Take advantage of these value-based benefits at no cost to you. PEBA Perks are available to State Health Plan primary members at network providers and pharmacies. These benefits can help make it easier for you and your family to stay healthy.
Identifying health issues early can prevent serious illness and help save you money. This benefit, worth more than $300, allows members to receive a biometric screening at no cost. The screening includes:
a health risk appraisal;
blood pressure screening;
height and weight measurements; and
blood work and lipid panels.
There are three ways to take advantage of this benefit:
Attend a preventive worksite screening. Contact your benefits office for more information about scheduled screenings. Any worksite with at least 20 participants can host a screening. If your worksite doesn't meet that rule, consider hosting a joint screening with another worksite. To get started, complete and email the Preventive Worksite Screening Request Form to firstname.lastname@example.org to get started.
Attend a regional preventive screening. If your worksite doesn’t offer a screening, or if you missed it, you can register for a regional screening. To find a screening near you, check out the 2018 regional screening list.
No matter how you take advantage of this benefit, you will receive a confidential report, which will include required tests and appraisals. Some screening providers may provide more results above the minimum requirements.
Participating screening providers may also offer optional tests for an extra fee. You may contact the screening provider about out-of-pocket expenses associated with these tests. Please note, optional tests may vary based on screening provider.
The flu affects between 5 and 20 percent of the U.S. population each year. An annual flu vaccine is the best way to reduce your risk of getting sick and spreading it to others. This benefit allows members to receive the flu shot for a $0 copayment. Coverage includes the full cost of the vaccine and administration fee. Any associated office visit charges follow your regular Plan coverage rules.
Vaccines are one of the safest ways to protect your health and the health of those around you. The State Health Plan covers all adult vaccinations as recommended by the Centers for Disease Control. Coverage includes the cost of the vaccine and administration fee if the member receives the shot in a network doctor’s office. Any associated office visit charges will follow regular Plan coverage rules.
Well child benefits (exams and immunizations)
This benefit aims to promote good health and prevention of illness in children. Covered dependents through age 18 are eligible for this benefit. The State Health Plan covers recommended doctor visits and immunizations at in-network providers.
The Plan pays 100 percent of the allowed amount for approved exams and immunizations. The American Academy of Pediatrics recommends services specific to certain ages and lab tests. The Centers for Disease Control recommends immunizations. Coverage is available for the following checkups:
Younger than 1 year old (up to six visits);
1 year old (up to three visits);
2 years old (up to two visits); and
3 years old until he turns 19 years old (one visit a year).
The well child care exam must occur after the child’s birthday
Colorectal cancer screening
Colorectal cancer is the second-most common cause of cancer deaths in the U.S. Early stage colorectal cancer is often prevented and detected through screenings. The State Health Plan covers the cost for both diagnostic and routine screenings for State Health Plan-primary members. Routine screenings are covered based on age ranges recommended by the United States Preventive Services Task Force. Eligible members can also opt for a take at home test. Visit your qualified network provider to find out which screening option is best for you.
Take at home tests include the fecal occult blood test (FOBT) and fecal immunochemical test (FIT). Covered benefits include a generic prep kit, pre-surgical consultation, the procedure and anesthesia. If you choose a non-generic prep kit, extra charges will apply. Any associated lab work as a result of the screening may be subject to patient liability.
Cervical cancer screening
Cervical cancer deaths have decreased since the implementation of widespread cervical cancer screenings. Most cases of cervical cancer occur in women who have not had a screening. The Plan allows women ages 18-65 to receive a Pap test each calendar year at no cost. For women ages 30-65, the Plan covers the HPV test in combination with a Pap test once every five years at no cost.
You should contact your provider be about the cost of the exam and related services. Before you receive this service, please consider the following:
This benefit also covers the cost of the part of the office visit associated with the Pap test.
Costs for the parts of the office visit not associated with the Pap test are not covered. Charges associated with other exams, lab tests and procedures are the member’s responsibility (i.e., pelvic exam, breast exam or physical).
Savings Plan members 18 and older can receive a routine annual exam. They may receive a routine annual exam or an exam performed in conjunction with the Pap test, but not both. If a member receives both in the same year, the Plan will only pay the first claim filed.
No-Pay Copay encourages members to be more engaged in their health—and saves them money. This program allows members with certain conditions to receive generic drugs at no cost. Participants qualify for the program on a quarterly basis. By completing certain activities in one quarter, they can receive certain generic drugs the next quarter.
Covered conditions include:
High blood pressure and high cholesterol;
Cardiovascular disease, congestive heart failure and coronary artery disease; and
No-Pay Copay will pay for your generic medications to treat your condition. All you need to do is complete a few simple health-enhancing activities each quarter. Your custom activities may include talking to a health coach, reading articles about your condition or having a lab test. Every three months, your required activities will change. You’ll need to complete the new activities to qualify for your generic drugs the next three months.
If you think you qualify for the program, call BlueCross at 855.838.5897. BlueCross administers the program. Express Scripts, the pharmacy benefits manager, can provide more information about eligible generic prescriptions. Contact Express Scripts at 855.612.3128.
A mammogram is an important step in taking care of yourself. Mammography is a type of breast imaging to detect cancer early when it is most treatable. This benefit provides one baseline routine mammogram (four views) for women ages 35-39. Women ages 40 and older can receive one routine mammogram (four views) each calendar year. The Plan also covers any diagnostic mammograms.
Managing your diabetes can help you feel better. It can also reduce your chance of developing complications. This benefit provides diabetes education to an eligible member through certified diabetes educators. The goal is to help you understand more about your condition and how to better manage it. The diabetes education curriculum includes the following subject areas:
Describing the disease process and treatment options;
Education about diet and exercise;
Developing personal strategies to promote health and behavior changes;
Instruction in self-monitoring of blood glucose and using the results for self-management decisions; and
Learning to use medications in a safe and effective manner.
Talk to your network physician if you have diabetes or think you may be at risk. Let your doctor know you're interested in meeting with a diabetes educator and he can refer you.
You can also get one-on-one coaching from a health coach to help you manage diabetes. For details, call 855.838.5897.
If you have diabetes, you may qualify for No-Pay Copay. This program provides generic medicine to treat your condition at no cost to you. Learn more about No-Pay Copay.
This benefit provides enrollment in the Quit For Life® program at no cost. It also includes a $0 copay for tobacco cessation drugs to eligible participants. Covered spouses and dependent children age 13 or older are also eligible for the program.
The American Cancer Society and Alere Wellbeing sponsors the research-based Quit For Life Program. An expert Quit Coach® will support you over the phone, online and via text. He’ll help you follow a Quitting Plan customized to your needs.
Your Quit Coach may recommend that a doctor prescribe a tobacco cessation drug, such as bupropion or Chantix. These drugs are available through the State Health Plan’s prescription drug coverage at no cost at an in-network pharmacy. For eligible members age 18 and older, the program also provides free nicotine replacement therapy. This may include patches, gum or lozenges, if appropriate.
You can enroll by phone or online. After verifying your eligibility, you can talk to a Quit Coach.
Call 800.652.7230 (the State Health Plan’s dedicated Quit for Life phone line) or call 866.QUIT.4.LIFE (866.784.8454).
This benefit provides members with certain electric or manual breast pumps at no cost. Members can learn how to get a breast pump by enrolling in our maternity management program, Coming Attractions.
Coming Attractions supports mothers throughout their pregnancy and post-partum care. Once enrolled, expectant mothers will receive educational materials throughout their pregnancy and the baby’s first year of life. You do not have to wait until you have seen your physician to enroll in Coming Attractions.
There are two ways to enroll:
Visit StateSC.SouthCarolinaBlues.com and log in to your My Health Toolkit® account. Select Wellness, then click on Health Coaching. Go to the My Activities Page, click on Assessments and complete the maternity health screening.
Call Medi-Call at 803.699.3337 or 800.925.9724 to talk to a maternity nurse to complete a maternity health screening.