South Carolina Health Insurance

South Carolina (SC)

Individual Health Insurance Regulations

Medical insurance is an essential aspect of an individual's life. As a head of the family, your main priority should be safeguarding your family against unpredicted events of illness and injury. A suitable health coverage requires a detailed assessment of your family's healthcare needs and your finances. If you reside in South Carolina, you can choose from various product. The South Carolina Department of Insurance supervises the legislature under which the South Carolina health insurers can sell private medical insurance to individuals and families.

Individual medical 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 policies. An elimination rider is an amendment to the insurance policy which may temporarily or permanently eliminate coverage for a specific medical condition. The state does not require that individual carriers give credit for prior coverage unless the new member is HIPAA eligible.

Search for plans and the costs associated with them using the search box above. We provide individual, family, Medicare supplemental, group and student health plan quotes for you to compare on all states and zip codes. Remember that having coverage leads to a healthier lifestyle as you are able to get regular doctor checkups and therefore a low-cost premium.

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 coverage 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 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. To qualify, you must have been continuously covered under the group policy for six months and termination of your prior group plan must have occurred for a reason other than nonpayment of your required contribution. In addition, you must not be eligible for Federal COBRA continuation coverage, similar group coverage or Medicare benefits. 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 medical insurance is available through the state high-risk health pool.