Pennsylvania Health Insurance

Health insurance is integral to the well being of Pennsylvania’s nearly 13 million residents. While most people recognize the importance of this type of coverage, staying informed on the industry’s ever-changing regulations can be downright frustrating. To help readers sort through the confusion, The Simple Dollar has put together a useful guide to health insurance, complete with links to regulations, rules, and resources for Pennsylvania consumers.

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Stats in Your State

Understanding what affects the health insurance rates is much easier with clear data. That’s why we’ve put together a handful of informative graphs and charts to demonstrate the factors that drive the industry. Read on to learn more about the state of health insurance in Pennsylvania.

Chip Medicaid

Between 2009 and 2010, both CHIP and Medicaid enrollment increased across Pennsylvania to just under 1.5 million residents enrolled in government-administered health care. Roughly one out of six of those residents were children enrolled in the CHIP health plan.

Individual Health Insurance Premiums

The average premium for Pennsylvania workers in 2009 was just below the U.S. average of $1,079, and well below neighboring states in the Mid-Atlantic region. Relatively safe white-collar and agricultural jobs make Pennsylvania a low-cost state in terms of individual health care.

Family Health Insurance Premiums

Going along with the lower-than-average health care premiums for single payers, families in Pennsylvania enjoy insurance premiums that fall well below the national average. Aside from New Jersey, families in Pennsylvania cost less to insure than any other state in the Mid-Atlantic region.

SAHIE Health Insurance Uninsured

From 2005 to 2009, the number of uninsured Pennsylvanians fluctuated between 1.1 and 1.2 million before rising to more than 1.25 million uninsured in 2010. While the number with or without health insurance has fluctuated with the economy, better economic times don’t mean this problem will go away on its own, and affordable options are in high demand throughout Pennsylvania.

Rules in Your State

Keeping track of your rights as a consumer is hard enough with the varying regulations and entities out there, so we’ve listed a couple of important regulations for consumers in Pennsylvania below. Click on the links to learn more about insurance regulations, and contact the Pennsylvania Insurance Department for further details on state legislation that governs the industry.

Pennsylvania Rules: Alcohol & Your Health Insurance

Although coverage for treatment of alcoholic disorders is required in Pennsylvania, providers may charge higher premiums and may deny coverage for treatment of injuries or accidents sustained while an insured was intoxicated.

Losses Due to Intoxication
Health Insurance Parity for Alcohol-Related Treatment
Pennsylvania law specifically permits insurers to deny benefits for losses arising from intoxication.
Health insurance coverage in Pennsylvania must cover treatment of alcohol-related disorders and provide the same levels of benefits for alcohol-related disorders as they do for medical and surgical conditions.
Health insurance plans that cover alcohol-related disorders MAY be subject to higher deductibles, higher premiums, and may be subject to more restrictive financial limits on lifetime treatment for alcohol-related disorders than for medical and surgical coverage.

More Rules

The Unfair Insurance Practices Act addresses unfair insurance practices and how they are regulated. Click to read the legislation in detail.

This 2006 amendment to the above act lists additional specific unfiar acts or practices for insurance claims.

Representatives & Resources in Your State

Whether you need assistance for a particular insurance-related issue or you’re just looking to learn more about different types of insurance coverage in Pennsylvania, use the links and resources below to obtain more information directly from your state’s government agencies.

Pennsylvania Insurance Department
1326 Strawberry Square
Harrisburg, PA 17120
(877) 881-6388
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Contact Information
Consumer Complaint Resource
Health Insurance Guide
The Insurance Department offers a guide to health insurance in Pennsylvania that addresses some of the widespread concerns among state residents.

Pennsylvania Department of Public Welfare
P.O. Box 2675
Harrisburg PA 17105-2675
Contact For Various Programs
The Department of Public Welfare oversees assistance programs and services for families, children, seniors, disabled persons, and others who need infrastructural support to live a healthy life.

Pennsylvania Children’s Health Insurance Program (CHIP)
The Children’s Health Insurance Program provides health coverage for children of low-income families across the state.
Contact Information