Health Insurance

By selecting BlueCross BlueShield of South Carolina, you can feel confident about your health coverage. You now have access to the best quality of care from the largest provider network in the nation. Evening Post Industries gives you two options of health coverage to choose from.
Plan Type: Preferred Provider Organization (PPO), Health Incentive Plan(HIP)
Group Number: 71-85251-00 through 83
Phone: 800.922.1185
Web: southcarolinablues.com
Eligibility: Active employees working 30 or more hours per week
Effective Date: 1st of the month after 30 days of continuous employment
HIP

A health plan with a higher deductible than a traditional insurance plan. The monthly premium is usually lower, but you pay more health care costs yourself before the insurance company starts to pay its share (your deductible). This plan is combined with a Health Reimbursement Account (HRA) to allow you to pay for qualified out-of-pocket medical expenses on a pre-tax basis.

The HIP is a high deductible option with a coinsurance for medical services, only co-pays with Generic Drugs. Employees and their covered spouses can earn up to $600 each by completing two tasks: an annual physical and the Rally Survey

PPO

A health plan that contracts with medical providers, such as hospitals and doctors to create a network of participating providers. You pay less if you use providers that belong to the plan’s network. You can use doctors, hospitals, and providers outside of the network for an additional cost. This plan has copays for office visits and prescription drugs.

My Health Toolkit

My Health Toolkit is the one-stop shop for answers about your health care — customized just for you! It has everything you need to understand your health plan coverage and manage your benefits. All BlueCross members, age 16 and older, including spouses and dependents, should sign up for an account. It’s easy to register and it’s free.

HIP Plan

BenefitsIn NetworkOut Of Network
Deductible (Embedded)$1,500 Individual $3,000 per Family$2,000 Individual $6,000 per Family
Out of Pocket (Includes Deductible and Coinsurance)$3,500 Individual / $7,000 Family$7,000 Individual / $12,000 Family
Co-Insurance70% paid by insurance60% paid by insurance
Physician Services Inpatient/Outpatient/Office, allergy injections, diagnostic lab, x-ray, anesthesia services, radiology, pathology, obstetrical delivery, initial new born pediatric exam, all other outpatient/office servicesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Wellness Benefits – based on Health Care Reform Guidelines refer to www.healthcare.gov Mammograms - must see a provider in Mammography Network and follow specified age guidelines Pap Smear/Prostate Screening100%N/A
Sustained Health Services ($500 annual maximum)100%N/A
Inpatient Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Skilled Nursing Facility Charges (60 days per year)Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
Outpatient Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Second Surgical OpinionDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Chiropractic Benefits (20 visit maximum)Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
Physical/Occupational Therapy/Speech Therapy (20 visits maximum each)Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
Other Services Home Healthcare Services Hospice ServicesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
AmbulanceDeductible then 70% paid by insuranceDeductible, 70% paid by insurance
Emergency Room Facility Charges*Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
Emergency Room Professional Charges*Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
MENTAL HEALTH AND SUBSTANCE ABUSE BENEFITS
Inpatient Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Inpatient Professional ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Outpatient Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Outpatient Professional ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Emergency Room Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Emergency Room Professional ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Physician Services in the OfficeDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
PHARMACY BENEFITS
Prescriptions Mandatory Generic (Includes diabetic supplies and oral contraceptives)Prescription Drug Maximum Out of Pocket $2,700 Per Member60% Coverage After the Following Copays
Retail (31 day supply) Generic$10 Copay$10 Copay
Retail (31 day supply) Preferred Brand80% paid by EPI, Max of $100 paid by EE20% Coinsurance, Max of $100
Retail (31 day supply) Non Preferred Brand80% paid by EPI, Max of $100 paid by EE20% Coinsurance, Max of $100
Mail Order (90 day supply) Generic$20 Copay$20 Copay
Mail Order (90 day supply) Preferred80% paid by EPI, Max of $250 paid by EE20% Coinsurance, Max of $250
Mail Order (90 day supply) Non Preferred Brand80% paid by EPI, Max of $250 paid by EE20% Coinsurance, Max of $250
Specialty Drug 1-800-237-2767 for inquiries regarding this benefitCaremark Specialty Pharmacy Only 70% paid by insurance, Max of $250 paid by EECaremark Specialty Pharmacy Only 70% paid by insurance, Max of $250 paid by EE
Annual / Lifetime MaximumUnlimitedUnlimited

PPO Plan

BenefitsIn NetworkOut Of Network
Deductible (Embedded)$600 Individual Limited to 3 per Family$600 Individual Limited to 3 per Family
Out of Pocket (Includes Deductible, Copays and Coinsurance)$2,500 Individual $5,500 Family$2,500 Individual $5,500 Family
Co-Insurance70% paid by insurance60% paid by insurance
Physician Services in the Office excluding obstetrical delivery, dialysis treatment and second surgical opinion$20 Copay – PCP $40 Copay - SpecialistDeductible, 60% paid by insurance
Other Physician Services Inpatient/Outpatient Hospital, allergy injections, diagnostic lab, x-ray, anesthesia services, radiology, pathology, obstetrical delivery, initial new born pediatric exam, all other outpatient/office servicesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Wellness Benefits – based on Health Care Reform Guidelines refer to www.healthcare.gov Mammograms - must see a provider in Mammography Network and follow specified age guidelines Pap Smear/Prostate Screening100% paid by insuranceN/A
Sustained Health Services ($500 annual maximum100% paid by insuranceN/A
Inpatient Facility Charges$100 Copay then 70% paid by insurance$200 Copay, 60% paid by insurance
Skilled Nursing Facility Charges (60 days per year)$100 Copay then 70% paid by insurance$200 Copay, 60% paid by insurance
Outpatient Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Second Surgical OpinionDeductible then 100% paid by insuranceDeductible, 100%
Chiropractic Benefits (20 visit maximum)Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
Physical/Occupational Therapy/Speech Therapy (20 visits maximum each)Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
Other Services Home Healthcare Services Hospice ServicesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
AmbulanceDeductible then 70% paid by insuranceDeductible, 70%
Emergency Room Facility Charges*$175 Copay then 70% paid by insurance$175 Copay, 70%
Emergency Room Professional Charges*Deductible then 70% paid by insuranceDeductible, 60% paid by insurance
MENTAL HEALTH AND SUBSTANCE ABUSE BENEFITS
Inpatient Facility Charges$100 Copay then 70% paid by insurance$200 Copay, 60% paid by insurance
Inpatient Professional ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Outpatient Facility ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Outpatient Professional ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Emergency Room Facility Charges$175 Copay then 70% paid by insurance$175 Copay, 70%
Emergency Room Professional ChargesDeductible then 70% paid by insuranceDeductible, 60% paid by insurance
Physician Services in the Office$20 PCP/$40 SpecialistDeductible, 60% paid by insurance
PHARMACY BENEFITS
Prescriptions Mandatory Generic (Includes diabetic supplies and oral contraceptives)Prescription Drug Maximum Out of Pocket $3,000 Per Member60% Coverage after the Following Copays
Retail (31 day supply) Generic$15 Copay$15 Copay
Retail (31 day supply) Preferred Brand$35 Copay$35 Copay
Retail (31 day supply) Non Preferred Brand$55 Copay$55 Copay
Mail Order (90 day supply) Generic$30 Copay$30 Copay
Mail Order (90 day supply) Preferred$70 Copay$70 Copay
Mail Order (90 day supply) Non Preferred Brand$110 Copay$110 Copay
Specialty Drug 1-800-237-2767 for inquiries regarding this benefitCaremark Specialty Pharmacy Only $55 CopayCaremark Specialty Pharmacy Only $55 Copay
Annual / Lifetime MaximumUnlimitedUnlimited
 

QuestionAnswer
Forget your ID card? Need to order replacement Member ID card? Need to check the status of a claim or download claim forms? Need to print an Explanation of Benefits (EOB)? Haven’t received your ID card yet?No problem, everything you need to know about your health plan coverage and eligibility can be found online through My Health Toolkit. To log in to My Health Toolkit, https://www.southcarolinablues.com/web/public/sc/
How long does it take for me to get my insurance card(s) once my coverage is active?You should receive your Medical card(s) within 7-10 business days.
On the go?The My Health Toolkit® mobile website offers Members features designed for smaller smartphone screens. Unlike some mobile tools, as a BlueCross Member, you do not need to download an app. When you want to access the mobile site, simply navigate to www.SouthCarolinaBlues.com on your smartphone.
How do I know if my physician participates in one of the BlueCross networks?The BlueCross networks offer the best geographic access to Providers and Hospitals of any Preferred Provider Organization (PPO) in the nation. This national coverage is available through the BlueCard® Program in which all BlueCross BlueShield Plans participate. For more Provider information visit the Blue Cross website at https://www.southcarolinablues.com/web/public/sc/
How do I contact BlueCross if I have questions?How to get help with claims or Benefit questiFrom outside South Carolina, dial 1-800-845How to get help with claims or Benefit questions: From Greenville, South Carolina, dial 297-4665. From anywhere else in South Carolina, dial 1-800-922-1185. From outside South Carolina, dial 1-800-845-6067. How to get help on Preauthorization: For Magnetic Resonance Imaging (MRIs), Magnetic Resonance Angiography (MRAs), Computerized Axial Tomography (CAT) scans or Positron Emission Tomography (PET) scans in an outpatient facility: 1-866-500-7664. For all other medical care: 736-5990 from the Columbia, South Carolina area 1-800-327-3238 from all other South Carolina locations 1-800-334-7287 from outside South Carolina Please do not call these numbers for claims inquiries. Please note that Preauthorization is required for the procedures on the Schedule of Benefits that have a pre-authorization note. BlueCard outside the United States: You may also call 1-800-810-BLUE (2583) when traveling outside the United States for assistance with locating an international Provider, in translating foreign languages and submitting claims.
Where can I get a claim form and how do I file a claim to receive benefits?If you need a claim form, you may obtain one from the BCBS address below Blue Cross and Greenville, South Carolina 29606
How to get information on Drug coverage:Drug Coverage is handled by Caremark. Caremark is an independent company that provides pharmacy Benefits on behalf of BlueCross. For inquiries regarding the Prescription Drug Benefit, please call: 1-888-963-7290 For prior authorization on Prescription Drugs, please call: 1-800-294-5979 For inquiries regarding Specialty Drugs, please call 1-800-237-2767 For inquiries regarding the status of prior authorization on Specialty Drugs, please call: 1-800-237-2767

 

 

 

 

Download the app

 

My Health Toolkit is filled with resources that are customized to you and your health benefits.

What if you don’t know your Member ID?

No problem. After you select Register Now, select Haven’t received your membership card? Enter the subscriber’s Social Security number and your date of birth, then follow the instructions to Create Your Profile.

HOW TO FILE CLAIMS Participating Providers have agreed to file claims for healthcare services they rendered to you. However, in the event a Provider does not file a claim for such services, it is your responsibility to file the claim. If you choose to use a Non-Participating Provider, you are responsible for filing your claim. Once the claim has been processed, you will have quick access to an EOB through our website or by contacting customer service. An EOB will also be mailed to you. The EOB explains who provided the care, the kind of service or supply received, the amount billed, the Allowable Charge, the Coinsurance rate and the amount paid. It also shows Benefit Year Deductible information and the reasons for denying or reducing a claim. The only time you must pay a Participating Provider is when you have a Benefit Year Deductible, Coinsurance, Copayment or when you have services or supplies that are not Covered Expenses under your Plan of Benefits. If you need a claim form, you may obtain one from us at the address below or print a copy from the website. Or, call us at the telephone numbers listed on the previous pages and we will send you a form. After filling out the claim form, send it to the address below: Blue Cross and Blue Shield of South Carolina Piedmont Service Center Post Office Box 6000 Greenville, South Carolina 29606 Please refer to Article XI of the Plan of Benefits for more information on filing a claim.

Where do you want to go next?

Learn More

Get Insights

Enroll

 
It is important that you take steps to educate yourself on all employee benefit plan options and rewards. It is your responsibility to complete your benefits election in Ultipro, no later than 30 days from eligibility.