Pennsylvania Individual Health Insurance
Health insurance is a priceless safety net to have for every person and every family. Without proper health coverage, your family is exposed to the financial setbacks springing from medical injuries. For those considering Pennsylvania individual health insurance, the possibilities are endless, as there are often literally hundreds of plans to choose from. Finding out more about the rules and regulations regarding these individual health insurance plans in Pennsylvania is your first step to deciding if this option is right for you.
Eligibility: How Am I Evaluated?
Health insurance applicants in Pennsylvania are generally reviewed based on individual factors, such as age, health, and lifestyle choices. In most cases, private insurers in Pennsylvania are free to turn down any applicant for any reason and there are no regulations in the state's insurance law which mandate who should and should not receive individual health insurance from private insurers; the exception to this is for plans covered through Blue Cross and Blue Shield.
In compliance with HIPPA Group-to-Individual Portability coverage, Pennsylvania guarantees acceptance into a Blue Cross and Blue Shield health insurance plan for those who are HIPPA eligible and have been turned down by other private health insurance providers.
Pennsylvania Guaranteed Benefits & Pre-Existing Conditions
For the most part, your individual health insurance policy will cover benefits depending on what type of plan you choose. Insurers in Pennsylvania are not required to carry any standardized policies and can decide which plans and benefits to offer to residents. However, there are a few benefits that must be offered to all residents who purchase health insurance, including diabetes care, vaccinations for children, post-delivery hospital stays and breast and cervical cancer screenings. Pennsylvania health insurance companies must also cover mental health conditions and physical health conditions equally.
In Pennsylvania, an insurer can protect themselves from a pre-existing condition in one of three ways. First, they can look for pre-existing conditions in your medical history and add them to your elimination rider before your policy takes effect. This can exclude the condition from the policy indefinitely. Secondly, they may also look back into your health history for up to five years and exclude any conditions that you did or should have received treatment for from your policy for up to 12 months. Additionally, an insurer can deny a claim that is made within the first 3 years of your policy, if it is determined that the bill stemmed from a condition that should have been listed as pre-existing. The insurer can also look back into your health history for up to five years for this purpose.
Pennsylvania Individual Health Insurance Premiums
Premiums for Pennsylvania individual health insurance are determined at the discretion of the insurer and are usually based on individual factors, such as age, health status, and family size. There are no Pennsylvania laws that state what you can or cannot be charged for a policy. Essentially, an insurer can charge you what they want to and if you are older or have a medical condition, you will likely pay more for your insurance coverage. In Pennsylvania you are guaranteed the opportunity to renew your health insurance policy at the end of your plan's term, regardless of your health status. On the flip side, your insurer can also review your policy rates and charge you a higher premium if your health has declined since. This helps to protect both the consumer, from being without protection when in declining health, and the insurer, from paying costly medical expenses on their own dime.
Before choosing a particular health insurance policy, you need to know exactly what is and isn't covered in your policy and how much you will pay in your premiums. Get in touch with a qualified broker or agent who can help you in determining the health plan coverage suitable to you and your family healthcare requirements.
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