Member Resources

All Blue Option plans include routine pediatric and adult vision coverage through an independent company, the Physicians Eyecare Network (PEN).

PEN provides vision services through the Physicians Eyecare Plan (PEP) on behalf of BlueChoice HealthPlan. This benefit includes coverage for routine eye exams and materials.

Blue Option members have access to top retail providers, including Walmart® Vision Center, Pearle Vision®, Sam’s Club® Optical, LensCrafters®, Target Optical®, JCPenney® Optical, Eyeglass World® and America’s Best Contacts & Eyeglasses®.

Locate an in-network eye doctor with our Find Care tool. 

Pediatric Vision Care*

For children (ages 0 − 18), this includes:

• a $15 copayment for one annual routine eye exam.
• a $49 copayment for one standard contact lens fitting or a 15 percent discount off the provider’s nonstandard contact lens fitting fee per benefit year.
• a $150 material allowance with a $25 copayment every benefit year for glasses and contacts that can be spent on frames, lenses and lens upgrades with no limits on frame or lens selection.
• Discounts of 20 percent on glasses and 15 percent on contacts on any amounts spent over the material allowance (at most providers).
• If using an out-of-network provider, up to $40 toward the routine eye exam and up to 65 percent of the material allowance that is used less material copayment. You will need to file your own claim when visiting an out-of-network provider.

Please note for pediatric vision, you must visit an in-network provider to receive this benefit. Costs incurred from these services count toward maximum out-of-pocket (MOOP) expenses. These benefits are essential.**

*For dependent children until the age of 18. Adult vision care begins on the first day of the month following their 19th birthday.
** Essential benefit: a set of 10 categories of services health insurance plans must cover under the Affordable Care Act. These include doctors’ services, inpatient and outpatient hospital care, prescription drug coverage, pregnancy and childbirth, mental health services and more.

Adult Vision Care

For adults (ages 19 and over), this includes:

• a $0 copayment for one annual routine eye exam.
• a $49 copayment for one standard contact lens fitting or 15 percent discount off the provider’s nonstandard contact lens fitting fee per benefit year.
• a $150 material allowance with $0 copayment every benefit year for glasses and contacts that can be spent on frames, lenses and lens upgrades with no limits on frame or lens selection.
• Discounts of 20 percent on glasses and 15 percent on contacts on any amounts spent over the material allowance (at most providers).
• If using an out-of-network provider, up to $40 toward the routine eye exam and up to 65 percent of the material allowance that is used less material copayment. You will need to file your own claim when visiting an out-of-network provider.

Please note that you must visit an in-network provider to receive this benefit. Costs incurred from these services do not count toward MOOP expenses. These benefits are nonessential.*

*Nonessential benefit: Any benefit provided that is not considered an essential health benefit is a nonessential benefit.

Our plans include a reimbursement for preventive care, which includes exams and cleanings from a licensed South Carolina dentist.

Adults (ages 20 and over) and children (ages 19 and under) get:

• One exam every six months, a $50 allowance for an initial appointment or a $50 allowance for periodic appointments.
• One cleaning every six months with a $50 allowance.

You will be responsible for paying any additional balance above what we cover. You will need to submit a dental reimbursement form with a bill or receipt from the dentist to BlueChoice HealthPlan for reimbursement.

For example, if your dentist charges you $130 for an initial cleaning and exam, you will pay your dentist $130 at the time of service. We will reimburse you $100 once we receive your reimbursement form.

Please note: You can visit any South Carolina licensed dentist. Costs incurred from these services do not count toward maximum out-of-pocket (MOOP) expenses.

Locate a dentist with our Find Care tool.

All plans that have a copayment provide you with the convenience of an all-inclusive office visit copayment.

What does that mean?

If you visit a participating in-network provider, you will pay one copayment for all covered services performed in the doctor’s office for the same date when billed by the physician. Best of all, there are no dollar maximums!

Here are a few examples of what is covered under the all-inclusive office visit copayment:

• Office charges, including surgical services or treatment of an illness, accident or injury
• Allergy and tetanus shots
• Annual physicals
• Injections (immunizations)
• Diagnostic lab and X-ray services (Other charges could apply if the provider sends the claim to a hospital for processing.)

The all-inclusive office visit copayment benefit encourages members to see a contracting provider of their choice to establish and maintain a relationship, improving their health care experience.

Ensure laboratories are in network by using the Find Care tool.

The copayment does not apply to high-deductible (HD) plans.

We want to make sure you have the most current information about your health plan. Get important information delivered right to your phone when you sign up for our text messages.

Messages include:

• Important plan updates
• Health and wellness reminders
• Ways you can save

... and more!

Get started

You can sign up when you register for My Health Toolkit®. If you already have an account, you can update your contact preferences by going to your profile settings. 

The FOCUSfwd Wellness Incentive Program is designed to help you lead a healthier lifestyle.

Complete our FOCUS Points and GET FIT programs and earn up to $110 in rewards. Plus, increase your chances of winning one of the $1,000 quarterly and $5,000 annual cash rewards in our Sweepstakes!

Everyone needs some advice from time to time.

That’s why My Life Consult offers you and those in your household three free life management sessions and three counseling sessions to help you tackle some of life’s most challenging decisions.

Services Include:

• Financial counseling and planning.
• Adult care services.
• College consultation resources.
• Legal consultations and documents.
• Child care resources.
• Parenting or adoption services.

Dedicated professionals are available to serve you 24 hours a day, seven days a week. Call 800-968-8143. For more information about your benefits plus helpful articles, assessments, webinars, videos and more, visit www.FirstSunEAP.com.

My Life Consult services are offered through First Sun Employee Assistance Program (EAP). Because First Sun EAP is a separate company from BlueChoice HealthPlan, First Sun EAP is solely responsible for all services related to individual assistance programs.

Access your Blue Option 2025 Member Policy. Our Member Policy gives you answers regarding:

• When your coverage begins and ends.
• Covered services.
• Services and supplies we don't cover.
• General contract provisions.

... and more!

You can also view the 2024 Member Policy.

Your favorite features from the website are now available in a mobile app. With the My Health Toolkit app, you can: 

• View and share your digital ID card.
• Check the status of your claims.
• Confirm your coverage for services.
• Find a doctor or hospital in your network.
• Manage your medical spending accounts.

... and more!

Just grab your mobile device and search for “My Health Toolkit” in the App Store or Google Play.

Once downloaded, you can log in with your existing username and password. If you need help with the app, we've got you covered there, as well.

My Health Novel matches you with helpful resources and tools based on your specific health needs. With it, you can access weight management, behavioral health and musculoskeletal health mobile apps at no cost.

Learn more about My Health Novel.

When an email contains sensitive information, we will send it via a secure method. That means you will need to create a password to open it.

It's a straightforward process, but we have provided detailed instructions on how to access these secure emails in the event you need some assistance.

The Outline of Coverage gives you answers on: 

• Benefits.
• BlueCard. 
• Inpatient and outpatient services.

... and more!

You can also view the 2024 Outline of Coverage.

We offer an easy-to-understand summary of a health plan’s benefits and coverage, referred to as a Summary of Benefits and Coverage (SBC). An SBC includes plan details, called “coverage examples,” that let you see what the plan covers for certain health conditions or medical situations.

You can also view the 2024 Summary of Benefits and Coverage.

A new movement in the medical community reminds patients to ask follow-up questions to gain a fuller understanding of their options and get better care.

The Always Stay Knowledgeable (ASK) program was created in 2018 to raise awareness about low-value care. Its goal is to make sure health care facilities are providing high-value care that makes a real difference. It aims to reduce unnecessary care and improve health outcomes through better conversations between patients and providers.

Learn more about the ASK program