to remain a Qualified Health Plan under the Affordable Care Act.


Link to Checklist: open-enrollment-checklist-2018



Changes to ACA: Employers affordability contributions for 2018.

27 Sep , 2017,
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For 2018, the IRS announced a small adjustment to affordability parameters for employer sponsored plans. This may make it easier for SC residents to qualify for a tax credit to help pay for health insurance through the marketplace!

Have questions? Reach out to us anytime!

Earlier this year, the Internal Revenue Service (IRS) issued Revenue Procedure 2017-36 to change the contribution percentages in 2018 that determine the affordability of employer-sponsored minimum essential coverage for plans under the Affordable Care Act (ACA). For 2018, the numbers indicate a slight decrease from 2017 requirements.
For plan years beginning in 2018, employer-sponsored coverage will be considered affordable if the employee’s required contribution for self-only coverage does not exceed:

  • 9.56 percent of the employee’s household income for the year — for the purpose of both the employer shared responsibility penalty and premium tax credit eligibility rules (a decrease from 9.69 percent in 2017)
  • 8.05 percent of the employee’s household income for the year — for the purpose of exemption from the individual mandate (a decrease from 8.16 percent in 2017)

These updated percentages are effective for taxable years and plan years beginning after Dec. 31, 2017.

Additional information can be found at www.IRS.gov

BlueCross BlueShield SC: Vaccine network update

26 Sep , 2017,
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Seasonal Flu Vaccines: ACA Plan Holders
BlueEssentialsSM and Business BlueEssentialsSMmembers can get seasonal flu vaccines covered at a $0 copay. This flu season, the vaccine network for ACA members is limited to CVS pharmacies only; therefore, the $0 copay is only available at CVS under their pharmacy benefits. Members may be required to pay administration fees if they receive a vaccine at any other network pharmacy. [CVS is a division of CVS Health, an independent company that provides pharmacy benefit services on behalf of our health plans.] Members can receive the flu vaccine at their primary care physician (PCP) office at $0 copay under the medical benefit, if the visit is solely for the purpose of receiving the vaccine.

The vaccines covered under the program this year are:

  • Injectable Seasonal Influenza Vaccine
  • Injectable Seasonal Influenza Vaccine-High Dose (Fluzone)

Non-Seasonal Vaccines: ACA Plan Holders
In addition to seasonal flu vaccines, ACA members also can use the vaccine network (CVS-only) to receive some non-seasonal, preventive care vaccines at a $0 copay under their pharmacy benefit, and these vaccines also may be available at the member’s PCP office: