Paul Sanchez
Penn State Health accepts a variety of health insurance plans and will submit claims on your behalf. The health insurance plans accepted vary depending on the specific Penn State Health entity, with some examples including Highmark Vision, Highmark Northeast PA – First Priority, Humana Medicare Advantage, PA Medical Assistance, United Health Care Community Plan, UPMC for You, and Aetna Better Health. Students who do not have adequate coverage are encouraged to enroll in the Student Health Insurance Plan (SHIP) for Penn State, which offers comprehensive health insurance at a competitive price. Regular full-time faculty and staff members are eligible to enroll in Penn State's Health Care Plan.
| Characteristics | Values |
|---|---|
| Insurance accepted | A variety of health insurance plans |
| Insurance plan network | Hershey Medical Center, St. Joseph Medical Center, Hampden Medical Center, Lancaster Medical Center, Penn State Health Community Medical Group locations |
| Insurance for students | Student Health Insurance Plan (SHIP) |
| Insurance for employees | Lion Traditional, Lion Advantage HSA, Lion Advantage Flex |
| COVID-19 testing | Not covered at 100% |
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What You'll Learn
Penn State accepts major health insurers
Penn State accepts most major health insurance plans and will submit claims on your behalf. However, certain coverage restrictions may apply based on your individual benefit package. It is always best to check with your health insurance carrier to see if Penn State Health is part of your insurance plan network.
Penn State Health entities accept the following insurance plans unless otherwise noted:
- Highmark Vision – For Penn State Health and Commonwealth of PA employees only (Davis Vision) – Vision Insurance Plan Type
- Highmark Northeast PA – First Priority – Commercial Plan Type
- Humana Medicare Advantage – Medicare Advantage Plan Type
Penn State Behrend also accepts insurance from most major health insurers at the Health Center. However, it is recommended that you find out ahead of time if your insurance will cover your care at the Health Center, as there may be restrictions on primary care doctors outside of the insurance company's network. For instance, the Health Center is not a participating provider with Tricare, but will submit bills directly and accept the reimbursement amount set by federal regulation.
Additionally, Penn State offers its own Health Care Plan, which full-time faculty and staff members are eligible to enroll in. Part-time faculty and staff members can also become eligible for medical coverage under the Affordable Care Act (ACA) regulations. Furthermore, students who do not have adequate coverage are encouraged to enroll in the Student Health Insurance Plan (SHIP) for Penn State, which offers comprehensive health insurance at a competitive price.
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Students can buy a health insurance plan
Students can purchase a health insurance plan that is accepted at Penn State Medical. Having health insurance is important for students, as it can provide coverage for unexpected medical expenses, such as injuries or illnesses.
There are a variety of insurance plans available to students, and the best plan for an individual may depend on a variety of factors, including the student's age, health status, and financial situation. Students should carefully review the terms and conditions of each insurance plan before making a purchase.
One option for students is to enroll in a student health insurance plan offered by their school. These plans are typically designed to meet the specific needs of students and may offer coverage for on-campus and off-campus medical services. The cost of student health insurance plans can vary, but they are generally affordable and may be subsidized by the school.
Another option for students is to purchase an individual health insurance plan through the Health Insurance Marketplace. The Marketplace offers a diverse range of plans from various insurance providers, allowing students to make comparisons based on factors like price, benefits, and the scope of coverage. Financial assistance may also be available for students facing challenges in paying their insurance premiums.
In certain cases, students have the option to remain on their parents' health insurance plan until they turn 26. This option is not only cost-effective but also ensures continuous coverage throughout their time in school. However, it's important to carefully review the specific details of the parents' plan, as the extent of coverage may vary depending on the insurance company and their network of providers.
Additionally, international students attending Penn State Medical should be aware that they may need to purchase a specialized health insurance plan that complies with the requirements stipulated by their student visa. These plans are tailored to provide comprehensive coverage specifically for international students during their studies in the United States.
Overall, it is crucial for students to thoroughly assess the available health insurance options and select a plan that aligns with their unique needs. By securing adequate health insurance coverage, students can have the peace of mind that comes with knowing they are protected from unforeseen medical expenses.
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Employees can enrol in the Lion Advantage HSA plan
Penn State Health accepts a variety of insurance plans and will submit claims on behalf of the patient. Patients are advised to check with their insurance carrier to see if Penn State Health is part of their insurance plan network.
Regarding the Lion Advantage HSA plan, this is a High Deductible Health Plan (HDHP) option with a lower employee contribution. Employees can enrol in the Lion Advantage HSA plan, and a Health Savings Account (HSA) is automatically opened on their behalf through HealthEquity. Funds are contributed on a tax-free basis and can be used for eligible health expenses. These funds will roll over from calendar year to calendar year and will remain the employee's even if they leave Penn State employment or are no longer eligible for a Penn State medical plan.
With the Lion Advantage HSA plan, there is generally no payment due at the time of service. The subscriber will receive a bill from their provider, which they can then choose to pay from their HSA or from other personal accounts. If the bill is paid from an HSA, the subscriber may use the Health Equity debit card or pay the provider directly through the claims portal.
It is important to note that if an employee is enrolled in the Lion Advantage HSA plan, they must decline Medicare Parts A and B. Per IRS regulations, an employee cannot be enrolled in Medicare Parts A or B and be contributing to an HSA, which is automatically included with the Lion Advantage HSA plan. Employees with money in a Health Care Flexible Spending Account (FSA) must use all the money in the FSA before enrolling in the Lion Advantage HSA plan. Due to IRS regulations, Lion Advantage HSA plan members are not eligible to enrol in an FSA.
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Medicaid and CHIP recipients must renew coverage
Penn State Health accepts a wide range of insurance plans and will submit claims on behalf of patients. However, coverage restrictions may apply depending on an individual's benefit package. While Medicaid and CHIP recipients enjoyed continuous coverage during the COVID Public Health Emergency, this requirement ended on April 1, 2023, due to a change in federal law. As a result, all Medicaid and CHIP recipients must now renew their coverage annually or risk losing their insurance coverage.
The renewal process for Medicaid and CHIP coverage varies. Individuals will typically receive a packet in the mail when it is time to renew their coverage. This packet must be completed and returned as soon as possible to avoid any disruptions in coverage. For those who prefer to renew online or over the phone, this option is also available. Renewal packets are typically sent out 30 to 90 days before the renewal date, and recipients can opt to receive text message alerts when their renewal is due. It is important to complete and return the renewal forms by the due date to maintain continuous coverage.
The renewal process is necessary to determine if individuals still qualify for Medicaid or CHIP coverage. If an individual is no longer eligible for Medicaid or CHIP, they will be automatically connected to low- or no-cost health coverage options. This process ensures that individuals can choose a health plan that suits their needs and financial situation. It is important to note that no one will be disenrolled from Medicaid or CHIP without the opportunity to complete a renewal and explore alternative coverage options.
To facilitate the renewal process, the Department of Human Services (DHS) and Pennie® have developed a communications toolkit to assist with outreach and education. This toolkit includes resources to help individuals understand the end of the continuous coverage requirement and the importance of renewing their coverage. Additionally, it encourages recipients to keep their contact information up to date and provides information on how to complete their renewal early online, over the phone, or by mail. By providing clear guidance and multiple modes of communication, DHS aims to ensure a smooth transition for individuals renewing their Medicaid or CHIP coverage.
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Out-of-network providers may be covered
Out-of-network providers are physicians, hospitals, or healthcare providers who do not participate in a health plan's provider network. This means that they have not signed a contract agreeing to accept the insurer's negotiated prices. Out-of-network care is typically more expensive than in-network care, and you may have to pay the full price if your insurance plan does not cover out-of-network services.
At Penn State Health, out-of-network providers may still be covered, but the insurance plan may require out-of-network authorizations, and you may receive a lower level of benefits. Certain coverage restrictions may apply based on your individual benefit package. It is important to check with your health insurance carrier to see if Penn State Health is part of your insurance plan network.
If you receive services from an out-of-network provider, your insurance plan may have a lower level of benefits, and you may have to pay more out of pocket. In some cases, your insurance carrier may set a higher deductible and out-of-pocket limit for out-of-network care. Additionally, some insurance carriers may only provide partial coverage, so you will pay more of the cost.
It is worth noting that emergency services are typically covered by insurance plans, even if they are provided by out-of-network providers. The No Surprises Act also protects patients from surprise balance bills in emergencies or situations where the patient unknowingly received care from an out-of-network provider while at an in-network facility.
If you are unsure about your coverage for out-of-network providers, it is recommended to refer to your plan documents or contact your insurance carrier for more information.
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Frequently asked questions
Penn State Health accepts a variety of health insurance plans, including:
- Highmark Vision (for Penn State Health and Commonwealth of PA employees only)
- Highmark Northeast PA – First Priority (Commercial Plan Type)
- Humana Medicare Advantage (Medicare Advantage Plan Type)
- PA Medical Assistance (in-network fee for service plan only)
- United Health Care Community Plan
- UPMC for You
- AmeriHealth Caritas
- Aetna Better Health
- Gateway
- Access (but not Keystone First)
If your insurance is not accepted at Penn State Medical, you may be responsible for your visit charges. It is recommended that you find out ahead of time if your insurance will cover your care, as there may be restrictions on primary care doctors who are outside of your insurance company's network. Penn State offers financial counselling to determine whether you qualify for a special program, payment plan, or charity.
Students who do not currently have adequate coverage are encouraged to enrol in the Student Health Insurance Plan (SHIP) for Penn State. All undergraduate students taking three or more credits or graduate students taking one or more credits are eligible to purchase the plan.
Regular full-time faculty and staff members are eligible to enrol in Penn State's Health Care Plan. Part-time faculty and staff members can become eligible for medical coverage under the Affordable Care Act (ACA) regulations.
COVID-related testing is not covered at 100%. It will be subject to deductible and coinsurance under the Penn State medical plans. Employees can contact the Penn State Highmark Concierge customer service team at 844-945-5509 with further questions.
