Western Pennsylvania health insurance rates are very affordable compared to other parts of the state. Catastrophic, Comprehensive, short-term and HSA plans are available from most of the major health insurance companies in Western Pennsylvania. Whether you need individual or family coverage, there are many low cost options to consider.
Pahealthinsurancecoverage.com is the premier resource for affordable Western Pennsylvania health insurance plans. Instantly, you can view, compare or apply for quality coverage at rates that are guaranteed to be the lowest allowed by law. We’ll research all of the top-rated companies to find a policy that meets your budget needs and provides the coverage you want. We only consider top-rated companies and never use any type of “discount” plan.
The most popular health insurers for Pittsburgh and the Western Pennsylvania area are Aetna, UnitedHealthCare, Highmark Blue Cross Blue Shield, HealthAmerica and Assurant. Other companies such as Celtic also are licensed in Pennsylvania but do not write as many policies as the larger carriers. Humana, one of the nation’s largest insurance companies, does not offer individual health insurance in Pennsylvania.
Highmark Blue Cross Blue Shield is one of the largest health insurance carriers and serves the 29 counties of Western Pennsylvania. Their PPOBlue plan is a low cost policy that features a low deductible option ($1,200) with 90% coverage on most coverages once the deductible has been met. However, preventive benefits, such as routine physicals, gynecological exams, mammograms, pap tests and pediatric immunizations are not subject to a deductable. The PPODirectBlue plan offers deductibles as low as $250 per person and also includes 90% coverage once the deductible has been met. Since maternity coverage is included, it is a popular plan for young families.
Pennsylvania Health Savings Accounts (HSAs) have been increasing in popularity since they were established in 2004. Because of their cost-saving features, they should always be considered for individuals or families that don’t often use their health care coverage. Aetna and HealthAmerica offer very attractive rates in most of Western Pennsylvania. UnitedHealthCare is one of the few companies to have a “single family deductible” HSA. We’ll be happy to review your options and help determine if an HSA is the right fit for your needs.
Catastrophic health insurance plans offer rich major medical coverage while substantially lowering your premium. One of the best Western Pennsylvania catastrophic policies is Healthamerica’s “HealthGear” plan. Various deductibles are available and preventive benefits are provided without having to meet the deductible. UnitedHealthCare’s “Saver 80” plan is another low cost alternative designed to protect against major claims. Deductibles are available up to $10,000 and this type of policy is perfect for individuals or families that are not concerned with office visit or prescription coverage.
By clicking on the “Get Instant Quote” button at the top of the page, instantly and easily you can view affordable Western Pennsylvania health insurance plans. If you would like to speak to a live person, please call us at (888) 513 6446.
Helpful Links:
Highmark Provider Directory
Apply For Highmark Blue Cross Blue Shield Coverage
Pennsylvania health insurance providers offer comprehensive, catastrophic and short-term temporary coverage to Pennsylvania residents. A wide variety of plans are available at the guaranteed lowest allowable rate. As the state’s premier resource for affordable health care, we represent all of the major Pennsylvania health care providers. We have listed below details and important information about each of these companies:
Aetna offers an extensive combination of PPO and HMO Pennsylvania health insurance plans. As the first national, full-service health insurer to offer consumer-directed health plans, Aetna also features two very competitively-priced HSA plans ($3,000 and $5,000 deductibles). The PPO 5000 and HMO 30 are two very popular plans that are offered. Also, Aetna’s dental rates, if added to the healthcare policy, are typically only $14 per person (per month).
UnitedHealthcare (UHC) is one of the largest US health insurers and provides Pennsylvania health insurance plans through UnitedHealthOne. The “Copay Select” and “Copay Saver” plans are the most popular comprehensive plans in their portfolio. Rates are typically most competitive in Western and Central Pennsylvania with some exceptions. The “Saver 80” plan is one of the most popular catastrophic coverage options in the state. UHC is also one of the few carriers that utilizes a “family deductible” on their HSAs instead of individual deductibles.
HealthAmerica was recognized as one of the 20 best health plans in the country by “The US News” in their 2009-2010 list. Their $2500 and $5,000 deductible HSA plans are extremely competively priced and the “HealthGear” plan is a unique catastrophic policy that also provides preventive benefits. HealthAmerica is one of the Pennsylvania health insurance providers you don’t hear a lot about, but they are a well-respected company.
Highmark Blue Cross Blue Shield serves Pittsburgh and the 29 counties of Western Pennsylvania and has one of the largest provider Networks in the region. The DirectBlue and PPOBlue plans are the most popular Highmark policies and are available with deductibles of $250-$7,000. Rates are generally competitive and preventive benefits are typically very comprehensive. Major medical expenses are paid at 90% (after the deductible with out-of-pocket limit) and HAS and Short-term plans are also available.
Capital Blue Cross services 21 counties in Central Pennsylvania and the Lehigh Valley. PersonalBlue PPO is their popular medically underwritten individual policy. Rates are fairly competitive and many preventive benefits are not subject to the deductable. An optional prescription rider is available that covers most medications with small copays. Capital Blue Cross also offers short-term coverage and a “guaranteed issue” plan for persons with major health conditions.
Independence Blue Cross (IBC) is Southeastern Pennsylvania’s largest health insurer. The Keystone Health Plan East HMO policies offer a wide variety coverages with low out-of-pocket costs. HMO Copay and HMO Deductible plans are popular choices for individuals and families. The “Personal Choice” PPO plan offers guaranteed enrollment to applicants that can’t obtain health care coverage elsewhere.
Blue Cross Of Northeastern Pennsylvania is based in Wilkes-Barre and serves northeastern and north central Pennsylvania. BlueCare Direct and BlueCare Direct Select are popular individual plans that feature 100% coverage on many preventive services and copays on most office visits and prescriptions. Out-of-pocket maximum limits are very flexible, depending on the selected deductible.
Assurant provides a wide range of financial services in the US including health insurance to Pennsylvania residents. Assurant offers competitive short-term temporary plans with many optional deductibles. In some areas, their high-deductible Health Savings Accounts ($7,500 or $10,000 deductibles) are very popular.
Celtic Insurance Company is based in Chicago and offers individual short-term, comprehensive and HSA coverage. The Celtic “Basic” plan is perhaps the most competitively priced policy in their portfolio. It’s a PPO plan that provides two office visits per year (subject to a $30 copay) and a $200 wellness benefit that starts three months after the policy effective date. Some prescription coverage is also included.
For additional information on any Pennsylvania health insurance provider, please feel free to call us at (888) 513 6446. You can also email us at eharris@pahealthinsurancecoverage.com.
If you would like to instantly view, compare or apply for Pennsylvania health insurance, please click on the “Get Instant Quote” button at the top of the page. Your personal information is never shared.
Pennsylvania catastrophic health insurance plans are an affordable low cost option to reduce rates and still maintain major medical benefits. We specialize in helping Pennsylvania residents find low cost catastrophic coverage with major companies. Plans are offered through most large companies such as Aetna, UnitedHealthCare, HealthAmerica, Highmark Blue Cross Blue Shield, Capital Blue Cross and Assurant. The rates you view on this website are guaranteed to be the lowest allowable by the state, and the exact rate that you would pay by going directly to the carrier.
Catastrophic health insurance plans will insure major claims, such as hospital expenses (including semi-private room charges, surgery and fees charged by doctors, surgeons and nurses), outpatient surgery, and emergency room and facility charges. Also referred to as “high deductible” plans, this type of coverage typically has a high deductible ($1,000 to $10,000) that must be met before benefits are paid. Out of pocket expenses will depend on which deductible is selected. Whether you are an individual, family, uninsured, self employed or on Cobra, a catastrophic plan is always worth considering.
After researching hundreds of different options, three of our favorite Pennsylvania catastrophic policies are HealthAmerica’s “HealthGear” UnitedHealthcare’s “Saver 80” and Aetna’s “Preventive & Hospital Care” plans.
The HealthAmerica “HealthGear” policy is a catastrophic plan with a few features that normally aren’t found on this type of plan. For example, many preventive benefits are NOT subject to the deductible. Well child and adult physicals, routine mammograms, gynecological exams and preventive immunizations are covered with very little out-of-pocket cost. And once the deductible has been met, primary care and specialty office visits are covered with a copay along with some prescription coverage.
UnitedHealthCare’s “Saver 80” plan is a no-frills policy that has been a top Pennsylvania catastrophic health insurance plan for many years. Most major medical expenses are covered and subject to the deductible. Typical covered expenses are inpatient and outpatient hospital fees, emergency room charges, fees charged by doctors, surgeons and nurses, and radiation/chemotherapy treatments. Additionally, facility charges, CAT scans, MRIs, inpatient physician visits and prescriptions, and standard operating room and recovery room charges are also covered. This plan may lack some of the benefits of the “HealthGear” policy, but in many parts of Pennsylvania, it’s the lowest cost health plan available.
Aetna’s “Preventive & Hospital Care” policy is a low cost plan with $3,000 and $1,250 deductible options. It’s an HSA-eligible contract that provides comprehensive preventive benefits that are not subject to the deductible. Premiums are especially competitive in Central Pennsylvania.
We’re committed to finding the plan that best matches your specific budget and needs. To instantly view current rates, please click on the “Get Instant Quote” button at the top of the page. You can apply online for coverage or we can assist you. Please feel free to email or call us at (888) 513 6446. Your personal information is never shared with any other person or company.
Pennsylvania UnitedHealthcare health insurance plans are available through Pahealthinsurancecoverage.com, the state’s premier trusted resource for affordable Pennsylvania medical coverage. UnitedHealthcare offers affordable health care to individuals, families, the self employed, students and the uninsured. Whether your need is catastrophic, comprehensive, short-term or long-term, we’ll research all of the available plans. And the UnitedHealthcare rates you view on this site are guaranteed to be the lowest allowable by the state. We will discuss with you the impact of health care reform and how you can utilize some of the changes to reduce your premium.
Perhaps the most competitively-priced Pennsylvania UnitedHealthCare health insurance plan is the “Copay Select.” This policy utilizes the extensive UHC Network of doctors, hospitals, X-ray and lab facilities and other related providers. Premiums are reduced by approximately 40% compared to non-Network coverage, and the policy is designed to provide benefits similar to traditional employer plans. Rates are extremely competitive in the Pittsburgh and Philadelphia areas.
When a Network physician is used for an office visit, 100% of history and exam fees are covered at 100% after a $35 copay. X-rays and lab tests receive a negotiated fee reduction (for Network providers) that substantially reduces your out-of-pocket cost. Adult and child preventive care benefits are also provided after a 90-day waiting period on Pennsylvania UnitedHealthcare plans. Some of the included benefits are child immunizations, preventive mammogram, Pap Smear and PSA screening. Primary Care Physician and Specialist referrals are not required and comprehensive prescription coverage is included.
One of the premier low cost Pennsylvania health insurance policies is UnitedHealthCare’s “Saver 80” plan. Premiums are generally half the cost of a comparable comprehensive plan, while providing catastrophic coverage in the event of a major medical health insurance claim. The lifetime maximum benefit is a generous $3 million per person ($5 million is only $7 more) although recent health reform legislation will eliminate lifetime maximums. A wide range of deductibles from $500 to $10,000 is available and rates are guaranteed for 12 months.
The Pennsylvania “Saver 80” plan is ideal for early retirees wanting a bridge to Medicare or anyone wanting low-cost health care coverage in exchange for paying routine medical expenses out-of-pocket. Larger major medical benefits are covered, including room and board, professional fees of doctors, surgeons and nurses, intensive care unit, operating room and recovery room. Additional outpatient expense benefits are also provided such as outpatient surgery and emergency room fees for illness and injury.
An alternative Pennsylvania UnitedHealthCare plan is the “Copay Saver.” Premiums are quite affordable and major medical benefits provide coverage for catastrophic claims. But two office visits are also included (per person, per calendar year, including wellness visits) subject to a $35 copay. Generic prescription benefits are also included along with basic wellness and preventive care coverages.
UnitedHealthCare plans in Pennsylvania are offered through “Golden Rule Insurance Company.” Golden Rule is rated “A” by A.M. Best and “A+” by “Standard and Poors.” UnitedHealthCare processes 94% of their health insurance claims within 10 working days and offers one of the largest US Networks with more than 580,000 physicians and care professionals and 4,900 hospitals nationwide. So if you are traveling outside of Pennsylvania, you’ll still be able to use your coverage. Upon request, we’ll be happy to provide a list of local doctors and hospitals in any area of the country. Or, you can check online through the link provided at the end of this page.
To instantly view, compare or apply for Pennsylvania UnitedHealthCare medical coverage, please click on the “Get Instant Quote” button at the top of the page. Your personal information is never shared with any other person or company. You may also call us at (888) 513 6446. You’ll speak to a live person with 30 years of experience and not a customer service representative located outside of the area.
Pennsylvania health care reform information is updated regularly on this website. Pahealthinsurancecoverage.com is the state’s premier resource for current Pennsylvania health care reform information. There have been many changes, with dozens more being discussed. We’ll research and review these changes and discuss how they will affect your Pennsylvania health insurance coverage. Also, while you’re visiting the site, fell free to instantly view, compare or apply for affordable health care coverage. Simply click on the “Get Instant Quote button at the top of the page.
In March 2010, the US House of Representatives passed H.R. 3590 – The Patient Protection And Affordable Care Act and H.R. 4872 – The HealthCare and Education Reconciliation Act of 2010. Legislation starts going into effect in 2010, although much of the legislation will not be enacted until 2014 and later.
Pennsylvania Care Reform Changes For 2010
No Exclusion For Children
Pennsylvania health insurance companies will be prohibited from adding pre-existing exclusion riders to children’s coverage. This will apply to children AND adults in 2014.
Young Adults Can Stay On Parent’s Policy
Young adults may remain on their parent’s health insurance policy until age 26. Currently, many carriers require children that are not full-time students at age 19, to obtain their own coverage. This change will probably raise premiums to cover the extra risk.
No Lifetime Maximum
Lifetime caps will be removed from Pennsylvania health insurance plans. This portion of the reform bill will likely never affect you since individuals and families rarely exceed their maximum limit.
No Health Rescission
Health insurance companies will not be able to rescind policies when a person submits a claim. This practice, however, is rarely used.
Temporary High Risk Pool For Pennsylvania Residents
Pennsylvania health insurance reform will utilize a temporary national high-risk $5 billion pool to provide health insurance to Pennsylvania residents with pre-existing medical conditions.
Indoor Tanning Tax
Starting July 1, there will be a 10% tax on indoor tanning services. No kidding!
Preventive And Wellness Benefit Change
New Pennsylvania plans must offer wellness and preventive benefits without copays or deductibles. Currently, most comprehensive plans feature nominal copays but no deductibles on wellness coverage.
Pennsylvania Health Care Reform Changes For 2011
HSA Withdraw Change
HSA withdraws made before age 65 for nonqualified medical expenses will be subject to a tax of 20% (up from 10%). Archer Medical Savings Account withdraws will also increase to 20% (up from 15%).
Medicare Payroll Tax
Individuals earning more than $200,000 ($250,000 for married filing jointly) will see their Medicare payroll tax increase from 1.45% to 2.35%.
Pennsylvania Health Care Reform Changes for 2013
Less Paperwork
Health insurance plans must contain uniform standards for electronic exchange of medical information to reduce administrative costs and paperwork.
Flexible Savings Account Limit
Contributions to flexible savings accounts (NOT HSAs) will be limited to $2,500 per year (gradually increasing after 2013). Obviously, existing Pennsylvania HSAs will not be affected.
Hospital Insurance Tax
For Pennsylvania households earning more than $200,000 ($250,000 if married filing a joint return), the hospital insurance tax will increase 0.9%.
Pennsylvania Health Care Reform Changes for 2014
Pennsylvania Health Insurance Exchange
The Pennsylvania health insurance exchange must be created by 2014 and administered by a non-profit entity or government agency. The exchange will offer plans that meet stated required guidelines. We do not charge any fees for helping you find a plan in the exchange and the rate you receive will be the guaranteed lowest rate allowed by the state. Small employers will also be able to shop for plans. However, if you have no medical conditions, purchasing coverage outside of the exchange may be a better option. We will review all possible scenarios with you.
Change In How Your Rate Is Determined
Pennsylvania health insurance companies will be prohibited from denying coverage or charging higher rates based on medical condition, health status or prior claims experience. Premiums will vary by age, smoking status and other factors. Existing individual plans will not be subject to the new guidelines.
Tax Credits Will Help Pay Premiums For Exchange Plans
Tax credits will be given to individuals to help pay their Pennsylvania health insurance premiums. To qualify, household income must be between 100% and 400% of the federal poverty line. A family of four earning less than $88,000 per year would qualify for a partial credit. To receive the credit, you must purchase the policy. We’ll be happy to guide you through the process.
Get Health Insurance Or Pay A Fine
Pennsylvania citizens will be required to have “acceptable” coverage or pay a fine of $95 in 2014, $325 in 2015 and $695 in 2016. Children’s fines are half of those amounts with a cap of $2,250 per family. The government will decide what constitutes “acceptable coverage.” Failure to maintain coverage, however, will not result in criminal actions or fines. Penalties are absurdly too low and enforcement will have to be modified.
Pennsylvania Health Insurance Exchange Requirements
Any health insurance plan issued through the Pennsylvania health insurance exchange must provide medical benefits that include cost sharing limits. Coverage will be available in four benefit categories: Bronze (60% Coinsurance), Silver (70% Coinsurance), Gold (80% Coinsurance) and Platinum (90% Coinsurance). A lower-cost major medical catastrophic policy must be offered to individuals under 30 or any other individual that is exempt from the insurance requirement.
50 Or More Employee Requirement
Companies with 50 or more employees, must offer medical coverage to their employees or pay a $2,000 penalty. The fine is levied per employee (after 30) if at least one employee is receiving a tax credit. Waiting period for coverage to be effective is limited to 90 days.
Company Employee Exemption
Employees of a company who are exempt from individual responsibility for medical coverage, but don’t qualify for tax credits, can receive their employee contribution and buy coverage through the exchange. We offer free assistance when buying coverage through the health insurance exchange.
If you have any questions regarding Pennsylvania health insurance exchanges, health reform, or Pennsylvania health insurance plans, please call us at (888) 513 6446. You may also email us at eharris@pahealthinsurancecoverage.com
4-12-10 Update-No word yet on the exact date that high risk pools will be available. It should be in the Summer or Fall.
Additional Links:
Health Care Timeline
Health Care Section-By-Section Analysis
Congressional Budget Office Report
Affordable Central Pennsylvania Health Insurance Plans are available from most of the major health carriers such as Highmark Blue Shield, Capital Blue Cross, Aetna, HealthAmerica and UnitedHealthOne (formerly UnitedHealthCare). We offer health insurance plans to individuals, families, the self employed and the uninsured of Central Pennsylvania. The rates you view on our website are guaranteed to be the lowest allowable by the state and we’ll help research and find the policy that best meets your needs and objectives.
Central Pennsylvania health insurance rates are quite affordable compared to most parts of the state. Typically, rates in the Pittsburgh and Philadelphia areas tend to be approximately 10%-20% higher than Harrisburg area rates. Central Pennsylvania physician charges, hospital room rates and malpractice insurance premiums are generally lower than other parts of Pennsylvania, accounting for some of the difference. The Southeastern Pennsylvania area is served by Independence Blue Cross (IBX), who at one time was negotiating a merger with Highmark.
Each individual and family is different. Catastrophic coverage may be the best solution for certain situations, but not for others. That’s why we feel it is important to consider all of the available medical plans from all of the major companies, and not just a selected few. For many Central Pennsylvania residents, the following plans have been quite popular:
UnitedHealthOne’s Copay Select Plan is a comprehensive policy that provides unlimited covered office visits subject to a $35 copay. Both generic and non-generic prescriptions are covered, subject to a $3,000 annual maximum. A $3 million lifetime maximum benefit applies to each person. Many riders are available to increase prescription, lifetime maximum benefit and other coverages. Many preventive benefits are included without a waiting period. This health insurance plan has been a favorite of Central Pennsylvania residents for many years.
Aetna’s HMO 30 plan has no deductibles to meet on major claims. A $550 per day copay (five day maximum per admission) applies to hospital stays and only a $500 copay applies to outpatient surgery. Most office visits, lab tests, x-rays and preventive benefits are subject to low copays. Maternity benefits (including newborn services) are also included. Most prescriptions are covered and not subject to a deductible. Clearly, this policy is one of the top Central Pennsylvania health insurance options to consider if minimizing out-of-pocket cost is a priority.
Aetna’s PPO 5000 plan features $40 copays on covered office visits ($50 for specialist visits) with comprehensive prescription coverage subject to a $5,000 annual cap. Comprehensive preventive benefits are included without a waiting period. Premiums are generally very low because of the $5,000 deductible on major claims. A “PPO 2500” plan is also available, but the rate is not as competitive.
HealthAmericaOne’s HealthGear 5000 plan is an inexpensive catastrophic policy with some added benefits. Major medical expenses, primary and specialist visits and prescriptions are subject to a $5,000 deductible. However, preventive services, including gynecological exams, routine mammograms, well child and adult physical visits, and preventive pediatric and adult immunizations. This plan, along with UnitedHealthone’s “Saver 80” plan, are two of the most popular health insurance policies in the Central Pennsylvania area.
Highmark Blue Shield’s DirectBlue plan is a bit more expensive than its sister policy…the PPOBlue plan. Deductibles are low ($250 or $500 per individual) with a low 10% coinsurance after the deductible. Maternity coverage is included and subject to the deductible along with office visits. Preventive benefits (routine physicals, mammograms, pediatric immunizations etc…) are covered at 90% and not subject to a deductible. Prescriptions are subject to only a $100 deductible before copays of $10 or $20 apply.
Highmark Blue Shield’s PPOBlue plan is a major medical policy with individual deductibles ranging from $1,200 to $3,500. As an HDHP (High Deductible Health Plan), this policy qualifies for Central Pennsylvania Health Savings Accounts. Coverages are similar to the DirectBlue plan including many preventive benefits covered without a deductible. Prescriptions are covered at 90%, but subject to the deductible.
Of course there are hundreds of available health insurance plans to consider in addition to the six policies previously mentioned. We will carefully choose the plans that are best for you, and explain our reasons in detail. Our recommendations are always unbiased and we guarantee the rates are the guaranteed lowest allowable in the state. If government health insurance reform is passed, we will still continue to offer the same service.
To instantly view, compare or apply for coverage, please click on the “Get Instant Quote” button at the top of the page. Your personal information is never shared with any other person or company. You may also call us at (888) 513 6446.
Pennsylvania Highmark Blue Cross Blue Shield Health insurance policies are available at extremely affordable rates. As the premier resource for Highmark Blue Cross Blue Shield plans, we offer the guaranteed lowest allowable Pennsylvania rates for Highmark plans. Specific policies are designed for different situations, and we’ll be glad to research and review your options to provide you with the lowest cost, yet highest-quality policy options. Highmark provides coverage for the 29 counties of Western Pennsylvania.
PPOBlue & DirectBlue
The two most comprehensive Highmark plans are PPOBlue and DirectBlue. Both plans provide comprehensive benefits, preventive care services, prescription coverages and access to the large network of Highmark Blue cross Blue Shield doctors and hospitals. The biggest differences in the two plans are the deductible options. PPOBlue offers individual deductible choices of $1,200, $2,600 and $3,500 and qualifies as an HAS plan. DirectBlue offers lower deductible options of $250 and $500, but rates are generally higher.
PPOBlue & DirectBlue Coverages
Pennsylvania Highmark PPOBlue and DirectBlue plans include many preventive care coverages, including routine physicals, pap tests, gynecological exams, mammograms and pediatric examinations. These benefits are not subject to a deductible (Policy pays 90% of covered expense). Additional coverages include office visits, inpatient hospital services, maternity services, diagnostic services and emergency care, which are covered at 90% after the deductible has been met.
PPOBlue pays 90% of prescription drug expenses after the deductible has been met. There is a $50,000 calendar-year maximum and you must stay “In-Network” to use utilize the benefit. DirectBlue pays 100% of prescription drug expenses after a low $100 deductible has been met. A $10 generic and $20 brand name copay applies to the coverage. The calendar-year maximum is also $50,000.
Additional Benefits
Both Blue Cross Blue Shield plans feature a lifetime policy maximum benefit of $5 million along with additional benefits of diagnostic services, spinal manipulations, occupational and speech therapy and physical medicine. Mental health services and substance abuse rehabilitation expenses are not covered. Discounts are included on health-related services such as massage therapy, personal trainers, nutritional counseling and fitness centers and spas.
Since Pennsylvania Highmark Blue Cross Blue Shield plans are medically underwritten, when applying for coverage, an application must be submitted, although no physical is required. We’re experienced in helping you with the application process and working to expedite the approval of your policy. There are never any fees for our services and we will continue to provide unlimited support for as long as you own your policy. For additional information including current rates and applying for Highmark coverage, please call us at (888) 513 6446 or email eharris@pahealthinsurancecoverage.com.
Helpful Links:
Highmark PPOBlue & DirectBlue Rates
Highmark Blue Cross Blue Shield Provider Directory (Doctors or Medical Professionals)
Highmark Blue Cross Blue Shield Provider Directory (Hospitals or Facilities)
Highmark PPOBlue & DirectBlue Benefit Details
| | | |
| Services | PPOBlue, An Individual Comprehensive
Major Medical Preferred-Provider
High-Deductible Health Plan;
$3,500 Individual/$7,000 Family Deductible;
Medically Underwritten | DirectBlue, An Individual Comprehensive Major Medical Preferred-Provider Health Plan; $500 Individual/$1,500 Family Deductible; Medically Underwritten |
| | Network | Out-of-Network | Network | Out-of-Network |
| Benefit Period | Contract Year | Contract Year | Contract Year | Contract Year |
| Type of Coverage | Medically Underwritten | Medically Underwritten | Medically Underwritten | Medically Underwritten |
| Deductible - Individual | $3,500
Includes out-of-network benefits | Choice of network deductible applies to out-of-network benefits | $500 | $500 |
| Deductible - Family | $7,000
Includes out-of-network benefits
Family deductible must be met in full before benefits are payable | Choice of network deductible applies to out-of-network benefits | $500 per person with a maximum of $1500 | $500 per person with a maximum of $1,500 |
| Out of Pocket Maximum (does not include deductible) - Individual | $1,500 | $3,000 | $1,500 for network and out-of-network covered services combined | $1,500 for network and out-of-network covered services combined |
| Out of Pocket Maximum (does not include deductible) - Family | $3,000 | $6,000 | $4,500 for network and out-of-network covered services combined | $4,500 for network and out-of-network covered services combined |
| Coinsurance (only applied after any applicable deductibles have been met) | 90% | 70% | 90% | 70% |
| Lifetime Policy Maximum | $5,000,000
Includes out-of-network payments | $300,000
Included as part of network maximum | $5,000,000
Includes out-of-network payments | $300,000
Included as part of network maximum |
| Benefit Period Maximum | $1,000,000
Includes out-of-network payments | Included as part of network maximum | $1,000,000
Includes out-of-network payments | Included as part of network maximum |
| Hospital Facility Expense - Inpatient
(includes Maternity) | 90%
Includes maternity | 70%
Includes maternity
Limited to 90 days/benefit period | 90%
Includes maternity | 70%
Includes maternity |
| Emergency Room Care | 90% | 90% | 90% after $40 copayment
(waived if admitted) | 90 % after $40 copayment (waived if admitted) |
| Office/Home Visits | 90% | 70% | 90% | 70% |
| Medical/Surgical Expenses
(except office visits) | 90% | 70% | 90% | 70% |
| Preventive Care | Routine Physicals, Gynecological Exam, Pap Test, Mammogram and Pediatric Immunizations.
Deductible does not apply - 90% | Not Covered | Routine Physical and Mammogram
Gynecological Exam and Pap Test
Pediatric Care
Pediatric Immunizations
Adult Immunizations
90% - deductible does not apply | Not Covered |
| Diagnostic Services
( X-ray, lab, other tests) | 90% | 70% | 90% | 70% |
| Physical Medicine | 90%
15 visits per contract year | 70%
Included as part of network visits | 90%
15 visits per calendar year | 70%
Included as part of network visits |
| Occupational and Speech Therapy | 90%
Combined 15 visits per contract year | 70%
Included as part of network visits | 90%
Combined 15 visits per calendar year | 70%
Included as part of network visits |
| Spinal Manipulations | 90%
10 visits per contract year | 70%
Included as part of network visits | 90%
10 visits per calendar year | 70%
Included as part of network visits |
| Mental Health Services | Not Covered | Not Covered | Not Covered | Not Covered |
| Substance Abuse - Rehabilitation | Not Covered | Not Covered | Not Covered | Not Covered |
| Substance Abuse - Detoxification | Not Covered | Not Covered | Not Covered | Not Covered |
| Prescription Drug | 90%
$50,000 contract year maximum | Not Covered | $100 deductible per calendar year
$10 generic, $20 brand
$50,000 calendar year maximum | Not Covered |
| Discounts on Health-Related Services - Fitness Centers & Spas
- Massage Therapy
- Nutritional Counseling
- Personal Trainers
| Covered | Covered | Covered | Covered |
| Blues On Call
-Health Information and Support Toll-Free Hotline | Covered | Covered | Covered | Covered |
| Vision* | Not Covered | Not Covered | - Eye exam every two years - 100% -- Deductible Does Not Apply
- Discounts on lenses and frames, non-prescription sunglasses & Laser Vision Correction
- Davis Vision Provider Network Only
- Benefit does not apply towards deductible
| None |
| | | |
Pennsylvania Independence Blue Cross (IBX) has offered affordable high-quality health insurance plans to Pennsylvania residents for more than 60 years. IBX is the Philadelphia region’s largest health insurance company and serves the Philadelphia area and Southeastern Pennsylvania.
As Pennsylvania's premier trusted resource for affordable health care, we proudly represent Independent Blue Cross and offer IBX coverage at the lowest available rates. We'll take the time to review each plan and determine which policy best fits your budget and provides the coverage you need. You can easily apply for coverage online from this website. We are also happy to send or email you the application.
The two available types of Keystone HMO policies are “deductible” and “copay” plans. The Blue Cross “deductible” plans are the HMO $5,000, HMO $2,500 and HMO $1,500 plans. “Deductible” plans are the most affordable type of coverage, since the insured incurs a higher out-of-pocket expense on major claims. After the deductible, the insured is responsible for 30% of medical expenses, subject to maximum limits.
The Blue Cross “copay” plans are the HMO $20, HMO $15 and HMO $10. “Copay” plans are more expensive since there is no major deductible to meet. Instead of a deductible, a small ($100-$400) copay per day is charged. However, to reduce your expenses, there is a maximum of five copays per admission.
Both types of Pennsylvania Keystone HMO plans feature preventative services that are not subject to a deductible. Some of the covered services include mammograms (no referral required), pediatric immunizations, outpatient lab/pathology and routine gynecological exams. Routine eye care exams are also included (once every two years and subject to a copay).
Routine primary care and specialist office visits are covered with copays ranging from $10-$50. The “HMO Copay” plans will feature slightly lower copays than the “HMO Deductible” plans. Spinal manipulations and physical/occupational therapy are also covered expenses with copays starting as low as $20. Both HMO plans allow one routine eye care exam every two years.
Pennsylvania Independence Blue Cross Keystone HMO plans offer very comprehensive prescription coverage. However the “HMO deductible” plans do not require that you meet a deductible before using RX benefits. Copays range from $10 to $50. However, “HMO Copay” plans have deductibles ranging from $100 to $250 on each of their policies. Out-of-pocket expenses tend to be slightly less on non-generic prescriptions. Both types of plans have a yearly RX maximum of $2,500 per person and $5,000 per family.
Keystone HMO exclusions are typical for standard Pennsylvania health insurance plans and include services not medically necessary, treatment of substance abuse or mental illness, acupuncture, dental care, cosmetic services and private duty nursing. A complete list can be found in the “Benefits Summary.”
For additional information on any of the Independence Blue Cross Keystone HMO plans, please call us at (888) 513 6446. If you would like to instantly view, compare or apply for coverage, please click on the “Get Instant Quote” button at the top of the page. Your personal information is never shared with any other person or company.
There are many types of Pennsylvania health insurance plans. “Catastrophic” and “HSA” plans will tend to be the least expensive options, but feature high out-of-pocket costs to the insured. “Comprehensive” plans offer lower out-of-pocket costs on the most common claims, but are the most expensive type of coverage.
Pennsylvania comprehensive health insurance plans cover the standard inpatient major medical items such as room and board, intensive care unit, recovery room, operating room, prescription drugs and professional fees of doctors, surgeons and nurses. Outpatient expense benefits include facility and hospital fees for outpatient surgery, surgeon and assistant surgeon fees, emergency room fees for illness and injury, some mental and nervous disorders and X-ray and lab fees performed at network facilities.
But Pennsylvania comprehensive health insurance plans provide coverage for many additional items. Traditionally, office visits (primary care and specialist) and prescriptions (generic and non-generic) are covered expenses along with wellness/preventative care expenses. Some specific Pennsylvania wellness/preventative coverages include preventative mammograms, pap smears, PSA screenings, child immunizations and annual physicals.
Most major Pennsylvania health insurance companies offer comprehensive health care plans. Aetna, UnitedHealthOne, Blue Cross and HealthAmerica offer extremely competitive rates on their comprehensive plans. This type of coverage is typically available in either a PPO (Preferred Provider Organization) or an HMO (Health Maintenance Organization). With a Pennsylvania PPO, you can see any doctor or visit any hospital within the preferred network of providers. “Out of Network” providers will pay lower benefits. An HMO may provide a broader coverage, but with smaller Network availability.
Some of the most comprehensive Pennsylvania health insurance plans include HealthAmerica’s Copay 100% plan, Aetna’s HMO 20 and HMO 30 plans, UnitedHealthOne’s Copay Select Plan, Blue Cross’ KeystoneBlue HMO and Blue Cross’ Keystone Health Plan East’s HMO. Of course, there are other comprehensive plans that may be your best option, depending on your specific situation.
To instantly view, compare or apply for Pennsylvania’s best health plans, please click on the “Get Instant Quote” button at the top of the page. (Not all Blue Cross plans will be included in the quote because of software restrictions. But we’ll be happy to review any Blue Cross/Blue Shield plan with you)
Pennsylvania BlueCare Direct Advantage health insurance plan is available through Pennsylvania’s premier resource for affordable health insurance…Pahealthinsurancecoverage.com. This plan is issued through Blue Cross of Northeastern Pennsylvania, and is ideal if you are self-employed, retired, just out of college or without health care benefits.
BlueCare Direct Advantage is a qualified high-deductible health plan that provides benefits often not covered under other individual/family plans such as preventative health services, maternity and wellness programs. And because it is considered a high-deductible health plan (HDHP), you can combine a Pennsylvania Health Savings Account (HSA) with the policy. An HSA is a portable savings account that allows you to pay for current health care expenses and save for future qualified health care expenses on a tax-free basis.
The preventative care coverage is quite extensive and is not subject to deductibles OR copays. Adult (medically necessary) and childhood immunizations are included along with routine gynecological examinations. Popular preventive services such as mammograms, colorectal and prostrate screenings and pap tests are also covered in full.
The Pennsylvania BlueCare Direct Advantage health insurance plan also offers non-preventative office visit and prescription coverage, but they are subject to a deductible. Once the deductible has been met, 80% of the cost of office visits is paid by the policy. Prescriptions are subject to copays ranging from $0 to $65, depending on the “tier” classification. By purchasing prescriptions through mail order, the out-of-pocket cost will be less.
BlueCare Direct Advantage features a $2 million lifetime maximum, which is adequate coverage compared to what many other plans offer. The two available deductible options are $1,750 and $3,000. A traditional 20% coinsurance applies after the deductible.
Premiums are quite affordable compared to other Blue Cross plans. As an example, for a healthy 34 year-old male choosing the higher deductible option, the monthly premium is only $108. The rate for a healthy 44 year-old male is only $152. Female rates are higher for ages under 55. If you do not qualify for the rate for which you apply, you may be eligible for coverage at a higher rate.
To apply for coverage, please call us at (888) 513 6446, email us at eharris@pahealthinsurancecoverage.com or fax the application to (888) 513 6446 (Attn: Ed Harris). Pahealthinsurancecoverage.com is the premier resource for affordable Pennsylvania health insurance. Any information you provide is never shared with any other person or company.
BlueCare Direct Advantage Benefits
BlueCare Direct Advantage Rates
