2021 Insurance Summary - PDF document

1 2021 Insurance Summary 2021 Insurance Su
2021 Insurance Summary 2021 Insurance Summary South Carolina Public Employee Bene�t Authority Serving those who serve South Carolina l, tiene a su disposición servicios gratuitos de asistencia lingüística. Llame al 1.888.260.9430 Serving those wh

2 o serve South Carolina 202 Arbor Lake Dr
o serve South Carolina 202 Arbor Lake DriveColumbia, SC 29223803.737.6800 | 888.260.9430www.peba.sc.gov New hire worksheetChoose your health plan. (Page 2) Consider opening a Medical Spending Account. Consider opening a Health Savings Account Coverage

3 level Choose your dental plan. (
level Choose your dental plan. (Page 4) Your next opportunity to add or drop dental plan year. Basic DentalCoverage level Choose your vision coverage. (Page 6) Choose your additional life insurance coverage. (Page 7) Optional Life

4
Choose your additional long term disability coverage. (Page 8) Choose your MoneyPlus elections. (Page 9)Standard Plan members Savings Plan members

5
A All members $ 2021 Insurance Summary27 Clear form Open enrollment worksheet Choose your health plan. (Page 2) Consider opening a Medical Spen

6 ding Account. Consider opening a Heal
ding Account. Consider opening a Health Savings Account and Limited-use Medical Spending Account. Coverage level Choose your vision coverage. (Page 6) Choose your additional life insurance coverage. (Page 7) Optional Life

7
Choose your additional long term disability coverage. (Page 8) Choose your MoneyPlus elections. (Page 9)Standard Plan members Savings Plan members

8 A
A All members $ 2021 Insurance Summary26 Clear form 25 These companies provide services on behalf of the South Carolina Public lan lina dental nt s a product al health Program um

9 ciety tum ependent Health l health vice
ciety tum ependent Health l health vices. s Standard he • • • • • • r nal PEBA Privacy (phone), . You can �le lp �ling a ent ally t or by mail or INSURANCE BENEFITS GUIDE

10 24 Your employer will ini
24 Your employer will initiate the enrollment process. You will need to provide a valid email address to your employer, then make your elections online by following the able steps to enroll for 2021. View eligibility information, coverage details and limitations

11 on Pages 1-11. 23 Helpful terms insuran
on Pages 1-11. 23 Helpful terms insurance plan. health plan. The maximum amount you may 22 Avoid costs by getting the green light for your care.Medical services at 800.925.9724 • • An outpatient service that results in a hospital • • • Sc

12 lerotherapy (vein surgery). •

lerotherapy (vein surgery). • • • • • An organ transplant. • PregnancyEmergencies800.925.9724Radiology services866.500.7664. • CT scan. • • MRA. • To preauthorize your behavioral services, call Companion &#

13 149; • • Partial hospita
149; • • Partial hospitalization care. • Outpatient electroconvulsive therapy. • Repetitive transcranial magnetic therapy. • • Psychological/neuropsychological testing. 21 a breast pump by enrolling in the maternity management Sign u

14 p for mobile messaging. 1. Call 844.28
p for mobile messaging. 1. Call 844.284.5417 Text Data rates may apply. 08:15 20 .Preventive screening Have your adult well visit after your Flu vaccine This bene�t aims to promote good health and prevention Colorectal cancer screeningCervical cancer screenin

15 g No-Pay Copay • • •
g No-Pay Copay • • • 19 How to get the most out of your bene�ts We encourage you to take .Services not included as part of an adult well visit . Other Important note about well visits Adult well visits and the Savings Plan Step1 Ste

16 p2Step3Step4Step5 Step1 Step2 Step3Step4
p2Step3Step4Step5 Step1 Step2 Step3Step4Step5 Step1 Step2 Step3 Step4Step5 Step1Step2 Step3 Step4 Step5 Step1Step2Step3 Step4 Step5 18 Adult well visits and the Standard Plan.Who is eligible? Frequency of visits Can you get a well visit in 2021 if you’re younger than ag

17 e 50? Step1Step2Step3Step4Step5 Did you
e 50? Step1Step2Step3Step4Step5 Did you have a well You can take advantage of this bene�t in 2021 at an eligible network provider. If you have not met your deductible, you copayment plus the remaining allowed amount for the visit. If you have met your deductibl

18 e, you copayment coinsurance YesYour n
e, you copayment coinsurance YesYour next opportunity for a covered well visit at an eligible network provider will be 2023. If you have a well visit in 2021, of the State Your next opportunity for a covered well visit at an eligible network provider will be 2022. If you ha

19 ve a well visit in 2021, of the State 1
ve a well visit in 2021, of the State 17 Save money and get the care you need. Primary care physicianTelehealthEmergency room Your primary care physician, or regular doctor, is the best option for medical care, such as: • • • Cold and �u symp

20 toms, including fever, • Migrain
toms, including fever, • Migraines. • • Pinkeye. • Rashes, insect bites, sunburn and • Seasonal allergies. • Sinus or respiratory infections. • • plus the remaining allowed amount until you meet your deductible. Then,

21 you pay the copayment plus your coinsur
you pay the copayment plus your coinsurance. you’re traveling or you feel too sick to drive, use a video visit for non-emergency health issues, such as: • • Pinkeye. • • Seasonal allergies. • • plus the remaining allowed amount

22 until you meet your deductible. Then, y
until you meet your deductible. Then, you pay the copayment plus your coinsurance. This service is available at no cost for all State Health Plan members, Go to the ER or call 911 for very serious or life-threatening conditions, such as: • • • Loss of

23 consciousness or sudden • Major
consciousness or sudden • Major injuries, such as broken bones or • Severe allergic reactions. • Signs of a heart attack, such as chest • Signs of stroke, such as numbness, plus the remaining allowed amount until you meet your deductible. Then,

24 you pay the copayment plus your coinsura
you pay the copayment plus your coinsurance. visits, but will pay the full allowed 16 Behavioral health visits through Blue CareOnDemand 1 Health coaching Naturally Slim ®. Patient-centered medical homes PCMH near you. Quit For Life . Rally ® Resources for a bette

25 r you 1 Savings Plan members do not pay
r you 1 Savings Plan members do not pay copayments for any visits, but will pay the full allowed amount until meeting their deductible. 15 Don't pay more than you should.What’s an EOB? • • • • The total amount you may owe the provider (does no

26 t Date of ServiceJun 8, 2021Total CostT
t Date of ServiceJun 8, 2021Total CostTotal Covered StatusYou PayPROCESSED$0 JOHN QJan 1, 1975PatientDate of Birth StateHealthPlanP.O.Box100605Columbia,SC29260EXPLANATIONOFTHISISNOTAIfyouhaveaquestionaboutyourclaim,pleasecallCustomerServiceatorlocallyat803-736-1576Monday-Frid

27 ay8:00a.m.-6:00p.m.Page1of4STATEHEALTHPL
ay8:00a.m.-6:00p.m.Page1of4STATEHEALTHPLANMay22,2017 ZCS12345678Todate,youhavesatisfiedofthedeductibleforthebenefitperiodthatbegan.Thisclaimcontributedtowardyourout-of-pocketmaximum.Youhavesatisfiedoftheout-of-pocketmaximumforthisbenefitperiod.Wepaidatotalofforthispersonthisbe

28 nefitperiod.0001of0003SUMMARY INFORMATIO
nefitperiod.0001of0003SUMMARY INFORMATIONTOTAL AMOUNTWE PAID:TOTAL CHARGEFOR YOUR CLAIM:WHAT YOU OWEDETAIL INFORMATION 1 2 HomeID Card Benets Find Care My ProleMenu Claim DetailBack LTE View EOB 2 1 Go green! 1. Select the 3. Select . 4. 14 venient place for m

29 anaging your Access an electronic versi
anaging your Access an electronic version of your card or order a search and compare results side by side. You can even view feedback from other members about a speci�c Get started by signing up today. 1. Search My Health Toolkit in your app store. . You can als

30 o visit www.StateSC.SouthCarolinaBlues.c
o visit www.StateSC.SouthCarolinaBlues.com 3. 4. 5. 8. 13 South Carolina • • • • Express Scripts • • • • EyeMed • • • • ASIFlexFlexible spending accounts • • • &