Health Insurance Laws
Health insurance laws in Pennsylvania are designed to protect persons looking for coverage. Whether they are low income, high income, have pre-existing conditions, have a job or are unemployed, there are a lot of laws established in the Commonwealth of Pennsylvania for health insurance. What follows are the general summary of your rights and limitations.
Non-discrimination and Guaranteed Renewability
If your employer offers a group health plan, you cannot be denied, limited or required to pay more because of your health status. This law is called "nondiscrimination".
All group health plans must limit the exclusion of pre-existing conditions. Your coverage cannot be canceled in the case of you getting sick; this is called "guaranteed renewability". Provided you pay the premiums, do not commit insurance fraud, continue to live in the plan's service area, your coverage is secure. The only time they can cancel the coverage is if they decide to stop selling every single individual health insurance plans in Pennsylvania.
Losing Group Health Care Coverage
If you lose your group health plan and meet the qualifications, you are HIPAA eligible. You will not face a new pre-existing condition exclusion period. Blue Cross Blue Shield must offer you a choice between two different policies, one of which must contain comprehensive benefits. These policies must be state-approved and if they are not, then you must be offered a choice of all of their individual plans available.
If you are not HIPAA eligible, Blue Cross Blue Shield must offer you at least one individual policy on a guaranteed issue basis - you cannot be turned down because you are sick.
If you leave your job, you can be eligible to stay on your old group health plan for a certain length of time. Called COBRA continuation coverage or state continuation coverage, this can help you when you are between jobs, retire early or are not eligible for Medicare. There are limits on how much money you can be charged for this coverage.
If you lose your group health plan, you can buy individual plans under a group "conversion policy". There will be no new pre-existing condition exclusion periods and there are limits on how much you can be charged for a conversion policy.
Small Business/Employer Health Insurance
Small employers who are purchasing a small group health plan cannot be turned down because of health statuses, age or any other factors to predict how the health coverage will be used by the employees.
All health plans sold to these small employers must be sold on a guaranteed issue basis. Family genetic history cannot be used against you or your employees.
Individual Health Insurance Plans
When applying for an individual health insurance policy, the insurance companies cannot turn you down, charge extra or force a pre-existing condition exclusion period because of any genetic information you release. They are not allowed to ask about genetic tests or family history when you apply.
For example: if you mother has a history of diabetes and you have not been diagnosed with it yourself, and you tell the insurance company your mother's history - they cannot turn you down or put you through a waiting period based on the assumption that you may get diabetes too.
Low or Modest Income Insurance Policies
If your income is low or modest, you may be eligible for subsidized health care for yourself and family members. Medicaid offers free health coverage for pregnant women, families with children, and elderly or disabled persons with no insurance or to those who lost their insurance and jobs.
Children under the age of 19 who do not have health insurance coverage and who meet the qualifications, are able to be covered under the Pennsylvania Children's Health Insurance Program (PaCHIP).
Adults over the age of 18 may be eligible for a subsidized health insurance with very low premiums through the adultBasic state run program. There is usually a waiting list for this program however.
Laws Regarding Cancer
Those who are at risk for cancer but have little to no insurance may be eligible for free screening and/or treatment.
Tags: group health, group health plan, health plan, condition exclusion, Health Insurance, pre-existing condition, pre-existing condition exclusion
