Agents in PA

[J.R.]

I am about to start selling in PA and are looking for an agent familiar with the PA market who would be kind enough to give me the run down on the Blues as I am a bit insure about how they operate in the market (apparently there is Anthem and 5 other Blues depending upon where you are located).

-J.R.

 

[CHUMPS FROM OXFORD]

I did not know Anthem writes in Pa. BC uses Capital, Direct Blue, Highmark etc...) I use every company except BC in Pa. The reason is that I was told a few years ago that BC requires that the applicant must be seen in person. I'm sure many agents don't adhere to that rule. But then again, maybe that rule is no longer on the books.

If someone knows, please chime in. Obviously, if that is no longer a requirement, BC will get some of my business.

 

[J.R.]

I did not know Anthem writes in Pa. BC uses Capital, Direct Blue, Highmark etc...) I use every company except BC in Pa. The reason is that I was told a few years ago that BC requires that the applicant must be seen in person. I'm sure many agents don't adhere to that rule. But then again, maybe that rule is no longer on the books.

If someone knows, please chime in. Obviously, if that is no longer a requirement, BC will get some of my business.

Thanks for the info. Do you know of the plan names are on the respective card of policy holders? Reason I ask is because im trying to find the fastest way to learn what policy somebody is on versus going through Q & A on the many plans.

 

[wilkin]

I believe there are a total of 5 different Blue plans here in PA, and I don't think Anthem is included. I write for Highmark BCBS of Western PA and Highmark BS in Central PA. Agents must be separately contracted for each one. You can learn more and/or get contracted through EmersonReid www.emersonreid.com, Neishloss and Fleming www.neishloss.com or URL www.urlfinancial.com.
-Bill

 

[J.R.]

I believe there are a total of 5 different Blue plans here in PA, and I don't think Anthem is included. I write for Highmark BCBS of Western PA and Highmark BS in Central PA. Agents must be separately contracted for each one. You can learn more and/or get contracted through EmersonReid www.emersonreid.com, Neishloss and Fleming www.neishloss.com or URL www.urlfinancial.com.
-Bill

Thanks for the info. I was thinking about VA when I made the reference to Anthem. PITA having to deal with 5 different companies.

 

[arnguy]

In PA, at the present time there are Independence Blue Cross, Northeastern Blue Cross, Capital Blue Cross, and Highmark Blue Cross as well as Highmark Blue Shield. The Blue Shield entity covers the entire state of PA. It was PA Blue Shield until purchased by Highmark that used to be Blue Cross of Western PA. Independence Blue Cross covers the City/County of Philadelphia and the surrounding four Counties: Bucks, Montgomery, Delaware, and Chester. You can get information on all BXs nationwide by going to www.bcbs.com/coverage/find /plan. IBC is the one I am most familiar with inasmuch as I write in the Philadelphia and suburban areas. Highmark covers Pittsburgh and something like a total of 23 Western PA counties. There is a proposal pending to merge Highmark and IBC, but it is getting a lot of flak inasmuch as the combination would cover about 85% of Pennsylvanians, thus, reducing competitiion.

 

[J.R.]

In PA, at the present time there are Independence Blue Cross, Northeastern Blue Cross, Capital Blue Cross, and Highmark Blue Cross as well as Highmark Blue Shield. The Blue Shield entity covers the entire state of PA. It was PA Blue Shield until purchased by Highmark that used to be Blue Cross of Western PA. Independence Blue Cross covers the City/County of Philadelphia and the surrounding four Counties: Bucks, Montgomery, Delaware, and Chester. You can get information on all BXs nationwide by going to www.bcbs.com/coverage/find /plan. IBC is the one I am most familiar with inasmuch as I write in the Philadelphia and suburban areas. Highmark covers Pittsburgh and something like a total of 23 Western PA counties. There is a proposal pending to merge Highmark and IBC, but it is getting a lot of flak inasmuch as the combination would cover about 85% of Pennsylvanians, thus, reducing copetitiion.

Thank you for the information arnguy. Just got a new client I am working on who has depression/hypothyroid. Pretty much a decline there unfortunately. I was shocked to see the prices of the GI products in PA via BCBS......

 

[J.R.]

Case Deliberation

I have a client whose daughter will be declined w/ every company in PA due to a pre-existing condition/medications. She is located in the area covered by BC North-East.

I'm at a lose as to what and if I can help this young lady find a plan. She is a 20 year old full time student who was on her parents BCBS plan until January in which she was kicked off because of a status change. They decided to pick a up a MEGA plan for the family and the daughter has not had coverage since December! The family will be getting a much better plan, but the daughter is SOL right now

The only options I see at this point are the following. 1) Have her sign up for some STM policy that can be extended until she finds a job after college with benefits. 2) Possibly change her status from dependent to individual and she might be able to qualify for the Adult Basic Plan in PA (I don't know the specifics of this plan yet as it pertains to how they handle pre-existing conditions) and whether that is possible or legal.

Thoughts???


-J.R.

and has taken certain drugs for a disorder that

 

[CHUMPS FROM OXFORD]

Personal Choice (PPO) might be an option. Rates are high though (at least, they used to be). Keystone Health Plan East (an HMO) might be an option as well.

 

[arnguy]

[FONT=Verdana,Arial,Geneva]Facts about adultBasic
Introduction/Summary
Pennsylvania is committed to quality health care for all of its residents.
In June 2001, Governor Tom Ridge signed into law the Health Investment Insurance Act (Act 77 of 2001). Act 77 is a dramatic initiative that invests the proceeds of the state's tobacco settlement in the health of Pennsylvania consumers. The state is expected to receive approximately $11 billion over the course of 25 years.
The largest single component of the settlement will provide health insurance to a number of uninsured Pennsylvanians between the ages of 19 and 64. The program will provide health insurance for adults meeting certain income requirements and who do not have health care coverage.
This new program -adultBasic- is administered by the Pennsylvania Insurance Department and offers basic benefits, including, preventive care, physician services, diagnosis and treatment of illness or injury, in-patient hospitalization, out-patient hospital services and emergency accident and medical care.
Eligibility Requirements
Participation in the adultBasic Program is based on certain eligibility requirements, which include:

• <LI class=stdfont>Having no other health care coverage (including Medicaid or Medicare) <LI class=stdfont>Lack of prior coverage under any other insurance plan for 90 days prior to enrollment; except for a person (and their spouse) who has been laid off his/her job <LI class=stdfont>Are ages 19 through 64 <LI class=stdfont>Having family income below 200 percent of the Federal Income Guideline (see table below) <LI class=stdfont>Having lived in Pennsylvania for at least 90 days prior to enrollment; and
• U.S. citizenship or a permanent legal alien status

The following chart explains the number of people in the family versus the maximum income in order to be eligible for the program:
Benefit Package
The adult insurance program is designed to provide basic insurance benefits, including:

• <LI class=stdfont>Hospitalization (unlimited days) <LI class=stdfont>Physician Services (primary care and specialists) <LI class=stdfont>Emergency Services <LI class=stdfont>Diagnostic Tests (e.g. X-rays, mammograms and laboratory tests) <LI class=stdfont>Maternity care
• Rehabilitation and skilled care (in lieu of extended hospitalization)

Modest co-pays for certain benefits are required. They are:

• Doctor Visit- $5.00 Emergency Room-$25.00 (waived if admission occurs) Specialists - $10.00

How can I enroll?
Applications for enrollment in the adultBasic Program are available from adultBasic contractors or by calling toll-free number 1-800-G0-BASIC. On-line application is also available. See "Application for adultBasic" or reference www.compass.state.pa.us. Coverage will begin July 2002.
Frequently Asked Questions

1. <LI class=stdfont>Who qualifies for the adultBasic Program? <LI class=stdfont>What are the eligible income limits in order to participate in the program? <LI class=stdfont>What if a person has a Pre-existing conditions? <LI class=stdfont>What medical benefits are available? <LI class=stdfont>Any costs/co-pays involved? <LI class=stdfont>How can I enroll? <LI class=stdfont>What is the funding source and how much is available?
2. Is this the same as CHIP?

Who qualifies for the adultBasic Program?
Participation in the adultBasic Program is based on certain eligibility requirements, which include:

• <LI class=stdfont>Having no other health care coverage (including Medicaid or Medicare); <LI class=stdfont>Having no coverage under any other insurance plan for at least 90 days prior to enrollment; except for a person (and their spouse) who has been laid off his/her job; <LI class=stdfont>Being between the age of 19 through 64; <LI class=stdfont>Having family income below 200 percent of the Federal Income Guidelines (see table below); and <LI class=stdfont>Having lived in Pennsylvania for at least 90 days prior to enrollment; and
• U.S. Citizenship or a permanent legal alien status.

What are the eligible income limits in order to participate in the program?
The following chart explains the number of people in the family versus the maximum income in order to be eligible for the program:
Eligibility RequirementsNumber in FamilyMaximum Income1$17,9602$24,2403$30,5204$36,8005$43,0806$49,3607$55,6408$61,920

Income Guidelines according to February 7, 2003 Federal Register​

What if a person has a pre-existing condition?
The program will not exclude coverage based on a pre-existing health condition.
What medical benefits are available?
The adultBasic Program is designed to provide basic insurance benefits, including:

• <LI class=stdfont>Hospitalization (unlimited days) <LI class=stdfont>Physician Services (primary care and specialists) <LI class=stdfont>Emergency Services <LI class=stdfont>Diagnostic Tests (e.g. x-rays, mammograms and laboratory tests) <LI class=stdfont>Maternity care
• Rehabilitation and skilled care (in lieu of extended hospitalization)

Any costs/co-pays involved?
A monthly premium of $30.00 must be made prior to enrollment and each month thereafter for coverage to continue.
Modest co-pays for certain benefits are required. They are:

• <LI class=stdfont>Doctor Visit- $5.00 <LI class=stdfont>Emergency Room-$25.00 (waived if admission occurs)
• Specialists - $10.00

How can I enroll?
Applications for enrollment in the adultBasic Program are available from adultBasic contractors or by calling the toll-free number 1-800-G0-BASIC. On-line application is also available. See "application for adultBasic" or reference www.compass.state.pa.us. Coverage will begin July 2002.
What is the funding source and how much is available?
Funding for this program comes from a portion of the Commonwealth's share of the Tobacco Settlement money. Under this agreement with the country's major tobacco companies, the Commonwealth is slated to receive an estimated $11.5 billion over the next 25 years, or approximately $400 million a year.
Is this the same as CHIP?
No, The Children's Health Insurance Program (CHIP) offers children of low-income families affordable, or even free, health care coverage. The adultBasic Program provides basic health care coverage for eligible adults. Families, however, may apply for either or both programs (CHIP and adultBasic) using the same application.
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[FONT=Verdana,Arial,Geneva]Content Last Modified on 3/13/2003 3:52:55 PM[/FONT]

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