South Carolina Health Insurance

If you're confused about health insurance — how to find the right carrier, what an HMO is, and what the state has to say about medical coverage — don't worry, you're not alone. The search for medical coverage is quite complicated, so we've created a guide just for South Carolina residents like you about health care in your state.

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South Carolina Health Insurance for Individuals (SC)

There are two basic categories of health insurance plans that you can purchase. The first is an individual policy, ideal if you have specific health needs you want addressed. The second is a group policy, which usually will be less expensive. Group policies include HMO, PPO, POS, and HSA networks.

If you have a health problem and are applying for insurance, you could be denied coverage. Carriers in South Carolina have the right to search the past 12 months of your medical history for preexisting conditions, and if any are found, HMOs can impose an exclusion period (12 mo. maximum). In SC, there are two types of insurance applications, comprehensive and simplified, and each has different rules. Contact the South Carolina Dept. of Insurance if you'd like to know more.

Family Medical Coverage Options in South Carolina

The first rule when applying for family health insurance is, don't be late! In South Carolina, if you submit your application after the enrollment period, the insurance company has the right to deny you coverage due to a health problem. If you submit on time and are qualified, however, you cannot be turned down.

If you've recently gone through family-related changes, such as marriage, divorce, or a spouse's job loss, you may have special opportunities to acquire group coverage. The same is true if you have children that are newborn, adopted, or disabled.

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Pre-existing Conditions and Health Coverage in South Carolina (SC)

In South Carolina, HMO individual health plans can consider a preexisting condition as a condition for which medical advice, treatment or diagnosis was received or recommended the 12-month period immediately before the applicant enrolled. For non-HMO plans, the rules regarding preexisting conditions depend on the type of form the applicant completes when applying for a policy.

If the insurance company decides to use a comprehensive form, one asking the applicant for detailed information regarding their medical history, then the company can refuse to cover any condition disclosed for the first 24 months, or the company can impose an elimination rider. Pregnancy is considered a preexisting condition in South Carolina, but genetic information cannot be taken into consideration.

If you have had previous difficulty obtaining affordable premiums due to a preexisting condition, you may be eligible for coverage through the South Carolina Heath Insurance Pool (SCHIP). There are state-mandated limits on charges with SCHIP.

Getting New Health Coverage in South Carolina

If you're new to the state or have to change your health insurance plan for any reason, here are a few other things you should know about health insurance in South Carolina.

Employers in SC are not required to provide you with health insurance — they are only mandated to make sure that the coverage the provide is nondiscriminatory. Employers are also allowed to impose waiting periods on your benefits, so you may have to wait a few months before your plan begins. Non-federal public employers in South Carolina follow a different set of rules when it comes to health insurance, so ask your employer or the Dept. of Insurance if you want to know what your rights are.

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