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Pennsylvania Health Insurance

 

All health insurance policies in Pennsylvania are considered guaranteed renewable as long as your premiums are paid up to date.  So this means your health insurance can not be canceled because you become sick.

 

Pennsylvania mandates that health insurance companies cover newborns and adopted children for the first 31 days, on their parent’s policy.  But inversely pregnancy is, and can be considered a pre-existing condition, except on group health policies.  Pregnancy is a pre-existing condition but not on group health insurance.

 

It is also mandatory for all Pennsylvania Health Insurance Companies to cover annual mammograms and post pregnancy hospital stays.

 

The Pennsylvania Department of Insurance as put out a great brochure about buying health insurance in Pennsylvania.  To view these documents please click here.

 


                              Request a Pennsylvania Health Insurance Quote

 

 

Pennsylvania Small Business Health Insurance

 

 

 

 

Cities in Pennsylvania

 

Philadelphia PA

Pittsburgh PA

Allentown PA

Erie PA

Reading PA

Scranton PA

Bethlehem PA

Lower Merion PA

Abington PA

Upper Darby PA

 

 

 

 

Commonly Searched Terms

 

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PA Self Employed Health Insurance

Affordable Health Insurance in PA

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Health Insurance Companies in PA

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PA Health Insurance Policies

 

In Pennsylvania, a group health plan, can not base your health insurance premiums on your health.  This is called non discrimination.  Small Business Health Insurance in Pennsylvania is also guaranteed issue, meaning that you can not be turn down for coverage.  If your company has more than 50 employees you can be turned down for coverage.

 

Pre-existing exclusions are limited on the amount of time they can exclude coverage.  Also if you have current coverage, without lapses, that will be credited against your pre-existing period.  Pregnancy is not considered a pre-existing condition on a group health plan.

 

Pennsylvania small business insurers are only allowed to consider treatments and diagnosis that occurred during the last 6 months for pre-existing conditions; called look back period.

 

The maximum pre-existing waiting period is 12 months for an employee. If you are a late enrollee your maximum waiting period is 18 months.  Any pre-existing periods must be applied only after written notice.

 

Pennsylvania does limit the amount of variation between premiums of different group health plans.  Each Small Business Plan will have certain enrollment periods in which employees can sign on to get coverage.  Small businesses can be charged higher premiums based on the fact that they are a higher health risk.

 

For additional information about Small Business Health Insurance in Pennsylvania click here.

 

                              Request a Pennsylvania Small Business Health Insurance Quote

 

 

Pennsylvania Individual Health Insurance

 

All Pennsylvania Health Insurance Policies have to cover disabled children on their parent’s policy into their adulthood.

 

In Pennsylvania, insurance companies are able to decide if they want to insure you or not.  They can either rate you up or just refuse coverage.  Also Pennsylvania does not mandate what you buy, so insurance companies are able to design specific policies for specific consumers, rather than make insurance companies offer similar policies.

 

The exception to this is Blue Cross Blue Shield of Pennsylvania.  They will sell one policy as guaranteed issue.  The rest of their policies they can refuse coverage for.  If you are HIPAA eligible, you must be offered two state standardized policies.

 

Your health insurance rates for a Blue Cross policy will depend on if you buy a guaranteed issue policy or not.  If your policy is guaranteed issue, your rates can not be based on your health status or age.  If you do not buy a guaranteed issue policy your rates your rates will vary depending on your age, location, health status etc.

 

Pennsylvania allows health insurance companies to include pre-existing conditions on their policies.  Elimination riders might be used, or pre-existing condition exclusions might be used.  If pre-existing condition exclusions are used, they can not last more than 36 months.

 

Relative to Pre-Existing Conditions, Insurance companies in Pennsylvania must give credit to prior credible coverage as long as there was not more than a 63 day lapse in coverage.

 

The rates that an individual pays for a Pennsylvania Health Insurance Plan are based on age, location, health history, family size, sex etc.  Sadly there is no limit on how much an insurance company can charge and individual for coverage.

 

Adult Basic is a relatively new program in Pennsylvania.  It was started in 2002 and designed to help provide affordable health insurance for Pennsylvania's residents. 

 

Pennsylvania also has an insurance program designed to provide affordable health insurance for Pennsylvania's children.  It is called CHIP.

 

For additional information about Individual Health Insurance in Pennsylvania click here.

 

                               Request a Pennsylvania Individual Health Insurance Quote

 

 

Pennsylvania Self Employed Health Insurance

 

In Pennsylvania, if you are looking to buy a self employed health insurance policy you will nee to buy an individual policy.  Pennsylvania law does not allow self employed owners to buy small business health insurance.

 

Another option for affordable Pennsylvania Self Employed Health Insurance is often associations or self employed groups.  Just keep in mind that not all of these groups or associations are regulated by the state.

 

One benefit for Self Employed people is that they are able to deduct 100% of their health insurance premiums from their taxes!

 

For additional information about Self Employed Health Insurance in Pennsylvania click here.

 

                              Request a Pennsylvania Self Employed Health Insurance Quote

 

 

Temporary Pennsylvania Health Insurance

 

Many situations may arise where you find yourself without health insurance, or about to be without health insurance.  These reasons could range from graduating college to being in-between jobs.  Instead of going without health insurance you should look into getting a Pennsylvania Temporary Health Insurance Policy.  These policies will be cheap, with high deductibles and low coverage, but getting a Pennsylvania Temporary Health Insurance Policy is much better than going with out health insurance.  Temporary Health Insurance in Pennsylvania is not sold on a guaranteed renewable status.

 

For additional information about Temporary Health Insurance in Pennsylvania click here.

 

                              Request a Pennsylvania Temporary Health Insurance Quote

 

 

What types of Pennsylvania Health Insurance are there?

 

HMO- Health Maintenance Organization.  This type of insurance is called managed care.  This means you have certain network of doctors and hospitals in Pennsylvania that you have to go to for care.  Most Pennsylvania HMO’s have office visit co-payments that range from $10 to $35, and hospital deductibles that range from $250 to $1,500.  Often the most affordable health insurance plans are HMO’s due to the fact they are managed care.

 

PPO-Preferred Provider Organization.  This type of insurance is also called managed care but it gives the consumer much more freedom; they allow you to visit any doctor or hospital in or out of network.  Most Pennsylvania PPO’s have an in network and an out of network charge.  If the in network co-insurance is 100% then the out of network co-insurance would be 80%.  If the in network co-insurance is 90% then the out of network co-insurance would be 70%   Typically Pennsylvania PPO’s offer co-payments for doctor visits as well as hospitalization. 

 

Indemnity Plan - In Pennsylvania, as health insurance rates continue to rise, many people are finding it more affordable to drop their health insurance and buy a Pennsylvania Major Medical Health Insurance Plan.  An Indemnity plan can also be called a major medical plan or catastrophic health insurance.  Whatever you call it, typically a Pennsylvania Indemnity Plan would cover more “major” claims.  An Indemnity plan has an annual deductible and will usually allow you to pick different co-insurance options.  Indemnity plans allow you access to any doctor or hospital, and for this reason they are typically very expensive.

 

Discount Medical Plans – In recent years many Discount Medical Plans have started to surface.  These plans have relatively inexpensive, but consumers must realize that this is not insurance.  All these companies do is to get their customers discounted rates (20-50% off) on certain procedures at certain physicians and hospitals. 

 

Federal Mandated Health Insurance Laws

 

HIPAA

Along with Pennsylvania Health Insurance Laws, there are Federal Laws that regulate Health Insurance companies.   HIPAA (Health Insurance Portability and Accountability Act of 1996). This act mandated federal standards for individual and group health insurance plans.  Some of the standards that it established were relative to guaranteed renew ability, crediting for prior health coverage and pre-existing condition waiting periods.

 

ERISA

Large corporations do not have health insurance policies.  Typically they are self funded, meaning the corporation pays for all of their employee’s medical bills instead of buying health insurance.  Most of these “self funded” companies are regulated by the federal government under ERISA (Employee Retirement Income Security Act)

 

COBRA

In Pennsylvania it is mandated, by the state, that all companies that offer a Pennsylvania Group Health Insurance Policy must also enable their employees to extend their health coverage temporarily; called Cobra.  A Pennsylvania Cobra Insurance is typically available for a time period of 18 to 36 months.   In Pennsylvania you are given 60 days to decide if you are going to take Pennsylvania Cobra Insurance or not.  Once you have passed on the opportunity to take Cobra, you are not eligible to receive it.

 

Cobra Insurance was introduced in 1985.  Cobra stands for Consolidated Omnibus Budget Reconciliation Act.  If you would like more information about your Cobra Insurance options please contact your companies HR department.

 

Often employees are surprised at the cost of a Pennsylvania Cobra Insurance.  The reason for this is that they are now responsible for 103% (100% of the premium plus a 3% administration fee) of a monthly health insurance premium when they probably only paid 20% while employed. 

 

Whether nor not to take Cobra is an important question, and you should realize there are alternatives to a Pennsylvania Cobra Insurance Policy.  One should realize what they plan to do in the future.  If you are looking for another job, and it will be a few months before you get a job, it might make sense to look for a Pennsylvania Temporary Health Insurance Plan.  If you are contemplating working at a consultant, it would be in your best interest to look into a Pennsylvania Self Employed Health Insurance Policy.    

 

 

QuicklyQuoteMe’s Opinion on Health Insurance

On most health insurance policies you have the option of taking a higher deductible, which can save you on your monthly premiums.  For these people who are generally healthy and do not use their medical policy it makes sense to take a risk to lower a monthly bill.

 

QuicklyQuoteMe recommends you consider your risk and talk with our licensed professionals about which deductible is right for your policy.  At QuicklyQuoteMe.com we have the highest quality insurance professionals working with us.  Fill out an online form and speak to one of them directly, they all come highly recommended!

 

                           Request a Health Insurance Quote from one of QuicklyQuoteMe’s Agents

 

 

If you are a health insurance agent looking for Pennsylvania Health Insurance Leads click here

 

 

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