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Pennsylvania DOI Warns Consumers of Limited, Non-ACA Health Plans

July 13, 2016

Pennsylvania Insurance Commissioner Teresa Miller has issued a consumer alert advising consumers to be cautious and understand the policy before purchasing a health insurance plan. Health insurance plans can still be purchased “off-marketplace.” These plans may advertise coverage at a lower rate, but they are not required to meet the same coverage standards as Affordable Care Act (ACA) marketplace plans and may provide a more limited scope of benefits. In addition, these plans may not protect consumers from tax penalties for not having minimum essential coverage.

“Off-marketplace products are still available, and like any other insurance policy, consumers need to understand these products and the coverage they offer before making a purchase,” said Miller. “If your health insurance plan does not meet minimum essential coverage standards outlined in the Affordable Care Act, you may face a tax penalty.”

Off-marketplace plans are not required to provide coverage for pre-existing conditions, meaning you may have to pay for services related to pre-existing conditions out-of-pocket. In addition, many of these plans have pre-designated reimbursement rates for types of services. For example, you could be reimbursed $200 for a trip to the emergency room and would be responsible for any additional charges.

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