South Carolina's group accident and health rules are in S.C. Code 38-71-710 to 38-71-780. Expect questions on:

• Eligibility without evidence of insurability.
• The 31-day grace period.
• Group incontestability.
• The state continuation privilege (the rest of the policy month plus 6 months).
• Group disability preexisting-condition limits.

COBRA, HIPAA, ERISA and general group concepts are in the national Group Health Insurance guide.

Required group provisions (38-71-730, 38-71-735)

Enrollment and eligibility

• A group policy may not require evidence of insurability when a person first becomes eligible, or within 31 days afterward (38-71-730(3)).
• A group of small employers formed only to get health insurance must include at least 1,000 eligible employees (38-71-730(1)).

Premiums and contestability

• Grace period: 31 days after the first premium (38-71-735(a)).
• Incontestability: after 2 years in force, the policy can't be contested except for fraudulent misstatements (38-71-735(b)).

Certificates and claims

• Each covered person receives a certificate describing the coverage (38-71-735(f)).
• Benefits other than loss-of-time are paid within 60 days of proof of loss (38-71-735(j)).
• Benefits due an estate or a minor may be paid to a relative, up to $5,000 (38-71-735(k)).

Group disability income

• A preexisting-condition exclusion may exclude disabilities from preexisting conditions that begin in the first 12 months of coverage (38-71-730(4)).

State continuation (38-71-770)

• An employee insured continuously for at least 6 months may continue group health coverage after termination for the rest of that policy month plus 6 more months.
• Employees who are eligible for Medicare aren't entitled to it.
• Disabled dependents: coverage continues past the limiting age if proof is given within 31 days (38-71-780).

Group life (for combined Life, Accident and Health candidates) (38-65)

Eligibility and enrollment

• A group may be issued to people in a common group formed for a purpose other than buying insurance (38-65-40).
• For plans covering 25 or more people, evidence of insurability can't be required for basic coverage if the person enrolls when first eligible or within 31 days.
• Dependent children who are full-time students may be covered under age 25 (38-65-70).

Policy terms (38-65-210)

• Grace period: 31 days.
• Statements are representations, not warranties.
• Misstated age: premiums, benefits or both are equitably adjusted.
• Funeral expenses: up to $2,000 may be paid to whoever incurred them.
• Certificates: issued by the insurer, through the policyholder.

Conversion (38-65-210, 38-65-110)

• After employment ends: apply and pay the first premium within 31 days. The new policy may be any form except term, priced at attained age and class of risk.
• When the group policy itself ends: available to people insured at least 5 years. The converted amount may be capped at the smaller of the lost coverage or $10,000.
• Death during the window: the convertible amount is paid as a group claim.
• Late notice: a person not told of the conversion right at least 15 days before it expires gets more time, never more than 60 days past the original period.

Disability

• A totally disabled insured may continue coverage by paying the employee's share, generally for 6 months from the start of the disability.

Franchise policies

• Franchise or wholesale life may not be used to supplement group life on the same lives (38-65-350).

Common exam traps

• Continuation: requires 6 months of prior coverage, and lasts the rest of the month plus 6 months. Not available to people eligible for Medicare.
• Group A&H incontestability: 2 years. Grace: 31 days.
• No evidence of insurability when enrolling at first eligibility or within 31 days.
• Facility of payment in group A&H: $5,000. The individual policy figure is $1,000.
• Group life funeral payment: up to $2,000.