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The Palmetto Health Reimbursement Account medical plan is a consumer-driven health plan that maximizes your benefits when using Palmetto Health facilities and Palmetto Health Quality Collaborative physicians. The plan’s provider network consists of two tiers: a primary tier and a secondary tier. The primary tier consists mostly of Palmetto Health facilities and Quality Collaborative physicians. The secondary network tier consists of all providers in BCBS’ national network that haven’t already been included in the primary tier. Please click here for a list of primary tier (Palmetto Health Quality Collaborative) providers. Please click here for a list of secondary tier (BCBS) providers.

The Palmetto Health Reimbursement Account medical plan is intended for individuals and families who anticipate needing more than just routine preventive and minor sick care. The plan is designed to reduce financial barriers to care for individuals and families who may need to regularly see primary and specialty care providers, perhaps to help manage a chronic condition like diabetes or congestive heart failure. When using a Palmetto Health Quality Collaborative physician, there is no deductible and no coinsurance charges for most services. To assist you with the Palmetto Health owned and operated facility charges for which you are responsible, you can payroll deduct amounts more than $50.

By enrolling in the Palmetto Health Reimbursement Account medical plan, you will be eligible for an employer-funded Health Reimbursement Account (HRA). HRAs will be administered by BlueCross BlueShield of South Carolina. The HRA is 100 percent funded by Palmetto Health and can be used to automatically pay for qualified medical expenses until funds are exhausted or insurance coverage kicks in.

Palmetto Health’s 2018 contribution amount for employee-only coverage is $450/annually and $900/annually for all other coverage types for full-time team members. If you are a part-time team member, the 2018 contribution amount for employee-only coverage is $300/annually and $600/annually for all other coverage types. Funds are deposited on January 1, 2018. Any unused balances will be rolled over from year to year if you remain in the HRA Medical Plan. If you choose to leave Palmetto Health, your HRA balance will be forfeited; you will be unable to withdraw or transfer any unused HRA funds.

Palmetto Health is providing an HRA in your name to help pay for your eligible out-of-pocket medical expenses. You may not contribute to the funding of your HRA. However, you may contribute to a self-funded Flexible Spending Account (FSA) instead. If you use all of your HRA funds and incur additional medical expenses that are your responsibility, you’ll be required to pay for these additional expenses out of your own pocket or from an FSA.

Click here for a five-minute online tutorial about BCBS Health Reimbursement Accounts.

2018 Schedule of Benefits

The following chart is only an overview. You should refer to your Summary Plan Description for information on any exclusions or limitations that may apply to the specific benefits.

Deductibles and Out-of-Pockets Maximums

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Individual Deductible

$1,250

$3,125

$4,000

Family Deductible

$2,500

$6,250

$8,000

Individual Out-of-Pocket Max

$2,500

$6,250

none

Family Out-of-Pocket Max

$5,000

$12,500

none

2018 Palmetto Health HRA Contributions

Individual

$450 per year deposited January 1, 2018

Family

$900 per year deposited January 1, 2018

Physician Office Visits

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Primary Care Preventive 2

100%, no Deductible

100%, no Deductible

50%, after Deductible

Primary Care Sick

100%, no Deductible

100%, after Deductible

50%, after Deductible

Specialists

100%, no Deductible

100%, after Deductible

50%, after Deductible

Physician Office Services

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Lab Tests and X-rays

100%, no Deductible

100%, after Deductible

50%, after Deductible

Reading of Labs Preventive

100%, no Deductible

100%, no Deductible

50%, after Deductible

Reading of Labs Sick and X-rays

90%, after Deductible

100%, after Deductible

50%, after Deductible

Other Physician Office Services

90%, after Deductible

100%, after Deductible

50%, after Deductible

Outpatient Hospital Charges

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Surgery – Facility Charge

90% after Deductible

70% after Deductible

50% after Deductible

Surgery – Physician/Anesthesiologist

90% after Deductible

70% after Deductible

50% after Deductible

Labs – Test

90% after Deductible

70% after Deductible

50% after Deductible

Labs – Reading of Labs

90% after Deductible

70% after Deductible

50% after Deductible

X-rays – Facility

90% after Deductible

70% after Deductible

50% after Deductible

X-rays – Physician

90% after Deductible

70% after Deductible

50% after Deductible

MRI/CAT/PET/Nuc Scans – Facility

90% after Deductible

70% after Deductible

50% after Deductible

MRI/CAT/PET/Nuc Scans – Physician

90% after Deductible

70% after Deductible

50% after Deductible

Occupational, Physical and Speech Therapy and Cardiac Rehab

90% after Deductible

70% after Deductible

50% after Deductible

Inpatient Hospital Charges

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Facility

90% after Deductible

70% after Deductible

50% after Deductible

Physician/Anesthesiologist

90% after Deductible

70% after Deductible

50% after Deductible

Emergency Dept

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Visit

90% after Deductible

90% after Deductible

90% after Deductible

Urgent Care

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Visit

100% no Deductible

70% after Deductible

50% after Deductible

Mental Health

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Office Visit

100% no Deductible

70% after Deductible

50% afterDeductible

ED Visit

90% after Deductible

90% after Deductible

90% after Deductible

Other Ancillary Services

 

Primary (Palmetto Health/PHQC) Tier

Secondary (BCBS) Tier

Out-of-Network

Home Health

100% afterDeductible

70% after Deductible

50% afterDeductible

DME

90% after Deductible

70% after Deductible

50% afterDeductible

Hospice

100% no Deductible

70% after Deductible

50%afterdeductible

*For Employee + Spouse, Employee + Child (ren) and Family coverage, the family deductible is satisfied once your total family expenses reach the family deductible. One member cannot meet the family deductible. Only a combination of two or more individuals can meet the family deductible. Individual deductible applies to Employee coverage. In addition, there is an individual deductible within Employee + Spouse, Employee + Child (ren) or Family coverage. When only two individuals are on the medical plan, each member must meet their individual deductible For plans including three or more members, one member can meet their individual deductible, with the combination of all other members adding up to meet the remainder of the deductible. Or, the combined claims of all members can meet the deductible.
1. Palmetto Health Facilities include: Baptist (Columbia), Baptist Parkridge, Baptist Easley Hospital, Richland, Tuomey, Greenville Hospital System and Parkridge Surgery Center.
2. Pap Smear, PSA, Mammogram, Colonoscopy (screening), Bone Density, Physical, Immunizations (includes flu shots), Well-Baby, Well-Child Exam. Covered preventive services are subject to change.
3. Click here for a list of Primary Tier (PHQC) providers. Click here to search the BCBS network.

Please note the following related to health plan eligibility:

  • Working Spouse Eligibility –  Please note, team members may only cover a spouse if the spouse does not have access to medical insurance through his or her employer.
  • Same-sex Domestic Partners Eligibility - Palmetto Health offers benefits coverage to same-sex domestic partners of our team members. Please click here to review the tax implications of covering a domestic partner.

2018 Health Reimbursement Account Bi-Weekly Team Member Contributions

Class

Active, Full-Time

Active, Part-Time

Tier

Under $15.23

$15.23 - $30.45

$30.46 - $50.55

Over $50.55

Under $15.23

$15.23 - $30.45

$30.46 - $50.55

Over $50.55

Bi-Weekly Contributions

With Discount

Team Member Only

$57.00

$63.00

$69.00

$91.00

$108.00

$116.00

$126.00

$144.00

Team Member+Spouse

$126.00

$137.00

$151.00

$191.00

$207.00

$218.00

$237.00

$264.00

Team Member+Child(ren)

$116.00

$129.00

$141.00

$176.00

$195.00

$209.00

$222.00

$248.00

Team Member+Family

$192.00

$208.00

$231.00

$283.00

$282.00

$301.00

$325.00

$396.00

Without Discount

Team Member Only

$124.00

$131.00

$143.00

$167.00

$195.00

$205.00

$213.00

$238.00

Team Member+Spouse

$208.00

$219.00

$234.00

$283.00

$309.00

$323.00

$343.00

$375.00

Team Member+Child(ren)

$196.00

$210.00

$223.00

$268.00

$296.00

$312.00

$327.00

$357.00

Team Member+Family

$284.00

$303.00

$326.00

$389.00

$392.00

$416.00

$445.00

$525.00

 

 

 

Related Links

Enrollment Information

New Benefits for 2018

Have a Question?
Contact the Total Rewards Benefits Center at 800-963-3456 or 803-296-8893, or email TotalRewards
@PalmettoHealth.org