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There’s so much to consider when you look at health care plans that it can be something of a headache. Let’s take a look at some of the basics, so you know what you don’t have to worry about. You’ll be glad to know that some important things are already covered in all plans, so you can get good coverage for a good price. Under Pennsylvania law, every health plan must cover some important procedures.

First, they all must cover mammograms and cervical cancer screenings. Post-delivery care is another coverage requirement. Diabetes care cannot be excluded from a plan either. Children’s vaccinations also must be covered.

Mental health conditions are mandated to be covered at the same level as physical health conditions. Under federal HIPAA law, you cannot be excluded from any insurance plan if you have just left an employer’s groups health care plan and meet some other requirements. Group health plans are subject to a nondiscrimination requirement. This means that your employer’s plan cannot exclude you, limit your coverage, or raise your rates based on your health status.

There are limits to exclusion based on pre-existing conditions as well. The law defines what is a pre-existing condition and places time limits on how long you can be excluded. If you do not have a long time lapse between plans, your old plan will be credited to the pre-existing condition exclusion period. If you leave your job, you may be eligible for COBRA continuation coverage or state continuation coverage, meaning you can stay on your group health plan for a period of time.

These plans have rate limits and are useful when someone has a time lapse between jobs or retires early. A small employer group insurance plan has guaranteed issue, so an insurer cannot turn down a group due to any pre-existing conditions or risk factors within the group. The same groups cannot be excluded or charge higher rates due to any genetic information about or family history of any group members; insurers cannot enquire about these factors. Employers may require a waiting period before you join a group plan, but that decision cannot be due to health status.

If you initially do not join your employer’s plan and then you go through certain family changes, such as the addition of a child, marriage, or involuntary loss of coverage, you must be offered a special enrollment opportunity. There are also numerous laws protecting your children if your plan includes dependents. In addition to group health care plans, there are individual plans that offer low cost coverage. Insurers cannot enquire about your genetic information or family history, or exclude you, charge you higher rates, or impose an exclusion period due to these factors.

The Health Coverage Tax Credit (HCTC) is available to those who have lost health insurance and receive benefits from the TAA (Trade Adjustment Assistance) Program; it is also available to 55- to 65-year old retirees who receive pension benefits from the PBGC (Pension Benefit Guarantee Corporation). This tax credit covers 80% of qualified health insurance plans. If you have an individual plan that includes dependents, any newborn or adopted child is automatically covered for their first 31 days in your family, giving you time to enroll them in your plan. A disabled child meeting certain qualifications can remain on your plan after passing the normal age of dependency.

If you’ve lost your group plan and you still had three months of coverage when you left the job, you can get a group conversion policy. This also applies to your dependents. This kind of plan cannot impose exclusion periods for pre-existing conditions and has a rate limit of 120% of your previous group plan’s rate. These plans also have guaranteed renewability, so you cannot lose the plan if you get sick.

Pennsylvania does not impose requirements for standardized individual policies, so plans will vary. If you want to be sure you are getting the best low cost health insurance in PA, then enter your zip code at the top of the page to receive your free comparison health insurance quote.

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