Regulations for Individual Health Insurance in South Carolina

South Carolina allows for individual and family health insurance policies to be medically underwritten. This gives the insurance company a chance to examine the applicant's medical history. If they need to, the insurance company can request medical records to verify the application. The insurance company has the options to insure the applicant under the health plan, insure the applicant but add limitations due to certain health conditions, or totally deny the applicant insurance coverage. For individual HMO plans, South Carolina permits look back periods up to 6 months and 12 month exclusionary periods for pre-existing conditions. If an individual plan is non-HMO, the look back period has no time regulation, but the exclusionary period can be no longer than 24 months. Elimination riders, or changes to a health insurance policy that are made to temporarily or permanently stop a specific medical condition's coverage, are allowed when health insurance companies write up an individual health insurance policy . Unless a new member is eligible for HIPAA, South Carolina does not require insurance companies to recognize prior health insurance coverage.

South Carolina Small Group Health Insurance Regulations

Any company with 2-50 employees is considered a small group employer in South Carolina. Following the federal Health Insurance Portability and Accountability Act of 1996, the process for offering small group health insurance in South Carolina must be on a guarantee issue basis. This process ensures that no group is declined medical insurance coverage due to the health condition of an employee or the health condition of the group as a whole. If an applicant does not have prior creditable coverage, then the insurance company is allowed to perform a 6 month look back on the applicant's health history and put a 12 month exclusionary period on their plan for a pre-existing health condition. As long as there is a break in coverage of no more than 63 days, the applicant must give prior coverage credit. To join the employer's group health insurance plan, qualified employees may have to go through a waiting period before they are eligible to become a member. The length of the waiting period is established by the employer and it must be the same for every employee. The medical underwriting for all group health insurance rates in South Carolina is provided by the state. Depending on the overall health condition of the group, the insurance company can classify a group as high-risk and charge a greater premium, but the premium cannot be greater than 125% of the standard rate.

South Carolina COBRA and Continuation Coverage

If a company has at least 20 employees, it must abide by federal COBRA laws. These federal laws require that an employee be allowed to remain on their group health insurance plan for 18 months after their group health coverage is terminated. If a company has less than 20 employees, then South Carolina has mini-COBRA laws that those companies must follow. Under these laws, an employee can be covered on the group plan for 6 months if they were previously under the group plan for at least 6 months. After termination of group coverage, the employee has 60 days to apply for the mini-COBRA option. Anyone receiving COBRA coverage is responsible for paying the entire monthly premium, in addition to a 2 % administration fee. For those that are qualified, such as those who lose group coverage due to a divorce, there are conversion plans available in South Carolina. If someone has used up their COBRA coverage, the state high-risk health pool is available to them on a guarantee issue basis.

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