BlueChoice HealthPlan of South Carolina and BlueCross BlueShield of South Carolina COVID-19 Pandemic Group Eligibility Guidelines Extended Through December 31, 2020

As the COVID-19 pandemic continues to impact the workplace, BlueChoice HealthPlan of South Carolina and BlueCross BlueShield of South Carolina have extended the end dates of the Group Eligibility Rules and Guidelines for our Fully Insured Group lines of business.

While many questions can be addressed by our respective standard Premium Billing & Payment guidelines, we understand the need to remain flexible during this extraordinary time. As we have demonstrated during this pandemic and previous natural disasters, we will continue to work alongside our customers to keep individuals insured. Should local or federal authorities provide new or “emergency” guidelines or provisions, we will amend our policies consistent with such guidance.

Most inquiries continue to be related to eligibility and the “actively at work” provisions of our contracts. To clarify how we are determining eligibility during this time, we offer this guidance:

ACTIVELY AT WORK
BlueChoice® and BlueCross understand that employers may need to displace workers and amend work schedules during this crisis. Effective through December 31, 2020, BlueChoice and BlueCross will deem an employee to be actively at work, for eligibility purposes, so long as the employer:

  • Considers the employee to be “employed.”
  • Is collecting contributions toward insurance, unless 100 percent company paid.
  • Is paying the insurance premiums for that employee in a timely manner.

Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees, and employee contributions must be no greater than those in effect immediately before March 1, 2020.

GROUP SIZE
BlueChoice and BlueCross understand that some groups may downsize or lay off workers. Effective thorough December 31, 2020, the group will remain active with BlueChoice or BlueCross at the group’s current premium structure and/or rating methodology until the group’s renewal as long as:

  • At least two full-time employees remain on the group policy.
  • The group is collecting contributions toward insurance, unless 100 percent company paid.
  • The company is paying insurance premiums in a timely manner.

Coverage must continue to be offered on a uniform, non-discriminatory basis to all employees, and employee contributions must be no greater than those in effect immediately before March 1, 2020.

RENEWALS
BlueChoice and BlueCross will continue to meet market and regulatory provisions for offering timely renewals. Unless any temporary impacts to group size are sufficiently significant and anticipated to be permanent, or the group’s average number of employees on business days in 2020 changed by a sufficiently significant amount from 2019 to cause the group’s market segment to change (from large to small), the group will be renewed under the rating methodology in place at the time of the last renewal.  

COBRA AND CONTINUATION
Generally, employers with greater than 20 lives will qualify to offer COBRA coverage to displaced employees, while employers with fewer than 20 lives may qualify for state continuation coverage. BlueChoice and BlueCross also can offer individual coverage options to displaced workers. Please contact your marketing representative to review options.

RETURNING EMPLOYEES
Employees rehired or returning to full-time status on or before December 31, 2020, will not be subject to a waiting period. 

HELPING EMPLOYEES FIND OTHER INSURANCE COVERAGE
If individuals lose coverage due to a loss of eligibility, BlueChoice and BlueCross will work with agents and employers to assist with transitions to other types of coverage. We can help assess options and eligibility for Medicare, Medicaid, individual coverage or even short-term products.

Please continue to remind your customers who are our members that updated information regarding COVID-19 and any related changes in their coverage can be found on our websites.

BlueChoice members: www.BlueChoiceSC.com/COVID-19combo logo