In 2010, the Affordable Care Act set up a federal high risk pool temporarily in Pennsylvania called PA Fair Care through the Pennsylvania Insurance Department. This health insurance plan covered individuals with medical conditions and had no access to any other form of coverage. In order to qualify, you had to be uninsured for at least six months before you applied. Those who had been rejected by private individual health insurers could finally obtain coverage with fair rates, not adjusted according to their health. Once the most important provisions of the ACA took effect, these plans became ineffective as members can apply with any insurer of their choice beginning in the 2014 plan year.
PA Fair Care Benefits
Members of PA Fair Care receive coverage on a variety of benefits, including doctor’s office visits, prevention, and hospital services you would expect from a comprehensive health plan from any of your private Pennsylvania insurers. However, these plans also cover care for your preexisting condition, if needed, without a waiting period. PA Fair Care only covers services that are considered medically necessary, and have the right to decline numerous types of claims for unapproved services. Some of the services covered by PA Fair Care for all enrollees include:
- Diagnostic tests
- Physician services
- Therapy and rehabilitative services
- Preventive care
- Maternity and newborn care (up to 31 days)
- Hospital stays
- Outpatient hospital care
- Emergency care
- Durable medical equipment
- Mental health care
- Skilled nursing
For further details on PA Fair Care benefits and coverage when using in or out of network providers, view the Benefit Grid.
PA Fair Care Eligibility
As PA Fair Care is part of the federal Pre-Existing Condition Insurance Program, it adheres to rules set by all PCIP plans. In order to qualify, you must be a resident of Pennsylvania, a legally present national or citizen of U.S., and have been without creditable coverage (even short term health insurance) for six months from the date of your application. Of course, you must also have documentation of a preexisting condition, either from a physician who has diagnosed and treated you, or an insurer who has increased your rates, issued exclusions, or denied you coverage completely.
Individuals who have any form of health insurance will not qualify, which includes Medicare Part A or B, Medicaid, CHIP, private employer-sponsored or individual insurance, COBRA or continuation benefits, or military coverage. If you have a medical condition and your income is too low to consider paying for PA Fair Care, you may be eligible for Medical Assistance (MA), which also covers care for preexisting conditions. Pennsylvanians who are under age 19 with conditions may qualify for CHIP within a certain income level and receive coverage for medical conditions at a lower rate than a private plan.
How to Apply
You can fill out an application quickly and efficiently online. The PA Fair Care website provides a list of all required documents needed to complete the form, which include proof of identification and citizenship. Make sure you have your Social Security Number available if you are a U.S. citizen, or your Alien Registration Number or I-94 Number if your are a non-citizen. Also have your Pennsylvania driver’s license or ID number on hand.
*Please note that enrollment is close for PA Fair Care as of January 2013. You may qualify for subsidized coverage on the exchange.
Contact PA Fair Care
888 767 7015 or 888 767 7018 (TTY)