Jan. 23, 2026

Planned Administrator's Inc. (PAI) recently sent out this message with an update regarding ICHRA processing. At the bottom of this agent bulletin is additional information for your reference regarding ICHRA groups and their coverage with BlueCross BlueShield of South Carolina.

For Renewing Members - For renewing groups with members who have renewed their individual private marketplace plan, coverage is effectuated and active, regardless of processing status PAI.

For Members New to Their Plan in 2026 - This will include members of new groups, new members of renewing groups, or members of renewing groups who made plan changes from 2025 to 2026. Members new to their BlueCross individual private marketplace plan cannot be effectuated prior to the ICHRA groups processing. However, if the group was received prior to Jan. 1, 2026, coverage will be backdated to Jan. 1, 2026.

If an employee needs coverage before policy is active, below are potential steps to take:

• Ask the provider to hold claims until the employee receives an ID number and file at that time. Upon request, BlueCross can facilitate a phone call to the provider and explain the enrollment status on behalf of the member if there is an urgent appointment.
• Pay the medical or pharmacy claim out of pocket and file for reimbursement once benefits are active. Once the policy is active, and upon request, BlueCross can facilitate a call to the provider and provide them the ID number so the provider can submit the claim.
• Ask the pharmacy to fill the prescription and to hold the claim or refile once benefits are active.