South Carolina health plan · 2025

Blue Beaufort Gold 1 · 26065SC0740001

BlueCross BlueShield of SC offers this marketplace health insurance plan (Plan ID 26065SC0740001) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Standard Gold Off Exchange Plan Issuer: BlueCross BlueShield of SC
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 78.12% (21.88% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$323 – $1268

Before subsidies

Estimate after subsidies

Deductible

$250

$500 per group

See deductible details

Max out-of-pocket

$8,900

$17800 per group

Review MOOP rules

Office visits

Primary care $25.00
Specialist $50.00
HSA Not eligible

Drug tiers

Generic $12.00
Preferred brand $40.00

View formulary tiers

$443 / mo before subsidies

≈ $5317 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1404 / mo before subsidies

≈ $16850 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1701 / mo before subsidies

≈ $20407 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1081 / mo before subsidies

≈ $12969 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

No Charge after deductible, 50.00% Coinsurance after deductible

Durable Medical Equipment

No Charge after deductible, 50.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in South Carolina). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Gold Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge, No Charge

Emergency Room Services

No Charge after deductible, 50.00% Coinsurance after deductible

Durable Medical Equipment

No Charge after deductible, 50.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 26065SC0740001
Coverage year 2025
State South Carolina
Issuer BlueCross BlueShield of SC
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 26065SC0740001-00
Available variants

Standard Off Exchange Plan · 26065SC0740001-00

Standard On Exchange Plan · 26065SC0740001-01

Open to Indians below 300% FPL · 26065SC0740001-02

Open to Indians above 300% FPL · 26065SC0740001-03
Last plan update Wed, 19 Feb 2025 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in South Carolina N/A
PCPs in South Carolina N/A
Telehealth support Data pending
Nationwide providers N/A

Provider network(s)

Providers South Carolina All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

6,674 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
GENERIC 3,153
NON-PREFERRED-BRAND 2,070
NON-PREFERRED-BRAND-SPECIALTY 1,181
GENERIC-SPECIALTY 270
Prior authorization Drugs
Required 1,573
Not Required 5,101
Step therapy Drugs
Required 188
Not Required 6,486
Quantity limits Drugs
Has Limit 1,424
No Limit 5,250

Customer highlights

What stands out for members

  • Issuer: BlueCross BlueShield of SC · Plan ID 26065SC0740001 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 26065SC0740001-00 (Standard Off Exchange Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 500.0 Dollars per Benefit Period

nan

Exclusions: nan

Diabetes Education

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Diabetes self-management training and education will be provided on an outpatient basis when done by a registered or licensed health care professional that is certified in diabetes.

Exclusions: nan

Home Health Care Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

As required by USPSTF, CDC and HRSA, and including OBGYN exams (limit 2 per year), mammography services, pap smear services, prostate services, and routine colorectal cancer screening/testing.

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

When you use the Beaufort telehealth service, there is no charge for your first 4 telehealth office visits. Starting with the 5th visit, a copay applies.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Physical, speech and occupational rehabilitative therapy are combined for a maximum 30 visits per Benefit Period, other than inpatient therapy.

Exclusions: nan

Rehabilitative Speech Therapy

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Physical, speech and occupational rehabilitative therapy are combined for a maximum 30 visits per Benefit Period, other than inpatient therapy.

Exclusions: nan

Specialist Visit

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$60.00
Tier 1 in-network $60.00
Out-of-network 100.00%

An out-of-Network Provider may Balance-Bill you for the difference between the Allowed Amount we pay and their billed charge.

Exclusions: nan

X-rays and Diagnostic Imaging

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

No Preauthorization is required for the mother's hospitalization related to the delivery of a newborn child when the mother's hospital stay is 48 hours or less for a vaginal birth or 96 hours or less for a cesarean section. Confinements exceeding these limits require Preauthorization.

Exclusions: nan

Dialysis

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

A replacement DME is covered when due to a change in medical condition.

Exclusions: nan

Emergency Room Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network No Charge after deductible, 50.00% Coinsurance after deductible

An out-of-Network Provider may Balance-Bill you for the difference between the Allowed Amount we pay and their billed charge.

Exclusions: nan

Emergency Transportation/Ambulance

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Hospice Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 6.0 Months per Episode

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

The cost sharing that displays applies to outpatient office visits only. All other outpatient services (e.g., intensive outpatient and partial hospitalization programs) may be subject to additional cost sharing. Please refer to the plan policy documents for detailed information.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Physical, speech and occupational rehabilitative therapy are combined for a maximum 30 visits per Benefit Period, other than inpatient therapy.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Radiation

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 60.0 Days per Benefit Period

You must be admitted to a Skilled Nursing Facility within 14 days of discharge from an approved hospital admission.

Exclusions: nan

Substance Abuse Disorder Inpatient Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

nan

Exclusions: nan

Transplant

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prenatal and postnatal care will be covered after artificial insemination or in-vitro fertilization, but the actual insemination/fertilization is not covered.

Exclusions: nan

Routine Eye Exam for Children

$25.00
Tier 1 in-network $25.00
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

nan

Exclusions: nan

Well Baby Visits and Care

No Charge, No Charge
Tier 1 in-network No Charge, No Charge
Out-of-network 100.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$12.00
Tier 1 in-network $12.00
Out-of-network 100.00%

Generic, Brand, and Specialty drugs may be placed on any prescription drug tier. See the Summary of Benefits and Coverage for benefit information on all tiers. Quantity limits or prior authorization are required for some covered drugs. See Covered Drugs List for details.

Exclusions: nan

Non-Preferred Brand Drugs

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Generic, Brand, and Specialty drugs may be placed on any prescription drug tier. See the Summary of Benefits and Coverage for benefit information on all tiers. Quantity limits or prior authorization are required for some covered drugs. See Covered Drugs List for details.

Exclusions: nan

Preferred Brand Drugs

$40.00
Tier 1 in-network $40.00
Out-of-network 100.00%

Generic, Brand, and Specialty drugs may be placed on any prescription drug tier. See the Summary of Benefits and Coverage for benefit information on all tiers. Quantity limits or prior authorization are required for some covered drugs. See Covered Drugs List for details.

Exclusions: nan

Specialty Drugs

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Generic, Brand, and Specialty drugs may be placed on any prescription drug tier. See the Summary of Benefits and Coverage for benefit information on all tiers. Quantity limits or prior authorization are required for some covered drugs. See Covered Drugs List for details.

Exclusions: nan

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

nan

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

$50.00
Tier 1 in-network $50.00
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Frames and lenses are limited to 1 set per year.

Exclusions: nan

Gender Affirming Care

Coverage details pending

nan

Exclusions: nan

Habilitation Services

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Benefit Period

Habilitation services are health care services that help a person keep, learn, or improve skills and functioning for daily living. Examples include therapy for a child who is not walking or talking at the expected age. These services may include physical and occupational therapy, speech-language pathology and other services for people with disabilities in a variety of inpatient and/or outpatient settings. Habilitative therapies are combined for a maximum 30 visits per Benefit Period.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Infertility Treatment

Coverage details pending

nan

Exclusions: nan

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

No Charge after deductible, 50.00% Coinsurance after deductible
Tier 1 in-network No Charge after deductible, 50.00% Coinsurance after deductible
Out-of-network 100.00%

Reconstructive Surgery that is considered a Covered Expense is limited to Surgery: To correct a functional defect that results from a birth defect, disease and anomaly; or Performed to correct a seriously disfiguring condition resulting from injury; or For breast reconstruction after a mastectomy.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

nan

Exclusions: nan

Variant attributes

Blue Beaufort Gold 1 · Variant 26065SC0740001-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Gold Off Exchange Plan

HIOS Product ID

26065SC074

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

26065SC0740001-00

Plan Marketing Name

Blue Beaufort Gold 1

Plan Variant Marketing Name

Blue Beaufort Gold 1

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

26065

Issuer Marketplace Marketing Name

BlueCross BlueShield of South Carolina

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

SCN008

Out of Country Coverage

No

Out of Country Coverage Description

Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.

Service Area ID

SCS008

State Code

SC

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.781176701937043

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$6,200

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$250

SBC Scenario, Having Diabetes, Coinsurance

$1,900

SBC Scenario, Having Diabetes, Copayment

$400

SBC Scenario, Having Diabetes, Deductible

$250

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$1,100

SBC Scenario, Treatment of a Simple Fracture, Copayment

$200

SBC Scenario, Treatment of a Simple Fracture, Deductible

$250

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

50.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$17800 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$8900 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$8,900

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

SCF012

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2025-02-19 01:01:54

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

New

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

26065SC0740001

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$500 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$250 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$250

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

No

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in South Carolina?

Blue Beaufort Gold 1 (26065SC0740001) is a Gold HMO from BlueCross BlueShield of SC in South Carolina for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Beaufort Gold 1 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Beaufort Gold 1 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Beaufort Gold 1 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Beaufort Gold 1?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Blue Beaufort Gold 1?

No, out-of-country services are not covered for this plan. Details: Benefits are available only for emergency medical conditions. Special pricing may be available through a Blue Cross Blue Shield Global Core provider.

Does Blue Beaufort Gold 1 cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Benefits are available only for emergency medical conditions when treated in an outpatient hospital emergency room or urgent treatment center, or for urgent conditions when treated in an urgent treatment center. Special pricing may be available through a BlueCard provider.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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