South Carolina Health Insurance (SC)

South Carolina (SC)
Individual Health Insurance Regulations

Learn more about South Carolina Individual Health Insurance

Individual health insurance policies in South Carolina are medically underwritten. The underwriting process provides the insurance carriers an opportunity to review both past and present medical history of the applicant. They may request medical records for verification or assume that the application is completed honestly. The insurance carrier may decide to provide coverage under the standard terms of the applied for health plan, provide modified coverage that includes limitations and/or exclusions on specific medical conditions, or completely deny coverage to the applicant. On all individual HMO plans, the state allows for a 12 month look back period and a 12 month exclusionary period maximum on pre-existing conditions. For all non-HMO individual plans, there is no limitation on the look back period, but a maximum 24 month exclusionary period on pre-existing conditions may be enforced. South Carolina also permits the use of elimination riders when writing individual health insurance policies. An elimination rider is an amendment to the health insurance policy which may temporarily or permanently eliminate coverage for a specific medical condition. The state does not require that individual health insurance carriers give credit for prior coverage unless the new member is HIPAA eligible.

South Carolina (SC)
Small Group Health Insurance Regulations

South Carolina defines a small group employer as any company with 2 to 50 employees. Pursuant to the federal Health Insurance Portability and Accountability Act of 1996, all small group health insurance must be offered on a guarantee issue basis, which provides that no group may be declined medical insurance coverage based upon the past or current health status of the group or an individual employee. For group applicants lacking prior creditable coverage, the health insurance carrier is permitted a 6 month look back and a 12 month exclusionary period for pre-existing conditions. Credit for prior coverage must be given, provided there is no more than a 63 day break in coverage. Qualified employees may be subjected to a waiting period before becoming eligible to join the employer sponsored group health plan. Waiting periods are determined by the employer and must be consistent for each employee. South Carolina provides for the medical underwriting of all small group rates. Based upon the overall health status of the group, an insurance company may charge a high-risk group a greater premium, but no more than 125% of the standard rate.

South Carolina COBRA and Continuation Coverage

Federal COBRA laws apply to any company that has 20 or more employees. Under federal COBRA, an employee may remain on the employer sponsored plan for 18 months following the termination of their group health coverage. South Carolina has a mini-COBRA regulation which applies to groups of less than 20 employees. This state regulation allows an employee to remain on the group health plan for 6 months if they were covered under the group plan as an active employee for at least 6 months. You must elect your mini-COBRA option within 60 days of the termination of your group coverage. The COBRA beneficiary is responsible for 100 percent of the month premium, plus a 2 percent administration fee. Conversions plans are available in South Carolina for some qualified beneficiaries, such as those losing group coverage through divorce from the primary insured. For persons exhausting their COBRA option, guaranteed issue individual health insurance is available through the state high-risk health pool.

Additional South Carolina Resources

• South Carolina Partners for Healthy Children (PHC)
  A state sponsored program offering health care benefits for South Carolina children whose family income is at or below 150% of the federal poverty level.
• South Carolina Health Insurance Pool
  Administered by Blue Cross and Blue Shield of South Carolina, benefits under the high risk pool are available to South Carolina residents unable to obtain health insurance from any other source.
• South Carolina Department of Health and Human Services
  The Department of Health and Human Services manages the South Carolina Medicaid Program. Their site provides much useful information and consumer friendly links.
• South Carolina Department of Health
  Working with individuals, families, institutions and health care providers the South Carolina Department of Health provides health services to residents throughout the state.

SC Medical Insurance Statistics

Total Population: 4,181,000
With Health nsurance: 3,439,000 / 82.3%
Without Health Insurance: 741,000 / 17.7%
*According to 2005 CPS Reports / U.S. Census Bureau

Note: The percentage of South Carolina residents without health insurance has increased 3.0% since 2004. This is one of the most significant increases in the number of uninsured residents nationwide.

South Carolina Department of Insurance
Phone: 803-737-6180
The South Carolina Department of Insurance regulates the insurance industry throughout the state, while offering consumer protection, advice and information.

* Please refer to our legal terms and conditions for disclaimers pertaining to the content on this page.