Pennsylvania Health Insurance

Pennsylvania has a great health insurance system, and getting coverage for yourself or your family should be fairly straightforward, even if you have a preexisting health condition. Your biggest problem will probably be to decide between all the carriers available to you! Below, we’ve created a guide to getting health insurance in Pennsylvania to make your search for health coverage easier.

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Individual Health Benefits in Pennsylvania (PA)

Pennsylvania Individual Health Insurance Regulations

  • You may be rejected by an individual insurer due to health problems.
  • Carriers may impose elimination riders and exclusion periods (up to 3 years) on your policy if you have a preexisting condition.
  • There are no limits on the premiums you may be charged.
  • Pennsylvania law does not provide for creditable coverage for individual health policies

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Special regulations for Blue Cross Blue Shield of Pennsylvania (BCBS)

  • BCBS is required to issue coverage to all applicants.
  • If you are HIPAA-eligible, you will be offered at least 2 types of policies, and cannot be given an exclusion period for a preexisting condition.
  • BCBS rates are determined by community ratings.

Pennsylvania Families Medical Insurance Regulations (PA)

Are you looking to get medical insurance for your family in Pennsylvania?You have several choices, such as group policies (i.e., HMO, PPO, POS, or HSA network), individual policies (more costly but can be tailored to your needs), and employee health plans (if your employer offers one, your family could be covered under your plan).Either way, make sure you shop around and read about PA health insurance regulations such as the following:

  • Group health carriers cannot turn you down or charge you a higher rate based on health problems.
  • Significant family changes, such as marriage or divorce, may afford you extra opportunities for coverage. Check with the Pennsylvania Department of Insurance if you’d like to know more.
  • If you have a newborn or disabled child, he or she may be given special considerations for coverage.
  • Your family will be able to receive creditable coverage provided you haven’t had a break in coverage for more than 63 days.

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Pennsylvania Health Coverage and Pre-existing Conditions (PA)

Pennsylvania law guarantees insurance coverage for preexisting conditions, in the event that the applicant is entering a new group policy plan from the place of employment and that the applicant was insured the preceding year. However, coverage may vary. Some insurance companies in Pennsylvania may cover preexisting conditions, some may exclude coverage, and some may even cover them on a per-claim basis. Thus, it is imperative to shop around to find the best options, particularly in regards to a preexisting condition.

Under Pennsylvania law, Blue Cross Blue Shield is required to issue a policy to all applicants, and Blue is required to follow different rules in Pennsylvania than are other private providers. For preexisting conditions, private providers may attach an elimination rider to the policy or require an exclusion period of up to three years. The exclusion period may apply unless the applicant is HIPAA-eligible.

Changing Health Plans in Pennsylvania

If you’ve just moved to Pennsylvania, or are about to change jobs, here are some other important things you should know when switching health plans:

  • COBRA — Exercise your COBRA rights to keep your employee health plan when you leave your job.
  • Waiting periods — Having employee health benefits is great, but be aware that your employee is allowed to delay the start of those benefits for a few months.
  • Non-federal public employees — If you are employed by a county or municipal government, your employer may not be governed by the same rules we’ve discussed above, so check with your employer for more information.