Pennsylvania BlueCare Direct Advantage health insurance coverage was previously offered through our website at the lowest published prices. This plan was issued through Blue Cross of Northeastern Pennsylvania (BCNEPA), and was ideal if you are self-employed, retired, just out of college or without healthcare benefits. The plan is no longer available since BCNEPA merged with Highmark. We offer unbiased help so you can understand the plans and if they are your best option, apply for coverage.
You previously could purchase this plan if you resided in the following counties: Tioga, Lycoming, Clinton, Sullivan, Bradford, Wyoming, Carbon, Susquehanna, Pike, Wayne, Lackawanna, Luzerne and Monroe. If you lived in a different county, you were still able to apply for a Blue Cross plan in a different area.
BlueCare Direct Advantage is a qualified high-deductible plan that provides benefits often not covered under other individual/family contracts 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 HSA with the policy. (The Affordable Care Act mandates preventive services on all plans) This policy is underwritten by First Priority Life Insurance Company and by using the Blue Card, your coverage can potentially expand to outside the US.
An HSA is a private savings account that allows you to pay for existing health care expenses and save for future qualified expenses on a tax-free basis. It also contains certain investment and retirement features not found in most other types of policies. Because of their unique feature, you can often save thousands of dollars in premiums over your lifetime. But you are under no obligation to set up the savings portion of the coverage. About half of all policyholders waive that feature. Once eligible for Medicare, additional deposits can not be made, although accumulated funds can be used for qualified expenses.
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 at 100%. There are also several lab tests and screenings that may be considered “preventive.
Maternity And Non-Preventive Benefits
Many maternity-related expenses have also been recently added. Additional coverage added includes autism screening, obesity screening and counseling, vision acuity screening, alcohol and drug use assessment, and behavioral counseling for skin cancer. As more current mandates are passed by the state or federal government, they will be added to the policy.
The policy 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. And there are no lifetime caps on the prescription benefits. Tier 3 and Tier 4 drugs will result in the highest out-of-pocket costs.
Also, mental health, substance abuse and nutritional counseling benefits are provided, which is not found in non-qualified plans. Typically, you need to purchase an HMO, Marketplace, or employer-sponsored policy to obtain these benefits.
The policy features unlimited lifetime benefits, which is now standard on most contracts. The three available deductible options are $1,750 and $3,000 and $5,000. A traditional 20% coinsurance applies after the deductible. Once the deductible and coinsurance are met, covered benefits are payable at 100%. This is a nice money-saver compared to some of the 30% plans. Optional 10% and 0% coinsurance is also offered. If you tend not to use your policy very often, this plan might be a good choice. However, if multiple chronic conditions exist, an alternative option should be considered.
Cost Of Policy
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 $74. The rate for a healthy 44-year-old male is only $98. 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. And by using the trademarked BlueCard, you can utilize coverage in most parts of the US.
Recently, A. Paul Holdren, the Senior Vice President of BCNEPA, announced rate reductions between 7% and 17% that were expected to save customers millions of dollars. Customers that don’t benefit from decreases should still see their premiums remain level instead of the usual increase. Lifestyle management programs that were recently implemented are given credit for much of the savings.
Blue Health Solutions is an innovative unique program that helps customers stop smoking, eat healthier and manage chronic illnesses. Nurses and dietitians are among many specialists involved in this new idea. Since nicotine usage is still an underwriting determinant for the cost of coverage, the cessation of smoking will reduce premiums.
To apply for coverage, please call us, contact us by email, or fax the application to the same number. We will help you research and compare the most reputable options.
A December renewal offer was mailed to many small group policyholders offering an extension of coverage to December 31, 2014. An agreement form is available and would need to be signed and returned. Health Equity required plan amendment charges and costs will be paid by Blue Cross of NEPA including administration employment fees.
For groups not wanting to renew coverage, one of the new Blue ACA Metal options will need to be selected. Open Enrollment began on October 1st.
All good things must come to an end! And the BlueCare Direct Advantage from BCNEPA was one of the many casualties from the ACA legislation. Since benefits did not meet federal guidelines, the policy has been removed for purchase, and is not available on state or federal Marketplaces.
In its place are several policies, that although not identical, can be easily purchased. They are myBlue Access LP $4,500, myBlue Access $2,500, myBlue Access LP $3,000, and myBlue Care. Thus, DO NOT fax the application previously mentioned. We’ll provide a more current version upon request.
A breach-of-contract lawsuit for $90 million has been filed against Blue Cross of Northeastern Pennsylvania (now Highmark). The class-action lawsuit claims that between 2012 and 2014, money that should have been given back to policyholders in the form of profits, was instead spent on other expenses.
As a nonprofit company, any excess earnings must be returned to policyholders. However, Highmark indicated that the money was indeed correctly spent on various wellness and medical needs in the area. Plains Township is also part of the lawsuit.