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Pennsylvania Health Insurance

Health insurance is available in two broad categories at present: individual and group. Those who decide to buy individual insurance are usually self-employed, or are employed by a company that does not offer a health plan, or they have a family who want individual insurance for their family members. When one buys an individual plan, he/she is required to pay an annual premium as well as a deductible for each insured dependent, up to a base amount. Or if one buys a group policy, he/she needs to pay an annual premium, co-payments payable at each medical service, and a deductible payable before the insurer begins paying for his/her stipulated medical bills.

In Pennsylvania, rules for Blue Cross Blue Shield of Pennsylvania are different from those for other private insurers. For Blue Cross Blue Shield, the company must give you individual insurance if you seek one. If you are HIPAA eligible, they must offer you two policies that are state approved and the company is the only option for individual guaranteed issue insurance in the State. The insurer may need a waiting period of not more than 30 days for non-accident claims and six months for certain other elective claims. In case you have a pre-existing condition, the insurance companies can impose an exclusion period of three years. This does not apply for HIPAA eligible people. In a non-guaranteed policy, the insurer is free to attach an elimination rider to the policy. Both pregnancy and genetic information can be treated as pre-existing conditions in Pennsylvania. Your Blue Cross Blue Shield insurance cannot be cancelled because of your illness.

Other private insurers in Pennsylvania can reject your application due to a health problem. If you have a pre-existing condition, it can attach an elimination rider to the policy or it can impose an exclusion period of a maximum period of three years. There is no creditable coverage in any individual health policies.

In the case of group insurance in Pennsylvania, qualified persons can neither be denied nor charged extra for it because of a health problem. Your new employer may ask for a waiting period before providing coverage. There are some special, but conditional considerations for newborns and disabled children in the state. If you have a pre-existing condition, insurers can review your medical records for the last six months before coverage. They can also seek an exclusion period of no more than 12 months for the condition. If you have had no break in your coverage of over 63 days, you are entitled to creditable coverage.

Small employers with two to 50 employees cannot be refused small group health insurance or their policies cancelled due to health problems within the employee groups.
Self-employed people are not allowed to purchase group health insurance. For joining business associations, one can contact the Pennsylvania Department of Insurance for regulations.

Several programs, such as Medicaid, Healthy Women Project, and Pennsylvania’s Children Health Insurance Program offer financial help in Pennsylvania.

As choosing the right quotes are not easy, you should do some research before making a final decision. However, it is always better to appoint professional health insurance agents and brokers who can help you in this regard.

Some prominent health insurance providers in Pennsylvania are Aetna, American Medical Security, Assurant Health (formerly Fortis), Celtic, Fairmont Specialty Group,
Golden Rule, Guardian and Security Life.


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