Introduction: The health insurance situation in Pennsylvania is better than the overall health insurance situation in most of the American states. In accordance to a survey conducted by The Center for Disease Control, almost 11% of the total Pennsylvania population was uninsured for Pennsylvania medical insurance for each year, between 2001 and 2003.
In the article, we have talked about some important Pennsylvania medical insurance regulations as well as Pennsylvania state-aided medical insurance alternative programs.
Some Important Regulations for Pennsylvania Medical Insurance
Pennsylvania department of insurance has introduced certain regulations that the Pennsylvania medical insurance companies must follow. The regulations are as follows:
- Pennsylvania individuals having medical insurance through an employer can not be refused or restricted access to that particular medical insurance plan.
- Pennsylvania individuals looking for individual medical insurance are assured to buy a plan through any of the below mentioned Blue Cross and Blue Shield divisions that are active within the state of Pennsylvania.
- Blue Cross of Northeastern Pennsylvania (Northeastern Pennsylvania), Independence Blue Cross and Blue Shield (Philadelphia area), Highmark Blue Cross Blue Shield (Western Pennsylvania), Capital Blue Cross and Blue Shield (Central Pennsylvania)
- Blue Cross and Blue Shield or BCBS should offer standardized health insurance policies to the HIPAA qualified individuals. For others, plans can vary from individual to individual.
- Blue Cross and Blue Shield normally imposes a probationary period of no more than 6 months. During that period premiums should be disbursed but the policy holder is not entitled to get any coverage; only expect emergencies and accidents.
- HIPAA qualified Pennsylvania individuals do not have to face none of a probationary period or a pre-existing condition waiting period.
- Pennsylvania medical insurance companies, other than Blue Cross and Blue Shield, can implement both pre-existing condition waiting periods and elimination riders. They can even reject an application on the basis of health, age and other deciding criteria.
- Blue Cross and Blue Shield can inflict a pre-existing condition waiting period for no more than 36 months. During the period, if an individual files a claim for a health condition, the company is allowed to investigate the health record of that individual dating back 5 years; to confirm whether the condition was present previously. If it is so, then Blue Cross and Blue Shield will provide no coverage for that condition.
- An elimination rider can keep away certain medical conditions, body systems or body parts from coverage, even permanently for the entire term of respective insurance policy.
- As per state health insurance regulations, all Pennsylvania medical insurance companies including BCBS may consider pregnancy as a pre-existing health condition and thus subject to an exclusion period.
- All newborns should be covered under their parent's individual medical insurance plan that offers dependant coverage, for the initial 31 days from the day of birth.
- There are limitations for what Blue Cross and Blue Shield can charge for guaranteed issue policies. The company can not charge higher for such plans, depending on age, health status and other deciding criteria.
- However, private Pennsylvania medical insurance companies that offer individual medical insurance can demand any amount as premiums for all the policies offered by them. They consider health, age, gender, status, family size and tobacco use of the policy holder as deciding factors.
- All Pennsylvania medical insurance plans should have a provision for renewal, so that the policy holders can renew his or her existing medical insurance plans. However, guaranteed renewability provision is available to the individuals, who have disbursed all the premiums, in time and provided no fake information, during the term of existing Pennsylvania medical insurance policy.
- Premium rates may be hiked at the time of renewal.
- Pennsylvania individuals between jobs or medical insurance policies can avail temporary Pennsylvania medical insurance plans offered by BCBS as well as private insurance companies.
Pennsylvania Medical Insurance Alternative Options
There are some state-aided alternative medical insurance options available in Pennsylvania to let the individuals, who are unable to afford medical insurance costs or otherwise considered as uninsurable, get coverage. The programs are as follows:
- Pennsylvania Children's Health Insurance Program: The program is available to the children below and up to the age of 19. Nevertheless, children from the families, which are not qualified for Pennsylvania Medicaid or unable to pay for Pennsylvania medical insurance, are only eligible to apply for the program.
- Pennsylvania Medicaid: Pennsylvania residents, who meet all the health-related qualifying criteria including income criteria, are able to apply for this program.
- Pennsylvania Health Law Project: The program is available to the Pennsylvania individuals who face difficulties obtaining publicly aided health care coverage or services.
- COMPASS: This is basically an Adult Basic Health Insurance Program, which is created for the Pennsylvania adults between the age of 19 and 64. Individuals, who meet all the eligibility criteria, are able to avail the program. The program carries a waiting list.
Pennsylvania Department of Insurance
For more information on Pennsylvania medical insurance, you can contact at the following office address of Pennsylvania Department of Insurance:
Pennsylvania Department of Insurance
1326 Strawberry Square
Harrisburg, PA 17120
Phone: (717) 783-0442
Automated Hotline: (877) 881-6388
Fax: (717) 772-1969