Health Care Benefits: Pennsylvania

Federal law and guidance on this subject should be reviewed together with this section.

Author: Jayne Zanglein, Western Carolina University

Summary

• Pennsylvania chose to establish a state-based Marketplace under the Affordable Care Act. See Health Insurance Marketplaces Under the ACA.
• Same-sex marriage is legal nationwide. See Same-Sex Partner Benefits.
• Pennsylvania health mandates apply to group accident and sickness policies issued by insurance companies, hospital plan corporations, hospital service plan corporations and health maintenance organizations. (HMOs). See Scope of Mandates.
• Group health plans that allow dependents to enroll, must include coverage for newborns. See Dependent Coverage.
• Group health plans must provide basic health care for children. See Basic Health Care Services - Children.
• Health Maintenance Organizations (HMOs) must provide basic health care for adults. See Basic Health Care Services - Adults.
• Group health plans must cover certain women's health benefits. See Women's Health Care Services.
• Group health plans must provide mental health benefits and parity. See Mental Health Benefits and Parity.
• Group health plans must provide coverage for certain illnesses, services and supplies. See Colonoscopy Coverage; Diabetes Coverage; Emergency Care; Prescription Drugs for Cancer.
• The Living Donor Protection Act generally prohibits a health care insurer from taking certain actions against an individual based solely on their status as a living organ or tissue donor. See Organ and Tissue Donation.