The State Health Plan offers the Standard Plan, the Savings Plan and, if you are retired and enrolled in Medicare, the Medicare Supplemental Plan. Eligible members of the military community may enroll in the TRICARE Supplement Plan.
The State Health Plan: a self-funded plan
The State Health Plan is a self-insured plan that PEBA administers on behalf of its members. As a self-funded plan, the State Health Plan does not pay premiums to an insurance company. Instead, employee premiums and employer contributions are held in a trust fund. PEBA pays your claims and the Plan’s administrative expenses from this trust fund. Any interest earned from this account helps fund the Plan, too. Self-funding offers real advantages for the Plan’s members and employers since PEBA maintains control of the financial assets.
As the plan sponsor for the State Health Plan, PEBA is responsible for providing a comprehensive plan of benefits at a cost that is affordable to both the individuals covered by the plans and their employers. PEBA contracts with third-party administrators to provide benefits and process claims. PEBA works closely with these administrators to customize a comprehensive benefits package within available resources for all individuals covered by the plans. BlueCross BlueShield of South Carolina processes the State Health Plan’s medical claims. Express Scripts is the pharmacy benefits manager.
Grandfathered status under the ACA
PEBA believes the State Health Plan is a “grandfathered health plan” under the Patient Protection and Affordable Care Act (the Affordable Care Act). As permitted by the Affordable Care Act, a grandfathered health plan can preserve certain basic health coverage that was already in effect when that law was enacted. Being a grandfathered health plan means that your plan may not include certain consumer protections of the Affordable Care Act that apply to other plans, for example, the requirement for the provision of preventive health services without any cost sharing. However, grandfathered health plans must comply with certain other consumer protections in the Affordable Care Act, for example, the elimination of lifetime limits on benefits.
For questions about which protections apply and which protections do not apply to a grandfathered health plan and what might cause a plan to change from grandfathered health plan status, contact PEBA’s Customer Contact Center at 803.737.6800 or 888.260.9430.