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Finding Health Care Options

It’s an increasingly common story these days—you lose your job and your health insurance goes with it. Now what?

Health Connect

Mobile Healthcare in Adams County...Coming to Holy Trinity Lutheran Church, York Springs, the first Monday of the month beginning May 7, 2012, from 1 to 7 p.m. Other Adams County sites: Biglerville -- Mondays except 1st from 1 to 7 p.m. and Adams County Rescue Mission -- the 3rd Wednesday of the month from 10 a.m. to 4 p.m.

Health Connect is a mobile health care van that provides free service to members of the community in York and Adams Counties. WellSpan Health and the WellSpan Medical Group developed the program in 1999. HealthConnect offers: • Treatment for short-term illness such as sore throat, cough, earache • Treatment for minor injuries • School and work physicals • Some children's immunizations • Flu Vaccinations for adults and children • Referrals to primary and specialized care HealthConnect services are free to those who: • Live in York or Adams counties • Have no health insurance or military health benefits • Meet income guidelines (household income at or below 200% of federal poverty level) • Do not have Medical Assistance, CHIP, Medicaid, Medicare or any other federal funding source of health benefits. For the complete HealthConnect schedule and site locations, please call 717-851-1689 or visit their website.

Family First Healthcare

Family First Health was started in 1970 from a movement started by H. Jack Geiger, physician and civil rights activist. By addressing the roots of illness drawn from community concerns, early health centers like Family First Health pioneered an effective method for approaching health care in under served communities. Today, there are almost a thousand community health centers in the United States, making health care accessible for more than 11.5 million patients each year. Family First Health is proud to be one of these centers that provide compassionate and comprehensive health services to people seeking accessible and affordable quality care. Programs including Healthy York Network, Caring Together and our Nurse-Family Partnerships keep Family First Health at the forefront of answering the needs of our patients and the communities they serve.

At Family First Health, fees range depending on the types of visit and tests that are performed. Using a sliding fee scale, discounts are based on family size and income. Our registration staff will be glad to explain our system to you when you come in for your visit. We will not deny health services to anyone due to an inability to pay. Family First Health - Gettysburg Center is located at (Peebles Plaza in Gettysburg)1275 York Road, Suite 17Gettysburg, PA 17325. Call (717) 337-9400 or visit their website.

Spousal coverage

If your spouse is eligible for health benefits at his or her job, that might be first place to look. Under federal law, loss of your group health insurance benefits entitles you to a special enrollment opportunity in your spouse’s employer group health plan. In other words, if you lose your health insurance, you have 30 days during which you and your children can join your spouse’s plan if you’re otherwise eligible.

COBRA

COBRA coverage is a federal requirement that allows workers in firms with 20 or more employees to continue their health insurance for up to 18 months after they lose their jobs if they pay the full premiums themselves. This applies as long as the employer did not go out of business. This group health insurance plan may be the best health protection you can get, and under federal law you have 60 days to decide whether to continue your coverage under your old job, and then another 45 days to pay that first premium.

COBRA coverage is not cheap; the average cost is about $400 a month for an individual and $1,000 for family coverage. Here’s one money-saving tip: Each member of your family is individually eligible to continue coverage, so if only one person really needs that coverage, you can sign just him or her up and try to find cheaper coverage for everyone else. Check for changes in COBRA as Congress will be looking to expand COBRA in 2009.

Pennsylvania conversion rights

If you’ve lost your employer group health plan from an employer of any size, you may be eligible to convert that coverage to an individual health insurance policy. Not all employer group health plans are required to offer you this individual conversion policy, so check with your employer’s insurance company. This is a valuable option, especially if you or an eligible dependent have health issues.

If COBRA continuation coverage is required to be offered by your employer, you must enroll in COBRA and exhaust COBRA coverage before you can be considered for this conversion policy. Keep in mind that once the insurance company notifies you of this option, you have only 31 days to submit your application or you will lose your right to this coverage.

HIPAA conversion coverage

If you’ve lost your employer’s group coverage, you may be eligible for a HIPAA conversion policy. This is a valuable option, especially if you or an eligible dependent have health issues. You will need a “certificate of creditable coverage” from your last employer’s insurer when you apply. If COBRA coverage is required to be offered by your employer, you must enroll in COBRA and exhaust COBRA coverage before you can be considered for a HIPAA conversion policy.

In Pennsylvania, only Blue Cross Blue Shield companies sell HIPAA conversion policies. Keep in mind that after your employer group health plans ends, you have only 63 days to submit your HIPAA conversion application to Blue Cross Blue Shield or you will lose this conversion right.

State-run health insurance programs

The Pennsylvania Insurance Department administers two health insurance programs. The adult basic insurance program offers basic health coverage to individuals aged 19 to 64 who have limited incomes (less than $42,400 for a family of four). There is a monthly premium of about $35. Currently, due to funding limitations, there is a significant waiting list. Should you qualify for coverage you can purchase coverage at full cost while you are on the waiting list. This costs about $330 a month.

The Children’s Health Insurance Program, or CHIP, provides all uninsured kids and teens with comprehensive benefits that include doctor and hospital visits, prescriptions, eye and dental care, and much more. Many can get CHIP for free, others at low cost. Find out more about CHIP at www.CHIPCoversPakids.com. If your child is without coverage because you’ve lost your job, the six-month go-bare requirement is waived.

Individual coverage

Check out what’s available in the individual health insurance market. Most of the individual market is medically underwritten, which means that you have to apply and disclose information about your health status and your health history. If you do get coverage, it’s likely to be less comprehensive than the group coverage you’re used to, so decide what you need: Catastrophic coverage? Routine medical visits? Prescriptions or dental? What is your pressing need in health care? What can you afford to pay for out-of pocket?

Pennsylvania does recognize that some citizens will not meet the medical eligibility requirements of health insurance companies, placing those individuals in a very difficult position. For those individuals, Pennsylvania’s Blue Cross Blue Shield companies make available a guaranteed issue health plan to those who live in their service area. Contact your local Blue Cross Blue Shield Company for more information.

Association health plans

An association health plan is insurance coverage that is offered to members of an association. These plans can be an option for consumers if they do not have access to job-based group coverage or as an alternative to individual policies. As a member of the association, you are part of a group that can negotiate lower premiums than are available in the individual insurance market. But these are not really group insurance plans and do not have to respect the consumer rights and protections that apply to group plans. Also, consumers do need to check the fine print because the Insurance Department has limited authority to regulate these products.

One final point . . .

If you are laid off or otherwise lose your group coverage, make sure that your employer or its insurer gives you a “certificate of creditable coverage.” This piece of paper helps guarantee that when you do get new health insurance—assuming you don’t have a lapse of more than 63 days—you won’t have to wait for coverage of a pre-existing condition. It also is needed to show your eligibility for the HIPAA coverage mentioned above.

Questions? Contact us.

• Automated Consumer Hotline 1 (877) 881-6388
• Consumer Services Harrisburg 1 (717) 787-2317; TTY/TDD 1 (717) 783-3898
• Consumer Services Philadelphia 1 (215) 560-2630; TTY/TDD 1 (215) 560-2471
• Consumer Services Pittsburgh 1 (412) 565-5020; TTY/TDD 1 (412) 565-2376
www.insurance.state.pa.us
www.heretohelp.pa.gov