BlueCross BlueShield of South Carolina

Personal Blue SE Application Process

January 05, 2011

We know it seems like we’ve changed everything that has anything to do with our Personal Blue^SM plans. We hope this bulletin helps clarify what really has changed and what has stayed the same. Additionally, we have created an individual underwriting guide that can be downloaded from Storefront.

Underwriting Process

We have not changed the notification processes for applications accepted, declined or accepted with permanent exclusion endorsements (previously known as exclusion riders).

We may now issue coverage with an increased premium or rate-up due to pre-existing conditions. These plans will also include a temporary exclusion endorsement for the condition(s) for members age 19 or older. Temporary exclusions will last a maximum of six months. Unlike permanent exclusion endorsements, qualifying certificates of creditable coverage may be used to reduce or eliminate a temporary endorsement. If we accept an application with a rate-up, we notify you and allow three days for a response. If we do not hear from you after that time, we will issue the plan with the monthly direct bill payment option so the member’s bank account or credit card is not drafted for an amount he or she is unaware of. Members can change their billing option at any time and will receive a 6 percent premium reduction if they choose bank draft. If you or your customers have any questions about their plans, please call Membership at 800-868-2500, ext. 46401

Pre-existing Condition Limitation

Personal Blue SE plans include a 12-month pre-existing condition limitation for members age 19 or older. This means we may limit coverage for 12 months for any condition for which a member received medical advice, diagnosis, care or treatment within 12 months prior to the effective date.

Creditable Coverage

Creditable coverage can reduce or eliminate the pre-existing condition limitation, unless an endorsement has been added that excludes the pre-existing condition(s) from coverage. We will use a certificate of creditable coverage or other acceptable proof of prior health insurance coverage to determine if we can reduce or eliminate this limitation. We cannot give credit for prior coverage if prior coverage lapsed more than 31 days prior to our receipt of the application.

Family Quoting

Family quoting is available on Accel-A-Rate^SM. Families can also apply online.

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