Health Insurance Carriers in Pennsylvania (PA)

Pennsylvania’s insurance laws differ from those of other states. For your convenience, we have provided a list of links below so that you can explore your options. Below, we’ve done the research on details of Pennsylvania insurance provisions.

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Health Insurance Providers in Pennsylvania

Aetna
American Medical Security
Assurant Health (Formerly Fortis)
Celtic
Clarendon National
Fairmont Specialty Group / TIG
Golden Rule
Guardian
Principal Life
Security Life

Group Health Insurance in Pennsylvania

• Eligible applicants may not be denied group coverage or be charged more due to health issues.
• Employer may impose a waiting period on new employees.
• Life changes relating to family or job loss may provide special opportunities for coverage.
• Newborns and disabled children are guaranteed special coverage considerations.
• In the case of a pre-existing condition, providers may review medical records for the six months prior to coverage.
• An exclusion period of up to 12 months may apply to the pre-existing condition.
• If continuous coverage has been maintained for over 63 days, creditable coverage applies to any exclusion period.

Small Business Health Insurance in Pennsylvania

• Small businesses with fewer than 50 employees may not be denied small group coverage or cancelled based on health problems within the employee group.
• Premiums may be higher based on health problems within the group.
• Blue Cross Blue Shield premiums are based on modified community rating.

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Self-Employed Health Insurance in Pennsylvania

• The self-employed may not buy group health coverage.
• Contact the Pennsylvania Department of Insurance for regulations concerning associations that are trade or business related and offer group health coverage.

Pennsylvania Department of Insurance
1326 Strawberry Square
Harrisburg, PA 17120
(717) 787-2317
www.ins.state.pa.us/ins/site/default.asp

Individual Health Insurance in Pennsylvania

• There are different regulations for Blue Cross Blue Shield of Pennsylvania than for other private providers.
• Blue Cross Blue Shield is required to issue a policy to all applicants.
• The HIPAA eligible, must be offered two state approved policies.
• Blue Cross Blue Shield may require a waiting period of up to 30 days for non-accident claims and six months for other elective claims.
• For pre-existing conditions, an exclusion period of three years may apply unless the applicant is HIPAA eligible.
• In a non-guaranteed policy, the provider may attach an elimination rider to the policy.
• Pregnancy and genetic information may be classified as pre-existing conditions.
• Community rating set the cost of a guaranteed issue policy.
• Non-guaranteed policies have no limits on costs.
• Blue Cross Blue Shield policies may not be cancelled based on sickness.
• Other private insurers may deny coverage due to a health problem.
• In the case of a pre-existing condition, private providers may attach an elimination rider to the policy or require an exclusion period of up to three years.
• There is no creditable coverage for individual health plans.
• There are no limits on premium costs.
• Coverage may not be cancelled due to illness.
• Contact the Pennsylvania Insurance Department for information that should be considered before purchasing health insurance coverage.

Pennsylvania Health Care Programs

Medicaid, Healthy Women Project, and Pennsylvania’s Children Health Insurance Program provide assistance to low income individuals.

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