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1. What is the continuing education (CE) reporting fee?

This fee is no longer required.

2. What happens if I fail to comply by the last day of my birth month?

Your license will expire and a $50 late penalty fee must be paid online through NIPR. For more details about the consequences of failure to comply, refer to that FAQ section.

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1. What is the date by which I must complete 24 hours of South Carolina continuing education (CE)?

All licensed producers except those with limited lines of authority and those that are exempt, must complete continuing education (CE) requirements biennially by the end of their birth month. Producers born in an odd numbered year must comply biennially by the end of their birth month every odd numbered year. Producers born in an even numbered year must comply by the end of their birth month every even numbered year. Producers must also renew their license by the end of their birth month in an odd or even numbered year. No one is exempt from the producer licensing renewal requirement except those producers with the travel baggage line of authority only.

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1. How do non-resident licensed producers comply with continuing education (CE) requirements?

Nonresident producers are not required to comply with CE in South Carolina. They must renew their non-resident license.  

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1. How will credit hours be counted and reported?

The provider must give you a certificate of course completion. The provider will upload the course roster to the CE Administrator electronically.  

2. Am I required to provide my social security number to continuing education (CE) providers?

No.

3. How will I demonstrate that I have completed the continuing education (CE) requirements to the CE administrator?

Producers can verify their credits and compliance status on SBS web site: www.statebasedsystems.com.  

4. How will I know if I have not complied with my continuing education (CE) requirement?

Your CE transcript will show that you are compliant and provide the date. www.statebasedsystems.com

5. How will my company know that I have completed the required continuing education (CE) hours?

Your CE transcript will show that you are compliant and provide the date. www.statebasedsystems.com

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1. What are the requirements for a newly licensed resident producer?

A total of 24 hours is required by the end of your compliance period.  At least 3 hours must be from courses categorized as ethics of those 24 required credit hours. Producers cannot be compliant if the CE hours have not been met.

 Extensions will not be granted.

2. What are the requirements for a newly licensed non-resident producer?

Nonresident producers are not required to comply with CE in South Carolina.

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1. Is my employer required to offer me health insurance coverage?

There is no law on a federal or state level that requires an employer to offer health insurance coverage. An opportunity to purchase health insurance is a benefit, not a law.

2. Can my employer change our health insurance carrier and level of benefits during the year?

Yes. It is completely up to the employer whether or not they will offer health insurance to employees at all and they can change carriers and level of benefits at any time.

3. Are all group health insurance policies regulated by the South Carolina Department of Insurance?

No. Many plans are self-funded and do not fall within the jurisdiction of this department. Plans that are not regulated by the South Carolina Department of Insurance fall under the laws of the U.S. Department of Labor, Employee Benefits Security Administration. You may contact them by calling 1-866-444-3272.

4. What happens to my group health coverage if I leave my employer?

You may be eligible for protection under the Consolidated Omnibus Budget Reconciliation Act (COBRA) law and entitled to a minimum of 18 months of continuation coverage. You can find out more about COBRA continuation of group health benefits from the U.S. Department of Labor, Employee Benefits Security Administration. You may contact them by calling 1-866-444-3272.

5. After terminating employment, how long is my employer required to continue my insurance, and under the new federal law, isn't this coverage free and shouldn't it last forever?

The South Carolina Department of Insurance does not regulate employers. Most employers terminate coverage at midnight on the day you leave. The employer should offer you the option of continuing your insurance through Consolidated Omnibus Budget Reconciliation Act (COBRA) (if he has 20 or more employees) or through the State Continuation of Benefits (if he has less than 20 employees and you have been covered by the group plan for six consecutive months).

Please note that under COBRA or State Continuation of Benefits, the former employee must pay the employer's portion, the employee's portion, and on COBRA, the employer may charge a 2% surcharge. There are limitations to the periods of time one can be covered. Please call us at 803-737-6180 for more information.

6. What happens when my group health coverage ends?

You have two options. You can apply for individual health coverage. The individual health insurance company underwriters do have the right to accept or reject your application. If they chose not to accept you under their plan then you would be eligible for the South Carolina Health Insurance Pool (SCHIP). The SCHIP is a state health plan designed to provide coverage for those who either do not have or have lost medical coverage at no fault of their own and are uninsurable. The SCHIP coverage is not an insurance policy nor is it a Blue Cross Blue Shield of South Carolina policy. The SCHIP coverage is administered by Blue Cross Blue Shield of South Carolina.

7. My health insurance company has not paid my claim. What is the time frame for a company to process the claim?

If it is a fully insured group plan, then a claim should be either paid or denied within 60 days of receipt of all information needed to process the claim.

8. I asked my employer to cancel my coverage due to lack of income. He says he can't do that until January 1. Why?

Apparently, your employer is deducting your insurance premiums from your paycheck prior to assessing income taxes. There are only certain situations in which the federal government allows you to make changes in your deductions, except at the beginning of your new tax year. If you wish to have the specifics on this situation, please call the federal IRS at 1-800-829-1040. That is a tax regulation, not an insurance regulation.

9. What is a “self-insured” plan?

An employer may choose to “self-insure” by paying out benefits from its own funds. Typically, an insurance company is used to administer the program, but the liability for paying for the care of the workers rests on the employer. It is important for workers to understand that if their employer “self-insures,” state patient protections (such as access to internal and external appeals processes, assurance of certain benefits, and the right to have grievances heard by the state insurance department) do not apply. All federal protections (i.e., Health Insurance Portability and Accountability Act [HIPAA] and Consolidated Omnibus Budget Reconciliation Act [COBRA]) do remain.

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1. What is Medicare supplement insurance?

The federal Medicare program pays most medical expenses for people 65 or older or for individuals under 65 receiving social security disability benefits. However, Medicare does not pay all expenses. As a result, you may want to buy a Medicare supplement policy that helps pay for certain expenses, including deductibles not covered by Medicare.

2. When should I apply for a Medicare supplement policy?

If you are 65 or older and elect coverage under Medicare Part B, either due to age or disability, you have a six-month open enrollment for a Medicare supplement policy, which guarantees you coverage with a plan and company of your choice. You may choose from a list of standardized plans – listed as A through L. If you do not purchase a plan within your six-month open enrollment, any company you apply to can deny coverage based on your health conditions. There are some limited additional open enrollment periods available to some persons disenrolling from a Medicare health maintenance organization (HMO).

3. Do Medicare supplement policies cover prescription drugs?

Medicare supplement policies may not include prescription drug coverage. Those who currently have a policy with prescription drug coverage may opt to keep that coverage or switch to the new Medicare prescription drug plans.

4. What are Medicare advantage plans?

Medicare Advantage plans (formerly known as Medicare+Choice plans) are private managed care plans that provide the standard Medicare benefits, plus additional supplemental benefits for a monthly fee. These plans may include prescription drug coverage. Medicare Advantage participants may even receive a subsidy for their prescription drug benefits in most cases.

5. What are Medicare select plans?

Medicare select plans provide supplemental benefits through a network of providers similar to a Preferred Provider Organization (PPO). If the participant received care for a provider under contract with the insurer, the cost will be lower.

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1. What is the purpose of the Small Employer Health Insurance Availability Act?

The purpose of the Small Employer Health Insurance Availability Act is to promote the availability of health insurance coverage to small employers regardless of the health status or claims experience of their employees.

Under the Small Employer Health Insurance Availability Act, any eligible small employer who wishes to have group health insurance coverage for its employees, regardless of the health conditions in that employer group, can obtain health insurance coverage.

The Health Insurance Portability and Availability Act of 1996 (HIPAA) required that all products in the small employer market issued or renewed after July 1, 1997, must be guaranteed to be issued to a small employer group, regardless of the health status of its members.

2. Who is eligible?

An employer group of 2-50 eligible employees. The employer must have employed no more than 50 eligible employees on at least 50% of the company’s working days in the last calendar year.

• Require employees to complete an application for coverage, including health history.
• Impose participation requirements on the group. That is, an insurer may require that a certain percent age of eligible employees be enrolled in the insurance program in order for a group to qualify.
• Require documentation from the employer concerning the business and hours worked by the employees.
• Consider an employee a late enrollee if he does not enroll within 30 days of becoming eligible for the coverage.

3. What happens if I don’t enroll when I am initially eligible?

If you do not enroll in the small employer group health insurance plan when you are first eligible, and decide to get the coverage later, then you will be considered a late enrollee.

In some instances, an employee may waive coverage under a small employer group, because he has other coverage. If that coverage is later lost, then that employee will not be considered a late enrollee if all of the following requirements are met:

• The employee was covered by qualified previous coverage at the time he waived initial enrollment in the employer’s group plan.
• The employee lost that qualified previous coverage as the result of termination of employment or eligibility, the involuntary termination of qualifying previous coverage, death of a spouse, or divorce.
• The employee requests enrollment in the employer group health plan within 30 days of the termination of the qualifying previous coverage.

4. What happens if I am a late enrollee?

The insurer may:

• Exclude you from coverage for 18 months
• Impose an 18-month pre-existing condition exclusion
• Impose both a period of exclusion from coverage and a pre-existing condition exclusion

However, the combined period must not exceed 18 months.

5. Can a pre-existing condition be excluded from coverage under the Small Employer Health Insurance Availability Act?

Yes. However, if you were previously covered under a creditable coverage and there was less than a 63 day break in coverage, then waiting periods met under the creditable coverage will be credited toward satisfying the pre-existing waiting periods under your new group policy.

6. What is creditable coverage under Health Insurance Portability and Availability Act of 1996 (HIPAA)?

Includes, but not limited to:

• A group health plan - whether fully insured or self-funded
• Comprehensive individual health insurance coverage
• Medicare
• Medicaid

Note: Waiting periods imposed by a new employer before you are eligible for coverage do not constitute a break in coverage.

7. Does a husband and wife constitute a group?

Yes, if they each meet the definition of eligible employee. Each must pay an employee premium.

8. If my group purchases a guaranteed issue policy from one insurer, does that policy cost the same through all insurers?

No. Each insurer can determine its rates for a group based on the claims experience for all small employers insured by that insurer.

Your rate for your guaranteed issue policy can be affected by several factors, including: age, gender, geographic area, industry, and family composition. In addition, your group, not one individual, can be charged more due to the health conditions of members of the group.

Prior to June 10, 1997, premium rates in the small employer group market were based on a modified community rating. With the change in legislation on June 10, 1997, a carrier in the small employer market is allowed to charge no more than 25% over the index rate for a small employer group with health conditions.

9. Can an employer offer coverage only to a certain classification of employees?

No. An employer cannot “classify” employees. Eligible employees are defined as: employees of a single employer, the officers, managers, and employees of the employer and of subsidiary or affiliated corporations of a corporate employer and the individual proprietors, partners; and employees of individuals and firms the business of which is controlled by the insured employer through stock ownership, contract, or otherwise, who:

• Work on a full-time basis
• Have a normal work week of 30 or more hours

10. Which insurers are marketing the guaranteed issue products?

The South Carolina Department of Insurance will maintain a listing of insurers marketing to small business employers.

The listings will be updated as insurers are added to the market.

11. Whom do I contact if I have more questions?

Your agent should be able to answer your questions for you. If not, then please feel free to contact the Consumer Services Division of the South Carolina Department of Insurance in Columbia at 803-737-6180 or 1-800-768-3467. You may also write to the department at:
P.O. Box 100105
Columbia, SC 29202

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1. The insurance company has non-renewed my homeowner's policy. Can they do that?

Your company can non-renew for any reason so long as the two requirements mandated by law are met. First, the company is required to put in writing the precise reason for the non-renewal. Second, the company must give 60 days’ advance notice for any non-renewal. Section 38-75-740.

There is, however, one exception. A policy can be non-renewed for claims even if the claims have not been your fault, though the law does not allow non-renewals for claims history if your only claims have been acts of God. Acts of God claims cannot be used when determining claim frequency. Section 38-75-790.

2. I just took out a new homeowner's policy and the company has notified me they are going to cancel my policy. Can they do that?

During the first 120 days, an insurance company can cancel for any reason. The law only requires 30 days notice be given. Section 38-75-730(c)

3. When can an insurance company cancel my homeowner’s coverage during the policy term?

Generally, your policy can be canceled for these reasons:

• Non-payment of premium
• Material misrepresentation / fraud
• Breaches of contractual duties by the insured
• Physical changes in the property which result in the property becoming uninsurable (except if the insurer should have reasonably foreseen the change or contemplated the risk when writing the policy)

4. I have had my homeowner's policy for five months and now the insurance company says they are going to cancel because I had claims with another company. Can they do that?

If you did not answer all questions correctly on the application, a company can mid-term cancel for material misrepresentation of facts. Section 38-75-730

The company must give 30 days notice and the reason must be stated.

5. I have a homeowner's policy. Is my home covered for damages caused by high winds or tornadoes?

Most homeowner policies cover damages to the dwelling caused by tornadoes or other wind damage. The homeowner policy covers the dwelling and personal contents items inside the home. The homeowner policy also covers storage buildings and other outside structures on the insured premises, including personal items inside the building.

6. Am I covered for wind damage if I have a mobile home policy?

Most mobile home policies will cover losses caused by wind. Storage buildings on the same premises of a mobile home are also generally covered under the mobile home policy. Most mobile home policies will also cover additional living expenses for the homeowner and his family if the mobile home was damaged by a covered loss such as wind.

7. Will the damages, caused to my home by flood or rising water, be covered under my homeowners policy?

Most homeowner and fire policies, with extended coverage, will not cover flood damages or claims resulting from rising water. Generally, a homeowner would need a flood insurance policy from the National Flood Insurance Plan to have protection for this type of loss.

8. What must I do after a loss occurs to my home or other property?

The homeowner's policy requires the owner to protect his property from further damage following a loss. Generally, the cost of protecting the property from further damage is covered. Examples of the expenses covered include: tarps, polyethylene, lumber, shingles, sidings, etc. The homeowner should also begin making a list of damaged items for the insurance company. This will allow for the claim to be handled in a timely manner.

9. How long should I wait for the insurance company to handle my homeowner's claim?

Most individuals with insurance claims receive contact from the insurance adjuster within 48 hours after the claim is reported. The resolution period of a claim will vary, depending upon how extensive the damage from a catastrophe. Generally, the insurance adjuster will schedule a time to meet with the homeowner and adjust the loss.

10. Will my insurance policy pay for my family to live somewhere else while my damaged home is being repaired?

Most homeowner policies include coverage for additional living expenses. This coverage is designed to cover additional living expenses while repairs are being made to the damaged home. The company / agent should be contacted immediately.

11. If the insurance company and I cannot agree on the amount that it will take to repair my home, do I have to file suit?

No, your first step should be to utilize the appraisal provision of your policy. You will find it under "Selection I - Conditions" of your policy contract.

12. Are deductibles required and, if so, what are they?

Yes, most homeowners forms contain deductible provisions applicable to losses occurring under Section I (Section I losses include (a) dwelling, (b) appurtenant structure, (c) unscheduled personal property, and (d) additional living expenses.) The type and amount of deductible varies by company. Deductible provisions do not apply to Section II losses (Section II losses include personal liability [bodily injury and property damage] and medical payments to others). Some companies offer an optional deductible applicable only to wind or hail losses. Most offer higher deductible options such as $500 or $1,000 at a reduced premium.

13. My house was completely destroyed by fire. I'm trying to collect on my personal property that I had in the house, but the insurance company is telling me I need an inventory. Can they do that?

Yes. Whether your policy pays for the replacement or just the actual cash value, the company is only obligated to pay for personal property that you can show you owned at the time of loss. It is a very good idea to keep an up-to-date inventory in a secure place. Also, to help you remember what you had, it is helpful to take pictures of each room and keep them with your inventory.

14. Our sump pump failed and the insurance company is denying our claim because the water backed up through our sewer. Can they do this?

Most insurance policies exclude water damage for water which backs up through sewers or drains. You may wish to contact your agent to inquire about putting an endorsement on your policy, which would cover sewer back up.

15. My boat was stolen and now my insurance company will not pay the claim on my homeowner’s policy. Can they deny my claim?

Theft to watercraft, including furnishings, equipment, and outboard motors, are typically excluded if the theft occurs outside your residential premises. To adequately cover your boat and its accessories, you should contact your agent regarding a separate policy covering the boat.

16. During a storm, a tree from my neighbor’s yard fell and destroyed my fence. Does my homeowner’s policy pay for the damage or does my neighbor’s policy?

Generally, your own policy should cover the loss. Your insurance company may be able to recover the amount it pays you for the loss and your deductible from the homeowner's insurance that your neighbor may have if the loss occurred as a result of your neighbor’s negligence.

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1. How do I search the status of my license, print my license, or find my license number?

Using Google Chrome, go to www.statebasedsystems.com. Under the SBS heading, select one of the options and follow the steps on the remaining pages.

2. How do I transfer from a resident to a nonresident license?

The individual must be licensed in the new resident state first, request cancellation of the SC resident license, and apply for the SC nonresident license online at www.nipr.com. 

3. How do I transfer from a nonresident to a resident license?

The resident license will need to be canceled in the previous home state. The SC nonresident license will also need to be canceled, if applicable. Once canceled, the resident license can be submitted online at www.nipr.com. A letter of clearance from the previous home state is not required if SC can verify on the State Producer Licensing Database (SPLD) that the license has been canceled in the previous home state. 

To exempt the state licensing examination, the individual must submit the resident application within 90 days of canceling the license in the previous home state. If the license in the previous home state has been inactive for more than 90 days, in accordance with SC law, the individual is required to take the SC examination. 

If the application is for a resident surplus lines broker license, the 90-day law does not apply. All applicants for a resident surplus lines broker license must pass our surplus lines broker examination. 

If applying for a resident producer license, the applicant must be fingerprinted.

4. How do I request letters of clearance or certification?

The department no longer issues letters of clearance or certification. Using Google Chrome, go to www.statebasedsystems.com. Under the SBS heading, click the print license option and log in. At the top of the page, you will see that the summary page serves as either a letter of clearance (if inactive) or a letter of certification (if active).

5. How do I change my address?

Using Google Chrome, go to www.nipr.com. Click on Licensing Center, Change Contact Information, Go to the Online Application, sign in as an Individual, and follow the steps on the remaining pages.

6. How do I change my name with the Department?

Using Google Chrome, go to www.doi.sc.gov. Click on Licensing & CE, then Forms, and look for the Name Change Form-Individuals.

7. How do I cancel my license?

Using Google Chrome, go to www.doi.sc.gov. Click on Licensing & CE, then Forms, and look for the License Cancellation Form-Individuals.

8. How can I find a list of my active and inactive producer appointments?

Using Google Chrome, go to www.statebasedsystems.com. Under SBS click on print license and log in. On your summary page, scroll down to the appointment heading to view your appointments.

9. How do I register to take the state licensing examination?

Contact Pearson Vue at 877-759-5226 or register to take the exam at Pearson Vue's website at home.pearsonvue.com/sc/insurance. 

10. How do I cancel my appointment with an insurance company?

Contact the insurance company directly and ask for the appointment to be canceled.

11. Can an insurance company with whom I am appointed cancel my appointment and license with the state?

The insurance company can cancel your appointment. The insurance company cannot cancel your license.

12. What is your mailing address?

South Carolina Department of Insurance (SCDOI)
P.O. Box 100105
Columbia, SC 29202-3105

13. What is your physical address for personal or overnight delivery?

South Carolina Department of Insurance (SCDOI)
1201 Main Street, Suite 1000
Columbia, SC 29201

14. What is your email address?

agentmail@doi.sc.gov

15. What is your fax number?

(803) 737-6100

16. What is the turn-around time for paperwork submitted to the Department?

All applications should be submitted online at www.nipr.com. Supporting documentation should be attached to NIPR's Attachment Warehouse. The application will be received the next business day and will be reviewed. Once all documentation has been received, our processing time is usually 48-72 hours.

17. How much are the license fees?

Producer $25 biennially
Adjuster $80 biennially*
Appraiser $80 biennially
Public Adjuster $80 biennially*
Surplus lines broker $200 biennially

*When the laws of another state require a higher fee, the nonresident shall pay an amount equal to the amount of charges imposed by their home state.

18. When do the licenses renew?

Adjusters August 1-31 of odd numbered years
Appraisers October 1-31 of odd numbered years
Producer Birth month of even (odd) years if born in an even (odd) year

Public Adjuster October 1-31 of even numbered years
Surplus Lines Broker May 1-31 of even numbered years

19. What are the basic requirements for obtaining a resident individual license?

The application should be submitted online at www.nipr.com and the appropriate license fee paid at the end of the application process. Please note that NIPR will charge a processing fee in addition to our license fee.

20. What are the basic requirements for obtaining a nonresident individual license?

The entity must first be licensed in their resident state prior to applying for a nonresident license. The application should be submitted online at www.nipr.com and the appropriate license fee paid at the end of the application process. Please note that NIPR will charge a processing fee in addition to our license fee.

21. How do I add a new line of authority to an existing license?

Using Google Chrome, go to www.nipr.com. Click on Licensing Center, Add a Line of Authority, Go to the Online Application, sign in as an Individual, and follow the steps on the remaining pages. 

22. What is required to obtain a resident producer Variable Contract license?

The producer must hold the life line of authority and pass Series 6 or 7 examination offered through FINRA. The applicant must also provide a CRD number on the application.

23. I am currently licensed for Life and Accident/Health insurance and would like to sell Long Term Care Insurance. Which line of authority do I have to apply for to sell this product?

Long term care is included with the life or accident/health lines of authority. Before selling long term care insurance, the producer must provide proof to the insurer that 8 hours of long term care product training has been completed. Thereafter, every two years the producer must provide to the insurer proof that an additional 4 hours of long term care training has been completed. Resident producers must complete South Carolina’s training requirements.

Nonresident producers will complete the training in their home state.

24. What individual license types require an appointment?

Producers

25. Who qualifies for a temporary license?

A temporary license may be issued only under certain circumstances. Please refer to South Carolina Code Ann. §38-43 102 at http://www.scstatehouse.gov/code/t38c043.docx.

26. Can a producer pay a finder's or referral fee to an unlicensed individual?

Yes. Please refer to Section 38-43-200 (D) of our law.

27. Is there a fee to cancel producer appointments with insurance companies?

The department does not charge a fee to an insurance company to cancel an appointment. NIPR will charge the insurance company a processing fee.

28. How can I obtain a copy of an individual's file?

A FOIA request should be submitted to our Legal Division. Please call  (803) 737-6132 for instructions.

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1. I purchased a life insurance policy and now I have decided I don't want it. My agent told me I have a "free look" period. What does "free look" mean?

You are allowed no less than 10 days from the date a life insurance policy is delivered to review and evaluate the policy. A policy sold by mail order must provide a 30-day review period. Should you elect to return the policy for any reason during the "free look" period, the insurance company must refund any premium you paid

2. Can an insurance company void my policy if I made a mistake in completing the application?

The insurer may contest a life insurance policy during the first two years after its date of issue. If the insurer finds that a material misrepresentation was made in the application that would have affected the insurer's decision to issue the policy, the carrier may void the policy. The company would have the responsibility only to refund premiums paid.

3. A family member has died. We are sure that he had insurance policies but we cannot find any. Can you check to see what policies exist?

The National Association of Insurance Commissioners (NAIC) offers a free, secure, national service that allows you to search for a deceased person's lost life insurance policies and/or annuities. You can access the NAIC Life Insurance Policy Locator by going to doi.sc.gov/lpsearch.

4. When I bought my life insurance policy, the agent said it would be "paid up" after ten years, but it’s been that long and I’m still getting bills. Why?

Your contract (insurance policy) may provide for guaranteed interest rates and/or dividends the insurance company will pay on your premiums. But your premiums must make very high earnings before they will "pay up" your policy. The company must stand behind items that are guaranteed in the contract. Promises of "paid up" life insurance are illegal when based on non-guaranteed values. You would need documentation of the agent promising this. Documentation would include any writing containing the promise -- even an informal, handwritten note or a similar notation by an agent.

5. Who can take out a policy on my life?

Only someone who has an "insurable interest" can purchase an insurance policy on your life. That means a stranger cannot buy a policy to insure your life. People with an insurable interest generally include members of your immediate family. In some circumstances your employer or business partner might also have an insurable interest.

Insurable interest may also be proper for institutions or people who become your major creditors.

6. Must my beneficiary have an insurable interest?

No. If you buy a policy on your own life, you become the owner of the policy. As the owner, you can name anyone as beneficiary... even a stranger!

Fraternal benefit policy laws differ and additional information on this issue can be referenced in Title 38, Chapter 38 of the SC Code of Laws.

7. What about companies that advertise "no physical exam?"

The insurance may be more expensive than if the company required a physical. Although there is no physical, you will probably have to answer a few, broad health questions on your application.

8. Some life insurance ads claim "you cannot be turned down." What's the catch?

Such ads are for "guaranteed issue" policies that ask no health history questions. The company knows it is taking a risk because people with bad health could buy their policies. The company balances the risk by charging higher premiums or by limiting the amount of insurance you can buy. The premiums can be almost as much as the insurance. After a few years you could pay more to the insurance company than it will have to pay to your beneficiary. Such policies may offer only the return of your premiums if you die within the first couple of years after you buy the policy.

9. Why is term life often called "temporary" insurance?

Insurance agents sometimes refer to term insurance as "temporary" because the term policy lasts only for a specific period. It is probably no more "temporary" than your auto or homeowner insurance. Term policies provide coverage for a specific period of time and must be renewed when that period ends.

10. Why are some insurance agents reluctant to sell term insurance?

An agent may believe term is risky, but only because you could have a hard time buying a policy in the future if your health deteriorates or you cannot afford the higher premiums. Commissions could also be a reason for an agent who discourages term. The agent often makes less money for selling term policies than for other forms of life insurance.

11. What do I get when I buy term insurance?

You have bought and received the company's guarantee that if you die during the term of the policy, it will pay a death benefit to your beneficiary.

12. Does that mean I've wasted my money if I don't die during the term?

No more than you have wasted money by buying car insurance but never having an accident. You've purchased peace of mind. With term life insurance, if you die during the term, you know the company will pay your beneficiaries.

13. An insurance agent has suggested I switch term companies every couple of years to take advantage of the company's promotional rates in the first couple of years. Anything wrong with that?

Nothing wrong, but there is always a risk when you switch polices that you could be subject to a new contestability period. You start a new 2-year contestability period anytime you switch. If you die during that 2-year period, the insurance company can (and probably will) investigate the statements you made on your application. If you've given inaccurate or incomplete answers, the company may (and probably will) refuse to pay the death benefit.

14. I understand my permanent policy would be "fully paid up" at age 65. What does that mean?

"Fully paid up" means just that. You have made enough premium payments to cover the cost of insurance for the rest of your life.

15. What happens to the cash value after the policy is fully paid up?

The company plans to use the cash value to pay premiums until you die. If you take cash value out, there may not be enough to pay premiums. The company could require you to resume paying premiums, or reduce the amount of the death benefit to an amount that the remaining cash value will support.

16. I had a policy that was paid up; now I'm told I don't. What can I do?

You may have signed papers that permitted the cash value of your paid up policy to be used to pay for another, larger policy. If you're not sure or can't remember, call the insurance company.

17. What is a "participating" policy?

It is a policy that may pay you dividends. You have a chance to "participate" in the company's earnings. A life insurance dividend is actually a refund of part of your premium. When a company collects more money in premiums than it needs to pay death claims and maintain the insurance pool for future claims, the company may pay dividends at the end of that year.

18. How much cash value is in my policy?

Read your policy. It has a table of cash values that should provide the answer. Call your agent if you are still not sure of the cash value amount.

19. What happens to the cash value in my policy when I die?

When you die, the insurance company will pay the death benefit. No matter how much cash value you may have had in the policy the moment before you died, your beneficiaries can collect no more than the stated death benefit. Any loans you have not repaid (plus interest) will be subtracted from the death benefit.

The result: your beneficiary could wind up with less than the face amount of the policy.

The exception: some whole life policies pay both the death benefit and the cash value when you die.

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1. What is long-term care insurance?

This is an insurance policy that is designed to help cover the costs of medical, personal, and social services when you are unable to take care of yourself due to prolonged illness or disability. These policies usually pay for skilled, intermediate, and custodial care in a nursing home. Home health care, adult day care, and assisted living care are also often covered. These policies usually pay a fixed amount per day or per visit to facilities or caregivers that are licensed by the state and/or participate in Medicaid and Medicare.

2. Where can I find out more information about Long-Term Care Insurance?

The National Association of Insurance Commissioners, an organization of state insurance regulators, has prepared a variety of free resources to help consumers understand Long-Term Care Insurance. These resources are available through their Long-Term Care Insurance special section as well as Insure U, a NAIC website specifically designed to provide information and educational materials to consumers. Below are some examples of the free resources the NAIC has developed for consumers.

10 Things You Should Know About Buying Long-Term Care Insurance
Shopper's Guide to Long-Term Care
Consumer Alert - Long-Term Care Insurance: What You Should Know
Take the Insure U long-Term Care Quiz

3. What is the difference between a tax qualified and a non-tax qualified plan?

Benefits paid by a tax-qualified long-term care plan generally are not taxable as income. Benefits from a non-tax-qualified long term care plan may be taxable as income. Check with your tax advisor about the possibility of deducting a portion of the premiums paid in addition to the individual tax consequences involved.

4. Does Medicare pay for long-term care?

Medicare will pay for some home health care and skilled nursing facility care following a hospital stay as a part of continuing care. It does not pay for nursing home care or longer-term home care. Medicare does not pay for most long-term care services. Individuals should not rely on Medicare to meet their long-term care service needs. Medicare does not pay for custodial care when that is the only kind of care needed. Find out more by visiting Medicare.gov's website.

5. Does Medicaid pay for long-term care?

Yes, but you must meet very low-income and asset requirements to qualify for Medicaid. Contact our office for more information by calling 803-737-6180.

6. How do I file a complaint?

To file a complaint with the SCDOI's Office of Consumer Services, complete the online Consumer Complaint Form .

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1. What are the minimum limits of liability coverage and uninsured motorist Coverage required in South Carolina? Is underinsured motorist coverage required?

$25,000 bodily injury per person
$50,000 bodily injury per accident
$25,000 property damage per accident
Underinsured motorist coverage is not required.

2. Where can I find the answers to my frequently asked questions?

Use the FAQs module to easily find answers to the questions you ask the most.

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1. If a company already complies with a PPACA requirement, do they have to file anything with the Department of Insurance?

Yes, please review the filing requirements listed in Bulletin 2010-04. The Uniform Compliance
Summary provides for each category, including a description and page number. This, along with
the certification will confirm compliance.

2. What plans are considered grandfathered?

Plans that were in effect as of March 23, 2010, and have maintained their grandfathered status per regulation are considered grandfathered.

3. What immediate health insurance reforms affect grandfathered plans for form filing requirements?

Individual

• Dependent coverage for children until age 26
• Individual lifetime dollar limits on essential benefits
• Prohibition of rescission

Small / Large Group

• Dependent coverage for children until age 26
• Eliminate annual dollar limits on essential benefits
• Eliminate lifetime dollar limits on essential benefits
• Eliminate pre-existing condition exclusions for enrollees under age 19
• Prohibition of rescission

4. How should the changes to the grandfathered plans be submitted to the department?

The changes should be made as amendments to the original product as specified in Bulletin 2010-04.

5. What are the plans effective March 24 through September 22, 2010 considered; grandfathered or non-grandfathered?

Non-grandfathered

6. What reforms affect the plans in effect March 24, 2010 through September 22, 2010?

All immediate market reforms as specified in Bulletin 2010-04 that are required of all non-grandfathered plans apply to these.

7. Can the changes to the non-grandfathered plans be made via amendment or does a new product have to be filed?

A new product must be filed because a single product number cannot offer different coverages.
A ‘me-too’ filing may be made with a new form number and the appropriate amendments.

8. What are the filing requirements for the prohibition of discrimination based on salary since it is not included on the Uniform Compliance Summary?

The same filing requirements as the other reforms must be adhered to. The category can be
manually filled in. It applies to non-grandfathered group health plans.

9. What are the filing requirements with regard to the internal and external review processes?

Internal claims appeal process:

• Grandfathered plans have no filing requirements.
• Non-grandfathered plans – all plans – new product must incorporate Department of Labor’s claims and appeals procedures.

External review:

• Non-grandfathered plans - all plans - must meet current state law requirements.

The department has until July 1, 2011, to adopt most recent model act at which time plans must comply with the new model act.

10. How will the rates be treated for the PPACA filings?

The current rating statutes apply. However, it is important to note that the new Medical Loss Ratio standards become effective Jan. 1, 2011. These new standards must be reflected in new rate filings. Also, the Department of Health and Human Services is establishing guidelines to define ‘unreasonable’ rate increases. Additional filing requirements may be required when the new regulations are developed.

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1. What is a pharmacy benefits manager?

Section 38-71-2200 of the SC Code of Laws, as amended, defines a Pharmacy Benefit Manager as follows:

‘Pharmacy benefits manager’ means an entity that contracts with pharmacists or pharmacies on behalf of an insurer, third party administrator, or the South Carolina Public Employee Benefit Authority to:

       (a)   process claims for prescription drugs or medical supplies or provide retail network management for pharmacies or pharmacists;

       (b)   pay pharmacies or pharmacists for prescription drugs or medical supplies; or

       (c)   negotiate rebates with manufacturers for drugs paid for or procured as described in this article.

2. What does the new South Carolina law do?

It creates a new PBM license and establishes other requirements for PBMs. It also authorizes the South Carolina Department of Insurance to promulgate regulations to enforce the provisions of the new law.

3. Will the Department promulgate new regulations?

Yes. Regulation 69-77, Pharmacy Benefit Managers, is the new regulation promulgated to implement the provisions of Act No. 48 of 2019 regarding the licensure and regulation of pharmacy benefit managers. 

4. My business is currently licensed as a Third Party Administrator (TPA). What do I need to do to become licensed as a PBM?

The PBM license application window is October 1, 2020- December 1, 2020. Detailed instructions for PBM licensure is available on the PBM webpage on the South Carolina Department of Insurance website. PBM licenses will become effective on January 1, 2021.

5. What happens if a PBM does not have a PBM license by January 1, 2021?

The PBM will not be authorized to operate in the state of South Carolina until proper licensure is obtained. An unlicensed PBM is subject to a fine of up to $10,000 per violation pursuant to Section 38-2-30 of the S.C. Code of Laws of 1976, as amended.   

6. Is completion of the PBM Application Requirements Checklist required for PBM licensure?

No. The PBM Application Requirements Checklist is for internal use only, but can function as a guide for all required documents necessary to obtain a PBM license and to ensure approval is granted in the most efficient manner.

7. How do I apply for a PBM license?

You can access the application and process fee payments via the NIPR website. The required supplemental application can be found on NIPR’s State Specific Requirements page and on the Department’s PBM webpage. Once completed, the application and supporting documents may be uploaded electronically via NIPR’s Attachment Warehouse or emailed directly to the PBM Office's email at PBMDept@doi.sc.gov.  

8. What happens when all requirements for PBM licensure are met?

Once the license becomes active, an email notification will be sent to each entity with a copy of their PBM license. PBMs can also print their license on the StateBasedSystem.com. 

9. Does a PBM need a TPA license in addition to a PBM license?

Each entity should review the definition of PBM and make a determination that every function the entity performs falls solely under the PBM license. If the entity performs additional functions that fall outside of the definition of PBM, then the entity may fall outside of the PBM license authority, and the TPA license would be required in addition to the PBM License.

10. How can a PBM submit a name/address change?

PBMs can complete the PBM Information Change Form and submit it to the Office of PBM Oversight at PBMDept@doi.sc.gov

11. How can I file a complaint with the Office of PBM Oversight?

Pharmacy providers may complete the PBM Complaint Form and email, fax or mail it to the Office of PBM Oversight along with any supporting documentation that would assist in the complaint process. Providers may also complete the Online PBM Complaint Form and submit the form and attach all supporting documents on the SCDOI website. 

Consumers should continue to contact the Office of Consumer Services to file a complaint. Consumer Services can be reached at (803) 737-6180 or you can email your question to consumers@doi.sc.gov.  

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1. What is the license fee for an insurance premium service company?

The annual license fee is $1,000 payable to the department by March 1 (biennial), according to Section 38-39-20(b) of the South Carolina Code of Laws.

2. How long does a premium service company have to keep its records?

Every licensed insurance premium service company must keep and maintain its records for at least three years after making the final entry on any premium service agreement. The records must be open to examination and investigation at any time by the department, according to Section 38-39-50 of the South Carolina Code of Laws.

3. What are the cancellation procedures for an insurance premium service company?

The premium service company must deliver to the insured a 10-day notice of its intent to cancel the insurance contract. No less than five days after the expiration of the notice, the insurance premium service company may request in the name of the insured cancellation of the insurance contract by delivering the notice of cancellation to the insurer, according to Section 38-39-90 of the South Carolina Code of Laws.

4. What is the maximum fee an insurance premium service company can charge on a delinquent account?

The maximum fee of a delinquent account may not exceed 5% of the installment, according to Section 38-39-80(g) of the SC Code of Laws.

5. How much is the initial charge for an insurance premium contract?

The initial charge for an insurance premium contract can be up to $20, which may not be refunded. This is according to Section 38-39-80(d) of the SC Code of Laws.

6. Can an insurance premium service company charge the non-refundable fee twice?

An insurance premium service company cannot induce an insured to become obligated under more than one premium service agreement for the purpose of obtaining more than one nonrefundable charge. Additionally, an insurance premium service company cannot intentionally cancel an insurance contract for the purpose of obtaining an additional nonrefundable charge on a new premium service agreement accepted within sixty days of the cancellation of the prior agreement. This is according to Section 38-39-80(f) of the SC Code of Laws.

7. What happens if a policy is cancelled and there is a premium credit?

If the crediting of return premiums to the insured’s account results in a surplus over the amount due from the insured, the insurance premium service company must refund the excess to the insured or the agent of record. A refund is not required if it amounts to less that $5, according to Section 38-39-90(f) of the SC Code of Laws.

8. What are the procedures if the owner or partner of an insurance premium service company dies; withdraws from the company; is arrested, indicted or convicted by state or federal law enforcement; has t

In this case, the department must be notified by registered or certified mail no later than 10 days after the event occurs, according to Regulation 69-10-12.

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1. How do I apply for a SC Safe Home Grant?

To apply for an SC Safe Home grant, please visit Apply for a Grant on the SC Safe Home webpage and submit an application via the online portal. Video tutorials are available to assist applicants with the application submission process, as well as these slides. 

2. I forgot my password, how do I reset it?

If you are having trouble logging in, click Reset Password on the login page of the SC Safe Home webpage. From there you will be prompted to enter the email address you used to sign up for the SC Safe Home website. If the email address you enter is valid, a password reset link will be sent to the email address.

3. Can I go ahead and do home improvements and then get reimbursed by the department?

No, the program cannot reimburse you for retrofits you have already done, in accordance with state law. You must have an inspection and receive grant approval from the SC Safe Home before the retrofits are done to be eligible.

4. Do I qualify for a SC Safe Home Grant?

To qualify for a SC Safe Home grant, the home must meet the following requirements; the home must be located in the coastal region of South Carolina, must be owner-occupied, primary residence, site built or manufactured/modular, must not have existing previous damage, and the home and homeowner together must not have previously received and utilized a SC Safe Home grant.

5. How do I make changes or corrections to my application?

It is sometimes necessary to submit changes or corrections to an application submission. If any errors are identified in a submission they must be corrected. To make these corrections, contact the SC Safe Home staff at (803) 737-6087 and our staff will be happy to make the necessary changes for you.

6. How do I find the status of my application?

You may check the status of your application by logging into the SC Safe Home online portal.

7. How long do I have to complete a retrofit?

Approved recommended improvements must be completed within three months of the date of the Grant Award Notification letter.

8. How do I find an inspector or contractor?

It is the responsibility of the homeowner to contact a wind inspector. It is also the responsibility of the homeowner to pay the certified wind inspector for the Wind Inspection Report. Please note that wind assessments and reports will not exceed $250.00. Inspection fees are now based on the sliding scale below.

≤ 1,500 square feet; up to $150

1,501 to 2,000 square feet; up to $200

> 2,000 square feet; up to $250

SC Safe Home requires the estimate for the retrofit to be submitted along with the completed SC Safe Home grant application. SC Safe Home encourages homeowners to “shop” the list of participating contractors to get more than one estimate for the specified retrofits. Please request proof of insurance and licensure from the contractor of your choice.

9. Do I qualify if I rent my home?

No, the funds provided by this program are for the sole purpose of retrofitting South Carolina owner-occupied, single-family homes. 

10. What does the color of the status bar mean when I log in?

If the status bar is highlighted in green, the South Carolina Safe Home program is currently accepting new applications. If the status bar is highlighted in yellow, the South Carolina Safe Home program is currently accepting limited new applications. If the status bar is highlighted in red, the South Carolina Safe Home program is not accepting new applications.

11. If my roof is already damaged, do I qualify?

No, in order to qualify for a SC Safe Home grant, the home must not have existing or previous damage.

12. Do apartments, duplexes or townhomes qualify?

No, the funds provided by this program are for the sole purpose of retrofitting owner-occupied, single-family homes.  

13. I do not have internet access and/or an email address to submit my application electronically, what are my options?

SC Safe Home has implemented an online application process to ensure efficiency and to provide better customer service and communication. The online application will allow you to keep track of your application’s tasks and status throughout the process. Free internet access is available at all public library locations. In addition, there are many free, web-based email providers that are currently available to suit your needs and it only takes a few minutes to create an email account. You may submit a paper application, however, the application will be received in a timelier manner when submitted electronically.

14. Which counties are eligible to receive SC Safe Home grant funds?

Currently, the Department of Insurance SC Safe Home program awards grant funds to Beaufort, Berkeley, Charleston, Colleton, Dorchester, Florence, Georgetown, Horry, Jasper, Marion and Williamsburg counties.

15. How does the Department of Insurance determine who receives grant funds?

All grants will be determined based on the cost of the mitigation project and a percentage of the total adjusted household income of the applicant as per the most recent federal income tax return.  However, once funds are exhausted for the year, the program will cease issuing new grants.

16. Do I qualify for a matching or nonmatching grant?

This is determined by your household income.  To help determine which grant you may qualify for, please visit the Estimate Calculator.

17. What if the cost of the mitigation project exceeds the amount of the award I was granted?

If the cost of the mitigation project exceeds the amount of the grant award, the remaining cost is the applicant’s responsibility.

18. What do I need to apply?

You will need a (1) copy of your latest 1040 or other income tax return, (2) a copy of your homeowner’s insurance declaration page, (3) a copy of your county tax assessment and (4) a SC Safe Home Inspection Report of your home completed by a participating SC Safe Home Inspector who will also collect (5) photographs of the home.

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1. How is Your Insurance Rate Determined?

Two factors determine what you pay for auto insurance. The first factor is underwriting and the second factor is rating. Insurance companies underwrite to assess the risk associated with an applicant, group the applicant with other similar risks and decide if the company will accept the application. Based on the results of the underwriting process, the rating assigns a price based on what the insurer believes it will cost to assume the financial responsibility for the applicant’s potential claim.

2. How do I file a complaint?

If you're having a specific problem with an insurance company, broker, agent, or adjuster, file a complaint with our Office of Consumer Services at doi.sc.gov/complaint.

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1. What is a service contract?

A service contract is defined as a contract or agreement for a separately stated consideration for a specific duration to perform the repair, replacement, or maintenance of property or indemnification for repair, replacement, or maintenance for the operational or structural failure due to a defect in materials, workmanship, or normal wear and tear, with or without additional provisions for incidental payment of indemnity under limited circumstances including, but not limited to, towing, rental, and emergency road service. Service contracts may provide for the repair, replacement, or maintenance of property for damage resulting from power surges and accidental damage from handling, according to §38-78-20(12) .

2. What is a warranty?

A warranty is made solely by the manufacturer, importer, or seller of property or services without charge, is not negotiated or separated from the sale of the product, that is incidental to the sale of the product, and guarantees indemnity for defective parts, mechanical or electrical breakdown, labor, or other remedial measures, such as repair or replacement of the property or repetition of services, as according to §38-78-20(14).

3. What is a provider?

A provider is defined as a person who is contractually obligated to the service contract holder under the terms of the service contract, as according to §38-78-20(9).

4. Are the fees collected by the contract service provider subject to premium taxes?

Provider fees collected on service contracts are not subject to premium taxes, as according to §38-78-30(H).

5. What are the requirements of a service contract provider insuring service contracts under a reimbursement policy?

Reimbursement insurance policies insuring service contracts issued, sold, or offered for sale in this state shall conspicuously state that the insurer that issued the policy shall either reimburse or pay on behalf of the provider any covered sums the provider is legally obligated to pay or in the event of the provider's nonperformance, shall provide the service that the provider is legally obligated to perform according to the provider's contractual obligations under the service contracts issued or sold by the provider, as according to §38-78-40.

6. What are the requirements of a service contract provider insuring service contracts not covered under a reimbursement policy?

Service contracts not insured under a reimbursement insurance policy shall contain a statement stating, "Obligations of the provider under this service contract are backed by the full faith and credit of the provider," as according to §38-78-50(C).

7. How long should a service contract provider preserve its records?

The provider should preserve its records for a period of no less than one year after the specified period of coverage has expired, as according to §38-78-70(4).

8. What are the procedures if a contract service provider cancels its reimbursement policy?

The insurer who issued the reimbursement insurance policy may not terminate the policy until a notice of termination has been mailed or delivered to the department in accordance with Chapter 75 of the SC Code of Laws (§38-78-80).

9. Is there a “free look” period in a service contract?

Yes, the service contract holder has 20 days to review the service agreement and to return the contract to the service contract provider for a full refund, as according to §38-78-30(F).

10. Is there any required language that must be disclosed in the service contracts?

Yes, service contracts marketed, issued, sold, or offered for sale should be easy to read and must disclose the requirements set forth in § 38-78-50 of the SC Code of Laws. In addition, the department requires that all service contract providers disclose the department name and address regarding disputed claims on their contracts.

11. Is a service contract an insurance policy?

No, service contract providers are restricted from using the word “insurance” in the contract. The agreement is not an insurance contract, as according to §38-78-60.

12. Can a bank or lending institution require a borrower to purchase a service contract as a condition of a loan?

No bank, savings and loan association, lending institution, manufacturer, or seller of any product shall require the purchase of a service contract as a condition of a loan or a condition for the sale of any property, as according to §38-78-60(c).

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1. What is happening?

The director of the South Carolina Department of Insurance has expanded the territory covered by the South Carolina Wind and Hail Underwriting Association (Wind Pool).

2. When is the expansion effective?

The initial expansion was effective on March 30, 2007, and the additional expansion was effective on June 1, 2007. The expansions will continue in effect until March 29, 2013, unless changed via an order of the director or action by the South Carolina General Assembly.

3. What does this mean?

The territory in which the South Carolina Wind and Hail Underwriting Association may provide wind and hail insurance coverage (i.e., coverage that protects property from losses due to hurricane, tornadoes, severe thunderstorms, other catastrophic wind and hail) has been expanded to include some additional areas. This is an initial expansion and it is limited. It is intended to help improve availability by providing access to wind and hail insurance coverage to consumers who have had difficulty obtaining that coverage. It is also intended to encourage more standard insurers to write insurance coverage in the wind pool territory.

4. What is the new area?

Maps depicting the expanded area may be viewed by accessing the South Carolina Wind and Hail Underwriting Association's website.

5. Will this expansion solve the coastal property insurance crisis?

This expansion is a part of a comprehensive approach to improve the availability and affordability of property insurance coverage being advanced by the governor, members of the General Assembly, and the director of insurance.

6. How can I obtain insurance through the wind pool?

You may contact any licensed insurance agent or broker. Your current agent should be able to assist you with obtaining coverage.

7. Will expanding the wind pool save me money?

Some consumers whose coverage is currently written by a surplus lines carrier may see a reduction in what they are paying for property insurance coverage if they obtain coverage through the wind pool. The cost of coverage may increase for others if it is written by a standard carrier and the wind coverage is excluded.

8. Am I eligible for coverage as a part of the expansion?

If you are in the territory covered by the wind pool and meet the eligibility requirements for coverage, you may obtain coverage through the wind pool. Proper maintenance of the property one is seeking to insure is one of the criteria required for coverage.

9. How was the expansion area determined?

The location of the expanded areas was determined through surveys, data calls, and discussions with producers, legislators, and consumers about the areas along the coast that are having the most significant availability problems.

10. Who should I contact if I want more information about coverage offered through the wind pool?

You may contact your agent or the wind pool at 803-779-8373.

11. What if I don't want to be in the wind pool?

You do not have to be in the wind pool if you can secure the insurance coverage you desire elsewhere. You always have the option of securing coverage from a standard insurance company, such as State Farm, South Carolina Farm Bureau, Travelers, Nationwide, Allstate, etc., or the surplus lines market. You should always shop around for the best coverage and rates.

12. Can you explain wind pool rates?

The wind pool was not created to be the low cost provider of wind and hail insurance. Its rates will be higher than the standard market, but may be lower than some excess and surplus lines companies. This is why it is extremely important that you shop around and try to secure coverage through a standard insurer before going to the wind pool. The wind pool exists to provide coverage for consumers who cannot find that coverage in the standard market.

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1. When are surplus lines taxes due?

Surplus lines taxes are due thirty days after the close of each quarter. Therefore, due dates are April 30th; July 30th; October 30th an January 30th of each calendar year.

2. Are there penalties for late submissions?

At the current time, we do not have any penalties for late submissions. If you enter a submission late, the tax application will prompt you for a late reason which you will choose from a drop-down box. However, we do impose a $200.00 Administrative penalty if the tax payment is not received in our office on or before the due date. This penalty is automatically assessed in the tax application.

3. What kind of penalties are associated with filing surplus lines premium taxes?

If your tax payment is not received on or before the due date, you will be automatically assessed an Administrative fine of $200.00.

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1. What tax credits are available for fortification measures?

Learn about the two income tax credits available.

2. Can the tax credits be claimed for new construction?

No, the credits are only available for retrofits made to an existing residential structure that would make the existing structure more resistant to loss due to hurricane, rising floodwater, or other catastrophic windstorm event and meet the criteria provided in Regulation 69-75.

3. Is there a list of items or projects that are approved and qualify for the tax credit?

There is not a list of projects or items that are approved and qualify for the tax credit. View the Regulation 69-75 Information page more information.

4. What documentation is needed to claim the tax credits?

The acceptable forms of evidence include:

• A written certification or a report (with certification) from a licensed professional with expertise in construction techniques, building design, or property inspection or appraisal including, but not limited to an: architect; appraiser; building inspector; or contractor stating that the fortification measure has been implemented in accordance with applicable standards. Copies of the applicable receipts must accompany the certification or report.
• An affidavit from the individual taxpayer certifying that the fortification measures have been implemented. Copies of the applicable receipts must accompany the affidavit.

5. How does a homeowner claim the tax credits?

Both credits can be claimed on the homeowner’s individual income tax return using a South Carolina Schedule TC-43.

6. Where can I get the form to claim the tax credits?

The South Carolina Schedule TC-43 form is available on the Department of Revenue website or by calling the Department of Revenue forms request line at 1-800-768-3676.

7. I completed my fortification project in 2007 and have already filed my taxes. Can I claim the tax credit? If so, how?

A taxpayer may amend his 2007 tax return to claim the credits for qualifying expenditures. File SC1040X and South Carolina Schedule TC-43 to claim the credits. The credits should be claimed on Line 9 of the SC1040X. In order to receive a refund, this amended return must be filed within 3 years of the original filing date or 3 years from the date of filing if a proper extension was filed and a return was filed by the extended due date. For individuals who filed their 2007 returns by April 15, 2008, the amended return must be filed by April 15, 2011.

8. I plan to complete several approved fortification projects in the next few years. Will I be able to apply for the tax credit each year for the fortification measures I have made during that year?

Yes, the credit may be claimed in each year that fortification measures are completed.

9. Do SC Safe Home grant projects automatically qualify as approved fortification projects for purposes of being eligible for the tax credit?

Yes. Fortification measures that are in accordance with the standards that are contained in the South Carolina Safe Home Resource Document for Mitigation Techniques qualify for tax credits. You may find additional information regarding these mitigation techniques in the documents below. 

Section A. Introduction

Section B. Roof Deck Attachment

Section C. Secondary Water Barrier

Section D. Roof Coverings

Section E. Gable End Bracing

Section F. Reinforcing Roof to Wall Connections

Section G. Opening Protection

Section H. References and Resources

10. Can projects that are not part of the SC Safe Home Grant Program qualify for tax credits?

Yes. A homeowner does not have to be a recipient of an SC Safe Home grant to qualify for income tax credits. However; all qualifying fortification measures must meet the requirements of the South Carolina Department of Insurance Regulation 69-75.

11. If a homeowner received an SC Safe Home grant and the grant is not required to be included in the homeowner’s income tax return, can the homeowner claim the tax credits for the grant money spent?

No. Tax credits cannot be claimed if the only money spent on the fortification project was grant money that was not included in income on the homeowner’s individual income tax return. See S.C. Code Sections 12-6-3660 and 12-6-3665. Refer to the help tools and resources of the IRS for further federal tax questions. 

12. My question was not answered in the above. Who should I contact for assistance?

Questions concerning mitigation techniques that may qualify for tax credits should be directed to the SC Safe Home Program. Questions and concerns regarding SC tax credits should be directed to the South Carolina Department of Revenue.

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1. Are payments made to third-party administrators (TPAs) from policyholders considered received?

Yes, whenever an insurer utilizes the services of a TPA under terms of a written agreement as required, the payment to the TPA of any premiums or charges for insurance by or on behalf of the insured is considered to have been received by the insurer, as according to Section 38-51-50.

2. How long does a TPA required to preserve its records?

Every TPA shall maintain its records for a duration of five years, which will be open for inspection by the department, as according to Section 38-51-60.

3. What are the requirements for TPAs collecting for more than one insurer or client?

The TPA must place the funds in a separate account for each insurer or client in a fiduciary capacity.

4. Can a TPA pay claims from premiums collected?

TPAs can pay claims from withdrawals made from the fiduciary account. However, any withdrawals from the fiduciary account must be stated in the written agreement. Claims paid from funds collected on behalf of the insurer must be paid only on drafts authorized by the insurer, as according to Sections 38-51-90 and 38-51-100.

5. How are TPAs compensated for services rendered?

TPAs compensation may be based on the premium or charges collected or the number of claims paid or processed. The compensation may in no way be contingent on claim experience, as according to Section 38-51-110.

6. Do TPAs have additional requirements when they contract with an insurer?

Yes, when the services of a TPA are utilized, the TPA is to provide a written notice to the policyholder identifying the relationship between the TPA, policyholder, and the insurer. The notice must be approved by the insurer, as according to Section 38-51-120.

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1. What is utilization review?

Utilization review is defined as a system for reviewing the necessary, appropriate, and efficient allocation of health care resources and services given or proposed to be given to a patient or group of patients. §38.70.10(1)

2. What is a private review agent?

A private review agent is defined as a person performing utilization reviews who is either under contract with or acting on behalf of, but not employed by:

• A hospital
• A South Carolina business entity
• The State of South Carolina

Section §38.70.10(2)

3. Who is subject to the state’s utilization review laws?

View the Subjects of the State's Utilization Review Laws page for information.

4. Is it required for a private review agent performing utilization review on single-employer, self-insured health plans to obtain a license?

No. Private review agents performing utilization reviews only for single-employer, self-insured employee health plans are not required to obtain a certificate. South Carolina Regulation 69-47 (H)(2)

5. Is the license transferable?

No. A utilization review license is not transferable. If the business is sold or transferred, the issued certificate will automatically cancel. The surviving business must apply for a new certificate. SC Regulations §38.70.10(5)

6. Where can I find the laws and regulations that govern utilization review and private review agents?

The laws and regulations that govern utilization review and private review agents are found in §38.70 and SC Regulation 69-47.

7. What are the licensing requirements to become licensed as a utilization review and private review agent?

The licensing requirements are:

• Complete a application packet
• Submit a licensing fee of $1,200 dollars
• File a copy of certificate of authority from home state, letter of good standing, and copy of articles of incorporation
• Provide list(s) of toll free number for accessibility
• Provide number of incoming telephone lines
• Provide incoming call queue time
• Submit all materials designed to inform applicable patients of the requirements of the utilization plan

8. How often must licensure be renewed?

Every two years, beginning on July 1 of even-numbered years. SC Regulation §38.70.50

9. What are the licensure fees (initial and renewal)?

The application fee is $400 and the biennial/renewal fee is $800. SC Regulation 69-47 (3)(A)

10. When does a utilization review and private review certificate of license expire?

All certificate of license expire on June 30 of each even-numbered year. SC Regulation §38.70.50(A)

11. Does South Carolina recognize Utilization Review Accreditation Commission (URAC) accreditation?

No. South Carolina does not recognize URAC accreditation.

12. Are there any other requirements of utilization review and private review agents?

Yes. View the Private Review Agent Application Requirements page for more information.

13. Where do you file complaints?

Complaints are filed with the South Carolina Department of Insurance. Complaints should be addressed to the Consumer Service Division.

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1. Who is required to respond to this data call?

Only companies who are licensed to write personal property (“personal”) and/or commercial property (“commercial”) insurance coverage in South Carolina and actively wrote over $1 million in premium for such policies in any one previous calendar year beginning in 2006 are required to respond.

• Agents: No response is expected from any agents
• Commercial Lines: Includes Business Owners Policy (BOP) and Special Multi Peril (SMP)
• Personal Lines: Includes dwelling, tenant, condo, and mobile-homeowners
• Surplus Lines: No response is currently required from surplus lines insurers

2. How should total written premium be calculated to determine whether or not the company exceeds the $1 million threshold for eligibility?

Please use all policies written in South Carolina (not just the wind pool territory) and calculate personal and commercial separately. For personal please use annual statement line 040 homeowners and for commercial please use lines 051 commercial multiple peril (non-liability).

3. Is a reply necessary if the company is under the $1 million threshold for both "personal" and "commercial"?

No, a response is not necessary, - even a null (all zeros) spreadsheet. An email indicating such ("N/A: under $1M for both Personal and Commercial") will be accepted, but is not necessary, either.

4. Is a reply necessary if the company is over the $1 million threshold for either personal or commercial and none of the policies written were in the wind pool territory?

Yes, please reply with a null (all 0s) spreadsheet for that tab (personal and/or commercial) and indicate such ("over $1 million, but none in the wind pool") in the spreadsheet.

5. If the company wrote less than the $1 million threshold in 2006 and more than the $1 million threshold in 2007 for personal and/or commercial, is a response necessary to the data call in 2008?

Yes, only companies who wrote less than $1 million in 2006 and 2007 for both lines are not required to respond.

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1. How does one determine whether or not a location falls within the wind pool territory? Is a list of zip codes available? Are there map files available?

View the wind pool territory page for information.

2. How should a policy with multiple risks / locations, some with wind and some without wind, be recorded?

Please use the predominant risk / location. For policies with locations that are split evenly between with wind vs. without wind, please split the policy count in half and report 0.5 in each with wind and without wind.

3. How should a policy with multiple locations, some in the wind pool territory and some not, be recorded?

For recording policies, please use the predominant location. Please report those policies with locations that are split evenly between inside the Wind Pool (WP) territory (required to report) versus outside the WP territory (not required to report). There is no need to report those that have a predominate location outside the WP territory.

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1. When should a new policy / policy change be recorded if it has been booked / processed but the change does not become effective until the future? What if it is effective retro-actively?

Please record a policy change as follows:

• If the effective date is in the future, record based on the effective date.
• If the effective date is in the past, record based on the booked / processed date.

2. How should a policy that is cancelled and then reinstated in the same month be recorded? What if it was reinstated in a following month?

Please do not record policies cancelled and then reinstated in the same month. For policies cancelled one month and then reinstated the following month, please record one cancellation in the first month and one renewal in the following month.

3. Should a lapse be recorded as a cancellation?

No, a lapse or a cancellation due to nonpayment is considered a request to cancel from the insured and should not be included in cancellations.

4. What should be recorded under “total policies in force”?

"Total policies in force" is meant to be the overall total number of policies in force at the end of each month. It should be evaluated at the end of the month and should be equivalent to the total policies in force at the start of the month (i.e. end of the previous month) plus adjustments due to new policies, renewals (including reinstatements), and all types of cancellations made during the month.

Please note that it is not the sum of new policies and renewals minus cancellations. This would imply that there were no policies in force before the date range requested in the data call, all renewals were reinstatements, and there were no cancellations made by the insured (e.g. no lapses).

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1. How do I submit a response? / Who do I contact if I have a question?

Please submit all questions and responses via email.

2. Can a response be submitted by group?

No. Please submit a separate worksheet for each company rather than submitting by group.

3. Should the number of policies or total written premium be recorded on the worksheet?

Please enter the total number of policies for each month and not the dollar amount of the premium written.

4. How often is a submission required and what months of data are required for each submission?

The data must be recorded monthly and reported to the department on a quarterly basis until further notice. The first submission was due Nov. 15, 2007, and covered the months Jan. through Sept. for 2006 and 2007 only.

Monthly data for Oct. through Dec. is requested by the subsequent Jan. 15 of the following year.

Subsequent submissions must be received by the 30th day following the end of each quarter thereafter and should, at a minimum, contain monthly data for the immediately preceding quarter (i.e. “current year”) and for the same months of the previous year (i.e. “prior year”).

5. Does the company need to submit an annual data certification?

Yes. The company will need to submit an annual data certification request as referenced in South Carolina Bulletin 2009-14 along with its fourth quarter data submission. This certification will need to be signed by an officer of the company, notarized, and submitted via email in PDF format.

6. Where is the wind pool data call link located on the new South Carolina Department of Insurance website?

The data call link may be found by visiting wind pool data call, which contains a list of all wind pool related information, including press releases, relevant orders, the original notice, worksheet, as well as a copy of this FAQ.