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  • 2018 Insurance Benefits Guide

  • See all your Missions at a glance

    Track your progress

    Earn and redeem Rally Coins

    Join challenges and go for the gold

    Introducing Rally® — an easier way to improve and maintain your health. Based on your responses to the quick Health Survey, Rally will offer personalized recommendations to help you move more, eat better and feel great.

    Use Rally on the web or download the app for the convenience of Rally on the go. The Rally Health app is available in the App Store (iOS) or on Google Play (Android).

    Rally is a product of Rally Health Inc., an independent company that offers a health management program on behalf of the State Health Plan. BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. Copyright © 2017 Rally Health, Inc. All Rights Reserved. iPhone® is a registered trademark of Apple, Inc. Android is a trademark of Google Inc.

    New users, get started by: 1. Visiting www.StateSC.SouthCarolinaBlues.com 2. Log in to your My Health Toolkit® account 3. Select Wellness, then Rally

    Already a Rally User? Search “Rally Health” to download the mobile app.

    Rally is available to you at no additional cost as part of your State Health Plan benefits.

  • INSURANCE BENEFITS GUIDE | 2018 3

    Table of contents

    General information ........................................................................................................ 11

    What’s new for 2018? ......................................................................................................................................... 12

    Eligibility for insurance benefits ........................................................................................................................ 12

    Initial enrollment ................................................................................................................................................. 15

    An open enrollment period occurs every October ......................................................................................... 18

    Special eligibility situations ................................................................................................................................ 19

    When coverage ends .......................................................................................................................................... 26

    Health insurance ............................................................................................................ 32

    Comparing the plans .......................................................................................................................................... 33

    Your online State Health Plan tools ................................................................................................................... 36

    Paying health care expenses with the Standard Plan .................................................................................... 38

    Paying health care expenses with the Savings Plan ....................................................................................... 40

    Using State Health Plan provider networks ..................................................................................................... 43

    Out-of-network benefits .................................................................................................................................... 45

    Getting preauthorization for your medical care ............................................................................................. 46

    Managing your health ........................................................................................................................................ 50

    PEBA Perks ...................................................................................................................................................... 50

    Health coaching ............................................................................................................................................. 54

    Additional State Health Plan benefits ............................................................................................................... 57

    Exclusions – services not covered ..................................................................................................................... 66

    How to file a State Health Plan claim ............................................................................................................... 69

    Appeals ................................................................................................................................................................. 70

    GEA TRICARE Supplement Plan ......................................................................................................................... 71

    Prescription benefits ...................................................................................................... 75

    State Health Plan Prescription Drug Program ................................................................................................. 76

  • 4 INSURANCE BENEFITS GUIDE | 2018

    Pharmacy network .............................................................................................................................................. 77

    Prescription copayments/formulary ................................................................................................................ 79

    Specialty pharmacy programs ........................................................................................................................... 80

    Coverage reviews ................................................................................................................................................ 80

    Filing a prescription drug claim ......................................................................................................................... 82

    Appeals ................................................................................................................................................................. 83

    Dental insurance ............................................................................................................. 84

    State Dental Plan ................................................................................................................................................ 85

    Dental Plus ........................................................................................................................................................... 85

    Dental benefits at a glance ................................................................................................................................ 87

    Exclusions – dental services not covered ......................................................................................................... 88

    How to file a dental claim .................................................................................................................................. 92

    Appeals ................................................................................................................................................................. 92

    Vision care ........................................................................................................................ 94

    State Vision Plan .................................................................................................................................................. 95

    Vision benefits at a glance ................................................................................................................................. 96

    Diabetic vision benefits at a glance ................................................................................................................... 98

    Using the EyeMed provider network ................................................................................................................ 98

    Exclusions and limitations ................................................................................................................................. 99

    Appeals ............................................................................................................................................................... 100

    Vision Care Discount Program ........................................................................................................................ 100

    Life insurance ................................................................................................................. 102

    Eligibility ............................................................................................................................................................. 103

    Applications ....................................................................................................................................................... 104

    Basic life insurance ........................................................................................................................................... 104

    Optional life insurance ..................................................................................................................................... 104

    Initial enrollment ..................................................