Many South Carolinians get their health insurance through their employers. This means that part of your health insurance may be paid by the company you work for. 

Many employers work hard to ensure their workers have affordable benefits to get the care they need. Generally, the company pays a portion of the health plan cost for employees and workers pay a monthly premium to cover the rest. Specifics on costs depend on each individual plan. 

People without health insurance through their work can purchase coverage on the Health Care marketplace at Healthcare.gov*. Individual health plans are often very different from employer-sponsored and group plans. 

To help South Carolinians with health insurance through their employer, we have compiled some important things to know to help you make the best decisions for your family’s health care. 

Every health plan is different

A lot of people have BlueCross BlueShield of South Carolina insurance. But every health plan is different. People with insurance through the Marketplace may have different benefits than someone with a plan through their employer. If you or your spouse work for a large company, the health plan offered to you may be highly customized.

Even within group plans, the specifics of the plan vary. Each company decides what it wants to cover and by how much. The network for your plan can also be different. Meaning a doctor that is in network for one plan may be out of network for another. 

Employers can customize just about every aspect of a plan to meet the unique needs of their population from choosing to cover certain services and medications, to offering deeper discounts for providers in certain networks, to building in rewards programs for employees who make healthy choices.

It's important to remember just how customized each health plan can be. This means that your BlueCross plan may be very different from your neighbor's, your brother's, and so on.

You can make changes during open enrollment 

Most employers have an open enrollment period each year. This allows you to make changes to your health plan. Changes can only be made during open enrollment or during special enrollment periods. 

Special enrollment periods* include qualifying life events such as having a baby or getting married. The particulars of the special enrollment period depend on company policy. 

Remember that changes related to special enrollment periods — like adding a family member to your plan or updating your last name — must be made directly with your human resources department. Your company will send the new information to BlueCross on your behalf.

Changes made during open enrollment take effect on the first day of the new benefits year. For most companies, this will be Jan. 1, although some companies may have a different timeframe. It is important to check with your workplace to find out when you can make changes to your health plan coverage and when it will take effect. 

Some groups have a passive enrollment period. This means employees do not have to reenroll every year. Some groups require you to choose a plan every year. And there are certain benefits such as a Flexible Spending Account that require you to enroll each year. 

Find out what your company requires by learning more about your particular health plan. Even if your company doesn’t require you to reenroll, you should reevaluate your benefits to make sure it meets your needs for the upcoming year for yourself and your dependents. 

Update your information 

Make sure that your information such as your contact, address or dependents are correct every year. If you’ve had any life changes in the last year, make sure you are updating your health plan. 

You update your health plan information through your employer not through insurance. If you move, correct your address through your employer. 

If your contact information isn’t up to date with that party, BlueCross receives outdated information, too. This can cause problems when we need to reach you. 

The information sent during open enrollment matters. Double check that it is correct. 

You can see the information we have for you by registering for My Health Toolkit and viewing your profile. 

Understanding your benefits is key 

Because every plan is different and you can only make changes once a year, it is important to understand your plan options up front. 

Think about how you plan to use your health insurance next year. If you are a generally healthy person who only needs basic or preventive care, certain plans may be better suited for your needs. If you need specialized care, another plan may be better. 

These questions can help you as you consider your plan options: 

• Type of care: How often do you see a doctor? What kind of doctors do you usually see? Primary care visits and specialists can have different costs. 
• Medications: What types of medications do you take regularly? You can’t predict all the medications you may need to take for unexpected health issues. But if you take any medications regularly, make sure you understand how those medications would be covered under any plan.

Your company should have information about the particulars of your health plan. This will help you know what types of care are covered and what may not be covered. 

Some plans cover certain services such as preventive care, doctor visits or prescriptions before you meet your deductible. In these cases, the service may be covered in full, or you may only be responsible for a copay, which is a set dollar amount, or coinsurance, which is a percentage of the bill. 

There are certain things your plan does not cover in any scenario. Take the time to look these up at the beginning so you’re not disappointed or blindsided later. 

Bariatric surgery, infertility treatment, chiropractic services and acupuncture are commonly excluded from coverage. However, some plans do provide coverage for these.

Understand the lingo 

A big part of knowing your benefits is knowing what those benefits mean. Health insurance has a language of its own. Knowing the difference between a premium and a deductible is key to choosing the right plan for your health care needs and your wallet. 

For example, low-premium plans usually come with higher deductibles, which is the amount you have to pay out of pocket before your insurance begins splitting the bill with you: 

• Do you want to pay less each month, or each paycheck, and pay more when you need health care? A higher deductible plan might be a good option for you. 
• Or do you want to pay a higher monthly payment to have lower costs when receiving care and filling prescriptions? If you visit doctors frequently or take medications regularly, a plan with a higher premium but a lower deductible may be better. 

Another important thing to understand is the network for each plan. A health care network is the doctors, dentists and other health care offices your health insurance plan has a contract with to offer a lower rate for the members of that plan. Visiting doctors and providers who are in network saves you money. 

Find more on the language of health insurance on our blog and watch the Know the Lingo video series*.

See what perks are available 

BlueCross members have access to a lot of plan perks. Because every plan is different, what you have access to varies. In some cases, you may have access to weight management tools or discount services. 

You can find out what kind of options are available to you through our online member portal and mobile app My Health Toolkit^®. The online portal can help manage your health care and answer many questions you may have.

*These links lead to a third-party website. HealthCare.gov is an official website of the U.S. Centers for Medicare & Medicaid Services. These organizations are solely responsible for the contents and privacy policies on their sites.