Can't get your question answered here? Call us at 800-815-3314 (722-2115 in Charleston) or email firstname.lastname@example.org . We are happy to help.
GENERAL ENROLLMENT FAQS
Q. Who is eligible for coverage?
Full time employees (32 hrs/week+) and their family, including spouse, and child(ren) to age 26.
Q. When does my coverage become effective?
Benefits shall become effective on the ninety-first day of Full-time Employment.
Q. When am I eligible to enroll?
-When you are first hired, or
-If you lose other coverage (spouses, etc), or
-At open enrollment (October of each year, effective November 1st)
Q. When should I enroll?
Send in your completed paperwork shortly after you are hired to assure that you receive your ID cards by your effective date. Do not wait until after your waiting period has expired. Send paperwork to your Human Resources Department.
Q. Who can I call for assistance with enrollment and ongoing customer service?
Call the administrator (TCC Benefit Administrator) directly at 800-815-3314 (local in Charleston 722-2115)
MEDICAL COVERAGE FAQS
Q. What coverage is available during my waiting period?
You may have an option under your previous employer's plan to continue coverage under Cobra, or if you were employed by a firm with under 20 employees, the state mandated continuation provision under the plan. Contact the Human Resources Dept at your prior
employer, or call the insurance carrier directly.
Q. Are pre-existing conditions covered?
A pre-existing condition is a condition that was treated during the six months prior to your effective date. Pre-existing conditions are covered for members having prior creditable coverage and are otherwise covered after 12 months of coverage. If you have prior coverage and have had a claim denied for a pre-existing condition, please fax us the “Certificate of Creditable Coverage” from your prior carrier at 843-722-2866.
Q. Are referrals to specialists required?
No, referrals are never required under the plan, however, certification must be obtained prior to a hospital admission.
Q. Am I covered while traveling out of state?
Yes, while traveling outside of SC, use the First Health network of providers nationally to obtain "in-network" discounts and benefits. Should the situation arise that you must use an "out of network" provider, you will be covered at a lower level. You or your provider must file a claim and send to the address on your ID card.
Q. What medical providers do I use?
It is to your advantage to use providers in the network when possible. You may search for a network provider at Blue Cross/Blue Shield of SC, or simply ask your provider if he or she is a member of the Blue Cross/Blue Shield network. You are still covered by providers "out of the network", but at a lower level (additional deductibles, etc), and may have to file your own claims.
Q. How do I file a medical claim?
Blue Cross providers will file your claim for you. Simply present your ID card to the provider. Charges incurred out of the network must be filed by you or the provider. To file "non network" charges, send a completed claim form, along with itemized invoices, to the address on your ID card.
Q. Are prescription drugs covered?
Yes, prescription drugs are covered through your retail pharmacy as well as through Caremark's mail service program. Click here to find the online forms and click here to
visit the Caremark site.
Q. Are prior authorizations required for prescription drugs?
Yes, some prescription drugs require prior authorization. Your doctor would need to contact Caremark for authorization of these drugs. Click here for the prior authorization and quantity limits for your plan.
Q. What are the top reasons why a medical claim could be denied?