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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
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
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.