Blue Cross Blue Shield of SC Introduces Sustained Health

Blue Cross Blue Shield has announced a new benefit for small group members. Beginning Nov. 1, groups can choose to purchase their new Sustained Health Benefit. With this benefit, each member will receive an annual allowance of $300 for allowable, in‐network procedures not recommended by the United States Preventive Services Task Force.
Examples of allowable charges are:

  • Electrocardiogram (EKG)
  • Chest X‐rays
  • Blood work (except lipid screenings)
  • Urinalysis

The cost of the benefit will equal 1 percent of the group’s premium, which in our view is fairly insignificant. New groups with effective dates of Nov. 1 or later are eligible for this benefit. Existing groups with renewal dates of Nov. 1 or later can purchase it at renewal. This benefit option helps fill in some of the holes that were lacking in the preventive care benefits mandated by the new law, which have at times been leading to unexpected charges related to preventive care visits.
If your group is on a grandfathered plan (i.e. a plan that has been unchanged since the health reform law took effect), you would have to move to a non‐grandfathered plan. The only exception will be grandfathered groups that had purchased the old, no‐longer‐available, enhanced preventive benefit prior to health care reform.