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Employer Group Insurance

Q.  Is my employer required to offer me health insurance coverage?

 A.  There is no law, on a federal or state level, that requires an employer to offer health insurance coverage. An opportunity to purchase health insurance is a benefit, not a law.

 

 Q.  Are all group health insurance policies regulated by the South Carolina Department of Insurance?

A.  No. Many plans are self-funded and do not fall within the jurisdiction of this Department. Plans that are not regulated by the South Carolina Department of Insurance fall under the laws of the US Department of Labor, Employment Benefits Security Administration 1-866-444-3272.

 

Q.  After terminating employment, how long is my employer required to continue my insurance, and under the new Federal law, isn't this coverage free, and shouldn't it last forever?

A.  The South Carolina Department of Insurance does not regulate employers. Most employers terminate coverage at midnight on the day you leave. The employer should offer you the option of continuing your insurance through COBRA (if he has 20 or more employees) or through the State Continuation of Benefits (if he has less than 20 employees, and you have been covered by the group plan for six consecutive months.)

Please note that under COBRA or State Continuation of Benefits, the former employee must pay the employer's portion, the employee's portion, and on COBRA, the employer may charge a 2% surcharge. There are limitations to the periods of time one can be covered. Please call our Department for more information.

 

Q.  My health insurance company has not paid my claim. What is the time frame for a company to process the claim?

A.  If it is a fully insured group plan, then a claim should be either paid or denied within 60 days of receipt of all information needed to process the claim.

 

Q.  I have group coverage. I have been covered for several years. They withhold $200 from my check. I have decided that it is too much to be coming out of my check right now, and I asked my employer to cancel my coverage. He says he can't do that until January 1, why?

A.  Apparently, your employer is deducting your insurance premiums from your paycheck prior to assessing income taxes. There are only certain situations, in which the Federal Government allows you to make changes in your deductions, except at the beginning of your new tax year. If you wish to have the specifics on this situation, please call the Federal IRS at 1-800-829-1040. That is a tax regulation, not an insurance regulation.

Individual Health Insurance

Q.  Can an insurance company turn me down for individual health insurance coverage? If a company can turn me down, how can I obtain health insurance coverage?

A.  Yes, you may be turned down. The South Carolina Department of Insurance has no jurisdiction over the underwriting decisions of an insurance company; therefore, we can't require they insure you. If you are turned down for coverage, you can get coverage through the South Carolina Health Insurance Pool (SCHIP). Contact SCHIP at
1-800-868-2500, ext. 46401.

 

Q.  I have an exclusionary rider on my individual health policy, how long can the insurance company keep it on my policy?

A.  The rider will remain in effect for the length of time specified in the terms of the rider. If there is no time limitation specified, it will remain in effect for the duration of the policy unless the insurance company agrees to remove it.

 

Q.  Why do my health insurance premiums go up? I have not been sick or presented any claims to my insurance company.

A.  Only rate increases by licensed insurance companies in this state for individual policies must be filed with our Department. The filings are reviewed very carefully to make sure that the claims experience and expenses warrant the increase. Please note that this Department does not regulate group rates. Although an Association policy is underwritten on an individual basis, it is group insurance, and the rates are not subject to our review.

State Continuation of Benefits

Q.  Dependent child on state continuation due to reaching the limiting age of the policy, gave birth to a baby during that six-month period. Is company responsible for offering state continuation to the child up to the end of the mother's six-month period?

A.  Research indicates that coverage for the newborn would not [be] required by SC statute in this instance.