Region

What is a Pre-Existing Condition?

A pre-existing condition is one where symptoms exist that would cause a reasonable person to seek diagnosis, care or treatment within a one-year period before the effective date of the policy; or a condition for which you received medical advice or treatment from a physician or other clinician within a five-year period before the effective date of the policy, whether or not a specific condition was diagnosed. Coverage is not available for pre-existing conditions. This does not change whether or not you list the names of your providers, we ask, or if you tell us about the condition on this application or if the services or benefits needed are medically necessary.

IMPORTANT: This is a short-term, limited-duration policy, NOT comprehensive health coverage

This is a temporary limited policy that has fewer benefits and Federal protections than other types of health insurance options, like those on HealthCare.gov

This policy	Insurance on HealthCare.gov
Might not cover you due to preexisting health conditions like diabetes, cancer, stroke, arthritis, heart disease, mental health & substance use disorders	Can’t deny you coverage due to preexisting health conditions
Might not cover things like prescription drugs, preventive screenings, maternity care, emergency services, hospitalization, pediatric care, physical therapy & more	Covers all essential health benefits
Might have no limit on what you pay out-of-pocket for care	Protects you with limits on what you pay each year out-of-pocket for essential health benefits
You won’t qualify for Federal financial help to pay premiums & out-of-pocket costs	Many people qualify for Federal financial help
Doesn’t have to meet Federal standards for comprehensive health coverage	All plans must meet Federal standards

Looking for comprehensive health insurance?

Visit HealthCare.gov or call 1-800-318-2596 (TTY: 1-855-889-4325) to find health coverage options.
To find out if you can get health insurance through your job, or a family member’s job, contact the employer.

Questions about this policy?

For questions or complaints about this policy, contact your State Department of Insurance. Find their number on the National Association of Insurance Commissioners' website (naic.org) under "Insurance Departments."

IMPORTANT LIMITATIONS OF THIS POLICY

This Short-Term coverage is not the same as coverage purchased under the Affordable Care Act (ACA), and it is not required to comply with the federal market requirements for health insurance contained in the ACA.

This policy does not cover pre-existing conditions, which are defined as a condition (or conditions) where a) symptoms existed that would cause a reasonable person to seek diagnosis, care or treatment within a one-year period before the effective date of the policy; or b) you received medical advice or treatment from a physician or other clinician within a five-year period before the effective date of this policy, whether or not a specific condition was diagnosed. No coverage is available for pre-existing conditions, regardless of whether we ask about them on the application.
This policy is not guarantee-issue, and if we determine you failed to fully disclose a condition on the application, we may rescind your coverage; that is, we may refund your premiums and void the coverage as though it was never in effect.
This policy is not renewable. When it expires/terminates, you can apply for a new policy, but the new policy’s requested effective date must be at least 24 hours after the previous policy’s termination date. The new policy performs as if your prior policy never existed. If you are not eligible for a new policy, you might have to wait until an ACA open enrollment period to get health insurance coverage.
There is a maximum payable benefit under this policy for all covered services. There are additional limitations and exclusions for some services, such as mental health and substance use disorder care, emergency transportation, home health care, maternity care, preventive care and prescription drugs.

Approval pending review of coverage history and application limit

We're pleased you've decided to shop with us! Please fill out the application below. Once you complete the information on this page, select Continue to move to the next step.

Term Length:

null

Effective Date:

End Date:

Remove

First Name:

null

Middle Initial:

null

Last Name:

null

Suffix:

null

Gender:

Social Security Number:

   -  -

Date of Birth:

Home #:

(   )    -

Cell #:

(   )    -

Work #:

(   )    -

Email:

Do you have a Primary Care Physician?

Yes

Are you working with an agent?

Yes

Street Address:

Apt / Unit:

City:

State:

ZIP Code:

County:

Do you have a different billing address?

Yes

Add Dependent

Back

Note: When you enroll in a plan, a one-time application fee of $25 will be added to your first month's payment.

Term Length:

Effective Date:

Sort by:

Note: When you enroll in a plan, a one-time application fee of $25.00 will be added to your first month's payment.

Change Plan

Monthly Premium

More Details

Continue

It’s important you carefully review the Terms & Conditions for this policy and provide your digital signature. Please make note of our policy for pre-existing conditions.

Once you sign, you will proceed to the payment page. This agreement is in effect after you make your first payment.

In signing this application, I full understand and agree:
Acceptance and review of the application
BlueCross BlueShield of South Carolina has the right to accept or reject coverage on any or all persons applying.
This plan is not available to persons who are not U.S. citizens or full-time residents of South Carolina.
No insurance coverage shall be in force until BlueCross receives my application, first month's premium payment, and assigns a date on which coverage shall become effective.
The application fee is non-refundable.
The coverage under this policy is not renewable; however, I can apply for a new policy after the coverage ends.
If this policy is cancelled due to nonpayment, and I apply for new coverage at any time thereafter, BlueCross will require the payment of all past due premiums before new coverage will take effect.

Pre-existing conditions, mis-representation, or rescission
BlueCross relies on the answers provided in this application to determine eligibility. If it is determined false or materially inaccurate answers have been provided, BlueCross has the right to void (rescind) my coverage.
NO BENEFITS will be provided for any pre-existing condition. Pre-existing conditions are NOT covered by the policy.
I hereby represent the information on this application is complete, true and correctly recorded; and acknowledge that coverage may be terminated or rescinded for myself and any covered dependents (if applicable) for fraud, deception in the use of policy, or for materially misrepresenting information in the application.
I authorize release to BlueCross, or its representatives, of past and future medical records and other information deemed necessary by BlueCross to process claims.
BlueCross may deny claims and/or void coverage if it determines any information was misrepresented on the application or any claims. If coverage is voided, BlueCross will refund premiums I paid minus any claims paid.
I understand that payments will be refunded in the same manner as they are received. I acknowledge that a check refund may take up to 10 business days to receive.

Return or cancellation of policy
If I am not satisfied with this Policy, I can return it to BlueCross within 30 days after receiving it and all Premiums will be refunded minus any claims paid. If the Policy is returned, it will be void from the beginning, and the parties will be in the same position as if no Policy had been issued.

If you wish to cancel the Policy more than 30 days after it is effective, contact BlueCross at the phone number or address listed on the back of your Identification Card. Coverage will end at 12:01 a.m. Eastern Standard Time within 14 days after we receive your request.

I hereby attest that I understand that this coverage is not required to comply with federal requirements for health insurance and does not provide "minimum essential coverage" as defined under the Affordable Care Act.

If you are working with an agent to purchase this policy, the agent’s monthly commission is 12 percent of the initial premium of the policy to be paid monthly. This commission does not add to your monthly premium.

I HAVE READ AND FULLY UNDERSTAND EACH AND EVERY PART OF THIS APPLICATION FOR INSURANCE.

First Name

Last Name

Suffix

mm/dd/yyyy

Applicant's Birthday

Last 6 Digits of Applicant's Social Security Number

Your Relationship to the Applicant

Signature Date

Back

60 Days null null $1,500 $3,500

Plan Details

$99.99 $25.00

$124.99

You're almost finished! Making your first premium payment is the last step in the enrollment process. Your application will be submitted when you select one of these payment options.

Automatic payments are the easiest way to pay your premium. Just enter your bank account information and we'll take care of the rest. After today's payment, your premium will be drafted out of your account between the 1st and 3rd of each month you're covered. (You won't be billed twice for your first month of coverage.)

Once you make your initial payment and receive your membership materials, you will be able to set up recurring credit card payments online.

I would like to make a payment using a debit or credit card.

Prefer to pay later? You can submit your application now and we'll send a paper bill to the address we have on file for you. (Remember, your policy won't begin until we've received your first premium payment.)

I would like to be billed later.

Submit

Shop With Us

What is a Pre-Existing Condition?

IMPORTANT: This is a short-term, limited-duration policy, NOT comprehensive health coverage

Looking for comprehensive health insurance?

Questions about this policy?

IMPORTANT LIMITATIONS OF THIS POLICY

When will the coverage take effect?

Who is the primary applicant?

1. Do you currently have any health insurance that will not terminate prior to the requested effective date of this policy?

3. Are you currently pregnant or do you suspect you may be pregnant, or are you an expectant father (regardless of whether the mother is applying)?

4. In the last 24 months: Have you had testing performed and not yet received results? Have you discussed or considered treatment, surgery or further testing that hasn't been performed? Has a referral to another health care provider been discussed or considered, but hasn't yet occurred?

5. In the last six months, have you had any symptoms for which you considered consulting a doctor or other healthcare provider but did not?

6. In the past six months, have you received treatment, therapy, or taken any medication for any spine disorder or arthritis or degenerative joint disease of the knee or hip?

7. In the last five years, have you had a life, disability or health insurance application or policy that was declined or rescinded?

8. Are you a U.S. citizen and resident of South Carolina?

Tell us about the dependents.

Thank you!

When will the coverage take effect?

Who is the primary applicant?

Do you have a Primary Care Physician?

Are you working with an agent?

What is the applicant's address?

Do you have a different billing address?

Tell us about the dependents

Here's what we've found for you

Plan Details

Terms and Conditions

Applicant's Signature or Signature of Legal Guardian if Under 18

Do you have the power-of-attorney or another legal document allowing you to act for the Applicant?

Spouse's Signature

Do you have the power-of-attorney or another legal document allowing you to act for the spouse?

Intelliscript Authorization

BlueEssentialsSM HD Bronze 2

Term Length

Effective Date

End Date

Deductible

Max. out of Pocket

Estimated Monthly Cost

One-Time Application Fee

First Payment

Select a Payment Method

Bank Draft (ACH)

Debit or Credit Card

Paper Bill

ApplicationConfirmation

PaymentMethod

4. In the last 24 months:

Have you had testing performed and not yet received results?

Have you discussed or considered treatment, surgery or further testing that hasn't been performed?

Has a referral to another health care provider been discussed or considered, but hasn't yet occurred?

BlueEssentials^SM HD Bronze 2

Application
Confirmation

Payment
Method