Select Health of South Carolina

Name

Select Health of South Carolina

Legal name

SELECT HEALTH OF SOUTH CAROLINA INC.

Website

https://selecthealthofsc.com

Company type

Private

Founded year

2001

Operating status

Operating

Headcount range

51–100 employees

Ownership category

akta.pro rank

Product category

Medicaid Managed Care

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Integrated Physical-Behavioral-Social Care (Whole-Person) Medicaid Plans (HLAEAEAI)

akta.pro secondary industries

Medicaid Expansion (ACA Adult) Managed Care Plans (HLAEAEAB), MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG)

Keywords

• Medicaid managed care
• Health insurance plans
• Government health programs
• Managed care organization
• Healthcare coverage

Headquarters

HQ city

Charleston

HQ country

United States

HQ region

North America

Offices3 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Operations, Personnel, Technology or R&D, Marketing or Sales, Others

Revenue model

1. Medicaid Capitation Payments: Select Health of South Carolina is a Medicaid managed care organization that receives capitation payments (fixed monthly payments per member) from the South Carolina Department of Health and Human Services (Healthy Connections) to provide healthcare coverage to Medicaid beneficiaries. The company administers benefits and manages care delivery for its members under government-funded healthcare programs.

Go-to-market motion1 record

Distribution channels3 records

Marketing channels6 records

Core offering

Select Health of South Carolina operates First Choice, a Medicaid managed care health plan that delivers comprehensive medical, prescription drug, behavioral health, dental, vision, and transportation benefits to more than 330,000 South Carolina Medicaid beneficiaries through a network of 22,000+ providers. The company also offers First Choice VIP Care (a D-SNP for Medicare/Medicaid dual-eligibles) and First Choice Next (an ACA Marketplace plan), along with disease management, care coordination, and value-added community programs. Revenue is generated through capitation payments from the South Carolina Department of Health and Human Services (SCDHHS) under the Healthy Connections Medicaid program.

Product overview

First Choice by Select Health of South Carolina is a Medicaid managed care organization offering a comprehensive health plan portfolio. The core product is the First Choice Medicaid health plan serving over 330,000 members, supplemented by First Choice VIP Care (dual-eligible special needs plan) and First Choice Next (Marketplace plan). The company provides integrated digital services including a member portal, mobile app, provider portal (NaviNet), and online provider/pharmacy directories. Member-facing digital tools include the FCSH Mobile app, Nurse Call Line, and Health Library powered by WebMD Ignite. The health plan operates specialized disease management programs including In Control (diabetes), Heart First (cardiovascular), Breathe Easy (respiratory), and Bright Start (prenatal care), plus wellness initiatives like First Choice Fit and Healthy Rewards. The company also offers behavioral health services, rehabilitative BH programs, and care coordination for complex medical needs. All services are delivered through a network of 22,000+ provider partners.

Differentiator

Problem solved

Functional benefit

Brands

• First Choice VIP Care: Dual-eligible special needs (D-SNP) plan offered by First Choice.
• First Choice Next

Products and services

• First Choice by Select Health of South Carolina Core Medicaid managed care health plan offering comprehensive medical benefits, prescription coverage, mental health services, dental, vision, and extra benefits to over 330,000 South Carolina Medicaid beneficiaries.
• First Choice VIP Care Dual-eligible special needs plan (D-SNP) for individuals eligible for both Medicare and Medicaid, providing coordinated coverage, reduced cost-sharing, and integrated care management for dual-eligible beneficiaries in South Carolina.
• First Choice Next ACA Marketplace health insurance plan offering coverage options for individuals and families purchasing insurance outside Medicaid eligibility.
• Member Portal Secure web portal for First Choice members to view health history, track claims, order prescription refills, change PCPs, request ID cards, complete health assessments, and access health information.
• FCSH Mobile App Native mobile application for iOS and Android enabling First Choice members to access benefits, track claims, refill prescriptions, and manage care on mobile devices.
• NaviNet Provider Portal Provider self-service platform for claims management, status checks, dispute filing, eligibility verification, and administrative transactions, integrated with Select Health systems for real-time data.
• Provider and Pharmacy Directory Online searchable directory (powered by HealthSparq and DarwinRx) enabling members and providers to find doctors and pharmacies in the First Choice network by name, county, or ZIP code.
• Online Formulary Searchable comprehensive drug list allowing First Choice members to check whether specific medications are covered under their plan.
• Nurse Call Line 24/7 telephone nurse advice line providing symptom assessment, self-care guidance, and healthcare decision support for First Choice members.
• In Control Diabetes Program Disease management program helping First Choice members manage diabetes through education, care coordination, and ongoing support services.
• Heart First Cardiovascular Disease Program Specialized program for First Choice members with heart and vascular disease, providing education, monitoring, and care coordination.
• Breathe Easy Respiratory Program Respiratory disease management program supporting First Choice members with breathing conditions through education and care coordination.
• Bright Start Prenatal Program Pregnancy program providing prenatal care coordination, education, and support for expectant mothers enrolled in First Choice to promote healthy birth outcomes.
• Care Coordination and Complex Care Management Specialized care management program helping First Choice members with complex medical needs coordinate care across multiple providers and services.
• Behavioral Health Services Mental health and substance abuse treatment services including rehabilitative behavioral health benefits and access to behavioral health providers for First Choice members.
• First Choice Fit Health and wellness initiative encouraging children to eat right, stay active, and see their doctor for regular well visits, including healthy recipes and wellness resources.
• Healthy Rewards Program Incentive program rewarding First Choice members for completing healthy activities and preventive care visits.
• Health Library Online health education resource featuring WebMD Ignite quizzes and tools covering nutrition, exercise, mental health, smoking cessation, stress management, and weight management for First Choice members.
• First Choice Community Center Physical community hub in Columbia, SC providing health education, notary services, benefit screening, cooking demonstrations, computer access, and community events to First Choice members and the surrounding community.

Quantifiable outcome

• More than 330,000 South Carolinians served
• +4 more outcomes

Named customers1 record

Segments6 records

Ideal customer profiles6 records

Technology focussed No

API detail

Has API

No

API docs

API detail

Core technology

AI maturity

App detail

Integration13 records

Feature5 records

Partnerships

Seven partnerships are on record, tiered core and minor.

• DentaQuestcoreChannel Partner/ Reseller/ DistributorDentaQuest is the dental benefits manager for First Choice members, providing dental coverage coordination and connecting members with Medicaid dental providers. Members can call DentaQuest at 1-888-307-6552 or visit www.dentaquest.com to learn about covered dental services.
• South Carolina Healthy Connections (SCDHHS)coreStrategic or Co-development PartnerHealthy Connections is the South Carolina Department of Health and Human Services program that administers Medicaid benefits. First Choice partners with Healthy Connections as a managed care organization to provide healthcare coverage to Medicaid beneficiaries.
• NaviNetcoreTechnology or IntegrationNaviNet is the provider portal platform used by First Choice providers for claims status checks, eligibility verification, and administrative transactions. The portal enables providers to check dispute status and submit claims-related information.
• HealthSparqcoreTechnology or IntegrationHealthSparq provides the online provider directory for First Choice, allowing members to search for doctors by name, county, or ZIP code. The directory helps members find in-network providers.
• DarwinRxcoreTechnology or IntegrationDarwinRx provides the searchable pharmacy locator for First Choice members, helping them find participating pharmacies in the network.
• SomatusminorStrategic or Co-development PartnerSomatus provides the Healthy Living Program for First Choice members, offering in-home health evaluations and support for members with complex health needs.
• AvailitycoreTechnology or IntegrationAvaility is the electronic claims submission platform used by First Choice providers for submitting and processing claims electronically.

Scale indicators7 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Molina Healthcare of South Carolina: Medicaid managed care plan competing directly against First Choice in South Carolina Healthy Connections Choices. Serves similar TANF, aged, blind/disabled, and foster care populations under the same SC Medicaid contract structure.
• Healthy Blue (BlueCross BlueShield of South Carolina): Medicaid managed care plan offered through BlueChoice HealthPlan (BCBS SC) that competes head-to-head with First Choice for SC Medicaid beneficiaries through the same Healthy Connections enrollment system.
• Humana Healthy Horizons (South Carolina): Medicaid MCO operating in South Carolina under the Healthy Connections program, competing for the same dual-eligible and Medicaid populations served by First Choice.
• WellCare of South Carolina (Centene): Centene-owned Medicaid managed care plan in South Carolina directly competing with First Choice for Healthy Connections beneficiaries, particularly in the TANF and Marketplace-eligible segments.
• Absolute Total Care (Centene): South Carolina Medicaid MCO owned by Centene that competes with First Choice for state-contracted Medicaid members under the same SCDHHS managed care framework.

Others

• AmeriHealth Caritas: Parent company of Select Health of South Carolina; a national Medicaid managed care organization operating across multiple states. Directly comparable in product, customer base, and business model as the corporate parent.

Broad incumbents

• Centene Corporation: Largest U.S. Medicaid managed care insurer; operates WellCare and Absolute Total Care in SC and across dozens of other states. Broad incumbent competitor with overlapping Medicaid MCO products.
• Elevance Health (Anthem): Diversified health insurer offering Medicaid plans (including Healthy Blue in SC) alongside commercial, Medicare, and other product lines. Broad incumbent comparable to First Choice's parent at the segment level.
• Molina Healthcare: National Medicaid-focused managed care company operating across many states including South Carolina. Broader portfolio but directly comparable government-insurance business model and member populations.
• UnitedHealthcare Community & State: Medicaid and government-programs division of UnitedHealth Group, operating managed care plans across many states. Closely comparable business model and population focus, though presence in SC varies.

Market position

Strengths5 records

Weaknesses5 records

Competitive moat6 records

Key risks6 records

Key highlights7 records

Customer concentration

• LinkedInlinkedin.com/company/select-health-of-south-carolina

Compliance3 records

Revenue estimate

Valuation estimate

Number of profiles

Profiles1 record

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about Select Health of South Carolina