Pennsylvania Health Insurance

Pennsylvania has more health insurance regulations than most states. It's especially important to familiarize yourself with them, so you're more confident and wise in your purchase.

This guide:

  • Describes Pennsylvania health insurance policy regulations.

  • Lists rules Pennsylvania health insurance companies must follow.

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Health insurance policies are regulated by each state's own health insurance laws. Pennsylvania health insurance companies and policyholders alike must abide by established insurance laws.

Pennsylvania health insurance policy provisions

Some of the most important Pennsylvania health insurance laws are the ones that influence the health insurance policy specifically.

For instance, at the end of your Pennsylvania health insurance policy's term, you always have the option of renewing it for another term. This is called the guaranteed renewability provision.

Also, medical conditions that you have been diagnosed with 5 years before the effective date of your health insurance policy can be excluded from coverage for a period of time. Conditions falling under this description are considered ?pre-existing conditions?.

In Pennsylvania, health insurance companies can exclude pre-existing conditions from coverage, but not for more than 12 months.

In instances of switching your health insurance, your old policy's exclusion period credits your new Pennsylvania health insurance policy's required exclusion period.

Finally, Newborns and adopted children are automatically included under a parent's individual Pennsylvania health insurance plan for a minimum of 31 days as long as the policy already provides coverage for dependents.

Regulating Pennsylvania health insurance companies

The other area of importance in regards to health insurance laws is the degree of influence your health insurance company has over your policy and its price.

First of all, Blue Cross Blue Shield is required to offer Pennsylvania health insurance to every resident. Premiums, under Blue Cross Blue Shield are based on age, gender, family size and type of plan but will not be affected by health status.

Other Pennsylvania health insurance companies selling individual policy premiums can take health status into account but cannot increase the cost of your renewal premiums if your health declines.

Also, some Pennsylvania health insurance companies can require a probationary period of no more than 30 days before coverage begins.

And lastly, Pennsylvania health insurance companies cannot cancel your health coverage or refuse you renewal on the grounds of illness.

Temporary Pennsylvania health insurance

If you are seeking temporary Pennsylvania health insurance, conversion policies are a good choice. They are available to individuals who have recently left a fully insured group policy, have lost health coverage because of the death of a spouse, or are no longer covered as a dependent.

Conversion policies are guaranteed renewable and no new pre-existing condition period can be imposed.

Unlike in other states, the premiums for conversion policies are limited to a percentage of your previous policy's premium. Benefits, however, may be much different than under your former Pennsylvania health insurance policy.

Applications for a conversion policy must be received no later than 31 days after the end of your previous policy.

If you are ineligible for a conversion policy, temporary health insurance is also available from a few insurance companies.

More PA health insurance help

If you want more help getting the a good health insurance policy, read our guide to health insurance.

Also see the guide to Pennsylvania small business health insurance.

To find out more about PA health insurance laws and regulations, visit the official website of the Pennsylvania Insurance Department.