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Changes to flexible spending accounts

May 26, 2020

On May 12, 2020, the IRS issued two notices granting relief related to flexible spending accounts. Based on these notices, PEBA is implementing the following changes to its flexible spending accounts.

 

MoneyPlus elections

Employees can make prospective mid-year changes to Medical Spending Accounts (MSAs), Limited-use Medical Spending Accounts (LMSAs) and Dependent Care Spending Accounts (DCSAs) without a qualifying change in status. The following changes will be allowed:

  • Make a new election.
  • Increase an election.
  • Decrease or revoke an election.

The decrease cannot be greater than the amount that has already been reimbursed to the participant.

To make a change, employees should complete an Active Notice of Election (NOE) form between June 1 and June 30, 2020. Indicate “COVID” at the top of the NOE as the change reason. PEBA must receive completed forms by June 30, 2020. The change will be effective July 1, 2020.

 

2019 DCSA claims

The claims period for 2019 DCSA claims is extended through December 31, 2020. This means DCSA participants can use their remaining 2019 funds for expenses they incur through December 31, 2020. It’s important to note that participants can claim an expense only once; they cannot claim the same expense for 2019 funds and 2020 funds.

 

MSA carryover for 2021

The MSA carryover amount will increase to $550. This means MSA participants can carry over up to $550 of unused 2020 funds into the 2021 plan year.

 

Coverage of COVID-19 tests

May 19, 2020

The State Health Plan adheres to the testing guidelines set forth by the Centers for Disease Control and Prevention (CDC). As this is a rapidly changing situation, adjustment to plan provisions will continue to be made as needed. Currently, testing for COVID-19 is covered by the Plan as follows:

 

  • Diagnostic tests. Commonly known as COVID-19 PCR test or simply PCR, the State Health Plan covers this test at no member cost when prescribed by a healthcare provider for individuals who are symptomatic and for those who have been exposed to COVID-19 and are concerned about infection, for the purpose of identifying and treating the disease. In this situation, other services related to the administration of the diagnostic test are also covered at no member cost.
  • Antibody tests. Sometimes referred to as a serology or immunity test, the State Health Plan covers this test at no member cost when medically appropriate as determined and ordered by a healthcare provider. In this situation, other services related to the administration of the diagnostic test are also covered at no member cost. It is important to note that the World Health Organization, the Infectious Diseases Society of America, and the CDC do not recommend using antibody testing as the sole method of diagnosing COVID-19 or confirming immunity as this type of test currently has too many variables and unknown performance characteristics.
  • Return to work tests. Currently, the CDC does not recommend return to work testing, and therefore is not covered by the State Health Plan for this purpose.

 

Public health surveillance

Generally, public health surveillance is the systematic collection, analysis and interpretation of health-related data to improve public health and prevent disease. Increased COVID-19 testing and recently appropriated funding to assist in this testing are part of the ongoing efforts to ramp up public health surveillance of the disease in South Carolina. Data collected will be used to monitor spread and develop additional responses to combat COVID-19.

 

As part of the public health surveillance, the South Carolina Department of Health and Environmental Control (DHEC) is operating mobile testing and popup clinics throughout the state, especially in rural and underserved communities. These clinics offer free COVID-19 testing to the public. To view current mobile testing clinics sites, visit scdhec.gov/covid19mobileclinics.

 

If you feel sick

If you develop symptoms of COVID-19, such as a fever, cough or difficulty breathing, or if you have been in close contact with someone who has COVID-19, contact your healthcare provider by phone or online before you attempt to see anyone in person. Your healthcare provider can give you instructions on how to get your medical needs addressed while minimizing the risk of exposure to yourself and others.

 

More information

For the most up-to-date information on South Carolina’s response to the COVID-19 disease, go to accelerate.sc.gov or scdhec.gov.

 

Updates to BlueCross virtual visit benefits

May 12, 2020

BlueCross BlueShield of South Carolina (BlueCross) is the third-party administrator for the State Health Plan. Below is updated information from BlueCross about Blue CareOnDemand and other telehealth services. If you have questions, please contact BlueCross at 800.868.2520. You can also refer to the original update from March 20, 2020, here.

 

Telehealth visits provide convenience for people to access care at home. This will also help slow the spread of COVID-19 by limiting exposure, mitigating the surge of demand on our health care system and helping protect health professionals on the front lines.

 

Blue CareOnDemandSM

Any visit type through Blue CareOnDemand is available with no member cost share, effective until May 31, 2020, when code COVID19 is used. For more information on the member experience follow this link to details.

 

Telehealth

Our provider telehealth policy has been expanded effective March 17, 2020, through June 15, 2020. After that, the policy will be reevaluated for extension or modification.

  • Telephone visits: Services delivered over the phone to existing patients will be covered. Providers offering these services must already be credentialed in the BlueCross system.
  • Telehealth services: Telehealth services will be covered at the same benefit level as office visits. This includes visits with new patients and current patients for providers already credentialed by BlueCross to offer telehealth services. Other providers will need to apply to BlueCross to use these telehealth services in their practices.
  • Members are encouraged to call their doctor and ask for a virtual visit. These virtual visits must be medically necessary and meet qualifying criteria. Please note that the member’s copay and coinsurance will still apply.

 

For the latest information, visit bcbs.sc/covid-19.

 

Home delivery options for prescription medication

April 10, 2020

As part of our efforts to ensure the safety and wellbeing of our membership, PEBA is providing a list of pharmacies that are offering prescription home delivery service. This list was compiled by the S.C. Pharmacy Association and is based on data as of March 31, 2020. Store hours and delivery capability may be adjusted due to COVID-19. Be sure to call or check the pharmacy’s website for the latest information on hours and delivery options. You can view the list here.

 

You may also have your medications mailed to you. Simply contact Express Scripts at 855.612.3128 to have Express Scripts Home Delivery fill and mail your prescription to you. CVS, Walgreens and Rite Aid are also offering home delivery service to State Health Plan subscribers on a temporary basis. Check your local CVS’ or Walgreen’s website for the latest information. Rite Aid customers must call their local store to enroll in this option.

 

It’s important to remember the State Health Plan does not offer out out-of-network coverage for prescription drugs. You can find a network pharmacy by logging in to your Express Scripts account at www.express-scripts.com.

 

New feature added to Member Access

April 8, 2020

Active members may now change their beneficiary designations by logging into Member Access. Members will select the Beneficiaries link which allows them to designate one or more people or their estate as beneficiary for their retirement contributions and/or survivor benefits.

 

To make a change, members will need to have all beneficiary information, such as full names, dates of birth and Social Security numbers. Any beneficiary changes they make will override their prior designations and will take effect immediately. Before making any changes, members may wish to consult an attorney/estate planner.

 

Members must complete an Active Member Beneficiary Form (Form 1102) or Beneficiary/Trustee Designation Form (Form 1103) if they choose to designate any of the following as their beneficiary:

  • Trust.
  • Entity.
  • Charity.
  • Organization.

 

State Optional Retirement Program (State ORP) participants may now also update their incidental death benefit beneficiaries through Member Access. State ORP participants may also still complete a State ORP Active Incidental Death Benefit Beneficiary Designation (Form 1106).

 

All beneficiary changes made using the paper form require the member’s signature be notarized and must be submitted to PEBA.

 

PEBA awards contract for Basic and Supplemental Long Term Disability insurance

April 7, 2020

The South Carolina Public Employee Benefit Authority (PEBA) has awarded the contract to for Basic and Supplemental Long Term Disability insurance to The Standard Insurance Company. The award is located here.

 

Coronavirus Aid, Relief and Economic Security Act

April 2, 2020

The Coronavirus Aid, Relief, and Economic Security Act (CARES Act) was signed into law on March 27, 2020. Although the Act contains several provisions related to retirement plans, many of those provisions are not immediately applicable to the retirement plans administered by PEBA. For example, some provisions relate to plan features that are not currently offered by these plans or relate to different types of retirement plans altogether. The information below describes the mandatory provisions of the CARES Act that will take effect automatically for the retirement plans administered by PEBA. PEBA is continuing to review the other provisions of the CARES Act and will provide additional guidance as we assess whether any of the non-mandatory provisions of the Act will have an impact on the retirement plans.

 

Defined benefit plans

PEBA administers five defined benefit plans:

  • South Carolina Retirement System (SCRS);
  • Police Officers Retirement System (PORS);
  • General Assembly Retirement System (GARS);
  • Judges and Solicitors Retirement System (JSRS); and
  • South Carolina National Guard Supplemental Retirement Plan (SCNG Plan).
  •  

The CARES Act provides mandatory tax relief for certain retirement plan distributions made during 2020. As implemented for the defined benefit plans administered by PEBA, this tax relief will not create a new type of distribution for the defined benefit plans. However, if a member or beneficiary has a distributable event under the existing plan provisions and certifies that the distribution meets the CARES Act requirements for a “coronavirus-related distribution,” the distribution may be eligible for the tax relief provided by the CARES Act for such distributions.

 

Certification

To receive the tax relief for a distribution as a coronavirus-related distribution made during 2020, the recipient (i.e., member or beneficiary) must certify that he or she meets one or more of the following coronavirus-related criteria:

  • Recipient has been diagnosed with the virus SARS-CoV-2 or with coronavirus disease 2019 (COVID-19) by a test approved by the Centers for Disease Control and Prevention;
  • Recipient’s spouse or dependent (as defined in section 152 of the Internal Revenue Code of 1986) has been diagnosed with such virus or disease by such a test; or
  • Recipient experienced adverse financial consequences as a result of being quarantined, being furloughed or laid off or having work hours reduced due to such virus or disease, being unable to work due to lack of child care due to such virus or disease, or closing or reducing hours of a business owned or operated by the recipient due to such virus or disease.

 

In addition, because an individual cannot claim coronavirus tax relief for more than $100,000 in retirement plan distributions in a calendar year, the recipient must also certify that the distribution from the defined benefit plans administered by PEBA will not cause the recipient to exceed that limit.

 

Eligible distributions

For the defined benefit plans administered by PEBA, distributable events that may be eligible to be considered coronavirus-related distributions include:

  • Refunds; and
  • Direct payment of death benefits.

 

Refunds

Members receiving a coronavirus-related refund of their retirement contributions during 2020 would not be subject to the automatic 20 percent federal income tax withholding. Also, members under age 59½ at the time of the refund distribution would not be subject to the 10 percent early withdrawal tax penalty. The waiver of mandatory withholding does not necessarily mean taxes will not be owed on the distribution. Members should consult with a tax advisor for more information on tax implications. Members are required to complete the COVID-19 Certification (Form 4275) certifying that the refund meets the requirements of a coronavirus-related distribution.

 

Members who received a coronavirus-related refund and later return to covered employment would have three years from the date of the distribution to repay contributions to re-establish their service credit without interest. The repayment of contributions after that three-year period would be subject to interest.

 

Death benefits

Beneficiaries who choose to receive a direct payment of benefits rather than rolling the amount over into another qualified retirement plan for coronavirus-related reasons would be exempt from the automatic 20 percent federal income tax withholding during 2020. The waiver of mandatory withholding does not necessarily mean taxes will not be owed on the distribution. Beneficiaries should consult with a tax advisor for more information on tax implications. Beneficiaries are required to complete the COVID-19 Certification (Form 4275) certifying that the direct payment meets the requirements of a coronavirus-related distribution.

 

State Optional Retirement Program and S.C. Deferred Compensation Program

For both the State Optional Retirement Program (State ORP) and the South Carolina Deferred Compensation Program (Deferred Comp), the CARES Act provisions of providing tax relief for coronavirus-related distributions made in 2020 under existing plan terms and the waiver of required minimum distributions (RMDs) for 2020 will take effect automatically. The third-party administrators of the plans will implement the provisions as soon as possible. As implemented, this tax relief will not create a new type of distribution for State ORP or Deferred Comp. However, if a participant or beneficiary has a distributable event under the existing plan terms (i.e., severance of covered employment), and certifies that the distribution meets the CARES Act requirements for a “coronavirus-related distribution,” the distribution would be eligible for the tax relief provided by the CARES Act for such distributions. The waiver of mandatory withholding does not necessarily mean taxes will not be owed on the distribution. Participants should consult with a tax advisor for more information on tax implications.

 

In addition, for Deferred Comp, the provisions of the CARES Act extending certain loan repayment dates will take effect automatically and will be implemented by Empower Retirement. No other plan changes are effective for State ORP and Deferred Comp at this time.

 

Use PEBA’s online resources to submit transactions

March 31, 2020

To better serve our members during this time, we strongly encourage you to use PEBA’s online resources to submit your transactions instead of mailing paper forms. Since PEBA has limited staff working in the office, using the online tools will ensure your transactions are processed in a timely manner. If you submit transactions via paper, processing time will be delayed as we deal with the effects of COVID-19.

 

Insurance benefits

MyBenefits is the fastest, most convenient way for subscribers covered by PEBA-administered insurance programs to manage their benefits. You can use My Benefits to:

  • Make changes to benefits due to birth, marriage, divorce or adoption.
  • Complete new hire enrollment elections after your employer initiates the process.
  • Upload any required documentation.
  • Update beneficiary information for Basic Life and Optional Life insurance.
  • Change your address and contact information.

Learn how to register for MyBenefits here.

 

Retirement benefits

Member Access, is the online resource that allows you to view and update the personal information on file for your retirement account. You can use Member Access to:

  • Update active member beneficiary information.
  • Apply for service retirement
  • Apply for a refund.
  • Change your address and contact information.
  • Create benefit estimates.
  • Submit service purchase requests.

Retired members can use Member Access to:

  • Update contact information;
  • Change their tax withholdings;
  • View and print a 1099-R form;
  • View and print an benefit verification letter;
  • View their current payment method and history;
  • Change their payment method from paper check to direct deposit; and
  • Modify an existing direct deposit account or add an additional direct deposit account.

Learn how to register for Member Access here.

 

BlueCross expands benefits for virtual visits

March 20, 2020

BlueCross BlueShield of South Carolina (BlueCross) is the third-party administrator for the State Health Plan. Below is information from BlueCross about Blue CareOnDemand and other telehealth services. If you have questions, please contact BlueCross at 800.868.2520.

 

Telehealth visits provide convenience for people to access care at home. This will also help slow the spread of COVID-19 by limiting exposure, mitigating the surge of demand on our health care system and helping protect health professionals on the front lines.

 

What we are doing

Blue CareOnDemandSM

Any visit type through Blue CareOnDemand is now available with no member cost share, effective until further notice, when code COVID19 is used. For more information on the member experience follow this link to details.

 

Telehealth

Our provider telehealth policy has been expanded effective March 17, 2020, and for 30 days thereafter. After that, the policy will be reevaluated for extension or modification.

  • Telephone visits: Services delivered over the phone to existing patients will be covered. Providers offering these services must already be credentialed in the BlueCross system.
  • Telehealth services: HIPAA-compliant telehealth services (process and technology using both audio and video) will be covered at the same benefit level as office visits. This includes visits with new patients and current patients for providers already credentialed by BlueCross to offer telehealth services. Other providers will need to apply to BlueCross to use these telehealth services in their practices.
  • Members are encouraged to call their doctor and ask for a virtual visit. These virtual visits must be medically necessary and meet qualifying criteria. Please note that the member’s copay and coinsurance will still apply.

 

In addition to expanding virtual access to health care providers, BlueCross has taken the following steps to help our members as it monitors COVID-19. These steps include:

  • Waive prior authorizations. BlueCross will waive prior authorizations for diagnostic tests and for covered services that are medically necessary and consistent with CDC guidance for members if diagnosed with COVID-19. We will make dedicated clinical staff available to address inquiries related to medical services, ensuring timeliness of responses related to COVID-19.
  • 100 percent coverage on testing. BlueCross will cover medically necessary diagnostic tests that are consistent with CDC guidance related to COVID-19 at no cost share to the member where such testing is not covered as part of the Public Health Service response. We will ensure patient testing and any subsequently needed care are done in close coordination with federal, state and public health authorities. There are not limitations on the number of times a member can get the test.

It is important to understand that the waiver or all cost sharing is solely for the COVID-19 test and not the associated physician office visit and other services. These services will still be subject to office copay, deductible and coinsurance.

 

Where to find more information

For the latest information, visit bcbs.sc/covid-19.

 

PEBA’s plan to provide critical business operations

March 19, 2020

Due to Governor McMaster's executive order, PEBA is significantly decreasing the number of staff who will be in the office beginning Friday, March 20, 2020. The Governor's decision is to protect state employees during this unprecedented public health crisis. Even though PEBA staff will be limited, we will still provide critical business operations, including our Customer Contact Center, the processing of retirement claims and payroll, and the processing of insurance enrollments and billing. Monthly retirement benefits and insurance claims payments will continue without interruption as well.

 

Online systems

We strongly encourage members to use our online systems, MyBenefits and Member Access, and to refrain from mailing paper forms and documentation to PEBA.

 

Urgent insurance appeals

If you have an urgent insurance appeal, you should email your appeal to iad@peba.sc.gov. Please include as many details as possible, including the plan for which the appeal is (State Health Plan, MUSC Health Plan, dental, etc.).

 

Contacting us

Because staff will be limited, please direct all inquiries to our Customer Contact Center at 803.737.6800 or 888.260.9430. We also encourage you to check our website (www.peba.sc.gov), and our Facebook and Twitter pages periodically for updates.

 

PEBA to suspend in-person visits

March 18, 2020

Due to the threat of COVID-19, PEBA will close our Visitor Center beginning March 19, 2020, until further notice. This is in response to the directive we received from Governor McMaster to take proactive measures to help safeguard the health and safety of our workplace. Members are encouraged to take advantage of PEBA’s online tools.

 

For insurance subscribers, MyBenefits is the fastest, most convenient way for subscribers covered by PEBA-administered insurance programs to manage your benefits. MyBenefits also ensures speedy transmission of your coverage changes to our third-party claims processors.

 

Member Access is the online resource that allows you, as a member of a PEBA-administered retirement plan, to view and update the personal information on file for your retirement account and conduct online transactions such as applying for your service retirement or a refund of contributions.

 

If you participate in the State Optional Retirement Program (State ORP), you may contact your service provider for questions about your State ORP account.

 

If you participate in the South Carolina Deferred Compensation Program (Deferred Comp), you may log in to your Deferred Comp account at www.southcarolinadcp.com or call Empower Retirement at 877.457.6263.

 

Our Customer Contact Center is also available to assist you from 8:30 a.m. until 5 p.m., Monday through Friday. You can reach the Contact Center by calling 803.737.6800 or 888.260.9430.

 

Be sure to check our website (www.peba.sc.gov), and our Facebook and Twitter pages for updates.

 

Refilling your prescriptions through the State Health Plan

March 13, 2020

The South Carolina Public Employee Benefit Authority (PEBA) wants to make sure that its State Health Plan members, including its older members and those with underlying health conditions, have an adequate supply of their medication during this time. Typically, you can refill your medication when 25 to 35 percent of your current prescription is remaining.

 

If you are concerned about your supply of medications due to COVID-19, you can contact your pharmacist to obtain an additional 30-day supply outside of the normal refill procedures. Please note that regulations pertaining to dispensing controlled substances still apply. Due to the COVID-19 outbreak, pharmacies may be waiving charges for home delivery of prescription medication. Check with your network pharmacy to see if this service is being offered. You can find a network pharmacy by logging in to your Express Scripts account at www.express-scripts.com.

 

If your network pharmacy does not have your medication available, you may also contact Express Scripts at 855.612.3128 to request a supply of your prescription be filled by Express Scripts Home Delivery and mailed to you.

 

COVID-19 tests

The State Health Plan will cover testing to diagnose COVID-19 at no member cost when prescribed according to guidelines set by public health authorities. Any services associated with treatment will be covered following normal Plan provisions.

 

The State Health Plan and coronavirus

March 9, 2020

PEBA, along with the governor’s office and other healthcare authorities in South Carolina, is closely monitoring the spread of the coronavirus (COVID-19) in our state. The safety of our membership is our top priority. If you are sick, we encourage you to take advantage of the MUSC Health Virtual Care telehealth service, which is available at no cost to all State Health Plan members, including our Medicare-primary members.

 

Here’s how to use this service:

  1. Go to www.MUSChealth.org/virtual-care.
  2. Click Get Care Now, then Create Account.
  3. Select State Health Plan, then Continue.

 

The best preventive measures against COVID-19 are the same as those for the flu or other viruses:

  • Stay home if you are sick, regardless of whether your symptoms match COVID-19.
  • Wash your hands regularly and for 20 seconds. An alternative is to use hand sanitizer.
  • Cover your mouth and nose with a tissue when coughing or sneezing, then throw the tissue away.
  • Avoid close contact with sick people.
  • Avoid touching your eyes, nose and mouth.

 

For the latest information about COVID-19, refer to the Centers for Disease Control and Prevention’s website. For the latest information about the spread of the disease in South Carolina, see the Department of Health and Environmental Control’s website.

 

New year brings a new logo

January 14, 2020

Each new year offers us fresh starts and new beginnings. This new year also brings a new logo for PEBA. The previous logo was unveiled on July 1, 2015, as a part of the agency’s official branding. During the past four-and-a-half years our agency has grown and evolved in ways none of us could have ever imagined. As a result, we felt the time was right to refresh our logo so that it better reflects who we are as an agency and what we do. We will transition to the new logo over the next few months so keep an eye out for updated materials.

 

PEBA releases request for proposal for Pharmacy Benefits Management Services

January 3, 2020

The South Carolina Public Employee Benefit Authority (PEBA) has released a request for proposal (RFP) for the Pharmacy Benefits Management Services. The RFP is located here. Please see the RFP for instructions on asking questions or requesting additional information.

 

2020 open enrollment for participants of State ORP

December 27, 2019

The annual open enrollment period for all participants of the State Optional Retirement Program (State ORP) is January 1 to March 1 of each year. During this period, State ORP participants may change their State ORP service provider or, if eligible, may irrevocably elect to participate in the South Carolina Retirement System (SCRS).

 

Details about the 2020 open enrollment period are available online.

 

A new telehealth option for 2020

December 4, 2019

Beginning January 1, 2020, State Health Plan members, including our Medicare-primary members, will have access to a telehealth option through MUSC Health Virtual Care. MUSC Health Virtual Care is available at no cost to members and there is no cost to the State Health Plan. Members can opt for non-video visits or video visits. Common conditions treated include allergies, pink eye, sinus infections, skin rashes, sore throat, urinary tract infections and flu.

 

A member does not need to be a South Carolina resident; however, a member must be in South Carolina at the time of the visit. Members ages 18 and older can create an account. Members can also add dependents to their account. Visits for dependent children under age 18 must be completed by a parent. Beginning in January, members can go to www.MUSChealth.org/virtual-care to start a visit.

 

Lower copayment for preferred insulin in 2020

December 2, 2019

Beginning January 1, 2020, the Patient Assurance Program will enable State Health Plan members to get a 30-day supply of their preferred insulin for $25 (90-day supply for $75) at a network pharmacy or through home delivery from Express Scripts Pharmacy. On or after January 1, 2020, members can see if their insulin medications are eligible for the reduced copayment by logging in to their account at express-scripts.com or by calling Express Scripts at 855.612.3128.

 

PEBA releases request for proposal for State ORP

November 22, 2019

The South Carolina Public Employee Benefit Authority (PEBA) has released a request for proposal (RFP) for the State Optional Retirement Program (State ORP). The RFP is located here. Please see the RFP for instructions on asking questions or requesting additional information.

 

Deferred Comp fee to reduce in 2020

October 15, 2019

Empower Retirement was awarded the recordkeeping contract for Deferred Comp beginning January 1, 2020. As part of the new contract, the annual recordkeeping fee that participants pay on their account will decrease next year. Participants currently pay 0.0975 percent of their account balance, which is divided and deducted quarterly. Beginning in January 2020, the annual recordkeeping fee will be 0.065 percent.

 

Tobacco-use premium now includes e-cigarettes

October 8, 2019

An electronic cigarette, or e-cigarette, is a hand-held, battery-operated device that emits both vaporized nicotine and non-nicotine solutions for inhalation. E-cigarette usage has become more prevalent the past few years, and has most recently become a significant health concern because of conditions believed to be associated with such use.

 

Accordingly, PEBA has updated the Certification Regarding Tobacco and E-cigarette Use form to include e-cigarettes. Subscribers who use e-cigarettes, or cover dependents who use e-cigarettes, need to complete a new form. Similar to those who use tobacco, subscribers and their covered dependents who use e-cigarettes can complete the Quit for Life® smoking cessation program.

 

PEBA releases request for proposal for Basic and Supplemental Long Term Disability insurance

September 27, 2019

The South Carolina Public Employee Benefit Authority (PEBA) has released a request for proposal (RFP) for Basic and Supplemental Long Term Disability insurance. The RFP is located here. Please see the RFP for instructions on asking questions or requesting additional information.

 

State Vision Plan will change to EyeMed's Select provider network

September 25, 2019

Beginning January 1, 2020, the State Vision Plan will change to EyeMed's Select provider network from the Insight provider network. State Vision Plan members can maximize their vision benefits by using a provider in the Select Network. If they use an out-of-network provider, the vision plan will pay at a lesser rate.

 

PEBA awards contract for Deferred Compensation Program

August 2, 2019

The South Carolina Public Employee Benefit Authority (PEBA) has awarded the contract to provide recordkeeping, administration, communication, education, custodial trustee services and investment management services (Deferred Compensation Program) to Great-West Life & Annuity Insurance Company. The award is located here.

 

S.C. Supreme Court ruling on common law marriage may impact insurance benefits eligibility

July 25, 2019

The South Carolina Supreme Court recently ruled to prospectively abolish common law marriage, effective July 24, 2019. Common law marriage was defined as longtime couples who publicly held themselves out to be married but did not have a marriage license. The ruling means that, beginning July 24, 2019, citizens can no longer enter into a common law marriage in South Carolina. Existing common law marriages remain valid and have not been impacted. Beginning July 24, 2019, a subscriber cannot cover his or her spouse unless he or she is married and has a marriage license on file.

 

As a result of this ruling, the Common Law Marriage Affidavit is no longer available on PEBA’s website. A subscriber whose common-law spouse was covered by PEBA-administered insurance benefits prior to July 24, 2019, and for whom an affidavit is on file with PEBA, is not impacted by this ruling. If you have any questions, please call our Customer Contact Center at 803.737.6800 or 888.260.9430.

 

PEBA releases request for proposal for Deferred Compensation Program

April 11, 2019

The South Carolina Public Employee Benefit Authority (PEBA) has released a Request for Proposal (RFP) to provide recordkeeping, administration, communication, education, custodial trustee services and investment management services (Deferred Compensation Program). The RFP is located here. Please see the RFP for instructions on asking questions or requesting additional information.

 

Intent to sole source TRICARE Supplement Plan

March 8, 2019

The South Carolina Public Employee Benefit Authority (PEBA) intends to offer a voluntary group TRICARE Supplement Health Insurance plan to its TRICARE eligible subscribers as a health plan option for plan year 2020. The voluntary group TRICARE Supplement Health Insurance plan will be offered to TRICARE eligible subscribers through the PEBA's Section 125 cafeteria plan in order that subscribers may pay premiums on a pretax basis, in accordance with federal law and regulations. Additional information is located here.

 

PEBA releases request for proposal for Dental and Dental Plus

March 5, 2019

The South Carolina Public Employee Benefit Authority (PEBA) has released a Request for Proposal (RFP) to Provide Claims Administration Services for the Self-Funded State Dental Plan, and Accompanying Insurance for the State’s Voluntary Supplemental Dental Product, Dental Plus. The RFP is located here. Please see the RFP for instructions on asking questions or requesting additional information.

 

Your how-to guide for your MSA

 February 20, 2019

As a Medical Spending Account (MSA) participant, you are setting aside money from your paycheck pretax to pay for out-of-pocket health care expenses. We want to make sure you understand how to monitor your account, access your funds and provide documentation to ASIFlex, if needed.

 

How do I access my account?

ASIFlex offers an online participant portal that allows you to access your account balance, read messages from ASIFlex, file and view the status of a claim and submit documentation. Create your account by visiting www.asiflex.com/SCMoneyPlus and selecting Participant Login from the Account Login menu option. Once you've created your account, you can download the ASIFlex mobile app to manage your account and submit claims on-the-go. The app is available for download in the App Store and Google Play. Just search for "ASIFlex Self Service."

 

From your account, you can also update your communication preferences. Go green by signing up for email and text alerts. You can also set up direct deposit for your reimbursements.

 

How do I access my MSA funds?

You have access to your total election amount, even though you'll contribute to your account each paycheck. You can find a comprehensive list of eligible expenses online. As you have eligible expenses, you can use your ASIFlex Card or pay for the expense out of your pocket and submit a claim for reimbursement. If you opt to submit a claim, there are several ways you can do that.

  • ASIFlex mobile app: Just snap a picture of your itemized statement of service(s) or insurance explanation of benefits (EOB) and submit a claim via the app.
  • ASIFlex Online: Sign in to your online account to submit a claim.
  • Toll-free fax or mail: Download and complete a claim form. Then, submit it with your itemized statement of service(s) or EOB. Be sure to keep a copy for your records.

If approved, reimbursement will be made to you within three business days following receipt of a complete claim.

 

What is auto-adjudication and how does it work?

Auto-adjudication is when card transactions are automatically substantiated following IRS guidelines and using available data. IRS guidelines allow the following items to be auto-adjudicated and will not require follow-up documentation:

  • Flat dollar copayments under PEBA's insurance plans, such as a $14 physician office copayment or $9 prescription copayment.
  • Identified recurring expenses at the same provider for the same dollar amount each month that has been substantiated once.
  • Prescriptions or over-the-counter health care products purchased at pharmacies or merchants that identify which products are qualified health care items.
  • Claim data reported from BlueCross BlueShield of South Carolina (BlueCross) and EyeMed that match the amount of an ASIFlex Card transaction.

ASIFlex receives claims data weekly from BlueCross for health and dental claims, and from EyeMed for vision claims. ASIFlex will auto-adjudicate as many card transactions as possible using the data it receives, but can only do so if a transaction amount is equal to the amount shown on the file. If the card transaction does not exactly match the insurance claim data, you will need to provide follow-up documentation.

 

It's important to remember using the ASIFlex Card is not a completely paperless process; there are times when you will need to submit documentation. IRS regulations require you to retain appropriate documentation each time you use the card in case you need to substantiate a transaction. Carry the ASIFlex Wallet Card with you to show your provider. Each time you use the debit card, ask the provider for an itemized statement of the service(s) provided in case you need to submit documentation. The itemized statement must include the following:

  • Provider name;
  • Patient name;
  • Date of service (not just the date paid);
  • Description of service; and
  • Dollar amount owed.

 

How do I know if documentation is required?

ASIFlex will only receive data once your provider submits a claim to BlueCross or EyeMed. If ASIFlex does not have data for you or the amount does not match your card transaction, you will be notified.

 

There are two ways you will know if documentation is required:

  1. ASIFlex sends your first notification at least 10 days after receiving notice of your card transaction. You'll have 52 days to submit documentation and will receive three requests for documentation. If a transaction is not substantiated within 52 days, your card will be deactivated.
  2. You can log in to your participant account to view your account statement. Transactions that require documentation will be highlighted and you will have a secure message.

If you choose to pay your provider after you receive a final bill, ASIFlex will look back at insurance claims data it has received in the last 120 days to attempt to auto-adjudicate the transaction.

 

If you believe that a card transaction matches an insurance claim, but it is still highlighted online, you can call ASIFlex at 833.SCM.PLUS (833.726.7587) and ask them to match the insurance claim data with the card transaction.

 

What else should I keep in mind?

You must submit valid claims incurred by December 31, 2019, before March 31, 2020, for reimbursement. However, if you don't use all your funds, you can carry over up to $500 in unused funds into 2020. You will forfeit unused funds over $500.

 

Where can I get more information?

You can review your account statement and read messages by logging in to your participant portal. You can also find a variety of resources, including forms and useful links, online at www.asiflex.com/SCMoneyPlus. More information is available in the MSA FAQs and ASIFlex Card FAQs.

 

Who do I contact if I need help?

ASIFlex is your best contact if you need help with your MSA or have questions about something you see in your portal. You can reach them at 833.SCM.PLUS (833.726.7587). Customer Service is available Monday - Friday, 8 a.m. to 8 p.m., and Saturday, 10 a.m. to 2 p.m., ET.

 

You can also email ASIFlex at asi@asiflex.com.

 

State Health Plan premiums remain among nation's lowest

February 12, 2019

Composite premiums for the State Health Plan are the fourth lowest in the nation, according to the lastest analysis of what public employers and employees are paying for health insurance. The Plan's composite premium is 20.2 percent lower than the South regional average and 30.1 percent lower than the national average of other state plans.

 

Learn more about how the Plan compares to other plans around the nation in the 2019 50-State Survey. You can also check out the State Health Plan benchmarks.

 

PEBA releases bid for Group Vision Benefits

January 7, 2019

The South Carolina Public Employee Benefit Authority (PEBA) has released an Invitation for Bid (IFB) to Provide Group Vision Benefits. The IFB is located here. Please see the IFB for instructions on asking questions or requesting additional information.

 

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