Pennsylvania Health Insurance Coverage...
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If you are searching for ways to lower your health insurance costs and you live in the State of Pennsylvania...We, here at HealthInsureCoverage.com, work hard to supply you with the information you need to make an informed decision regarding your health insurance needs and requirements.

• What are your protections when buying individual health insurance in the State of Pennsylvania?
     If you do not have access to employer-sponsored group insurance, you may want to buy an individual health plan from a private insurance company. However, in Pennsylvania – as in most other states – you have limited guaranteed access to individual health insurance. Whether you can buy an individual health plan may depend on your health status, the kind of coverage you want to buy, and other circumstances. Also, there are some alternatives to individual health insurance coverage such as COBRA or conversion policies.
• Blue Cross and Blue Shield plans in Pennsylvania.
     In Pennsylvania, there are four regional Blue Cross plans and one statewide Blue Shield plan that, together, cover the entire state. Western Pennsylvania is covered by Highmark Blue Cross Blue Shield. Northeastern Pennsylvania is covered by Blue Cross of Northeastern Pennsylvania and Blue Shield. Central Pennsylvania is covered by Capital Blue Cross and Blue Shield. The Philadelphia area of Eastern Pennsylvania is covered by Independence Blue Cross and Blue Shield.
• When does Blue Cross Blue Shield have to sell you coverage?
     Blue Cross and Blue Shield plans in Pennsylvania will sell individual health insurance to any resident.
• What will your Blue Cross Blue Shiels Plan cover?
     It depends on what you buy. Pennsylvania does not require health insurers in the individual market to sell standardized policies. Health plans can design different policies and you will have to read and compare them carefully. However, Pennsylvania does require all health plans to cover certain benefits – such as post-delivery hospital stays and breast cancer screening. Check with the Pennsylvania Department of Insurance for more information about mandated benefits.
• If you are federally eligible, a regional Blue Cross and Blue Shield Plan must offer you a choice of at least two state-approved policies, whose benefits must be similar to others they typically sell.
     At least one of the policies must offer comprehensive benefits. If two policies are not designated, you must be offered a choice of all of their individual insurance products.
• When you buy an individual health plan in Pennsylvania, insurance companies can require a probationary period before most of your coverage becomes effective.
     This period cannot exceed 30 days for non-accident-related conditions, or 6 months for certain procedures defined as elective. Accidental injuries will be covered immediately. Unlike an HMO affiliation period, you can be charged a premium during this probationary period even though the plan will not pay claims other than for accidental injuries during this time. If your insurance company requires a probationary period, the pre-existing condition exclusion period begins on the first day of the probationary period. Probationary periods cannot be applied if you are federally eligible.
• There are certain criteria you must meet to be Federally Eligible.
     No matter where you live, if you are federally eligible you are guaranteed the right to buy an individual health plan with no pre-existing condition exclusion periods. In Pennsylvania, you are guaranteed the right to buy coverage only from a Blue Cross and Blue Shield plan. To be federally eligible, you must meet all of the following:
  
  * You must have had 18 months of continuous creditable coverage, at least the last day of which was under a group health plan.
  * You also must have used up any COBRA or state continuation coverage for which you were eligible.
  * You must not be eligible for Medicare, Medicaid or a group health plan.
  * You must not have health insurance. (Note, however, if you know your group coverage is about to end, you can apply for coverage for which you will be federally eligible.)
  * You must apply for health insurance for which you are federally eligible within 63 days of losing your prior coverage.
  
     Federal eligibility ends when you enroll in an individual plan, because the last day of your continuous health coverage must have been in a group plan. You can become federally eligible again by maintaining continuous coverage and rejoining a group health plan.
  
  
• If you have a pre-existing health condition what kind of coverage can you qualify for?
     Unless you are federally eligible, the regional Blue Cross and Blue Shield Associations in Pennsylvania can exclude coverage for your pre-existing condition for up to a year. Unlike group plans, individual plans can look back 5 years before you enroll for evidence of a pre-existing condition, and refuse to pay claims for services related to that condition. In general, individual health plans will not give you credit for any prior coverage. However, Blue Cross and Blue Shield individual health plans may give you credit for having been continuously covered under another Blue Cross and Blue Shield plan in the same region.
• If you are federally eligible, Blue Cross and Blue Shield plans cannot impose a pre-existing condition exclusion period.
• What can you be charged for Individual Coverage from Blue Cross Blue Shield?
     Premiums will vary depending on your family size, age, gender and the type of policy you want. However, Blue Cross and Blue Shield may not vary premiums based on your health status. For information about coverage and premiums, call the Blue Cross and Blue Shield plan that serves your area.
• Can your policy be cancelled?
     Your individual health insurance policy cannot be cancelled because you get sick. This is called guaranteed renewability. You have this protection provided that you pay the premiums, do not defraud the company, and in the case of managed care plans, continue to live in the plan service area.

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