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. Visit a network provider or pharmacy to take advantage of these value-based benefits at no cost to you. PEBA Perks are available to State Health Plan primary members, and these benefits can help make it easier for you and your family to stay health.

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 annual well visit.

This screening is offered at no cost to employees, retirees, spouses, dependent children ages 19 and older, and COBRA subscribers whose primary coverage is the State Health Plan or MUSC Health Plan. 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 State Health Plan covers all adult vaccinations, including the flu vaccine, as recommended by the Centers for Disease Control and Prevention   (CDC). Members can get vaccines from a network pharmacy for a $0 copayment. If a member receives a vaccine in a network doctor's office, the cost of the vaccine and administration fee will be paid in full. Any associated office visit charges will follow regular Plan coverage rules.

State Health Plan primary members, ages 19 and older, are eligible for one adult well visit each year at no member cost. Evidence-supported services, based on USPSTF A and B recommendations, are included as part of an adult well visit. Adult members can take advantage of this benefit at a network provider specializing in general practice, family practice, pediatrics, internal medicine or gerontology.

Eligible female members can also receive an annual adult well woman visit at no cost. Women can take advantage of the well woman benefit at a network provider specializing in obstetrics and gynecology, or they can have a well woman exam in conjunction with or in addition to their annual well visit with a network provider specializing in general practice, family practice, internal medicine or gerontology. Members should talk with their physician to determine the best plan for their care. A female member may receive both an adult well visit and a well woman visit in the same plan year, but the USPSTF recommended services will not be covered more than once per plan year. Additionally, female members cannot receive the same service at both an adult well visit and a well woman visit in the same plan year; duplicate services will be denied.

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% 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; however, it does not have to be 365 days from the previous year's visit.

  • 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).

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.

The State Health Plan allows women ages 18-65 to receive a routine Pap test each calendar year at no member cost. Based on recommendations from the United States Preventive Services Task Force   (USPSTF), the Plan also covers the routine HPV test once every five years at no member cost for women ages 30-65, or as otherwise recommended by the USPSTF.

No-Pay Copay encourages members to be more engaged in their health—and saves them money. By completing certain activities in Strive each year and earning at least two credits, members can receive certain generic drugs related to their condition the following year at no cost. Covered conditions include:

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

Eligible generic prescriptions

BlueCross BlueShield of South Carolina (BlueCross) identifies eligible members and mails an invitation to join the program. Participants must then register for Strive to complete activities. Log in to your My Health Toolkit   account, select Wellness, then No-Pay Copay to learn more. You can also 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.

President Bush nominated Matthews to a judgeship on the U.S. Fourth Circuit Court of Appeals in Richmond. That nomination was one of 10 federal appellate court nominations that expired when the 110th Congress adjourned without Senate action. Matthews is involved in various professional organizations and civic activities.

This benefit provides one baseline routine mammogram (four views) for women ages 35-39 at a provider in the BlueCross mammography network. Women ages 40 and older can receive one routine mammogram (four views) each calendar year at no member cost. The State Health Plan also covers any diagnostic mammograms, which are subject to patient liability.

Meru Health offers a 12-week treatment program at no cost to State Health Plan primary members to reduce anxiety, stress, depression and burnout. It combines therapist and psychiatrist support, a biofeedback training device, anonymous peer support, meditation practices and habit-changing activities. Learn more about the program and enroll at meruhealth.com/cba 

Members can also take advantage of health coaching at no cost through BlueCross.

Wondr Health is a clinical behavioral weight management program focusing on weight loss and diabetes prevention. State Health Plan members, including spouses and dependent children ages 18 and older, are eligible to apply. Medicare-primary members are also eligible to apply. Some medical conditions or body mass indexes (BMIs) might prevent you from participating in the program. It is a 10-week, online program that uses weekly video lessons and interactive tools to teach the behavioral skills necessary to lose weight and keep it off long-term. Learn more at www.wondrhealth.com/PEBA 

BlueCross also offers health coaching to help you meet your weight management goals.

Hello Heart is an easy-to-use program that helps you track, understand and manage your heart health from the privacy of your own phone. The Hello Heart program is available at no cost to eligible State Health Plan primary members and includes a free blood pressure monitor that connects to an app on your smartphone. It’s engaging and rewarding! Enroll and get started at join.helloheart.com/PEBA2w   to determine if you are eligible for the program.

You can also work with a BlueCross health coach who can help you better understand your heart condition and how to manage it at no member cost.

Virta is a program that can help you reverse Type 2 diabetes while naturally lowering and controlling your average blood sugar (HbA1c). The program is available at no cost to eligible State Health Plan primary members. Learn more and apply at virtahealth.com/join/peba 

Diabetes health education through certified diabetes educators is also offered at no cost to State Health Plan primary members at a network provider. Diabetes education trains diabetics to manage their condition to avoid disease-related complications. People who receive diabetes education are more likely to use primary care and preventive services; take medications as prescribed; and control their blood glucose, blood pressure and cholesterol levels. Visit a network provider for more information.

You can also get one-on-one coaching from a health coach to help you manage diabetes at no member cost. For details, call BlueCross BlueShield of South Carolina at 855.838.5897.

If you have diabetes, you might 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 member cost. It also includes a $0 copay for certain 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 customized to your needs. Your Quit Coach might recommend that a doctor prescribe a tobacco cessation drug, such as bupropion. 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 

Coming Attractions supports mothers throughout their pregnancy and postpartum care. It also assists with Neonatal Intensive Care Unit infants or other babies with special needs until they are one year old. You do not have to wait until you have seen your physician to enroll in Coming Attractions.

There are three ways to enroll:

  1. Download the My Health Planner App from the App Store or Google Play. Select Create New Account and enter the access code MATCARE to get started.
  2. Visit StateSC.SouthCarolinaBlues.com and log in to your My Health Toolkit account. Select Wellness & Care Management, then Care Management. Select the care management member portal link, then select the member and OK. Select Assessments and complete the maternity health screening, which is listed as Enroll in the Maternity Program.
  3. Call Medi-Call at 803.699.3337 or 800.925.9724 to talk to a maternity nurse or health coach to complete a brief maternity health screening.

Members can also receive certain electric or manual breast pumps at no member cost. Members can learn how to get a breast pump by enrolling in our maternity management program, Coming Attractions.