questionkeyboardBecause of the Affordable Care Act, the 84% of South Carolinians who have insurance have more choices and stronger coverage than ever before. The new online Health Insurance Marketplace will provide the 16% of South Carolinians who don’t have insurance with a new way to find health coverage that fits their needs and their budgets.

The Health Insurance Marketplace will make it easy for South Carolinians to compare qualified health plans, get answers to questions, find out if they are eligible for lower costs for private insurance or health programs like Medicaid and the Children’s Health Insurance Program (CHIP), and enroll in health coverage.

Families and small businesses that currently don’t have insurance or are looking for a better deal now have more options than ever before.

What do we mean by ‘members?’

If you choose Consumers’ Choice Health Plan as your health insurance company, you won’t just be a policy number. You’ll be a member, with full voting rights to choose how your health insurance company conducts business. No other insurance provider in South Carolina can say that.

Why should you care about health insurance?

The Affordable Care Act seeks to provide more coverage opportunities for the uninsured and the under-insured. So, beginning on January 1, 2014, most citizens will be required to either purchase health care coverage or pay penalties for not having coverage. Contact us to learn more about Consumers’ Choice Health Plan and how we can help you live a healthy lifestyle..

What is the Health Insurance Marketplace?

The Marketplace is actually a website where consumers can shop for health insurance. Consumers are able to compare plans and networks. The experience is similar to using Travelocity or Expedia.

Who operates the Marketplace in South Carolina (initially called the Health Insurance Exchange)?

The Marketplace is operated by the Federal Government for residents of South Carolina.

When will plans be available?

Plans were available October 1, 2013. This date was mandated in the Affordable Care Act. The plans will have an effective date of January 1, 2014.

What should I do to get ready today?

Create your Marketplace account

Open enrollment in the Health Insurance Marketplace began October 1, 2013. You can apply for health coverage, compare plans side-by-side, and enroll in a plan.

When you apply you’ll need to provide the following information about yourself and your household:

  • Social Security Numbers (or document numbers for legal immigrants)
  • Employer and income information for every member of your household who needs coverage (for example, from pay stubs or W-2 forms—Wage and Tax Statements)
  • Policy numbers for any current health insurance plans covering members of your household A completed Employer Coverage Tool for every job-based plan you or someone in your household is eligible for. (You’ll need to fill out this form even for coverage you’re eligible for but don’t enroll in.)

What will the plans offer?

Plans offered within the Marketplace have essential health benefits. The plans offered off the Marketplace also need to offer essential health benefits. Essential health benefits include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Laboratory services
  • Maternity and newborn care
  • Mental health and substance use disorder services, including behavioral health treatment
  • Prescription drugs
  • Rehabilitative services
  • Preventive and wellness services and chronic disease management
  • Pediatric services, including oral and vision care

How long can I keep a child on my health plan?

Under the health care law, if your plan covers children, you can now add or keep your children on your health insurance policy until they turn 26 years old. Thanks to this provision, over 3 million young people who would otherwise have been uninsured have gained coverage nationwide, including 59,000 young adults in South Carolina.

What is the policy on pre-existing conditions?

As many as 2,764,651 non-elderly South Carolinians have some type of pre-existing health condition, including 352,794 children. Today, insurers can no longer deny coverage to children because of a pre-existing condition, like asthma or diabetes, under the health care law. And beginning in 2014, health insurers will no longer be able to charge more or deny coverage to anyone because of a pre-existing condition. The health care law also established a temporary health insurance program for individuals who were denied health insurance coverage because of a pre-existing condition. 1,915 South Carolinians with pre-existing conditions have gained coverage through the Pre-Existing Condition Insurance Plan since the program began. Learn more

What are my preventive care benefits?

Most health plans must cover a set of preventive services like shots and screening tests at no cost to you. This includes Marketplace private insurance plans. Learn more

What if I have job-based insurance?

If you have job-based health insurance you like, you can keep it. You’re considered covered. You may be able to change to Marketplace coverage if you want to. Learn more

What if I’m pregnant or plan to get pregnant?

If you’re uninsured and pregnant you may be turned down, charged a higher premium, or have benefits excluded until 2014. Until then, Medicaid and CHIP may help. Learn more

What if I’m self-employed?

If you’re self-employed with no employees, you’re not considered an employer. You can use the Marketplace to find coverage that fits your needs. Learn more

What are the Benefit Categories of Marketplace Plans?

There will be five categories on the Marketplace:

  • Bronze
  • Silver
  • Gold
  • Platinum
  • Catastrophic

BRONZE represents a minimum plan; still providing essential health benefits, with a 60% coverage of the benefit costs and an out of pocket limit equal to the current health savings account law ($5,950 for individuals and $11,900 for families in 2010).

SILVER provides essential health benefits, covers 70% of the benefit costs of the plan, and also follows HSA out of pocket limits.

GOLD provides essential health benefits, covers 80% of the benefit costs of the plan, and also follows HSA out of pocket limits.

PLATINUM provides essential health benefits, covers 90% of the benefit costs of the plan, and also follows HSA out of pocket limits.

CATASTROPHIC will be available to those up to age 30 or to those who are exempt from the mandate to purchase coverage.

This plan will provide catastrophic coverage only with the coverage level set at the HSA current law levels except that preventive benefits and coverage for three primary care visits would be exempt from the deductible.

This plan is only available in the individual market.

What is the Maximum deductible?

Within an Essential Health Benefit Plan, the maximum deductible is $2,000 for an individual and $4,000 for a family.

Will a person be allowed to purchase health insurance on the way to the hospital emergency room?

There are specific guidelines and timelines for enrollment. Otherwise, only acceptable extenuating circumstances will allow for enrollment outside of normal enrollment dates. Hospitals may use staff to enroll consumers.

What if a person wants to change insurance providers after enrollment?

If the contract has not gone into effect, a person will be allowed to change insurance providers.

If the effective date has passed, the policyholder will only be allowed to change if they qualify under the extraordinary circumstances criteria.

What is the Patient’s Bill of Rights?

A Major Goal of the Affordable Care Act was to put consumers back in charge of their health care. The result is called the “Patient’s Bill of Rights”.

The Patient’s Bill of Rights includes the following 10 areas of Healthcare Reform. Several of the rights have already been implemented.

  1. Provides coverage to Americans with pre-existing conditions.
  2. Protects a person’s choice of doctors.
  3. Keeps young adults covered.
  4. Ends lifetime limits on coverage.
  5. Ends pre-existing condition exclusions for children under the age of 19.
  6. Ends arbitrary withdrawals of insurance coverage.
  7. Reviews premium increases
  8. Helps a person get the most from his/her premium dollars.
  9. Restricts annual dollar limits on coverage.
  10. Removes insurance company barriers to emergency services.

Why should I enroll with Consumers’ Choice?

Beginning January 2014, health insurance will become mandatory for most Americans, just as car insurance is mandatory. At Consumers’ Choice Health Plan, we understand your needs and promise to treat you fairly and respectfully. As a policyholder, you will be a full voting member — not just a policy number. Our goal is to help you become healthier and avoid the burden of disease, which adversely affects so many South Carolinians. Providers in our network are partners committed to traveling with you step-by-step toward health and positive outcomes. We will even have health coaches to quickly respond to your day-to-day health questions.

Of course, many factors go into choosing a health insurance plan. You are invited to take a close look at what Consumers’ Choice Health Plan has to offer. We are a compelling new option for South Carolina residents. Be sure to sign up to receive more information as we approach a new day for health insurance in South Carolina. You can do so on our home page.

Online. HealthCare.gov and CuidadoDeSalud.gov offer live chat, where you can ask a specialist questions in real time. You can also set up an account today, so you’re ready for open enrollment, which starts October 1.

Phone. We speak your language: Our trained call center staff speaks 150 different languages. You can reach them 24 hours a day, 7 days a week, at 1-800-318-2596. (Small business owners can reach the dedicated SHOP Marketplace call center at 1-800-706-7893, Monday through Friday, 9 a.m. to 5 p.m. EST.)

For general updates and the latest news about the Health Insurance Marketplace, both HealthCare.gov and CuidadoDeSalud.gov provide e-mail and text message reminders. Visit the site and look for the “sign-up” button on the home page.