PEBA Perks

logo that reads PEBA Perks: Value for a Healthier State

It’s always better to address a health issue before it becomes a health crisis. 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 you 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. Have your adult well visit after your preventive screening and share your results with your network provider to eliminate the need for retesting at a well visit. Sharing your results will minimize the cost of your adult well visit.

There are three ways to take advantage of this benefit:

  1. 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, ask your benefits office to consider hosting a joint screening with another worksite. To schedule a worksite screening, submit a preventive worksite screening request.
  2. Attend a regional preventive screening. If your worksite doesn’t offer a screening, or it you missed it, you can register for a regional screening. Find a screening near you.
  3. Visit a participating screening provider. Visit one of our participating screening providers. While it’s not required, you can print this voucher and take it when you visit for a screening.

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 if the member receives the shot in a network doctor’s office. Any associated office visit charges follow regular Plan coverage rules. Members can also take advantage of this benefit at a network pharmacy.

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 and Prevention (CDC). 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. Members can also take advantage of this benefit at a network pharmacy.

This benefit aims to promote good health and prevention of illness in children. Covered children through age 18 are eligible for this benefit. The State Health Plan covers doctor visits based on recommendations from the American Academy of Pediatrics and immunizations based on recommendations from the Centers for Disease Control and Prevention (CDC) at network providers.

The Plan pays 100 percent of the allowed amount for approved exams and immunizations. Coverage is available for the following checkups, and the well child care exam must occur after the child’s birthday:

  • 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 19 years old (one visit a year).

Colorectal cancer is the second-most common cause of cancer deaths in the U.S. The State Health Plan covers the cost for both diagnostic and routine screenings based on age ranges recommended by the United States Preventive Services Task Force (USPSTF). The State Health Plan also covers some early detection take-at-home tests for eligible members. Visit your qualified network provider to find out which screening option is best for you.

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 facility charges or associated lab work as a result of the screening may be subject to patient liability.

Cervical cancer deaths have decreased since the implementation of widespread cervical cancer screenings. The State Health 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 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).
  • Eligible Standard Plan female members may use their well visit at their gynecologist or their primary care physician, but not both. If a woman visits both doctors in the same year, only the first routine office visit received will be covered.
  • Eligible Savings Plan female members can receive a well visit each year at no member cost. They may receive a routine annual exam or an exam performed in conjunction with the Pap test, but not both. If a woman receives both in the same year, only the first claim received will be covered.

No-Pay Copay encourages members to be more engaged in their health – and saves them money. By completing certain activities in Rally each quarter, members can receive certain generic drugs the next quarter at no cost. Covered conditions include:

  • High blood pressure and high cholesterol.
  • Cardiovascular disease, congestive heart failure and coronary artery disease.
  • Diabetes.

No-Pay Copay will pay for certain 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.

BlueCross BlueShield of South Carolina (BlueCross) identifies eligible members and mails an invitation to join the program. Participants must then register for Rally to complete activities. Visit StateSC.SouthCarolinaBlues.com or call BlueCross at 800.868.2520 for more details.

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. 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 State Health Plan also covers any diagnostic mammograms, which are subject to patient liability.

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 BlueCross BlueShield of South Carolina at 855.838.5897.

If you have diabetes, you may qualify for No-Pay Copay, which provides certain generic medicine to treat your condition at no cost to you.

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 ages 13 or older are also eligible for the program.

An expert Quit Coach® will support you over the phone, online and via text. Your coach will help you follow a Quitting Plan that is 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 a network pharmacy. For eligible members ages 18 and older, the program also provides free nicotine replacement therapy. This may include patches, gum or lozenges, if appropriate.

To enroll:
You can enroll by phone or online. After verifying your eligibility, you can talk to a Quit Coach.

  1. Call 800.652.7230 (State Health Plan’s dedicated line) or call 866.QUIT.4.LIFE (866.784.8454).
  2. Visit www.quitnow.net/SCStateHealthPlan.

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 postpartum 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:

  1. 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.
  2. Call Medi-Call at 803.699.3337 or 800.925.9724 to talk to a maternity nurse to complete a maternity health screening.

Lactation consultations through Blue CareOnDemand

This benefit allows members to video chat with a lactation consultant at no cost. Get help for many of the common issues associated with breastfeeding from the comfort and privacy of your own home. And, it doesn’t have to stop after the first visit. You can schedule follow-up appointments at a time and frequency that are right for you. Appointments are available seven days a week.