HARRISBURG, Pa. – Governor Corbett yesterday announced that nine commercial organizations have submitted successful applications to participate as an insurer in the Healthy Pennsylvania Private Coverage Option plan and will soon move forward in the negotiation process with the commonwealth.
The Corbett Administration is currently seeking approval from the U.S. Department of Health and Human Services (HHS) to utilize federal money and allow adults earning up to 133 percent of the federal poverty level to purchase private commercial health care coverage through the Healthy Pennsylvania Private Coverage Option (PCO).
There are nine designated regions of operation for the Healthy Pennsylvania plan across the state. The administration set a goal for consumer choice of at least two commercial plan options per region, and received at least three qualified applications in each region – some regions with five and six insurance plans.
“This response from insurers was a critical step in building the framework to responsibly increase health care coverage through the private market for more than 500,000 Pennsylvanians,” Governor Corbett said. “The number of applicants demonstrates that this innovative approach can and will work once approved. I’m encouraged that so many health care insurers are committed to providing innovative, commercial products to thousands of Pennsylvanians.”
Pennsylvania will soon begin negotiations with each of the applicants. In order to qualify to proceed with negotiations, the providers had to meet the following criteria:
Possess a current and valid Pennsylvania HMO Certificate of Authority or submit a plan to indicate how they would obtain one by Aug. 4, 2014;
Provide documentation that coverage provided would meet all applicable federal and state laws regulating health insurance coverage in individual market;
Possess valid Pennsylvania Department of Health operational authority for all counties in the region(s) in which they applied or a plan to obtain one by Aug. 4, 2014;
Possess recent National Committee for Quality Assurance accreditation of “commendable” , “excellent” or “accredited,”;
Provide an acceptable Emergency Preparedness statement;
Demonstrate financial stability or economic capacity to perform as a private coverage plan; and
Provide a statement of net worth supported by a copy of filing with the Pennsylvania Insurance Department or a balance sheet attested to by an independent public accounting firm.
Though the formal negotiations with the federal government are still ongoing, the Corbett Administration remains committed to providing access to quality, affordable health care coverage for more than 500,000 Pennsylvanians by January 1, 2015.
“In order to avoid delaying coverage to uninsured Pennsylvanians, we and HHS agreed that it would be sensible to move forward with soliciting applications from PCOs while the waiver is being negotiated,” Corbett said. “The federal government has also provided funding for necessary technological changes to support the Healthy Pennsylvania plan.”
The Healthy Pennsylvania plan for Medicaid modernization includes two parts: making common-sense reforms to the current Medicaid program to better align the benefits with individual needs and the nationally established essential health benefits and offering the Healthy Pennsylvania PCO for uninsured Pennsylvanians.
“Healthy Pennsylvania encourages personal responsibility, provides benefits that match individuals’ health care needs and promotes healthy behaviors,” Corbett said. “I am happy to see it continue to advance and pleased with the high level of interest from the private market.”
More information about the Healthy Pennsylvania plan is available at www.pa.gov.
Listed below are qualified insurer applicants by region of operation:
Region 1 (Clarion, Crawford, Erie, Forest, McKean, Mercer, Venango and Warren Counties): United Healthcare, UPMC, Gateway Health, Vista
Region 2 (Cameron, Elk and Potter Counties): UPMC, Gateway Health, Vista, Keystone Health Plan West/Highmark
Region 3 (Bradford, Carbon, Clinton, Lackawanna, Luzerne, Lycoming, Monroe, Pike, Sullivan, Susquehanna, Tioga, Wayne and Wyoming Counties): Geisinger Health Plan, United Healthcare, Vista
Region 4 (Allegheny, Armstrong, Beaver, Butler, Fayette, Greene, Indiana, Lawrence, Washington and Westmoreland Counties): United Healthcare, Aetna Better Health, UPMC, Vista, Keystone Health Plan West/Highmark
Region 5 (Bedford, Blair, Cambria, Clearfield, Huntingdon, Jefferson and Somerset Counties): United Healthcare, UPMC, Gateway Health,Vista
Region 6 (Centre, Columbia, Lehigh, Mifflin, Montour, Northampton, Northumberland, Schuylkill, Snyder and Union Counties): Geisinger Health Plan, United Healthcare, Gateway Health, Vista, Capital Blue Cross
Region 7 (Adams, Berks, Lancaster and York Counties): Geisinger Health Plan, United Healthcare, UPMC, Gateway Health, Vista, Capital Blue Cross
Region 8 (Bucks, Chester, Delaware, Montgomery and Philadelphia Counties): United Healthcare, Aetna Better Health, Health Partners, Gateway Health, Vista
Region 9 (Cumberland, Dauphin, Franklin, Fulton, Juniata, Lebanon and Perry Counties): United Healthcare, Aetna Better Health, Gateway Health, Vista, Capital Blue Cross
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