Health Care Insurance Plans
Legal Information
This section of PALawHelp.org has information and resources about issues relating to Health Care Insurance Plans in Pennsylvania.
Click on a resource category listed below to see information related to that category.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
PA Health Law Project Toll-Free Helpline - Call: 1-800-274-3258
The PA Health Law Project provides free legal services and advocacy to Pennsylvanians having trouble accessing publicly funded health care coverage or services. For assistance, call the PHLP Helpline at 1-800-274-3258 or 1-866-236-6310 TTY or e-mail the PHLP at staff@phlp.org. Information from the PHLP is also available online at www.phlp.org.
How to Obtain Mental Health and Drug & Alcohol Services in Pennsylvania
Booklet from the Pennsylvania Health Law Project explaining how to obtain Mental Health Services and Drug & Alcohol Services under various programs in Pennsylvania. [PDF]
MAWD or Marketplace? - What Pennsylvanians with Disabilities Need to Know About Choosing Health Insurance Coverage
Information on the selection of medical insurance by persons eligible for Medical Assistance for Workers with Disabilities (MAWD). Today, people with serious health issues and persons with disabilities who are working or may be able to work, can choose between Marketplace health insurance and MAWD. Includes eligibility requirements for each program, how to apply and highlights factors to consider when choosing coverage.
Need Health Insurance and Not Working in Your Prior Job? Act Now!
If you are not working because you are on leave, on layoff, or have lost your job, you should look at the following options for health care for yourself and your family. You should secure coverage within 60 DAYS of when you lose coverage through your employer, or you will lose the opportunity to get affordable benefits through the Affordable Care Act Marketplace until the end of the year.
Pennie - Pennsylvania's Health Care Marketplace
Pennie provides information on health care coverage available and how to sign up. All Pennsylvanians can search and choose coverage from November to January 15. After January 15th, folks who experience a Qualifying Life Event are still eligible to apply for financial assistance and shop for health insurance. Visit their website to learn more on qualifying life events.
Are you eligible to use the Marketplace?
Information from HealthCare.gov about the requirements you must meet to be eligible to enroll in health insurance through the Health Insurance Marketplace.
Health Insurance Marketplace - Healthcare.gov
The new Health Insurance Marketplace helps uninsured people find health coverage. When you fill out the Marketplace application you will be told if you qualify for Medicaid and the Children’s Health Insurance Program (CHIP) or for a private health insurance plan. You will be able to compare your options and enroll in a plan right from this site.
The Affordable Care Act's New Patient's Bill of Rights
Information from the Centers for Medicare & Medicaid Services on the new Patient's Bill of Rights under the Affordable Care Act which will help children (and eventually all Americans) with pre-existing conditions gain coverage and keep it, protect all American's choice of doctors, and end lifetime limits on the care consumers may receive. These new protections apply to nearly all health insurance plans
Understanding Health Insurance Terms
This glossary from HealthCare.gov explains many of the terms you hear when reading about or discussing health care coverage.
Continuation of Health Coverage - COBRA
Information from the United States Department of Labor about the Consolidated Omnibus Budget Reconciliation Act (COBRA), a federal program that provides the right to continued health care coverage for people who lose their benefits under certain circumstances.
Employee Retirement Income Security Act - ERISA
The United States Department of Labor provides this introduction to the Employee Retirement Income Security Act of 1974 (ERISA), which is a federal law that sets minimum standards for most voluntarily established pension and health plans in private industry to provide protection for individuals in these plans.
Health Benefits Advisor
The Health Benefits Advisor from the United States Department of Labor is designed to help workers and their families better understand employer and employee organization (such as a union) provided group health benefits and the laws that govern them, especially when they experience changes in their life and work situations--such as marriage, childbirth, job loss or retirement.
Health Plans & Benefits
Information on group health plans, which are employee welfare benefit plans established or maintained by an employer or by an employee organization (such as a union), or both, that provides medical care for participants or their dependents directly or through insurance, reimbursement, or otherwise.
Portability of Health Coverage (HIPAA)
Information from the United States Department of Labor on the Health Insurance Portability and Accountability Act (HIPAA). This law provides rights and protections for participants and beneficiaries in group health plans. It includes protections for coverage under group health plans that limit exclusions for preexisting conditions; prohibit discrimination against employees and dependents based on their health status; and allow a special opportunity to enroll in a new plan to individuals in certain circumstances. HIPAA may also give you a right to purchase individual coverage if you have no group health plan coverage available, and have exhausted COBRA or other continuation coverage.
Health And Retirement Benefits Coverage Information For Reservists
Information from the United States Department of Labor providing questions and answers for reservists about their rights protecting their retirement benefits and the health benefit options available to their family members to maintain health coverage during the time of active duty.
USERRA - Uniformed Services Employment and Reemployment Rights Act
Information from the United States Department of Labor on the Uniformed Services Employment and Reemployment Rights Act which protects civilian job rights and benefits for veterans and members of Reserve components.
Women's Health and Cancer Rights Protections
Information from the United States Department of Labor about health care plan coverage for women who have breast cancer and are considering a mastectomy.
Coverage for Young Adults
Information from the Centers for Medicare & Medicaid Services on the Affordable Care Act provisions that allow young adults to stay on their parents' health care plan until age 26.
Newborns and Mother Protection (Newborn's Act)
Information from the United States Department of Labor about maternity and newborn coverage in health care plans.
Retirement Plans-Benefits & Savings
Information from the United States Department of Labor regarding retirement plans offered by your employer.
Self Employed: Social Security and Medicare
Fact Sheet from the Social Security Administration for people who are self-employed regarding paying Social Security and Medicare taxes, earning credits, calculating net earnings, and more. (2022) [PDF]
Termination
If you've lost your job, you have certain rights, such as the right to continue your health care coverage and, in some cases, the right to unemployment compensation. Here is information from the U.S. Department of Labor about your rights when you are terminated from your employment.
Your Employer's Bankruptcy - How Will It Affect Your Employee Benefits?
Information from the United States Department of Labor on how your retirement and health benefits might be affected when your employer files for bankruptcy. (November 2016)
Health Insurance Marketplace Calculator
This tool from the Kaiser Family Foundation illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA).