Highmark health insurance pittsburgh

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Coverage for the first subscribers became effective on January 1, Over 75, members were enrolled within the first year, and by enrollment had increased to , In the s, Blue Cross expanded the benefits offered in its original day hospital contract to cover 50 percent of an additional 90 days of care. It also introduced "direct-pay" coverage for individuals who were self-employed or otherwise ineligible for participation in a group plan. Blue Cross also encouraged the development of the Medical Services Association of Pennsylvania to provide prepaid coverage for physician fees.

This agreement provided uniform Blue Cross and Blue Shield benefits to companies and unions whose operations extended across state lines. Blue Cross' goal was to provide quality health care to all Pennsylvanians. Unlike many other insurers, Blue Cross continued coverage to its subscribers after they retired.

Over the years, Blue Cross began acquiring noninsurance businesses in addition to providing insurance coverage, and in , the organization changed its name to Veritus Inc. Enrollment declined in World War II as many members left the state to support the war. Arthur Daugherty replaced Palmer as president in and recruited new, larger accounts, including the United Mine Workers and the Congress of Industrial Organizations.

In , MSAP became a chapter of the national Blue Shield association, which was started that year by the medical societies. MSAP recruited the , employees of United States Steel in , which brought its total enrollment to more than 1. Despite the organization's large client base, it had trouble keeping up with its payments to doctors and was forced to raise premiums.

The commission suggested that MSAP control costs rather than continue to raise premiums. In response, MSAP formed a utilization control unit the following year to help keep track of expenses.

Two years later, the organization began managing the federal government's Medicare insurance plan for the state's elderly and also started the Special plan to supplement Medicare coverage. In the s, the organization again fell behind in its payments to doctors. Rates were once again increased and expenses were scrutinized. Pennsylvania Blue Shield faced serious competition in the s from newly formed health maintenance organizations HMOs within the state.

Despite physicians' protests and state regulators' concerns, Pennsylvania Blue Shield merged with Veritus in The new company chose the name Highmark Inc. The merger of Pennsylvania Blue Shield with Veritus, formerly Blue Cross of Western Pennsylvania, was highly controversial, giving Highmark a staggering 60 to 65 percent of the total market share in Western Pennsylvania.

The approval of the merger by the state insurance commission on November 27, shocked those who opposed it. The approval was not without contingencies, however. Kaiser also stipulated that Highmark stay nonprofit for at least two years after its creation. His approval was also contingent upon Highmark providing continued coverage to the poor. In addition, Highmark also could not demand exclusivity from any hospital it contracted.

The newly merged Blues had a total enrollment of roughly 2. Pittsburgh's next largest insurer, HealthAmerica, had only , members. While Highmark brandished a great deal of power, its first year was not an easy one. The organization posted sizable losses in for its most popular product, the Select Blue health plan. To offset the losses, Highmark launched a plan to entice employers to offer Select Blue as the only point-of-service POS plan for employees.

To compensate for the underperforming Select Blue, Highmark cut costs and expanded its dental and vision health care programs. Highmark maintained both of the former Blues' headquarters--in Pittsburgh and Camp Hill--but it downsized its staff by 4. At Veritus out of 3, employees accepted; at Blue Shield out of 8, employees accepted.

Highmark also scaled back its Medicare claims processing business. The government divides the administration of the federally funded Medicare among many different insurance carriers, and prior to the merger, Pennsylvania Blue Shield was the nation's largest Medicare carrier.

However, Highmark found it necessary to cut back on its Medicare claims processing, since the federal government reduced its payment to administer these claims. The Blues had begun expanding their dental and vision programs before the merger. Highmark's Clarity Vision Inc. Moreover, Highmark significantly increased its dental business when it contracted the families of active military personnel throughout the United States with one of its subsidiaries, United Concordia Companies, Inc.

The military contract covered 1. The network created to service the contract included 45, dentists. United Concordia became the nation's sixth-largest dental insurer. Nineteen ninety-seven brought increased competition for Highmark.

In response to the growing health insurance consumer market, Highmark Inc. Highmark, an independent Blue Cross Blue Shield plan with 4. Highmark said those first two stores have seen a total of more than 20, visitors. Melani, MD , Highmark Inc. By opening four new facilities, our Highmark Direct stores will reach many more people in our community.

The stores offer consumers one-on-one time with a Highmark health insurance specialist to discuss health insurance options. Highmark Direct stores sell plans to individuals, seniors, and small businesses. The insurer also recently added United Concordia Dental to its offerings. The stores have helped them to better understand what they are purchasing and make more informed decisions about their health.

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It assists clients with the Affordable Care Act, Medicare, and an array of other health insurance plans like dental, disability, vision, and long-term care insurance. TJS Insurance Group has been specializing in health insurance services for over 90 years. It caters to business owners in Pittsburgh who want to provide medical benefits and compensation to their employees. These include health savings accounts, dental, vision, flexible spending account, and health reimbursement accounts. It also assists clients in additional purchase options, coordination of benefits, and cost of living adjustment.

The Advance Premium Tax Credit is a federal tax rebate designed to lower the cost of health insurance plans purchased through the Marketplace. Eligibility is based on income and household size.

Consumers can decide how much of their tax credit to put toward their premiums. Companies that choose not to offer such benefits may have to pay a penalty. In most cases, out-of-pocket expenses for approved services count toward your deductible. However, it's increasingly common for hospitals to request all or part of the deductible upfront when scheduling major services, such as CT scans and surgeries.

Children can stay on their parents' health insurance plan until their 26th birthday. There's a day special enrollment period following this date. Exemptions allow disabled adult children to remain on their parents' policy beyond this age. Premiums for employer-sponsored health plans are generally deducted from the worker's pretax income. The same is true for voluntary contributions made to Flexible Spending Accounts and Health Savings Accounts that are paired with a qualifying high-deductible health plan.

It's possible to have primary and secondary health insurance. This is most common with Medicare and Medicaid beneficiaries, including dual enrollees and individuals who purchase supplemental plans. Secondary plans can cover some additional expenses, but you're still responsible for premiums and deductibles.

Consumers can cancel their health coverage at any time. Cancellations may be effective immediately or at a specified date. However, you must wait until Open Enrollment to sign up for a new plan unless you qualify for a Special Enrollment period. Individuals who don't have access to health insurance through their job can purchase ACA-compliant plans through the Health Insurance Marketplace. Off-exchange plans are also available through private insurers and independent agents.

The Health Insurance Marketplace is a federal service designed to help consumers compare and purchase subsidized health insurance plans that comply with the Affordable Care Act. A number of states operate their own insurance marketplaces, including California, Colorado, New York, and Pennsylvania.

A copay is a fixed price that you pay at the time of service after your deductible is satisfied. Insurance companies set specific rates for primary and specialty care and other services, such as emergency room visits and X-rays.

Alternatively, plans may have coinsurance rates that require beneficiaries to pay a certain percentage of covered charges. All Marketplace plans must cover behavioral health care services, including counseling, inpatient care, and substance abuse treatments. However, there are coverage limits, and preauthorization may be required. Starting in , the federal government eliminated the penalty that applied to individuals who could afford health insurance but chose not to purchase it.

A deductible is a fixed amount you must pay out-of-pocket before normal copays or coinsurance rates apply. Under the Affordable Care Act, some services, such as annual physicals and wellness screenings, must be covered at no charge.

Subsidized health insurance is available exclusively through the Health Insurance Marketplace. This system applies federal tax credits that can reduce or eliminate premiums. Health insurance companies make money by collecting premiums from consumers and reinvesting the funds. Health insurance policies are contracts that require an insurer to pay some or all of a beneficiary's health care expenses in exchange for a premium and deductible.

Plans cover preventive care and emergency medical services arising from an injury or illness. They may also offer optional coverage for dental and vision. Affordable insurance is available through employers, Medicare, Medicaid, and the federal Health Insurance Marketplace, which offers subsidies in the form of tax credits. You can also purchase coverage through private insurance companies and independent agents. If you're looking for health insurance for yourself or your family, an agent can help you save time, understand your options, and manage your costs.

Insurance agents must be licensed in the state where they operate. They can provide information about on- and off-exchange plans to help you weigh all of your options, and they can see if you qualify for tax credits that can lower your monthly premiums. There's no cost to work with an agent, and they can help you save quite a bit by recommending the best plan for your needs.

Here's what you should know before you get started. We did the research for you! Last updated: January 17, Reviews: 12 Providers Selection criteria. Business Description. Reputation: We scour the internet for reviews from well-known resources.

Each provider is evaluated based on the quality and quantity of their reviews, their presence on multiple review sites, and their average minimum rating. Google 5. Leave Feedback. Professionalism: We hire mystery shoppers to call our providers anonymously and evaluate them. Providers who respond quickly, answer questions thoroughly, and communicate politely score higher. Responsiveness Friendliness Helpfulness Detail. License Verified:. License: Pennsylvania Insurance Department.

Google 4. Call your local Highmark Direct Retail Store or click the link above to schedule an appointment. Store Locations. Use your zip code to find a store in your area or check the listing below the map. Enter your zip code:. Make This My Store. Member Login Contact Us Privacy. Cancel Submit. The ZIP code you entered is outside the service areas of the states in which we operate.

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