The South Carolina State High Risk Pool

People unable to get private health insurance coverage have the opportunity to do so through the South Carolina Health Insurance Pool. The pool was created by the General Assembly to help people who couldn’t get health insurance coverage from any other source, including people with certain disabilities. Blue Cross and Blue Shield of South Carolina currently administers the pool.

Coverage is available to a person who has been a state resident for at least 30 days and meets the following criteria:

* They were turned down for private health insurance coverage for health reasons;

* They were accepted for private health insurance, but have pre-existing illnesses or conditions excluded from coverage, for a period exceeding 12 months;

* They are paying health insurance premiums for comparable coverage which are more than 150 percent of the premium levels charged by the pool.

* In certain situations, other individuals whose last health insurance coverage was an employer based group health plan may be eligible for coverage.

Other eligibility requirements apply.

Pool benefits are comparable to many private insurance plans. The pool pays 80 percent of allowed charges for covered hospital inpatient and outpatient treatment, physician services, prescription drugs, and some other medical care.

Persons covered by the pool pay the remaining 20 percent and must meet a $500 deductible each year, before the pool coverage begins to pay. Monthly premiums are determined by the person’s age and sex. There is no family coverage under the pool. Each policy is for individual coverage.

As administrator, Blue Cross/Blue Shield of SC processes claims, determines eligibility and handles all services required to operate the pool. For more information about coverage or eligibility, call 1-800-868-2500, ext. 42757, toll free, or 788-0500, ext.42757 in Columbia.