Individual and Group Pennsylvania Health Insurance Differences

Both individual and group Pennsylvania health insurance providers are obligated to comply with a variety of laws imposed by the state legislature. These regulations protect both the insured individuals and the Pennsylvania health insurance companies. Individual and group Pennsylvania health insurance plans differ greatly in the rules that apply to each.

In order for a person to qualify to obtain a group Pennsylvania health insurance policy, he or she must work for an employer who provides benefits to his or her employees. If the individual meets the employer’s standard requirement for receiving benefits, then he or she cannot be denied the right to a Pennsylvania health insurance group policy based on his or her health status. With an individual Pennsylvania health insurance policy, however, the Pennsylvania health insurance applicant can be denied access to a policy based on a health condition or age. The one exception to this rule is the Blue Cross Blue Shield Company, which is required to give every individual Pennsylvania health insurance applicant a policy regardless of his or her risk factors.

Pennsylvania health insurance group policy members cannot be charged higher premiums than other individual members of the plan based on their health statuses. Pennsylvania health insurance group policy providers must charge the same premium rate for the same type of policy to every member of the group. However, the Pennsylvania health insurance companies reserve the right to increase all of the premiums at the end of a term based on the number of claims filed during the coverage year. Thus, a group’s Pennsylvania health insurance premium price can vary greatly depending on the general health of the entire firm.

Pennsylvania health insurance pre-existing condition laws also differ between group and individual policies. Group Pennsylvania health insurance policies define a pre-existing condition as one that has been diagnosed and treated within the six months prior to the new Pennsylvania health insurance policy taking effect. Pennsylvania health insurance companies are allowed to write in exclusion periods of up to one year, during which they are not responsible for paying claims relating to pre-existing conditions. However, after this period expires, the Pennsylvania health insurance company is required to pay for new claims relating to the pre-existing condition.

With individual Pennsylvania health insurance policies, both Blue Cross and Blue Shield and other regular Pennsylvania health insurance companies can impose exclusion periods. These Pennsylvania health insurance exclusion periods cannot last more than thirty-six months. This is one of the longest exclusion periods allowed in the entire country. Individual Pennsylvania health insurance companies can look back as far as five years to find pre-existing conditions. Pennsylvania health insurance companies can also impose elimination riders that permanently exclude Pennsylvania health insurance companies from having to pay for pre-existing conditions. The five-year definition of a pre-existing condition is extremely beneficial to the Pennsylvania health insurance companies. Thus, pre-existing condition law in Pennsylvania health insurance is very unfavorable to the insured individual both in the cases of group insurance and in individual Pennsylvania health insurance plans.

Individual and Group Pennsylvania Health Insurance Differences

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