As a Pennsylvania resident, you should be aware of the different Pennsylvania Health Insurance coverages, so you can find the best policy and get a Pennsylvania Health Insurance Quote at the lowest cost.
Types Of Pennsylvania Health Insurance
PA Health Insurance is available through two types of plans: group or individual. Group plans are offered through an employer or association; individual plans are purchased directly through an insurance company.
If you work for a company that offers a group insurance plan, or even a choice of plans to its employees, obtaining health insurance may not be a problem and you may not need a Pennsylvania Health Insurance Quote. However, if you are not covered by a group plan, or if you want different or additional coverage other than that offered by your employer, you may want to consider buying individual health insurance coverage for yourself or your family, or determine your eligibility for association or government sponsored health insurance.
Employer Sponsored Insurance is group PA Health Insurance coverage offered by your employer. The group health insurance coverage purchased by the employer can be through a private insurance company or coverage that is “self-funded” or "self-insured," meaning that the employer will use its own money to pay for the health care expenses of its employees.
Individual Insurance includes PA Health Insurance coverage you can purchase on your own directly through an insurance company. Many Pennsylvania Health Insurance companies offer individual health coverage to people who either are self-employed or work for a business that does not offer health insurance. All Pennsylvania residents can buy individual Pennsylvania Health Insurance through the Blue Cross and Blue Shield plans on a guaranteed issue basis.
Association Sponsored Insurance includes PA Health Insurance coverage that may be offered to you or a member of your family through a fraternal or professional association. Association sponsored insurance usually costs less than individual insurance because, similar to employer sponsored insurance, you may be able to purchase Pennsylvania Health Insurance insurance at a group rate.
Government Sponsored Insurance includes PA Health Insurance coverage that provides medical benefits to senior citizens, disabled persons, and the economically disadvantaged. Examples include Medicare and Medicaid. Government sponsored insurance also may be available to those with conditions related to military service.
Pennsylvania Health Insurance Glossary
Coinsurance - The share of your covered expenses, usually a percentage, you must pay after the deductible is reached. For example, a policy may require you to pay twenty percent of the cost up to a certain dollar amount.
Conversion of Privileges - Allows the participant or beneficiaries to convert coverage to a different plan of insurance without providing evidence of insurability. The privilege granted by a group policy is to convert to an individual policy upon termination of group coverage.
Coordination of Benefits - Provisions in Pennsylvania Health Insurance group policies that limit the total benefits payable under two or more group policies so that benefits do not exceed the actual amount of covered expenses incurred. COB is particularly important when a husband and wife each have obtained family coverage under separate group policies. Some policies may reduce the amount of benefits payable if benefits are payable under other insurance coverage.
Co-payment - A specified dollar amount a subscriber to a managed care plan must pay for covered Pennsylvania Health Insurance care services. It is paid to the provider at the time the service is rendered.
Deductible - The initial amount of covered expenses a policyholder will have to pay before benefits are paid under the Pennsylvania Health Insurance policy. Generally, the higher the deductible, the lower your premium. Remember, the deductible should not be so high that you could not afford to pay it should you become ill.
Effective Date - The date Pennsylvania Health Insurance protection begins.
Elimination Period - Specified number of days that you must be eligible for Pennsylvania Health Insurance coverage or disabled before the policy begins to pay benefits.
Exclusions and Limitations - Conditions or circumstances in which benefits are not payable or may be limited. Some examples of exclusions are suicide or self-inflicted injuries, injuries resulting from war, on-the-job accidents covered by workers’ compensation, eye or dental treatment, cosmetic surgery, services for which no charge is made, and services that are not medically necessary. Some policies also may place limitations on or exclude treatment of mental illness or substance abuse.
Pre-existing Condition - An illness or condition which was treated or diagnosed before the policy was issued. Many policies will not pay benefits for pre-existing conditions, or will only cover treatment of them after the policy has been in force for a specified period of time. This varies based on whether the policy is group or individual coverage.
Renewal and Premium Increase Provisions - Determine the conditions under which your Pennsylvania Health Insurance policy may be renewed or the premiums increased.
Waiting Period - The amount of time you must wait after buying a policy before coverage begins.
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