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Population: 12,440,621
(Source: U.S. Census Bureau)
Uninsured: 1,255,000
(Source: U.S. Census Bureau)
Health Benefits Direct is a licensed insurance broker for Pennsylvania health insurance policies. Click here to view our registration with the Pennsylvania Office of Insurance (We're listed as HBDC, and we're in Florida). |
Pennsylvania has the 9th highest number of uninsured in the U.S.
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Health Insurance News in Pennsylvania
Buying Individual Insurance Policies in Pennsylvania
State regulation of individual health insurance differs greatly from state to state. For you, this means certain conditions or providers covered in one state may not be covered in another.
Each state has its own health insurance mandates. Those mandates require that insurance companies and health plans cover, or offer coverage for, certain conditions, benefits, providers and patient populations.
Here is a list of mandated and non-mandated conditions, covered persons and providers in Pennsylvania:
(Source: Health Insurance Mandates in the States 2008¹, Council for Affordable Health Insurance. Last updated Jan 2008.)
| Mandated (Covered) Conditions |
Non-Mandated Conditions |
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- Alcoholism
- Birthing Centers/Midwives
- Breast Reconstruction
- Cervical cancer/HPV Screening
- Chemotherapy
- Diabetic Supplies
- Drug Abuse Treatment
- Emergency Services
- Mammogram
- Mastectomy
- Mastectomy Stay
- Maternity Stay
- Mental Health General
- Mental Health Parity
- PKU/Formula
- Prostate Cancer Screening
- Well-Child Care
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- Alzheimer's
- Ambulatory Surgery
- Ambulance Services
- Anti-Psychotic Drugs
- Autism
- Blood Lead Poisoning
- Blood Products
- Bone Marrow Transplants
- Bone Mass Measurements
- Cancer Medications
- Chlamydia
- Cleft Palate
- Clinical Trials
- Colorectal Cancer Screening
- Congenital Bleeding Disorders
- Contraceptives
- Dental Anesthesia
- Diabetes Self Management
- Early Intervention Services
- Habilitative Services
- Hair Prostheses
- Hearing Aid
- Home Health Care
- Hospice Care
- HPV Vaccine
- In Vitro Fertilization
- Kidney Disease
- Long Term Care
- Lyme Disease
- Maternity
- Minimum Hysterectomy Stay
- Minimum Testicular Cancer Stays
- Morbid Obesity Treatment
- Neurodevelopment Therapy
- Newborn Hearing Screening
- Newborn Sickle-Cell Testing
- Off-Label Drug Use
- Orthotics/Prosthetics
- Ostomy Related Supplies
- Other Infertility Services
- Ovarian Cancer Screening
- Port-wine Stain Elimination
- Prescription Drugs
- Psychotic Drugs
- Rehabilitation Services
- Second Surgical Opinion
- Smoking Cessation
- TMJ Disorders
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| Mandated Covered Persons |
Non-Mandated Covered Persons |
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- Adopted Children
- Continuation/Dependents
- Continuation/Employees
- Conversion to Non-Group
- Dependent Students
- Handicapped Dependents
- Newborns
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- Grandchildren
- Non-Custodial Children
- Domestic Partners
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| Mandated (Included) Providers |
Non-Mandated Providers |
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- Chiropractors
- Dentists
- Nurse Anesthetists
- Nurse Midwives
- Nurse Practitioners
- Nurses
- Optometrists
- Osteopaths
- Physical Therapists
- Physician Assistants
- Podiatrists
- Psychiatric Nurse
- Psychologists
- Speech or Hearing Therapists
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- Acupuncturists
- Chiropodist
- Denturists
- Dieticians
- First Nurse Assistant
- Lay Midwives
- Licensed Health Professional
- Marriage Therapists
- Massage Therapists
- Naturopaths
- Occupational Therapists
- Opticians
- Oral Surgeons
- Pain Management Specialist
- Pastoral Counselor
- Pharmacists
- Professional Counselors
- Public or Other Facilities
- Social Workers
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Although health insurance coverage for a particular condition or provider may not be mandated in your state, insurance carriers may still provide coverage for the condition or provider. Please keep in mind that major medical health insurance plans are subject to health underwriting and that mandates do not necessarily guarantee coverage. If you're not sure whether you could receive coverage, one call to Health Benefits Direct can help you determine if you're eligible to buy an individual health insurance policy in Pennsylvania.
Health Benefits Direct provides free health insurance quotes on affordable health insurance plans for Pennsylvania residents. We work with highly rated insurance carriers to deliver quality health insurance plans to families and individuals across Pennsylvania.
¹Authors: Victoria Craig Bunce & JP Wieske
Please note that information contained on this page can change at any time. Consequently, while we seek to present as up-to-date information as possible, Health Benefits Direct in no way warrants the accuracy of the information.
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