Pennsylvania HealthAmerica health insurance rates are extremely competitive in most parts of the state. Although high deductible plans are the most popular policy, one particular comprehensive plan stands out. They have featured premium policies since the mid 1970s and their copay 100% plan has lower out-of-pocket costs than almost every other available Pa plan.
The parent company, Coventry, is a recognized leader in US medical plans. Among their customer-friendly benefits is the ability to speak live to a Nurse Case Manager. Although they can not provide specific details about a claims issue, they can assist with medical condition concerns. Of course, HIPAA regulations must always be followed.
Copay 100% Plan
Primary care office visits feature low $20 or $25 copays ($40 or $50 for specialists). Unlike “Value” plans, there is no limit to the number of covered office visits during the year. Prescription copays are $15 (Generic), $35 (Non-Generic) and $60 (Non-Formulary). A low $100 ($300 family) applies and there is no cap on the amount of benefits paid. Of course, mail order can be utilized. These contracts closely mirror group policies that are offered by large employers.
Perhaps the most attractive feature about the Copay 100% policy is the lack of a deductible or coinsurance on Network major medical claims. The only listed out-of-pocket expense is a $350 or $500 per day hospital care charge for the first five days, a $200 copay for outpatient surgery and a $200 copay for an MRI, CAT or Ultrasound. The lifetime maximum benefit is unlimited. Lab services are 100% covered while x-rays are subject to a $40 deductible.The structure of the contract is actually very similar to an individual Aetna HMO plan.
If you want to minimize what you potentially may have to pay on a hospital visit, you'll like this policy. It is the closest match to a "Platinum" Metal option on the Exchanges. The "Gold" Metal plan would be the next closest policy that is offered. It will be very popular for policies that include children.
Covered By Coventry?
If you were covered by a Coventry Group policy through work, and that coverage ended, you may be eligible for a conversion to a personal policy and you would not have to qualify medically. Whether you are disabled or suffer from chronic disease, you may be automatically accepted. Typically, you have 31 days from receiving the notice and approximately 90 days from leaving your employer.
New Pa Exchange Options
In 2014, you will also be able to switch policies from one carrier to another, without evidence of insurability. However, it will only be during Open Enrollment periods that you can utilize this new change.
Preventative coverage is included with no out of pocket costs or waiting period. Some of the included preventative coverages include gynecological exams, adult physicals, routine mammograms, well-child visits and routine pediatric immunizations. There are many additional preventive benefits that can be found in a policy spec sheet.
Each year the Department of Health and Human Services reviews existing free services and often adds additional options. This should continue beyond 2014, regardless of which political party holds office. Some of the most recent additions are mandatory maternity benefits and breast-feeding counseling and information. These changes are part of the Affordable Care Act legislation.
Optional Choice 1 PPO
The Choice 1 PPO plan is a less expensive option than the Copay 100% plan. However, visits to a specialist will be subject to the deductible instead of a copay (although a negotiated discount will help). Non-generic prescriptions also have a higher cost, but the total policy savings does make it worth considering. The Choice 1 plan can potentially cost you more out of pocket money if you have a serious illness.
But, you save money each month on your premium payments. So you may actually put more cash in your pocket at the end of the year, despite paying a few more dollars in copays. It's a "risk-reward" analysis and we can help you understand which option to select.
Most of the options are ideal for individuals, families, the self employed, uninsured, students or anybody on COBRA. Policies can be specifically molded to meet almost any person's personal budget and coverage needs. Small and large business owners often offer coverage like this to their employees.
HealthAmerica is one of many large reputable companies including United Healthcare, Highmark Blue Cross Blue Shield, UPMC, Capital Blue Cross, Independence Blue Cross and Aetna. The Copay 100% plan is not the right fit for all situations, but should be considered when comprehensive coverage with low out-of-pocket costs is a priority.
To compare Pa HealthAmerica options, we have provided a free quote section on the top of the page. You'll be able to review plans along with other reputable carriers and apply for a policy. We give you more than three decades of experience and the quickest methods to purchase the benefits you need.
UPDATE: In 2013, HealthAmerica was acquired by Coventry Health Care (who was previously acquired by Aetna!). The cost of the purchase was more than $7 billion. Aetna and Coventry offer individual and family medical plans both on and off the Marketplace. Our website continues to offer these policies at the lowest available prices.