Small Group Training guide · 2020. 2. 24. · Welcome! Thank you for selling BlueChoice HealthPlan small group products. You are an integral part of our success, so we want to make

1

Focus on life. Focus on health. Stay focused.

Small GroupAgent Training Guide

Section 1: Primary Contacts ...................................................... 21.1 Agent Contacts......................................................................... 2

1.2 Other Important Contacts to Remember ............................. 3

Section 2: BusinessADVANTAGESM Overview and Selling Points ....................................................................... 32.1 Overview .................................................................................... 3

2.2 The Benefits of BusinessADVANTAGE ................................. 4

Section 3: Products Included with BusinessADVANTAGE ...... 53.1 Vision Care ................................................................................ 5

3.1.2 Adult Vision ............................................................................ 5

3.1.3 Pediatric Vision ...................................................................... 6

3.2 Preventive Dental ..................................................................... 6

3.3 Chiropractic Coverage ............................................................ 6

3.4 First Sun Employee Assistance Program .............................. 7

3.4.1 Assistance for Members ....................................................... 7

3.4.2 Employer Assistance ............................................................. 8

3.5 Doctor Visits Anytime, Anywhere ........................................... 8

3.6 FOCUSfwd® Wellness Incentive Program ............................ 93.7 Great Expectations® for health Coaching Programs .......... 10

Section 4: Additional Products to Purchase ............................134.1 Blue DentalSM .......................................................................... 13

4.2 Two-Tier Comprehensive Dental Plan ................................. 16

4.3 Life Insurance From Companion Life .................................. 16

Section 5: Web Tools and Services ..........................................175.1 BlueChoiceSC.com ................................................................ 17

5.2 My Health Toolkit®.................................................................. 17

5.2.1 Signing Up for a Free My Health Toolkit Account .......... 17

5.2.2 My Health Toolkit App ........................................................ 20

5.2.3 Cost Estimates ..................................................................... 20

5.3 Get Our Text Messages ......................................................... 20

Section 6: Quick Reference Section .........................................216.1 Group Size and Proposal Rating .......................................... 21

6.2 New Group Submission Requirements ............................... 21

6.3 Group Criteria ......................................................................... 22

6.3.1 Plan Effective Date .............................................................. 22

6.3.2 Plan Year ............................................................................... 22

6.3.3 Waiting Periods ................................................................... 22

6.3.4 Employer Contribution ....................................................... 22

6.3.5 Employee Eligibility ............................................................ 22

6.3.6 Participation Requirements ............................................... 22

6.3.7 Dual-Option Coverage ....................................................... 23

6.3.8 Two- or Three-Person Groups ........................................... 23

6.4 Additional Guidelines and Helpful Hints ............................ 23

6.5 Group Renewal Form Requirements ................................... 23

6.5.1 Grandfathered CarolinaADVANTAGE Plans ................... 23

6.5.2 Non-Grandfathered CarolinaADVANTAGE Plans .......... 23

6.5.3 BusinessADVANTAGE Plans.............................................. 23

6.5.4 Moving from CarolinaADVANTAGE

to BusinessADVANTAGE ....................................................24

6.5.5 Off-Anniversary Plan Changes........................................... 24

6.6 Group Termination Requests ................................................ 24

Section 7: Forms ...................................................................... 25

Section 8: Quoting Through Accel-a-RateSM (AAR) ................ 50

Section 9: The Marketing Storefront — Where You Order Marketing Materials ...................................529.1 Accessing the Marketing Storefront .................................... 52

9.2 Changing Your Password ...................................................... 52

9.3 Ordering Items ....................................................................... 52

Section 10: Agent of Record (AOR) Changes ........................ 53

Section 11: Membership Enrollment and Changes ............... 5311.1 Paper Enrollment.................................................................. 53

11.2 Electronic Data Integration (EDI) ....................................... 54

11.2.1 Setting Up EDI Enrollment .............................................. 54

11.2.2 Changes, Additions or Cancellations of

Members’ Plans for Groups with EDI ............................. 54

11.3 ChoiceEnroll ......................................................................... 54

11.4 Changes ................................................................................ 54

11.4.1 Changes in Employment Status ...................................... 55

11.4.2 Changes in Family Status ................................................. 55

11.5 Qualifying Events ................................................................. 55

11.6 Digital Member ID Cards .................................................... 56

11.7 ID Cards ................................................................................. 56

Section 12: QuickBillSM ............................................................. 5712.1 What is QuickBill? ................................................................. 57

12.2 How to Access QuickBill ..................................................... 57

12.3 How to Read and Pay a Bill ................................................. 57

12.4 Key Dates to Review a Bill ................................................... 59

Section 13: Learning Management System ............................ 60

Table of Contents

Welcome!Thank you for selling BlueChoice HealthPlan small group products. You are an integral part of our success, so we

want to make the process easier for you! This agent guide will help you:

• Understand our BusinessADVANTAGE plans.

• Understand all the programs and services included with the plans.

• Understand some of the administrative operations to help your clients when necessary.

We hope this guide provides you with valuable information and assists you with selling BusinessADVANTAGE

products and answering your clients’ questions.

We stay focused on helping you. You should always contact your Account Management Team if you have any questions that cannot be answered in this guide. If you can’t reach a member of your Account Management Team, please contact us in one of these ways:

QuickEnroll

QuickBill

FOCUSfwd GreatExpectations

Hearing Aids

Biometric Screening

Learning Management System

TobaccoCessationBlueChoice HealthPlan Wire

My Health Toolkit

Rewards

2018 Icons - Cumulative

Bases

Storefront

REV: 11/27/2018

Education Center

Laboratory Benefits Mgmt

Physician’s Office Manual

News

BlueOption

Blues Flash

ProducersGuide

Discounts andAdded Values

Business ADV Core ServicesCore ServicesHealth Care Reform

Video Carolina ADVAdvantage Plus MyChoice ADV Primary Choice Medical PoliciesFlexible SavingsAccount

Health Reimbursement

Account

EmployeeAssistanceProgram

Mobile App

Visit our website:

www.BlueChoiceSC.comEmail us:

[email protected]

We look forward to serving you and your clients, our valued customers, for years to come.

Call us Monday – Friday

between 8:30 a.m. – 5 p.m.:

866-280-0766, select option 1

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

1

http://www.BlueChoiceSC.commailto:[email protected]:866-280-0766

SECTION

1

2

Section 1: Primary Contacts1.1 Agent ContactsBlueChoice® prides itself on providing high levels of service. We assign staff to different portions of the state to

assist our agents. You have been assigned a Small Group Marketing Sales representative to answer any questions

you may have or help you navigate any issues that may arise.

ROLE CONTACT INFORMATION

Midlands/Pee Dee/Coastal

Name: Rhonda PierceEmail: [email protected]: 843-324-6567Direct Phone: 803-382-5595Fax: 803-714-6461 (cover sheet necessary)Street Address: 3060 Alpine Rd. AX-405, Columbia, SC 29223P.O. Box: P.O. Box 6170, AX-405, Columbia, SC 29260

Midlands/Spartanburg/ Rock Hill/Charlotte

Name: Melissa Gimbel SpearmanEmail: [email protected]: 803-361-7006Direct Phone: 803-382-5249Fax: 803-714-6461 (cover sheet necessary)Street Address: 3060 Alpine Rd. AX-405, Columbia, SC 29223P.O. Box: P.O. Box 6170, AX-405, Columbia, SC 29260

Charleston/Lowcountry

Name: Natalie RiggsEmail: [email protected] Cellphone: 843-901-2586 Direct Phone: 803-382-5185 Fax: 803-714-6461 (cover sheet necessary)Street Address: 3060 Alpine Rd. AX-405, Columbia, SC 29223P.O. Box: P.O. Box 6170, AX-405, Columbia, SC 29260

Greenville/Upstate

Name: Nan MinorEmail: [email protected]: 864-270-2729Direct Phone: 803-382-5585Fax: 803-714-6461 (cover sheet necessary)Street Address: 3060 Alpine Rd. AX-405, Columbia, SC 29223P.O. Box: P.O. Box 6170, AX-405, Columbia, SC 29260

Small Group Service Representative

Name: Kristie CorneliusEmail: [email protected]: 803-608-0159

Marketing Support Services*Monday – Friday, from 8:30 a.m. – 5 p.m. Phone: 866-280-0766, option 1 Email: [email protected]

* NOTE: Members should call the phone number listed on the back of their member ID cards with questions.

mailto:Melissa.Spearman%40BlueChoiceSC.com?subject=mailto:Nancy.Minor%40bluechoicesc.com?subject=mailto:Kristie.Cornelius%40BlueChoiceSC.com?subject=mailto:BCHPSmall%40BlueChoiceSC.com?subject=

SECT

ION

1

3

1.2 Other Important Contacts to RememberAs you assist your clients, you may have questions. In addition to your account team, here are some contacts that

may help you.

AREA TO CONTACT WHEN TO CONTACT US HOW TO CONTACT US

Billing Questions When your groups have questions about their bills

Phone: 866-569-5933, select option 3

Bill Payments To pay their bill Visit: www.QuickBillSC.com

Membership(For update requests and applications only. No responses to inquiries.)

To submit update requests and applications

Email: [email protected]: 803-870-9250

Member Services

Members can call when they have questions about:

• Claims or bills

• Benefits clarification

• Eligibility inquiries

• Coordination of other health coverage or benefits

• Out-of-area care and authorizations

• Emergency room services

Phone: 800-868-2528

Section 2: BusinessADVANTAGE Overview and Selling Points2.1 OverviewBusinessADVANTAGE is an affordable and comprehensive series of health plans with options to suit employers with

2 − 50 employees. We can work with employers to determine which features and benefits best fit their company and

their employees. Our plans include a variety of programs for medical, health and disease management.

BlueChoice routinely reviews our benefit plans and enhances them to meet employers’ needs. Employers can

choose from several levels of products with multiple plan designs. They can offer dual options in any combination

from any of our BusinessADVANTAGE plans down to two lives. All plans are health reimbursement arrangement-

compatible, and some plans are health savings account-qualified.

tel:866-569-5933http://www.QuickBillSC.commailto:BCHPMembership%40BlueChoiceSC.com?subject=tel:803-870-9250tel:800-868-2528

4

2.2 The Benefits of BusinessADVANTAGE• All-Inclusive Copayments — Cover all diagnostic and treatment services (including labs and X-rays) provided

at a medical office of a participating doctor. These services include preventive services, diagnostic procedures,

therapeutic procedures, surgical procedures, medical supplies, consultation and treatments. Also provide coverage

at other authorized places such as lab vendors and specialty providers.

• FOCUSfwd® Wellness Incentive Program — Members earn a $25 cash reward simply by completing these activities: – Personal Health Assessment

– Annual Wellness Visit

– Preventive Screenings or Flu Shot

Members can still win $1,000 quarterly and annual cash rewards of $5,000 for completing activities in all areas of

FOCUSfwd! To get started, members can visit www.BlueChoiceSC.com and log in to My Health Toolkit. Select Health & Wellness and then select FOCUSfwd Incentive Program. • Preventive Services Included — Automatically includes routine health screenings, and well-baby and well-child

care visits that in-network doctors provide with no dollar maximums. Routine preventive care is not covered out

of network.

• Adult and Pediatric Vision Care Included — All of our BusinessADVANTAGE plans automatically cover one eye exam each year and one pair of glasses or contact lenses every two years at network providers. Members do not have a

copay for adult vision care. Members, however, have a copay for an exam and eyeglasses for pediatric vision.

• Preventive Dental Included — All of our BusinessADVANTAGE plans automatically cover an allowed amount per benefit period for preventive exams and cleanings at any licensed dentist.

• Chiropractic Coverage — All of our BusinessADVANTAGE plans include chiropractic coverage limited to 5 visits for subluxation per benefit year.

• Blue CareOnDemandSM — Members have access to a doctor by video or telephone anytime, anywhere!• Employee Assistance Program (EAP) Provided by First Sun EAP Included in All Plans — All of our

BusinessADVANTAGE plans covers three face-to-face counseling sessions and three telephonic life management

sessions. Because First Sun EAP is a separate company from BlueChoice, First Sun is solely responsible for all services

related to individual assistance programs.

• Great Expectations for health — The program includes more than 20 wellness and disease management programs that focus on the early detection of illness and the prevention of disease.

• Contract Year or Calendar Year — Pick a benefit period. Benefit periods with year-to-date deductible credit for calendar year benefit periods only. Need to have information within 30 days of effective date.

• Blue Dental — Employers with five or more employees can choose from our comprehensive dental plans. Our plans offer flexible plan designs that are easy to administer.

• First or 15th of the Month Effective Date — You choose.• Comprehensive Provider Network — It includes BlueCard® national network and excellent provider network discounts.

SECTION

2

http://www.BlueChoiceSC.com

5

Section 3: Products Included With BusinessADVANTAGE3.1 Vision CareAll of our BusinessADVANTAGE plans automatically include adult and pediatric vision coverage through the

Physicians Eyecare Network (PEN). PEN is an independent company that offers a vision provider network on behalf

of BlueChoice.

The pediatric vision copayment is applied to the maximum out of pocket (MOOP). Adult vision is not applied to

the MOOP. Members can find a provider by visiting www.BlueChoiceSC.com.

3.1.2 Adult VisionOur vision plan provides a free eye exam every year and new eyewear every other benefit period. Contact lenses are available instead of frames and lenses as an option every other benefit period.

SERVICE BENEFIT MEMBER PAYSRoutine Eye Exam One routine eye exam per benefit year $0

Standard Frames Choose from designated frame selection $0

Non-Standard Frames

$60 credit or 30 percent discountFrames $61–$300: Cost of frames minus $60.Frames more than $300: 70 percent of frames cost.

Standard Lenses* Single vision or lined bifocal/trifocal $0

Non-Standard Lenses*

$60 credit or 30 percent discount

Lenses $61–$300: Cost of non-standard lenses minus $60.Lenses more than $300: 70 percent of lenses cost.

Standard Contacts90-day supply of disposable contacts or one pair of standard daily wear lenses

$45 fitting fee at the time of service

Non-Standard Contacts

30 percent discount on fitting fee and 90-day supply of contacts provided at 30 percent off the standard retail price

70 percent of usual and customary fitting fee and normal retail price of contacts

*Lens add-ons such as tint, scratch-resistant coating, UV protection or edge polish not covered. PEN providers may collect established prices for these options.For complete details, review your Schedule of Benefits. For members outside of the South Carolina service area, $71 is allowed toward the routine eye exam and a $120 credit is applied to the purchase of eyewear. Claims must be filed by the member.

SECT

ION

3


66

SECTION

3

3.1.3 Pediatric VisionPediatric vision benefits* includes one comprehensive routine vision exam and one pair of glasses or contact

lenses per benefit period.

* For dependent children through the age of 18. Adult vision care begins on the first day of the month following their 19th birthday.

BENEFIT MEMBER PAYSEye exam (one per benefit year) $25

Glasses and lenses – Includes:• Single vision, lined bifocal, lined trifocal or lenticular lenses• Frames from a standard frame selection• Scratch and UV protection• Polycarbonate for children ages 13 years or younger

$50

Contact lenses (in lieu of eyeglass benefit)** – Includes:• Standard (one pair annually) • Bi-weekly (three-month supply)• Monthly (six-month supply) • Dailies (three-month supply)

$50

** We cover necessary contact lenses in full for members who have specific conditions for which contact lenses provide better visual correction.For complete details, review your Schedule of Benefits.

3.2 Preventive DentalAll of our BusinessADVANTAGE plans automatically cover an allowed amount per benefit period for preventive exams

and cleanings at any licensed dentist. NOTE: If a group purchases a Blue Dental plan, it will have preventive dental.

With preventive dental, members enjoy a reimbursement for preventive care from any South Carolina licensed

dentist two times per year.

• Preventive dental, one exam every six months: $50

• Preventive dental, one cleaning every six months: $50

To be reimbursed, members must send a completed Dental Reimbursement form and the paid receipt from their

dentist to BlueChoice. Members can find a Dental Reimbursement form by going to www.BlueChoiceSC.com and selecting Find a Form.

Members should send the form to:

BlueChoice HealthPlan

Claims Department

P.O. Box 6170

Columbia, SC 29260-6170

Learn more about Blue Dental in section 4.1.

3.3 Chiropractic CoverageAll of our BusinessADVANTAGE plans include chiropractic coverage with no exclusions.


7

3.4 First Sun Employee Assistance Program (EAP)All of our BusinessADVANTAGE plans offer services for both members and employers through the First Sun EAP. Because

First Sun EAP is a separate company from BlueChoice, First Sun is solely responsible for all services related to the EAP.

3.4.1 Assistance for MembersAll of our BusinessADVANTAGE plans cover three face-to-face counseling sessions and three telephone life

management sessions. To access this benefit, members should call 800-968-8143. You can also check out the First Sun EAP website for additional information at www.firstsuneap.com.

Counseling Services include:• Personal Concerns

• Grief and Loss

• Trauma Issues

• Anger Management

• Marital/Relationship Issues

• Family Conflict

• Stress Management

• Spiritual Concerns

• Alcohol/Substance Abuse

• Workplace Concerns

• Depression

• Anxiety

The Life Management Services include:Financial Counseling and Planning• Budgeting

• Debt Counseling

• Refinancing

• Purchasing a Home/Car

• College Funds

• Retirement Planning/401(k)

Legal Consultations and Documents• Domestic/Family

• Civil/Consumer

• Criminal

• Estate Planning

• Real Estate

• Legal Documents

Adult Care Resources• Caregiver Support • Community Resources • Financial/Legal Education

Child Care Resources• Child Development

• Special Needs Concerns

• School Selection

• Tutoring Information

• Parent/Child Concerns

• Day Care Information

• Summer Camp Information

College and School Assistance – “College Coaches” help with:• Selecting the Appropriate School

• Understanding the Application and Admissions Process

• Admissions Testing Questions

• Financial Aid Websites

Parenting/Adoption Resources• Parenting Skills/Support

• Adoption Information

• List of Fertility Resources

SECT

ION

3

tel:800-968-8143https://www.firstsuneap.com/

8

3.4.2 Employer AssistanceNot only does First Sun EAP provide assistance for members, but they can also help employers in the following ways:

Training• Online and DVD employee orientations and manager training

• Free regional manager training and advisory conferences

• Full array of fee-for-service employee, manager and organizational training

Workplace Services• Group Leader consultation regarding policies and program planning

• HR/manager consultation regarding workplace issues

• Assessment, case management, referral and coordination of communications regarding troubled members

On-Site SupportFace-to-face consultation with an organizational consultant to set program goals, develop customized

promotional campaigns and complete free organizational assessments.

ReportingReporting is available to groups semi-annually.

3.5 Doctor Visits Anytime, AnywhereMembers can visit a doctor anytime, anywhere with their smartphone, tablet or computer, with Blue CareOnDemandSM.

Members should use Blue CareOnDemand when:

• They need to see a doctor, but can’t fit it into

their schedule.

• The doctor’s office is closed.

• They are too sick to drive.

• They have kids at home.

• They are traveling.

Types of conditions Blue CareOnDemand doctors can treat:

• Colds

• Flu

• Fever

• Rash

• Pinkeye

• Ear infection

• Migraines

Members can sign up by visiting www.BlueCareOnDemandSC.com, or downloading the mobile app from the App Store or Google Play. Be sure to have your member ID number to register.

SECTION

3

http://www.BlueCareOnDemandSC.com

Our nutrition program will help you

understand what and how much

you should be consuming based

on your individual needs. We’ll also

provide sample meal plans, nutritional

suggestions and more. Complete this

program and receive a $10 gift card to Panera Bread or Cold Stone Creamery.

9

SECT

ION

3

3.6 FOCUSfwd Wellness Incentive ProgramThe FOCUSfwd Wellness Incentive Program is designed to help you get healthy (or healthier) throughout allphases of your wellness journey. Complete our FOCUS Points, GET FIT and Nutrition programs and GET$55! Here’s how:

FOCUS Points*

Get rewarded for completing

activities that are important to

improving your overall health.

Complete your Personal Health

Assessment, annual wellness

visit and preventive screening

or flu shot and receive a

$25 cash reward!

GET FIT*$20

Get up to $20 in gift cards to Best Buy, Bed, Bath & Beyond or Amazon for stepping up to

annual challenges designed for

you, no matter where you are

in your journey.

Nutrition*$10

Sweepstakes$5K

You can also increase your chances of winning prizes by completing other health-related activities,

such as registering for My Health Toolkit®, connecting to Blue CareOnDemandSM, watching our

monthly health education videos and much more.

Complete FOCUS Points, GET FIT and Nutrition and receive 75 entries into the Sweepstakes, increasing your chance to win $1,000 quarterly and $5,000 annually.

Get started:1. Visit www.BlueChoiceSC.com.2. Log in to My Health Toolkit.3. Select the Health and Wellness tab.

4. Select the FOCUSfwd Incentive Program link.5. Enter your email address to be eligible to win.

*These are calendar-year programs and will restart annually.

$25


10

3.7 Great Expectations for health Coaching ProgramsComprehensive health management is an integral part of the services we offer to our members. We use a 360-degree

approach in managing the health of our members. There are programs for all members that focus on the early detection

of illness and the prevention of disease. Members with chronic conditions also receive more targeted educational

information and contact with our staff of highly trained health specialists. Those with intensive needs receive

care coordination and the support of our caring team of nurses. Members can self-enroll by calling 855-838-5897 and selecting option 2.

SECTION

3

CONDITION NAME DESCRIPTION

Adult ADHD

The Adult Attention Deficit Hyperactivity Disorder (ADHD) Program is a coaching program that educates members on steps to take to better manage their ADHD. The program helps members understand ADHD and empowers them with tools to manage medications and appointments. Members are able to set their own goals and may also receive educational mailings, access to online resources and newsletters, as appropriate.

Asthma (adult and pediatric)

The Great Expectations Asthma program helps members learn how to manage their asthma and improve their quality of life. Through ongoing partnership, collaboration, and telephonic coaching calls, our experienced respiratory therapists provide education about asthma and support for complying with each member’s doctor’s plan of care. Members can request a free peak flow meter.

Back Care

The Great Expectations Back Care program helps members learn to be active members of their health care team. Participants receive information on how to effectively partner with their healthcare provider(s), questions to ask their doctor, and options for pain management, including physical and behavioral therapies, self-care, and building an action plan to prevent future problems. Members with severe, chronic back pain will be considered for case management.

Bipolar Support

The Bipolar Support Program is a coaching program that helps members better manage their bipolar disorder. Coaches work with members in developing strategies to deal with mood shifts. The program educates and empowers members, allowing them to identify and self-monitor their symptoms. Members are able to set their own goals and may also receive educational mailings, access to online resources and newsletters, as appropriate.

Case Management

Great Expectations Case Management is a high-touch health care advocacy program designed to help members get the answers and services they need. We use a proactive, member-centered strategy focused on intensive education, care coordination and member empowerment across the care delivery system and throughout the life cycle of the disease.

Chronic Kidney Disease

Great Expectations Chronic Kidney Disease is an individualized program for members with stages 1 – 3 kidney disease. The program helps members learn how to manage their condition and reduce the risk of developing complications. Members have access to individualized telephonic coaching and educational materials. We automatically enroll eligible members at no charge. The program emphasizes the importance of having a personal physician to guide your kidney health management. This doctor can help you identify the best medications and dosing to enhance your kidney function and improve your quality of life.

Chronic Obstructive Pulmonary Disease (COPD)

Great Expectations COPD is a program that helps members with chronic obstructive pulmonary disease learn how to manage their disease. Our goal is to support members in practicing recommended self-care behaviors and following their physicians’ plan of care. Members may receive access to a personal health coach, educational materials, newsletters, and case management services, when needed.

tel:855-838-5897

11

SECT

ION

3


Depression

The Depression Program is a coaching program that assists members in developing a personalized plan for strategies to better manage their depression. The program educates and empowers members using evidence-based interventions for symptom monitoring. Members are able to set their own goals and may also receive educational mailings, access to online resources and newsletters, as appropriate.

Diabetes

The Great Expectations Diabetes program helps members learn how to manage their diabetes and reduce the risk of developing complications from their disease. Members may receive access to a personal health coach, educational materials, free preferred glucose monitors and a free yearly diabetes office visit. We also help members take advantage of their benefits for eye exams and diabetes education, both at no additional charge to the member.

Healthy and Active Kids and Teens

The Great Expectations Healthy and Active Kids and Teens program identifies children who are overweight or obese and offers their families education and interactive tools for adopting healthy habits.

Heart Disease

Great Expectations Heart Disease is a program for members with coronary artery or ischemic heart disease. The program educates members about lifestyle modifications and evidence-based guidelines for the monitoring and control of cardiac risk factors, such as hyperlipidemia and hypertension. Members may receive access to a personal health coach, educational materials, newsletters, and case management services, as appropriate.

Heart Failure

The Great Expectations Heart Failure program educates members with heart failure about appropriate self-care strategies to minimize exacerbation of their condition. Members receive access to a personal health coach, educational materials, newsletters, and case management services, as appropriate.

High Blood Pressure

Great Expectations High Blood Pressure is an educational program for members who want to learn more about managing their blood pressure. The program educates members about lifestyle modifications and evidence-based guidelines for the monitoring and control of cardiac risk factors, such as hypertension. Members may receive access to a personal health coach, access to online resources and newsletters, as appropriate.

High Cholesterol

The Great Expectations High Cholesterol program is an educational program for members who want to learn more about managing their cholesterol. The program educates members about lifestyle modifications and evidence-based guidelines for the monitoring and control of cardiac risk factors, such as high cholesterol. Members may receive access to a personal health coach, educational mailings, access to online resources and newsletters.

MaternityThe Great Expectations Maternity program educates members about taking steps toward having a healthy baby. We provide educational materials, support, and monitoring throughout a member’s pregnancy and postpartum period. The program is open to all eligible, expectant mothers.

Metabolic Health

The Great Expectations Metabolic Health program helps members learn how to manage pre-diabetes and/or metabolic syndrome, reducing the risk of developing complications such as type 2 diabetes and heart disease. Metabolic syndrome is the name of a group of conditions linked to being overweight or obese. Members may receive access to a personal health coach, educational materials to encourage lifestyle changes, free preferred glucose monitors for members with pre-diabetes, and information to help members take advantage of their benefits for free diabetes education.

Migraine

The Great Expectations Migraine program is for adults who suffer from severe, recurrent headaches. We provide information about the importance of having a personal physician to guide headache management. Members may receive access to a personal health coach, educational materials about pertinent migraine-related topics, access to online resources and newsletters, as appropriate.

12


Moms Support Program

The Moms Support Program is a coaching program that helps moms across the child-bearing spec-trum. Members develop strategies to better manage their depression and anxiety at any stage, pre or post-pregnancy. The program empowers and educates members, which allows them to identify and self-monitor their symptoms. Members are able to set their own goals. They may also receive educational mailings, access to online resources and newsletters, as appropriate.

NICU Case Management

We offer the Great Expectations NICU Case Management program to infants who have certain conditions. These conditions include, but aren’t limited to, complications associated with premature birth, congenital birth defects, hydrocephalus, seizures, cystic fibrosis and genetic disorders. Clinically experienced certified nurse case managers work closely with the caregiver and the member’s providers to ensure ongoing communication and coordination of care.

Recovery Support for Sub-stance Use Disorder

The Recovery Support Program helps members through recovery, one day at a time. Members set personal sobriety goals to stay off alcohol, opiates and other substances. Coaches help members develop a personalized action plan to help overcome the challenges of addiction and better manage their recovery. The program educates members about evidence-based coping strategies to deal with cravings and relapse triggers. Members may receive educational mailings, access to online resources and newsletters, as appropriate.

Stress Management

The Stress Management Program is a coaching program that helps members develop a person-alized plan for strategies to better manage their stress. The program educates and empowers members, providing them with tools to improve functioning for an overall healthier life and lifestyle. Members are able to set their own goals and may also receive educational mailings, access to online resources and newsletters, as appropriate.

Tobacco Cessation

The Great Expectations Tobacco Cessation program is for members ages 18 and above and provides support and resources to help members become tobacco free. This program guides members through deciding to quit, identifying triggers and overcoming the challenges of giving up tobacco.

Weight Management

The Great Expectations Weight Management program educates members about healthy eating and exercise, as well as behavior modification strategies to maximize weight loss and mainte-nance. Members who enroll in the program receive unlimited telephone access to a weight-loss coach and a wide variety of digital tools designed to help members learn more about the key principles of implementing a successful weight-loss plan.

Focus on life. Focus on health. Stay focused.

SECTION

3

13

SECT

ION

4

Section 4: Additional Products to Purchase4.1 Blue DentalGroups with five or more enrolled employees can purchase one of our Blue Dental plans.

NOTE: Medical and dental elections do not have to match with Blue Dental.

Our plans offer these benefits:• Flexible plan designs — Choose one of our plan options: Open Access or Select.

• Easy to administer — Single-source placement consolidates billing, eligibility and enrollment through a single

account team.

• Comprehensive dental networks — Members choose from more than 2,400 access points in South Carolina and

263,000 nationally. Referrals are not required before a member sees a specialist.

Eligibility:• Groups must have five or more enrolled employees to purchase any Blue Dental plan.

• Group — A minimum enrollment of five contracts or 50 percent of eligible employees enrolled. The employer

contribution should be 30 percent of employee-only rate.

• Orthodontia is available for employers with preferred pricing. Coverage is limited to children and adults up to age

19. Preferred pricing is for employers that contribute at least 50 percent or more of the single premium and have a

minimum 10 or more contracts or 50 percent participation, whichever is greater.

To continue benefits, we must receive the Membership Application and Change form indicating conversion within

31 days of the loss of coverage.

14

Blue Dental 2In-network/

Out-of-network coverage

In-network coverage


Preventive Care (Class I) Exams, cleanings, bitewing X-rays, fluoride treatment, sealants

100% 100% 80%

Basic Care (Class II) Complete series X-rays, space maintainers, periodontal maintenance, fillings, periodontal scaling and simple extractions

80% 80% 60%

Major Restorative Care* (Class III) Periodontal surgery, oral surgery, endodontic (root canal) treatment and general anesthesia, crowns, inlays and onlays, dentures, partials and fixed bridges

50% 50% 40%

Orthodontia Services (Optional)Includes:• Age limit of 19• Lifetime maximum of $1,000• A 12-month waiting period

50% 50% 40%

Deductible for Class II and III (single/family) $50/$150 $50/$150 $50/$150

Annual Maximum (Class I, Class II and Class III all accumulate toward the annual maximum)

$1,000 $1,000 $1,000

* When the employer contribution to the employee rate is less than 50 percent, there is a 12-month waiting period for members who have had no prior dental coverage with the employer.

SECTION

4



In-network coverage



100% 100% 80%


80% 80% 60%


50% 50% 40%

Orthodontia Services (Optional)Includes:

• Age limit of 19• Lifetime maximum of $1,000• A 12-month waiting period

50% 50% 40%



$2,000 $2,000 $2,000


15

SECT

ION

4



In-network coverage



100% 100% 80%


80% 80% 60%


50% 50% 40%

Orthodontia Services (Optional)Includes:• Age limit of 19• Lifetime maximum of $1,000• A 12-month waiting period

50% 50% 40%



$1,000 $1,000 $1,000


NUMBER OF EMPLOYEES

EMPLOYER CONTRIBUTION

ENROLLMENT REQUIREMENT PRICING*

ORTHODONTIA AVAILABLE?

5 to 930% to 100% of single premium

Minimum of 5 contracts Standard No


Minimum of 10 contracts Standard No

10 to 19Minimum of 50% of single premium

Minimum of 10 contracts Preferred Yes


Minimum of 50% participation

Standard No

20 to 50Minimum of 50% of single premium

Minimum of 50% participation

Preferred Yes

* Preferred pricing is for employers that contribute at least 50 percent or more of the single premium and have a minimum 10 or more contracts or 50 percent participation, whichever is greater. Blue Dental 1 is not available for standard pricing options.

16

4.2 Two-Tier Comprehensive Dental Plan (Sold prior to Jan. 1, 2017)This product is no longer available to sell. If a group currently offers our two-tier comprehensive dental plan, it can

continue to offer it. However, groups that do not currently have a dental plan and wish to purchase a dental plan

will have to purchase a Blue Dental plan (see section 4.1).

If the group elects to continue its Two-Tier Comprehensive Dental coverage:

• The employee’s dental election must match the medical election. Example: E/S medical = E/S dental.

• Employees cannot elect dental only.

4.3 Life Insurance from Companion Life*Groups can choose to offer their employees life insurance. A minimum of $10,000 group life and accidental death

and dismemberment insurance is optional.

Companion Life requires a personal health statement for amounts greater than $50,000.

ELIGIBLE EMPLOYEES INCREMENTS

2 – 19 $10,000, $15,000, $20,000, $30,000, $40,000, $50,000

20 – 50 $10,000, $15,000, $20,000, $25,000, $30,000, $35,000, $40,000, $45,000, $50,000

• Companion Life will underwrite and bill for all amounts over $50,000.

• If a group elects life, all enrolled in medical will be enrolled in life.

• If the employee elects only life insurance, he or she must complete the life section of the enrollment

form/census spreadsheet.

• Companion Life can sell dependent life with basic life. The dependent life amounts are flat amounts based

on group size.

ELIGIBLE EMPLOYEES COVERED SPOUSE AMOUNT PER COVERED CHILD AMOUNT

2 – 19 $2,000 $1,000

20 – 50 $5,000 $5,000

• The life insurance election does not have to match the medical/dental election. The employee can elect to have

dependent life (if the employer offers it), and only elect single medical/dental coverage. Also, the employee can

waive the dependent life, but elect to cover the family under the medical/dental plan.

*Because Companion Life is a separate company from BlueChoice, Companion Life will be responsible for all services related to this life insurance.

SECTION

4

17

SECT

ION

5

Section 5: Web Tools and Services5.1 BlueChoiceSC.comOur website has a variety of tools to help you and your BlueChoice clients.

They can:

• Get plan and product information

• Find participating medical providers or facilities

• Download forms

• Find a prescription drug list

• Access their member guide

• Learn about our wellness program FOCUSfwd as well as our Great Expectations for health programs

5.2 My Health ToolkitCovered members can use My Health Toolkit to access claims, health and other coverage

information. When they register, they can:

• View their digital ID card.

• See if their claim has been paid.

• Ask Member Services a question.

• Access the FOCUSfwd Wellness Incentive Program.• Find a doctor or hospital.

• Find out how much a prescription drug costs.

• Take a personal health assessment.

• Find out how much they have paid toward their deductible.

• View their Schedule of Benefits (SOB), which includes their copay and coinsurance amounts.

Covered spouses and dependents ages 16 years and older can register their own accounts.

5.2.1 Signing Up for a Free My Health Toolkit AccountMembers can sign up for a free My Health Toolkit account.

Step 1:Go to www.BlueChoiceSC.com.

Step 2:Select Register Now.

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

2


18

SECTION

5

Step 3:Enter the member ID located on the front of the member ID card or the subscriber’s Social Security number, along

with the date of birth. When entering the member ID, make sure to include both the letters and the numbers.

3

Step 4:Choose a username

and password.

Step 5: Enter the email

address and confirm it.

4

5

19

SECT

ION

5

Step 6: To receive paperless EOBs, move the

slider bar to the right and select Continue.

Otherwise, only select Continue.

7

6

Step 7: The launch pad for first-time visitors appears.

7

20

5.2.2 My Health Toolkit App Your clients can take My Health Toolkit with them when they’re on the go

with our FREE mobile app! They can:

• View and share their digital ID card.

• Check the status of their claims.

• Confirm coverage.

• Find a doctor or hospital in network.

• Update their contact information.

• Access the FOCUSfwd Wellness Incentive Program.

Get the AppSearch for My Health Toolkit in the App Store or Google Play to download the My Health Toolkit app.

5.2.3 Cost EstimatesYour covered clients can use Find Care in My Health Toolkit® to find the estimated cost of a serviceacross providers, like an office visit or radiology test. This gives your covered clients personalized

information so they can make informed decisions about health care treatment options.

The results show dollar amount estimates that are specific to their benefits and the treatments they researched.

They can also sort the information based on features that are important to them, such as:

• Average cost of a particular treatment or service

• Estimated out-of-pocket costs

• Distance from home to facility

• Whether a facility is a Blue Distinction Center® — a designation by the Blue Cross and Blue Shield Association

for medical facilities that have demonstrated expertise in delivering quality health care.

To access the Cost Estimates, members should:

• Visit www.BlueChoiceSC.com.• Log in to My Health Toolkit. Members (ages 16 and older) can register for a free account if they do not have one.• Select the Resources tab, and select the Find Care link.

5.3 Get Our Text MessagesBlueChoice HealthPlan Wire is a text messaging service that will deliver health information to our

members’ smartphones. They can opt in to this service by calling 844-206-0622. After they sign up for the service,they will receive updates about:

• How to make the most of their coverage.

• Health and wellness reminders.

• New features or enhancements.

Members can choose the frequency for receiving texts and can unsubscribe if they choose. They will need to have

their member ID card ready when they call to sign up.

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

SECTION

5

http://www.BlueChoiceSC.comtel:844-206-0622

21

SECT

ION

6

Section 6: Quick Reference Section6.1 Group Size and Proposal RatingAll BusinessADVANTAGE plans:

• 2–50 eligible employees — Adjusted Community Rates.

• Tobacco Surcharge — 20 percent on tobacco users 18 years or older (if participating in a tobacco cessation program,

surcharge can be removed by completing and submitting the Tobacco Usage form).

• The size of the group is determined by the number of full-time, eligible employees, not the number of

enrolled subscribers.

• If a business has 50 or fewer full-time employees, the health care law considers it a small business, and it is subject to

Affordable Care Act (ACA) requirements.

• Family dependent rates are based on the three oldest children under age 21 and all children 21 through 26.

A rate will only be applied to the three oldest dependents under age 21. Dependents age 21 and over will be

rated individually.

• ACA fees — All applicable ACA fees are included in new and renewal rates for all groups.

• Open enrollment — All groups will have an open enrollment period 30 days before their renewal/effective date.

Any member changes outside of that open enrollment period must be subject to a qualifying event.

Please email your new group submission/enrollment to BlueChoice Underwriting:

[email protected] and copy your Small Group Marketing Sales representative.

6.2 New Group Submission RequirementsRefer to the Agent New Group Checklist (see page 26), which lists all required documentation needed forsubmission of new groups:

1. Small Group Request for Coverage Form.

2. Master Group Application.

3. Copy of Accel-A-Rate (AAR) pr oposal that matches enrollment to include full legal names and correct dates of birth. New group proposals need to be run seven days before required effective date.

4. Membership Application and Change Form or Census Enrollment Spreadsheet (preferred).5. Quarterly Wage and Tax Report (UCE 101 and 120) or applicable tax documentation.

6. Medical Loss Ratio Form.

7. Tobacco Usage Form — only required for tobacco users if currently enrolled in tobacco cessation program.

8. Companion Life Employer Participation Application (if elected – optional).

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

mailto:Submissions%40BlueChoiceSC.com?subject=Question%20from%20Small%20Group%20Agent%20Guide

22

6.3 Group Criteria6.3.1 Plan Effective DateGroups can select effective dates on the first of the month (preferred) or 15th of the month. Proposals must be run in

AAR at least seven days before the effective date. Cases should be submitted a minimum of two weeks before the

effective date. This will ensure groups are loaded into the system and members receive ID cards in a timely fashion.

6.3.2 Plan YearCalendar or Contract Year — Deductible credit can be given back to January for groups on a calendar year with

a previous carrier that elect a calendar year with BlueChoice. Explanation of Benefits (EOB) information must be

submitted within 30 days of the effective date.

6.3.3 Waiting Periods• First of the month following 30 days

• First of the month following 60 days

• After 90 days

• If a group does not elect a waiting period, the default will be the first of the month following 60 days.

6.3.4 Employer Contribution• Employer Contribution Requirement: 50 percent of the single medical premium rate.

• Employer contribution does not include tobacco surcharges.

6.3.5 Employee Eligibility• All eligible employees (working a minimum of 30 hours a week, 48 weeks of the year) are eligible to enroll after

meeting the waiting period.

• New hires must enroll within 31 days of their eligibility dates.

• Late enrollees are not eligible until the group’s open enrollment period at renewal, and enrollees must submit by

the renewal date.

• Members enrolled on exchange individual plans CANNOT be added to the group plan until they have been

terminated off the exchange plan. Members MUST contact www.healthcare.gov for this service if coverage was purchased on the exchange.

• We will cover dependent children up to age 26. Coverage ends at the end of the birthday month.

• Contract (1099), leased employees and management (class) carve-outs of any kind are not eligible.

6.3.6 Participation Requirements• Valid waivers include Medicare, Medicaid, other employer-sponsored group insurance coverage and military/

veterans’ programs. Individual coverage is not a valid waiver.

ELIGIBLE EMPLOYEES MINIMUM PARTICIPATION REQUIREMENT2 – 50 70 percent of total full-time, eligible employees after excluding valid waivers

SECTION

6

Section 6: Quick Reference Section6.1 Group Size and Proposal RatingAll BusinessADVANTAGE plans:

• 2–50 eligible employees — Adjusted Community Rates.

• Tobacco Surcharge — 20 percent on tobacco users 18 years or older (if participating in a tobacco cessation program,

surcharge can be removed by completing and submitting the Tobacco Usage form).

• The size of the group is determined by the number of full-time, eligible employees, not the number of

enrolled subscribers.

• If a business has 50 or fewer full-time employees, the health care law considers it a small business, and it is subject to

Affordable Care Act (ACA) requirements.

• Family dependent rates are based on the three oldest children under age 21 and all children 21 through 26.

A rate will only be applied to the three oldest dependents under age 21. Dependents age 21 and over will be

rated individually.

• ACA fees — All applicable ACA fees are included in new and renewal rates for all groups.

• Open enrollment — All groups will have an open enrollment period 30 days before their renewal/effective date.

Any member changes outside of that open enrollment period must be subject to a qualifying event.

6.2 New Group Submission RequirementsRefer to the Agent New Group Checklist (see page 26), which lists all required documentation needed for submission of new groups:

1. Small Group Request for Coverage Form.

2. Master Group Application.

3. Copy of Accel-A-Rate (AAR) proposal that matches enrollment to include full legal names and correct dates of birth. New group proposals need to be run seven days before required effective date.

4. Membership Application and Change Form or Census Enrollment Spreadsheet (preferred).5. Quarterly Wage and Tax Report (UCE 101 and 120) or applicable tax documentation.

6. Medical Loss Ratio Form.

7. Tobacco Usage Form — only required for tobacco users if currently enrolled in tobacco cessation program.

8. Companion Life Employer Participation Application (if elected – optional).

Please email your new group submission/enrollment to BlueChoice Underwriting:

[email protected] and copy your Small Group Marketing Sales representative.

QuickEnroll

QuickBill


Hearing Aids

Biometric Screening



My Health Toolkit

Rewards


Bases

Storefront

REV: 11/27/2018

Education Center



News

BlueOption

Blues Flash

ProducersGuide





Account


Mobile App

http://www.healthcare.govmailto:Submissions%40BlueChoiceSC.com?subject=Question%20from%20Small%20Group%20Agent%20Guide

23

SECT

ION

6

6.3.7 Dual-Option Coverage• Groups can elect a dual option from any BusinessADVANTAGE plan option.

• Minimum group size for dual option is two employees, with at least one employee enrolled in each option.

6.3.8 Two- or Three-Person Groups• If a husband and wife are the only two employees in a valid group, they must enroll separately. They can only

enroll children under one parent.

• If the group has three or more employees, and two of those are a husband and wife, they can enroll together

with employee/spouse or family coverage.

• The employee covered as a spouse must complete a waiver enrollment form for medical/dental.

• The employee covered as a spouse must complete a waiver enrollment form for life insurance offered by

Companion Life Insurance Company. The covered spouse still has the option of electing the employee life

insurance. If elected, the life section on the enrollment form must be completed.

• If only husband and wife are employees of the group, then any sole proprietorships are excluded.

6.4 Additional Guidelines and Helpful Hints• All health plans include an embedded deductible and embedded MOOP.

• All groups switching to BusinessADVANTAGE plans will receive a new group number and new member ID cards.

• The ID card prefix for BusinessADVANTAGE and CarolinaADVANTAGE is ZCL.

• BusinessADVANTAGE/CarolinaADVANTAGE (legacy business) use the full Open Access Network.

6.5 Group Renewal Form RequirementsImportant Reminder — If any group currently has optional life or comprehensive dental coverage, it MUST be reflected on the group renewal proposal if the group plans to continue with this coverage. If it is not reflected, the

coverage will be dropped.

6.5.1 Grandfathered CarolinaADVANTAGE Plans1. Group Attestation form.

2. Medical Loss Ratio form — can be emailed to the address or faxed to the number on the form.

3. Revised signed rate sheet if group renews with rate concession.

6.5.2 Non-Grandfathered CarolinaADVANTAGE Plans1. Medical Loss Ratio form — can be emailed to the address or faxed to the number on the form.

2. Signed rate sheet (if switching to another CarolinaADVANTAGE plan).

3. Revised signed rate sheet if group renews with rate concessions.

6.5.3 BusinessADVANTAGE Plans1. Medical Loss Ratio form — can be emailed to the address or faxed to the number on the form.

2. Signed rate sheet (if switching to another BusinessADVANTAGE plan).

24

6.5.4 Moving from CarolinaADVANTAGE to BusinessADVANTAGE 1. The group MUST pay current month’s premium before BlueChoice completes the rollover to a

BusinessADVANTAGE plan.

2. No past-due balances can be rolled over to the new plan.

On Renewal Date:1. Signed metallic rate sheet.

2. Medical Loss Ratio form — can be emailed to the address or faxed to the number on the form.

3. New employer paperwork.

Off Renewal Date: Refer to Section 6.5.5 below.

6.5.5 Off-Anniversary Plan ChangesAll new group paperwork — including census spreadsheet or enrollment applications with tobacco usage

questions — answered.

6.6 Group Termination RequestsAll group termination requests should be submitted BEFORE the requested termination date for approval. Failure

to provide timely requests will result in the request being approved the first of the following month of the request.

Retro-termination requests will ONLY be granted if claims have not been paid on members, and the request is

within 30 – 60 days of the request.

SECTION

6

Section 7: FormsYou can find all forms on our website:

• Go to www.BlueChoiceSC.com.• Select Find a Form.• Select the Agents checkbox.

25

SECT

ION

7


BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. Rev. 10/19 BC‐2002

Agent New Group Checklist (Small Group Segment 2 – 50)

Proposed Agent’s Name: Agent’s Number: Effective Date: _

Group’s Name: _ Submission Date:

Required Forms and Documents: Medical Coverage Copy of the complete Accel‐A‐RateSM proposal (that matches enrollment, including the employee’s full name and exact date of birth)

1. __Small Group Request for Coverage

2. Master Group Application

3. _ MLR Form

4. _Prior Medical Carrier Contract Year __________ Calendar year___________

5. _ Enrollment Application and Change Form (BCHP_15512, Rev.2/14) for each eligibleemployee, including signed and dated waivers.

OR

6. _

7. _

BlueChoice HealthPlan‐Approved Census Enrollment Spreadsheet

Tobacco Usage Form (only if member is enrolled in a smoking cessation program)

Most Recent S.C. Quarterly Wage and Tax Statement: Both the UCE‐120 and UCE 101 (lists all W‐2 employees)

You need notation by each name — full time, part time, temp, seasonal, termed/with date, new hire. If new hire is not listed — add to the list and write in name, Social Security number and date of hire. Reconcile the wage report to match the number of enrollment/waivers received.

Please email your new group submission/enrollment to BlueChoice HealthPlan Underwriting: [email protected] and copy your marketing representative.

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association. Rev. 10/19 BC‐2002

Additional forms of tax documentation that are acceptable for group submissions.

Newly organized groups that do not have tax documentation available at time of submission:

Important reminder: BlueChoice HealthPlan reserves the right to pend any group until the required tax documentation has been received and approved. Failure to submit this information timely could result in a new effective date of coverage where rates would be impacted.

Companion Life — Required Forms and Documents

Companion Life – Employer Participation Application (optional) (2‐19 employees: Form 12437M rev. 6/04) (20‐100 employees: Form 12575M rev. 4/01)

Companion Life insurance requested is greater than $50,000: Personal Health Statement (Rev. 10/17) for each employee regardless of group size)

Life insurance is offered by Companion Life. Because Companion Life is a separate company from BlueChoice HealthPlan, Companion Life will be responsible for all services related to life insurance.

(Note: Binder check not required at submission.)

‐ Must provide payroll records, a business license and the Secretary of State form and/or articles of Incorporation listing owners’ names and ownership. - You must provide the tax documents within 30 days of the tax-filing deadline.

Please provide a letter the group signed that states the number of hours worked per week and weeks worked per year for each person. These documents are accepted if the owner/partner isn’t listed on the QW/W2 document. Also, provide one of these tax schedules:

Corporations Sole Proprietor Sole Proprietor – Farmer Partnerships – Spouse onlyPartnerships – Partners Nonprofit Business

(1120(S) with Schedule E & Schedule K)(1040 with Schedule C) (Form 943 & payroll records) (1065 with Schedule K1 & payroll records)(1040 with schedule K1 & payroll records)(Form 941 & payroll records)

Requested Effective Date: / / Tax ID: Mo. Day Yr.

Group’s Legal Name:

Group Address: (Street) (City) (State) (ZIP) (County)

Group Mailing Address: (P.O. Box) (City) (State) (ZIP) (County)

Group Billing Contact: Executive Contact:

Title: Title:

Telephone: ( ) Fax: ( )

Email Address: Number of Years in Business:

Nature of Business: Standard Industrial Classification (SIC) Code:

Do you provide workers’ compensation for all your employees? Yes No

If yes, carrier’s name and policy number:

If no, list employees not covered and reason:

Prior Medical Carrier: Prior Dental Carrier:

Small Group Request for Coverage (2 — 50) GROUP INFORMATION (New Business)

GROUP INFORMATION

WAITING PERIOD

Groups 2 — 50:

First of the month following 30 days

First of the month following 60 days

90 calendar days

Billing: First of the month

15th of the month

PLAN SELECTION

Select One: Contract Year Calendar Year Select One: Single Option Dual Option

Employer Contribution Amount: percent

Gold 1000

Gold 1001

Gold 1003

Gold 1100

Gold 1502

Gold 1750

Gold 2000

Gold 2001

Gold 2400

Gold 2503

Gold 2700

Gold 2850 HD

Gold 3000

Gold 3001

Gold 3225 HD

Gold 4500

Gold 5225

Silver 2000

Silver 2375

Silver 2850

Silver 3200

Silver 3500

Silver 4200 HD

Silver 4500

Silver 4600 HD

Silver 4800

Silver 5000

Silver 5001

Silver 5004 HD

Silver 5550

Silver 5800

Silver 6750

Silver 6850

Silver 7001

Silver 7100

Silver 7350

Silver 8150

Bronze 5550

Bronze 5800

Bronze 6000

Bronze 6200 HD

Bronze 6500

Bronze 6900 HD

Bronze 7300

Bronze 7901

Bronze 8150

Comprehensive Dental: (For groups sold before 1/1/17) Yes No Employer Contribution Amount: percent Preferred Standard Ortho

Blue DentalSM: Yes No

Blue Dental 1 Open Access Blue Dental 2 Open Access Blue Dental 3 Open Access

Blue Dental 1 Select Blue Dental 2 Select Blue Dental 3 Select

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.

BCHP-210306-BCS-2000-9-2019

Send ID cards to: Group Members

Summary of Benefits and Coverage (SBC) Delivered to Group: Yes No

To receive the contract, SBC and the Schedule of Benefits via email,

please provide the group administrator’s email address:

CC: Agency Administrator Yes No

Agency’s Email Address:

ID CARD/CONTRACT DELIVERY INFORMATION

Please be sure to include a full proposal that matches enrollment, including rates, for the plan design(s) you are requesting.

PLAN OPTIONS

Agent’s name: Agent’s number:

Agent’s email address:

Agent’s signature: BlueChoice® sales representative:

Agency administrator’s name:

Agency administrator’s email address:

AGENT INFORMATION

Companion Life: Yes No

Life insurance offered by Companion Life. Because Companion Life is a separate company from BlueChoice HealthPlan,Companion Life will be responsible for all services related to life insurance.

LIFE INSURANCE

Preferred health reimbursement accounts (HRAs) vendor: Benefit Coordinators, Inc.

Benefit Coordinators, Inc. is an independent company that manages HRAs for BlueChoice HealthPlan.

HEALTH REIMBURSEMENT ACCOUNT (HRA)

Chamber Name: Membership Start Date:

Chamber Code: (for external use only)

CHAMBER INFORMATION

BCHP_15515 (Rev. 1/18) 1 Business Advantage An independent licensee of the Blue Cross and Blue Shield Association

MASTER GROUP APPLICATION

Application is hereby made for coverage as set forth in the attached BlueChoice HealthPlan of SouthCarolina, Inc. contract as stated on this Master Group Application.

EMPLOYER INFORMATION

FULL LEGAL NAME OF EMPLOYER:

PHYSICAL ADDRESS OF EMPLOYER:

MAILING ADDRESS OF EMPLOYER:(if different)

EMPLOYEE AND DEPENDENT INFORMATION

CLASSIFICATION OF ELIGIBLE EMPLOYEES:

All full-time, active employees working at least 30 hours a week. To be considered actively at work, the employee must not be absent from work because of leave of absence or temporary layoff, unless the absence is due to a health status-related factor. If the employee does not meet this requirement, coverage willbegin upon completion of the group's waiting period.

PERIOD OF CONTINUOUS EMPLOYMENT AS PREREQUISITE TO ELIGIBILITY:Coverage for new employees hired following the Contract Effective Date will commence:

On the first of the month following 30 days of employmentOn the first of the month following 60 days of employmentAfter 90 calendar days of employment

This waiting period may not be waived for individual employees. The group may waive the waiting period only for employees during the initial enrollment for the new group. All eligible employees must be offered coverage.


CLASSIFICATION OF ELIGIBLE DEPENDENTS:

An eligible dependent is: 1) the subscriber's legal spouse; or 2) the subscriber's natural child, adoptedchild, foster child, stepchild or child for whom the subscriber has legal custody or legal guardianshipand who is under 26 years of age. This also includes any child of a divorcing/divorced employee who is recognized under a qualified medical child support order (QMCSO) as having a right to enrollment under this health plan.

BENEFIT PROVISIONS

BENEFIT PERIOD: Contract or calendar year

PARTICIPATION AND CONTRIBUTION REQUIREMENTS

CONTRIBUTION REQUIREMENTS

1. When the employer pays 100 percent of the single coverage premium, all eligible employees must enroll with at least single coverage.

2. The employer must pay at least 50 percent of the single coverage premium.

PARTICIPATION REQUIREMENTS

70 percent of total full-time eligible Employees after excluding waivers.

Valid waivers are those covered through another employer plan, Medicare, Medicaid, the military orveterans' programs. Individual non-group coverage is not a valid waiver.


EMPLOYER’S SIGNATURE

Effective date of coverage under this application shall be 12:01 a.m., Eastern Time on the first day of , at the address indicated. Such coverage will continue until

terminated in accordance with the provisions of the contract between the employer and the corporation. It isunderstood and agreed that the employer shall cause to be paid to the corporation, in advance, the premiumspecified in Schedule A of the contract. This premium is made on behalf of the employer’s employees whomeet the eligibility requirements specified in this application and who elect to be covered by the corporation.This application shall form part of the contract issued by the corporation.

It is also understood and agreed that if the employer had coverage with BlueChoice HealthPlan of South Carolina, Inc. or any of its affiliated companies, and the contract was cancelled due to nonpayment of premiums, and the employer reapplies for coverage within 12 months, the employer will be required to pay all past due premiums before new coverage can be effective.

The employer may accept this contract either by signature of this Master Group Application or by paying therequired premiums to the corporation. Such acceptance renders all terms and provisions hereof binding on the corporation and the employer.

By:

Title:

Date:

BLUECHOICE HEALTHPLANOF SOUTH CAROLINA, INC.

By:

Title: President and Chief Operating Officer

Date:

BlueChoice has free language interpretation services available. We can also give you information in languages other than English or other alternate formats.


DEFINITIONS

The terms defined shall have their defined meaning whenever they are capitalized in this Master Group

Application or in the Master Group Contract.

Contract Effective Date – The date the coverage goes into effect.

Enrollment Date – The date of enrollment under the group health plan or, if earlier, the first day of the waitingperiod for the enrollment.

Special Enrollment Period – Employees and/or dependents who are eligible to enroll other than during the initial enrollment period or open enrollment as described in the Master Group Contract or the Certificate.

of 2

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.(Rev. 1/1/20)

Part 1: Medical Loss Ratio 2020 Rebate Information

Group Administrator

MEDICAL LOSS RATIO & COBRA ELIGIBILITY SURVEY

Email: [email protected]: 1-803-735-1934

Group Name: Group Number: Group Contact’s Name: Group Contact’s Email Address: Group's Standard Industry Code (SIC):

Under the Patient Protection and Affordable Care Act (PPACA), health insurance carriers are required to report their medical loss ratios (MLR) to state and federal agencies annually.

1. What was the total average number of employees in your organization/company in 2019? .This is defined “by averaging the total number of all employees employed on business days during the preceding calendar year. Thisincludes each full-time, part-time, and seasonal employee.”

2. Of that number, how many were eligible for health insurancein 2019? .(This number represents the 2019 average of all full-time employees, defined as working at least 30 hours per week, 48 weeks peryear.)

3. Are you a new group with only 2 members enrolling? Yes No (If yes, answer questions 5 and 6)

4. Are you a renewing group with only 2 members enrolled? Yes No (If yes, answer questions 5 and 6)

5. Is the second enrollee your spouse? Yes No (If no, please answer question 6.)

6. Is this group a sole proprietorship, partnership, S corporation, or C corporation (circle one)? Please answer based on how thegroup is treated for federal tax purposes (e.g., a single-owner limited liability company (LLC) that chooses to be treated as a soleproprietorship (disregarded entity) or C corporation, for federal tax purposes, should indicate accordingly).

Sole Proprietorship Partnership C Corporation S corporation

6a. If the business is a partnership for federal tax purposes, is the second enrollee a partner/owner in your business?

Yes No N/A

6b. If the business is a corporation for federal tax purposes, is the second enrollee a shareholder in your business?

Yes No N/A

6c. Is the second enrollee a common-law employee (i.e. Enrollee receives a W2 wage statement (even if he or she is also ashareholder in a corporation)?

Yes No

6d. If the business is a partnership for federal tax purposes, and the second enrollee is a partner/owner, does he or she actually perform employee-type services for the business?

Yes No

of 2

BlueChoice HealthPlan is an independent licensee of the Blue Cross and Blue Shield Association.(Rev. 1/1/20)

7. Is your group a non-governmental, non-ERISA plan (i.e. church plan)? Yes No

If you answered yes to question #7, we need assurance if your employer group qualifies for a medical loss ratio rebate thatthe rebate will be used to benefit your group plan’s current enrollees. Please affirm which method you will use to distributethe subscriber portion of your rebate should you be eligible for one:

The group will reduce the subscriber’s portion of the annual premium for the subsequent policy year for all subscribers covered at the time we receive the rebate either (i) under any group health policy offered by the plan, or (ii) under the group health policy on which the rebate is based. This premium reduction will be applied within 3 months of when we receive the rebate, and will be either divided evenly among the subscribers, divided based on each subscriber’s actual premium contributions, or apportioned in a manner that reasonably reflects each subscriber’s premium contributions.

The group will provide a cash refund only to the subscribers that were (or are) covered, in the year on which the rebate is based (or at the time we receive the rebate, as applicable), by the group health policy on which the rebate is based. The cash refund will be distributed within 3 months of when we receive the rebate, and will be divided evenly among the subscribers, divided based on each subscriber’s actual premium contributions, or apportioned in a manner that reasonably reflects each subscriber’s premium contributions.

The group will not provide written assurance of the above. We understand that BlueChoice HealthPlan will distribute 100% of any medical loss ratio rebate evenly and directly to our subscribers.

Group hereby certifies that the plan qualifies as a “church plan” under section 3(33) of the Employee Retirement Income Security Act of 1974, as amended (“ERISA”), 29 U.S.C. section 1002(33), and is not subject to Title I of ERISA. Group shall defend, indemnify and hold harmless Company, and its parent companies, affiliates, directors, officers, employees, agents, successors and assigns from and against any and all threatened or actual litigation, claims, demands, causes of action, penalties, regulatory actions, fines, losses, liabilities, damages, out-of-pocket costs and reasonable attorney’s fees, settlements and/or judgments arising out of or relating to the Group’s certification of the plan as an ERISA-exempt church plan in accordance with the preceding sentence or non-church plan. The Group shall be the administrator of the plan represented by its contract with Company and shall have the sole responsibility for compliance with all state and federal laws and regulations with respect to such plan.

Part 2: COBRA Eligibility

In the previous calendar year, did you have 20 or more employees on more than 50 percent of your company’s typical business days?

Yes No

Please note: Both full-time and part-time employee are counted. Part-time employees are counted as a fraction of an employee with the fraction equal to the number of hours the part-time employee worked divided by the hours an employee must work to be considered full-time.+

*If any of the responses listed above change during the calendar year it will require the completion andsubmission of a new MLR form.

I certify that I am an authorized representative of the Group and that the information I provide on behalf of the Group is both true and correct to the best of my knowledge, information, and belief. As an authorized representative of the Group, I understand and acknowledge that BlueChoice HealthPlan of South Carolina, Inc. will rely on the information I provide herein on behalf of the Group.

Print Name and Title:Signature: Date:

BC-1019 (Rev. 5/2017)

MEMBERSHIP APPLICATION AND

CHANGE FORM

REQUIRED EMPLOYEE INFORMATION (Please Print) 1. Name (Last, First, MI): 2. Birthdate: / / 3. Male Female 4. Address (Street): (City): (State): (ZIP):5. Employee Social Security Number (Required): 6. Phone (Required): (___ ) Cellphone: Yes No 7. Email (Required): 8. Name of Employer:9. Effective Date of Action Requested: / / 10. Tobacco Use* (small group only): Yes No REASON FOR APPLICATION 11. New Member – Full-Time Employee; Full-Time Date of Hire: / /

Coverage Change – Reason for Change: Date of Occurrence: / / Cancellation – Date Left Employment: / / Reinstatement – Reason: Ret