We apologize for any inconvenience this may cause. Please expect a paper bill at the address you provided. This is the last step to secure your coverage.
" },{ "name": "enrollment/boaConfirmationInstructionsError", "content":"We apologize for any inconvenience this may cause. Please expect a paper bill at the address you provided. This is the last step to secure your coverage.
" },{ "name": "enrollment/boaConfirmationInstructionsPaperBillSent", "content":"Pay your first premium by the due date on your bill to complete the enrollment process. Your policy will take effect only if we’ve received your payment by that date. Otherwise, your application will be canceled. You’ll have until the end of Open Enrollment ({{ openEnrollmentDateRangeEndFormatted }}) to reapply for a later coverage date.
\n\nThank you for choosing Blue®!
" },{ "name": "enrollment/boaConfirmationInstructionsSuccessAfterFields", "content":"Interested in automatic debit or credit card payments? Once you make your initial payment and receive your membership materials, you will be able to set up recurring credit card payments through My Health Toolkit®.
" },{ "name": "enrollment/boaConfirmationInstructionsSuccessBeforeFields", "content":"Your payment has been successfully processed.
" },{ "name": "enrollment/confirmationInstructionsBankDraftOep", "content":"We\u0027re glad you found the BlueEssentialsSM plan that\u0027s right for you! We\u0027ve received your payment and your enrollment is complete. Here\u0027s a summary of your plan and payment details.
" },{ "name": "enrollment/confirmationInstructionsBankDraftSep", "content":"We\u0027re glad you found the BlueEssentialsSM plan that\u0027s right for you! We\u0027ve received your payment and your enrollment is complete. Here\u0027s a summary of your plan and payment details.
" },{ "name": "enrollment/confirmationInstructionsBankDraftShortTerm", "content":"We\u0027re glad you found the Blue TermSM plan that\u0027s right for you! We\u0027ve received your payment and your enrollment is complete. Here\u0027s a summary of your plan and payment details.
" },{ "name": "enrollment/confirmationInstructionsCreditCardAfterApplicationInfo", "content":"Your application has been submitted, but you must make your first premium payment to complete the enrollment process. Select Continue to finish.
" },{ "name": "enrollment/confirmationInstructionsCreditCardAfterApplicationInfoShortTerm", "content":"Select Continue to make your payment and enroll in this plan.
" },{ "name": "enrollment/confirmationInstructionsCreditCardOep", "content":"We\u0027re glad you found the BlueEssentialsSM plan that\u0027s right for you! There\u0027s just one more step in the process. Once you review your plan and payment details below, select Continue to enter your debit or credit card information on a secure payment page.
" },{ "name": "enrollment/confirmationInstructionsCreditCardSep", "content":"We\u0027re glad you found the BlueEssentialsSM plan that\u0027s right for you! There\u0027s just one more step in the process. Once you review your plan and payment details below, select Continue to enter your debit or credit card information on a secure payment page.
" },{ "name": "enrollment/confirmationInstructionsCreditCardShortTerm", "content":"Your enrollment is not complete.
\n\nYou must make your payment before your coverage becomes effective. Review your plan details below, then enter your debit or credit card information on the next page.
" },{ "name": "enrollment/confirmationInstructionsPaperBillOep", "content":"We\u0027re glad you found the BlueEssentialsSM plan that\u0027s right for you! There\u0027s just one more step in the process. Once you review your plan and payment details below, select Continue to enter your debit or credit card information on a secure payment page.
\n\nPay your first premium by {{ payByDateFormatted }} to complete the enrollment process. Your policy will take effect on {{ effectiveDateFormatted }} only if we\u0027ve received your payment by that date. Otherwise, your application will be canceled. You\u0027ll have until the end of Open Enrollment ({{ enrollmentEndDateFormatted }}) to reapply for a later coverage date.
" },{ "name": "enrollment/confirmationInstructionsPaperBillSep", "content":"We\u0027re glad you found the BlueEssentialsSM plan that\u0027s right for you! Please expect a paper bill at the address you provided. There\u0027s just one more step to secure your coverage.
\n\nPay your first premium by {{ payByDateFormatted }} to complete the enrollment process. Your policy will take effect on {{ effectiveDateFormatted }} only if we\u0027ve received your payment by that date. Otherwise, your application will be canceled.
" },{ "name": "enrollment/confirmationInstructionsPaperBillShortTerm", "content":"We\u0027re glad you found the Blue TermSM plan that\u0027s right for you! Please expect a paper bill at the address you provided. There\u0027s just one more step to secure your coverage.
\n\nPay your first premium by {{ payByDateFormatted }} to complete the enrollment process. Your policy will take effect on {{ effectiveDateFormatted }} only if we\u0027ve received your payment by that date. Otherwise, your application will be canceled.
" },{ "name": "getAQuote/familyInfoMemberCountLabel", "content":"How many members of your family will be insured?
" },{ "name": "getAQuote/familyInfoMemberCountLabelShortTerm", "content":"How many are you covering?
" },{ "name": "enrollment/familyInformationDisabledMedicareMessage", "content":"If you or your dependents are already covered by Medicare, you cannot enroll in a BlueEssentialsSM plan.
" },{ "name": "enrollment/intelliscriptAuthorization", "content":"AUTHORIZATION TO DISCLOSE PROTECTED HEALTH INFORMATION
\nI authorize any entity covered by the HIPAA Privacy Rule as a covered entity or business associate to disclose to BlueCross BlueShield of South Carolina (BlueCross) or its authorized representative, my protected health information, prescription information, care or treatment provided to me, including without limitation, information relating to autoimmune deficiency syndrome (AIDS), human immunodeficiency virus (HIV), or the use of drugs or alcohol.
\nI understand this authorization is voluntary and that such information will only be used by BlueCross for the purpose of determining whether I qualify to be enrolled in a disease management, case management or wellness program.
\nThis authorization is valid for one year from the date signed below unless earlier revoked. I understand that I may revoke this authorization at any time by sending written notice of my revocation to BlueCross. I understand that revocation of this authorization will not affect any action taken by BlueCross before my written notice of revocation was received.
\nI am making this authorization voluntarily and have had full opportunity to read and consider the contents of this authorization. I understand that BlueCross will not condition the approval of this application or my eligibility for benefits upon my signing this authorization. I further understand that information disclosed pursuant to this authorization may be subject to re-disclosure by the recipient and may no longer be protected by federal or state privacy laws. Disclosure of my protected health information pursuant to this authorization may result in remuneration to the entity releasing the data.
\nI understand that I may receive a copy of this authorization upon my request.
\nThis only applies to applicants 18 and older.
" },{ "name": "enrollment/introductionContentAnnual", "content":"We\u0027re pleased you\u0027ve decided to shop with us! Please fill out the application below. Once you complete the information on this page, select Continue to move to the next step.
" },{ "name": "enrollment/openEnrollmentDateRange", "content":"2019-10-15 to 2019-12-31
" },{ "name": "enrollment/paymentAchAuthorizationOneTime", "content":"By submission of this payment request, you give BlueCross and BlueShield of South Carolina permission to debit your account for the amount indicated. This is permission for a single transaction only, and does not provide authorization for any additional unrelated debits or credits to your account.
" },{ "name": "enrollment/paymentAchAuthorizationRecurring", "content":"I authorize BlueCross and BlueShield of South Carolina (Company) to initiate debit entries to my checking account. This authority is to remain in force until the Bank/Company has received written notification from me of its termination in such time and such manner as to afford the Bank/Company a reasonable opportunity to act on it.
\n\nA customer has the right to stop payment of a debit entry by notifying the Bank/Company prior to charging the account. If BlueCross and BlueShield of South Carolina initiates an erroneous debit entry to a customer’s account, the customer shall have the right to have the amount of the entry credited to his/her account by the Bank/Company. If, within 15 calendar days following the date on which the Bank/Company sent to the customer a statement of account or written notice pertaining to the entry or 46 days after posting, whichever occurs first, the customer shall have sent to the Bank/Company a written notice identifying the entry, stating that the entry was in error and requesting the Bank/Company to credit the amount to his/her account.
" },{ "name": "enrollment/paymentBankDraft", "content":"Automatic payments are the easiest way to pay your premium. Just enter your bank account information and we\u0027ll take care of the rest.
" },{ "name": "enrollment/paymentBankDraftRecurring", "content":"Automatic payments are the easiest way to pay your premium. Just enter your bank account information and we\u0027ll take care of the rest. After today\u0027s payment, your premium will be drafted out of your account between the 1st and 3rd of each month you\u0027re covered. (You won\u0027t be billed twice for your first month of coverage.)
" },{ "name": "enrollment/paymentDebitCreditCard", "content":"Use your debit or credit card to pay your premium.
" },{ "name": "enrollment/paymentDebitCreditCardRecurring", "content":"Once you make your initial payment and receive your membership materials, you will be able to set up recurring credit card payments online.
" },{ "name": "enrollment/paymentPaperBill", "content":"Prefer to pay later? You can submit your application now and we\u0027ll send a paper bill to the address we have on file for you. (Remember, your policy won\u0027t begin until we\u0027ve received your first premium payment.)
" },{ "name": "enrollment/preExistingConditions", "content":"A pre-existing condition is one where symptoms exist that would cause a reasonable person to seek diagnosis, care or treatment within a one-year period before the effective date of the policy; or a condition for which you received medical advice or treatment from a physician or other clinician within a five-year period before the effective date of the policy, whether or not a specific condition was diagnosed. Coverage is not available for pre-existing conditions. This does not change whether or not you list the names of your providers, we ask, or if you tell us about the condition on this application or if the services or benefits needed are medically necessary.
\n\nThis Short-Term coverage is not the same as coverage purchased under the Affordable Care Act (ACA), and it is not required to comply with the federal market requirements for health insurance contained in the ACA.
\n\nPlease review the agreements below and provide your digital signature. Once you sign, you will proceed to the payment page. (Note that these agreements don\u0027t take effect until you\u0027ve made your first payment.)
" },{ "name": "enrollment/signAgreementInstructionsShortTerm", "content":"It’s important you carefully review the Terms & Conditions for this policy and provide your digital signature. Please make note of our policy for pre-existing conditions.
\n\nOnce you sign, you will proceed to the payment page. This agreement is in effect after you make your first payment.
" },{ "name": "enrollment/termsAndConditions", "content":"The undersigned authorizes release of all past and future medical records and other information to Blue Cross and Blue Shield of South Carolina (BlueCross) or its representatives as deemed necessary by BlueCross to process claims.
\nI fully understand and agree that no insurance coverage shall be in force until BlueCross receives the application and assigns the date on which coverage shall become effective.
\nI hereby expressly acknowledge that I understand this agreement is a policy solely with Blue Cross and Blue Shield of South Carolina, which is an independent corporation operating under a license from the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. The \"Association\" permits Blue Cross and Blue Shield of South Carolina to use the Blue Cross and Blue Shield service marks in the State of South Carolina, and Blue Cross and Blue Shield of South Carolina is not contracting as an agent of the Association. I further acknowledge and agree that I have not entered into this policy based on representations by any person other than Blue Cross and Blue Shield of South Carolina. No person, entity or organization other than Blue Cross and Blue Shield of South Carolina shall be held accountable or liable to me for any of the obligations created under this policy, which remain solely the responsibilities of Blue Cross and Blue Shield of South Carolina. This paragraph shall not create any additional obligations whatsoever on the part of Blue Cross and Blue Shield of South Carolina other than those obligations created under the policy I am purchasing.
\nI understand that payments will be refunded in the same manner as received by Blue Cross and Blue Shield of South Carolina. I acknowledge that a check refund may take up to 10 days to be received by me.
\nIf you aren’t satisfied with this Policy, return it to us or our agent within 30 days after it is received. All Premiums will then be refunded minus any claims paid. If the Policy is returned, it will be void from the beginning. The parties will be in the same position as if no Policy had been issued.
\nIf, after 30 days, you wish to cancel this Policy, contact us at the phone number or address listed on the back of your Identification Card. Coverage will end at 12:01 a.m. Eastern Standard Time within 14 days after we receive your request.
" },{ "name": "enrollment/termsAndConditionsShortTerm", "content":"In signing this application, I full understand and agree:
\nAcceptance and review of the application
\nBlueCross BlueShield of South Carolina has the right to accept or reject coverage on any or all persons applying.
\nThis plan is not available to persons who are not U.S. citizens or full-time residents of South Carolina.
\nNo insurance coverage shall be in force until BlueCross receives my application, first month\u0027s premium payment, and assigns a date on which coverage shall become effective.
\nThe application fee is non-refundable.
\nThe coverage under this policy is not renewable; however, I can apply for a new policy after the coverage ends.
\nIf this policy is cancelled due to nonpayment, and I apply for new coverage at any time thereafter, BlueCross will require the payment of all past due premiums before new coverage will take effect.
Pre-existing conditions, mis-representation, or rescission
\nBlueCross relies on the answers provided in this application to determine eligibility. If it is determined false or materially inaccurate answers have been provided, BlueCross has the right to void (rescind) my coverage.
\nNO BENEFITS will be provided for any pre-existing condition. Pre-existing conditions are NOT covered by the policy.
\nI hereby represent the information on this application is complete, true and correctly recorded; and acknowledge that coverage may be terminated or rescinded for myself and any covered dependents (if applicable) for fraud, deception in the use of policy, or for materially misrepresenting information in the application.
\nI authorize release to BlueCross, or its representatives, of past and future medical records and other information deemed necessary by BlueCross to process claims.
\nBlueCross may deny claims and/or void coverage if it determines any information was misrepresented on the application or any claims. If coverage is voided, BlueCross will refund premiums I paid minus any claims paid.
\nI understand that payments will be refunded in the same manner as they are received. I acknowledge that a check refund may take up to 10 business days to receive.
Return or cancellation of policy
\nIf I am not satisfied with this Policy, I can return it to BlueCross within 30 days after receiving it and all Premiums will be refunded minus any claims paid. If the Policy is returned, it will be void from the beginning, and the parties will be in the same position as if no Policy had been issued.
If you wish to cancel the Policy more than 30 days after it is effective, contact BlueCross at the phone number or address listed on the back of your Identification Card. Coverage will end at 12:01 a.m. Eastern Standard Time within 14 days after we receive your request.
\n\nI hereby attest that I understand that this coverage is not required to comply with federal requirements for health insurance and does not provide \"minimum essential coverage\" as defined under the Affordable Care Act.
" }]}