Author Archives: jtdickerson

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:

Graham – Cassidy Health Reform Bill Update.

21 Sep , 2017,
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Currently, the United States Senate is considering a Health Care Reform Bill devised by South Carolina Senator Lindsay Graham (R-SC), Bill Cassidy (R-LA), Dean Heller (R-NV), Ron Johnson (R-WI) and former U.S. Senator Rick Santorum (R-PA).

Kaiser Family Foundation has a very good summary of the bill available by CLICKING HERE or at the link below:



There are a number of measures for market stabilization for 2018 – 2020, that could be very helpful. However, we have reviewed other elements of the bill that could have severe negative consequences for South Carolina residents, which we will outline below. It is important to keep in mind that the U.S. Senate is attempting to pass this bill via simple majority, which is only possible until September 30, 2017.

Positive parts of the bill include premium ratio flexibility and near term market stabilization funds.

HOWEVER, we have noticed a few “lesser talked about” points that could have SEVERE consequences for South Carolina residents:


Something to point out that will likely hurt many older and lower income SC residents:

Text of the bill:

For 2018-2019, ACA premium tax credit formula and eligibility standards are unchanged, except:

– For end of year reconciliation of advance credits, the cap on repayment of excess advance payments does not apply.

Let’s look at someone age 63, who worked hard their entire life, saved for retirement, and retired at age 63, but still works part time to help pay the bills and get out of the house. I see these folks every day at the grocery store, etc.

Someone age 63 working as a part time cashier making $15k/year, currently gets an $817/mo. tax credit to help afford health insurance (remember, they’re working part time, so employer doesn’t offer a group plan to them). Lets say that person gets laid off of the job in September and cannot find new employment. NOW, due to circumstances beyond that persons control, they fall below the tax credit eligibility threshold for the year (currently ~$11,880) so must pay the full premium for the remaining months ($785/mo for the cheapest bronze plan – $841/mo for cheapest Silver plan in Charleston County SC) AND repay the tax credit they were previously receiving – an extra $7,353 owed immediately to the IRS when they file taxes the following year, due to NO fault of their own.

Currently, the ACA provides clawback protections that limit the repayment amount to something reasonable in these situations.

Some may say “but health insurance was cheaper be fore ACA/Obamacare”, keep in mind, prior to the ACA we had 5:1 age banding – most people age 60 – 65 were paying ~$1200/month for a policy IF they could purchase one at all due to pre-existing condition limitations. And if they had a Pre-Existing condition, the South Carolina High Risk pool is EVEN MORE EXPENSIVE – to the tune of $1900 – $2400/month at age 60-65. Don’t believe me? You can view South Carolina High Risk pool rates by CLICKING HERE.

The ACA/Obamacare certainly isn’t perfect, but we would be better off FIXING ACA issues rather than passing bad legislation like this……



SChealthconnector in the Post and Courier today!

2 Aug , 2017,
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Great article by Lauren Sausser of the Charleston Post & Courier today! CLICK HERE to read the article. Spoiler:

If Congress fails to extend the discounts which significantly lower the amount of money Obamacare customers spend on their health care, Affordable Care Act premiums in South Carolina may jump by more than 33 percent next year, new federal data shows.


Link: http://www.postandcourier.com/features/your_health/bluecross-blueshield-of-south-carolina-proposes-dramatic-rate-increase-for/article_e29a6ffa-779e-11e7-89c6-eb4b03a2fa46.html

Senate fails to pass “Skinny” ACA Repeal in early morning vote.

28 Jul , 2017,
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As reported by The Hill this morning, we have learned that a late Thursday night / early Friday morning vote in the Senate to pass a “Skinny” ACA repeal bill has failed, by a vote of 49-51. Multiple sources are reporting this as a final blow to GOP efforts to repeal the Affordable Care Act. We hope Congress will now work to make changes needed to sustain the individual health insurance markets for South Carolina (and all other states, too!). Stay tuned to www.SChealthconnector.org for more breaking Health Insurance News!

BlueCross BlueShield release framework for market stability

24 May , 2017,
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As reported by multiple news sources, the BlueCross BlueShield Association recently released a framework for market stability. This press release was in response to the White House seeking a 90 day delay in the House vs. Price lawsuit. The House vs. Price lawsuit appears to be a central issue for insurers planning to participate in the Health Insurance Marketplace for 2018, as this lawsuit may determine the fate of $7 billion in Federal funding for Cost Sharing Reductions (CSRs) – money used to reduce co-pays, deductibles and out-of-pocket amounts for Americans that fall within certain income parameters. As insurance carriers scramble to file rates for 2018, the availability of CSR funding may be a linchpin for actuaries responsible for determining how much insurers will charge for coverage, or whether some insurers will participate at all in the individual health insurance marketplaces. Below are the key points released by the BlueCross Blueshield Association:

-Continued protections for people with pre-existing medical conditions and sustained federal funding to offset the cost of care for the sickest patients.

-More leeway for states to experiment with health insurance benefits, with a basic floor of federal standards.

-Preserving ACA consumer safeguards including no lifetime caps on benefits, no higher premium for women based on gender, and a requirement that insurers spend a minimum of 80 cents of every premium dollar on medical care.

-Penalties such as waiting periods for people who fail to maintain their coverage. Republicans want to repeal the Obama-era tax penalties on uninsured people deemed able to afford coverage.

-Significant federal funding to subsidize premiums and out-of-pocket costs.

BlueEssentials Member Claims Filing Error by Carolinas HealthCare System

6 Apr , 2017,
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We just received an update from Blue Cross Blue Shield of South Carolina pertaining to a claims issue affecting members who have received treatment at a Carolinas Health Care system provider. As you may recall from our previous blog entry, Carolinas Health Care (CHC) providers were added to the BlueEssentials network earlier this year. Thankfully, it appears that both parties are working diligently to correct the problem!

Scroll down for details!

Claims have been denied in error for BlueEssentials members who received services from a Carolinas HealthCare System (CHS) provider in 2017. These members may have received an Explanation of Benefits (EOB) and/or a bill from CHS showing that a claim or multiple claims were denied for services received from an out-of-network provider. The claim(s) in question were denied because of a claim filing error.

We are working diligently to ensure the claim(s) will be refiled by CHS and processed correctly. Approximately 900 subscribers have been impacted and will receive a letter from us within the next week explaining the circumstances.

If you speak with clients affected by this issue, please encourage them to remain patient as we work with CHS to resolve it as quickly as possible. No action is needed on the part of agents or members. Incorrect bills from CHS and incorrect EOBs from BlueCross BlueShield of South Carolina should be disregarded. If a member received a bill from CHS and has already paid it or has questions about it, the member should call the phone number on the bill.

As a reminder, the 2017 BlueEssentials network includes numerous providers throughout South Carolina, as well as more than 1,600 CHS physicians at more than 300 CHS practice locations in Chesterfield, Lancaster and York counties in South Carolina, and in Anson, Cleveland, Columbus, Gaston, Mecklenburg, Polk, Richmond, Robeson, Rutherford, Scotland and Union counties in North Carolina.


SChealthconnector recognized as Top Health Insurance Agent!

10 Jan , 2017,
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As your #1 South Carolina Obamacare Agent, we are pleased to announce that we recently received the honor of being a member of the Marketplace Circle of Champions! As one of the top South Carolina health insurance brokers, we are proud to be honored in this manner!

Check out the press release below!

If you need help getting enrolled during the 2017 Open Enrollment, just give us a call at 843-882-7062 to schedule an appointment! We are always happy to help!

Check out the press release by clicking here!



Blue Cross Blue Shield SC premium payment extension!

29 Dec , 2016,
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Great News!

Premium Payment Deadline Extended to Jan. 13
Blue Cross Blue Shield of South Carolina Members with individual Affordable Care Act (ACA) plans with effective dates of Jan. 1, 2017, have until midnight on Friday, Jan. 13, to pay their first month’s premium. Although the payment deadline is extended, members must pay before they can use their benefits.