Out of a Job? Looking for health care benefits and options?

Out of a Job?Looking for health care benefits and options?

www.insurance.state.pa



For many people, having health insurance is essential. With medical care costs ever increasing, health care coverage can be expensive, especially for those in the process of seeking employment. For those with pre-existing conditions, the situation becomes even more difficult.

50 percent of all bankruptcy filings are at least in part, if not entirely as the result of medical expenses. In the US, someone files for bankruptcy after a serious health problem an average of every 30 seconds. Those that do file for bankruptcy carry an average of $12,000 out-of-pocket medical debt.

Don’t take risks! Though costly, securing health insurance coverage while out of a job will greatly reduce this possibility from happening.



Before reviewing your options, there are three very important things that need to be stressed…Time! Time!! Time!!!

COBRA = 60 day limit to elect to continue coverage under your old job, and 45 days to pay your first premium. Don’t lose this right because of time.

PA Conversion Rights = 31 day limit for the insurance company to receive an application for an individual conversion policy. Don’t lose this conversion right because of time.

HIPAA Conversion Coverage = 63 day limit from the end of your employer group health plan to when Blue Cross Blue Shield receives your HIPAA conversion application. Don’t lose this conversion right because of time.

Time is of the essence, so ACT QUICKLY!



Spousal Coverage

Even if the benefit year has begun, under federal law, you and your children have 30 days to join your spouse’s group if otherwise eligible due to a ‘major event’ to include losing your own group health insurance benefits.

This option may be much less expensive than COBRA.



COBRA

Consolidated Omnibus Budget Reconciliation Act allows workers to maintain their health insurance for up to 18 months IF the employer is required to offer COBRA continuation coverage.

Employers who provide group health plans to their employees with 20 or more employees on more than 50% of its typical business days in the previous calendar year are required to offer COBRA (some exceptions apply).



COBRA can be expensive, however there are some critical advantages to enrolling:

• No lapse in coverage• Eligibility for HIPAA conversion without any pre-existing condition

exclusions after COBRA is exhausted• Generally speaking, group plans offer better benefits than individual

policies

Should you questions or concerns about obtaining COBRA, contact the US Department of Labor online at:

www.dol.gov/ebsa

Or call:

(215) 861-5300, or toll free at 1-866-275-7922



Federal HIPAA Conversion Rights

If you have health issues, HIPAA conversion may be something to seriously consider. Like COBRA, HIPAA policies can be expensive. However, they are issued without pre-existing condition exclusions and is guaranteed issue if you are eligible.

There are two options available: Standard and Comprehensive.

Warning: Please keep in mind that because there are no pre-existing conditions, this does not mean that the policy will cover everything your group plan covered.




If your employer was required to offer COBRA coverage, you must enroll and exhaust COBRA before being considered for HIPAA conversion (it is highly recommended that you obtain your HIPAA conversion information and application before COBRA ends)

You may only obtain a HIPAA conversion policy through the Blue Cross/Blue Shield company that sells coverage in the county in which you live. When requesting information and an application, make sure to document the date, time and name of person you talked to.

You have 63 days from the end of your group or COBRA coverage for your application to be received. If you submit your application within this 63 day window, you will have a lapse in coverage before your HIPAA conversion policy starts.




To qualify, you need at least 18 months of prior continuous coverage and will need a ‘certificate of creditable coverage’ from your last employer’s insurer when applying (note 18 months of COBRA satisfies this requirement).

Certificates of creditable coverage are sometimes difficult to obtain, or obtain in a timely manner. You can prove you had 18 months of continuous coverage by submitting pay stubs from your previous employer showing your health care deductions, or by submitting your explanation of benefits forms.

Warning: Keep track of ALL applications. Use certified mail/signature required forms of mail to ensure that nothing is ‘lost’.




When requesting an application from your Blue Cross/Blue Shield company, it is critical that you specifically ask for information regarding HIPAA conversion. Failure to do so may result in you being sent an application for a medically underwritten policy which might result in a denial of coverage as well as cause you to miss your 63 day window.

The US Department of Labor regulates HIPAA. For any questions or concerns you may go to the following website:

• www.dol.gov.ebsa and select Employee Benefit Administration• Click Publications/Reports on the left side of the screen• Under ‘Health Section’ click “Your Health Plan & HIPAA, Make the

Law Work for You”

Or call (215) 861-5300, or toll free at 1-866-275-7922



Pennsylvania State Conversion Rights

If your employer group health plan was provided under a fully insured health plan and was issued in Pennsylvania, you may be eligible for an individual conversion policy under the Pennsylvania State conversion law. Not all employer group plans are required to offer this individual conversion policy.

It is recommended that you call the insurance company providing your employer’s group health plan and ask if it is required to offer individual conversion policies under PA Conversion law. If so, request information and an application be sent immediately.

As with HIPAA conversion, you must elect and exhaust COBRA if offered before being considered for a conversion policy, and your application must be received, and your first premium paid within 31 days of notification of your conversion option.



Pennsylvania State Conversion Rights

The benefits of a policy under PA State conversion law is that there will be no pre-existing condition exclusions unless the pre-existing condition was excluded by your previous group policy.

The effective date of conversion will be the day following the termination of your group or COBRA coverage, so there exists no lapse in coverage. Any dependents covered by your group policy are also eligible for conversion.

Even without pre-existing condition exclusions (unless excluded from your previous group policy), please keep in mind a conversion policy is only required to provide basic health benefits and they may be considerably less than what your group plan offered.

Note that policies issued under PA State conversion law is done so by individual insurance companies, not the state or the Blues.



Guaranteed Issued Health Plans

If you are not eligible for COBRA continuation coverage, Federal HIPAA conversion, or conversion under PA state law and have health issues, you should seriously consider a guaranteed issued health plan provided by your Blue Cross/Blue Shield company.

Note, guaranteed issued health plans will have pre-existing condition exclusions, which should expire after 12 months. Confirm this timeframe with the Blue Cross/Blue Shield company.

When requesting an application from your Blue Cross/Blue Shield company, it is critical that you specifically ask for information regarding Guaranteed Issued Policies. Failure to do so may result in you being sent an application for a medically underwritten policy which might result in a denial of coverage if you have health issues.



Low Income Health Plans

As part of their social mission, Blue Cross/Blue Shield companies provide health plans for low income individuals. The cost of these plans are subsidized by the Blues, and therefore are less expensive. Contact your Blue Cross/Blue Shield company for eligibility information, as well as inquire about pre-existing condition exclusions and length they may apply.

Please note that low income health plans do have limited benefits, however they are good avenues to pursue for good basic health care coverage.



adultBasic

adultBasic provides basic health care coverage for adults between 19 and 65 and is provided by the Commonwealth of PA.

You must have gone without insurance for 90 days prior to enrollment except if you or your spouse lost health coverage because you are no longer employed.

adultBasic does not currently have pre-existing condition exclusions, but it also does not provide prescriptions, vision or dental treatment.

There is presently a waiting list. However, if eligible and on the waiting list you can purchase coverage at cost which may be considerably less than an individual policy from an insurance company. For more information visit:

www.insurance.state.pa.us or call 1-800-462-2742



CHIP

If you lost your employer group health insurance coverage on your children, or they are without health insurance coverage for any reason, Pennsylvania CHIP covers all uninsured children and teens. There is no income eligibility requirements and premiums will be charged based on a sliding scale.

www.chipcoverskids.comOr call:

1-800-986-5437



MEDICAID

Medicaid is available to those whose income and assets are insufficient to pay for health care. Information about the PA Department of Welfare’s Medicaid Program can be obtained from your county assistance office or you can visit:

www.dpw.state.pa.us

Veterans Health & Prescription Benefits

If you are a military Veteran, you may be eligible for Veteran’s Administration (VA) health and prescription benefits. Contact your nearest VA medical care facility. You may also visit the Veterans Benefits Administration website:

www.va.gov

Or call:

1-800-827-1000



Partnership for Prescription Assistance Program

This program offers a single point of access to 475 public and private patient prescription assistance programs, including more than 150 prescription programs offered by pharmaceutical companies. Pharmaceutical companies, doctors, health care providers, patient advocacy organizations & community groups help qualifying patients obtain medicine they need:

www.PPARx.org

Or call:

1-888-477-2669

Pennsylvania Patient Assistance Program

For those who are 55 or older or adults with disabilities, with little or no prescription coverage. The program helps individuals find out about and apply for free prescriptions. 1-800-955-0989



PACE, PACENET & PACE PLUS MEDICARE

Pennsylvania’s prescription program for older adults, offering low-cost prescription medication to qualified residents 65 and older.

PACE – you must be 65 or older, a PA resident for at least 90 days before applying, and cannot be enrolled in the PA Dept of Public Welfare’s Medicaid prescription program. Income limitations may apply.

PACENET – The same eligibility requirements as PACE but with higher income limits so you may qualify if not eligible for PACE.

PACE Plus Medicare – Supplemented by Federal Medicare Part D prescription coverage, this program offers the most generous prescription plan in the United States.

For more information, call the PA Dept of Aging at (717) 772-2730 or visit:

www.aging.state.pa.us



Prescription Discount Cards

Ask your local pharmacist about any discount programs they may have or if they sell prescription discount cards. Ensure that the discounts you receive will exceed what you pay for the discount card and that they cover your prescriptions. Be wary of buying discount cards not offered directly through a pharmacy.

Veterans Prescription Benefits

If you are a military veteran, you may be eligible to make an application to receive VA prescription/health benefits. 1-800-827-1000, www.va.gov

Costco/Wal-Mart etc Prescription Programs

Though not endorsed by the PA Insurance Department, you may be able to find prescriptions at bargain prices through retail chains. Make sure you shop around and compare apples to apples when deciding which options are the least expensive.



Dental Insurance or Dental Assistance

If you are looking to purchase dental insurance, consult with a local insurance agent to discuss your dental insurance needs. If you do not have coverage but require dental assistance you may find a free or reduced fee dentist through the Pennsylvania Dental Association at (717) 234-5941.

The PA Dental Association also lists free and reduced fee dental offices on their website at:

www.padental.orgOn the right of the screen find ‘Patients’

Click “Find Free/Reduced Fee Dental Clinics



Blue Cross of Northeastern Pennsylvania

1-800-829-8599

TDD 1-866-280-0486

Counties served: Bradford, Carbon, Clinton, Lackawanna, Luzerne, Lycoming, Monroe, Pike, Sullivan, Susquehanna, Tioga, Wayne, Wyoming

Highmark Blue Cross Blue Shield

1-800-876-7639 ( Non Members)

1-800-544-6679 ( Current Members)

Counties Served: Allegheny, Armstrong, Beaver, Bedford, Blair, Butler, Cambria, Cameron, Centre, Clarion, Clearfield, Crawford, Elk, Erie, Fayette, Forest, Greene, Huntingdon, Indiana, Jefferson, Lawrence, McKean, Mercer, Potter, Somerset, Venango, Warren, Washington, Westmoreland



Independence Blue Cross215-569-8189 (Within the five-county Philadelphia area)1-800-556-5455 (Outside of the five-county Philadelphia area)Counties Served: Bucks, Chester, Delaware, Montgomery, Philadelphia

Highmark Blue Shield 1-888-269-8412 (Non Members)1-877-986-4571 (Current Members)Counties Served: Adams, Berks, Centre, Columbia, Cumberland, Dauphin,

Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union, York

Capital Blue Cross1-800-962-2242Counties Served: Adams, Berks, Centre, Columbia, Cumberland, Dauphin,

Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union, York



Health policy conversion can be a very complicated process. There may be many questions and concerns that you have specific to your individual experience. If you do, or you feel you were treated unfairly or misled while trying to obtain continued health insurance coverage, do not hesitate to contact the Insurance Department’s Bureau of Consumer Services:

Automated Consumer Hotline: (877) 881-6388

Harrisburg: (717) 787-2317 TTY/TDD (717) 783-3898

Philadelphia: (215) 560-2630 TTY/TDD (215) 560-2471

Pittsburgh: (412) 565-5020 TTY/TDD (412) 565-2376

Or visit: www.insurance.state.pa.us

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Out of a Job? Looking for health care benefits and options?