The Pennsylvania Insurance Exchange (Marketplace) is the Federally-Facilitated Marketplace.
The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
General information about the Federally-facilitated Marketplace can be found at: https://www.healthcare.gov/marketplace/individual/#state=pennsylvania.
PATIENTS
The Federally-facilitated Marketplace is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.
HIV PROVIDERS
Providers must contract with each of the plans in the marketplace individually in order to fully participate in the Alabama Health Benefit Exchange.
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them.
If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any otherproblems related to the Affordable Care Act, please report these problems to the state office of insurance:
Pennsylvania Insurance Department
1326 Strawberry Square
Harrisburg, PA 17120
877-881-6388
www.insurance.pa.gov/
Complaints: http://www.insurance.pa.gov/portal/server.pt/community/file_a_complaint/9258
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the Alabama Health Benefit Exchange.
Alabama has established Blue Cross Blue Shield of AL as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates
Aetna
Plan Website: http://www.aetna.com/individuals-families/health-insurance-exchange.html
Provider Enrollment: http://www.aetna.com/healthcare-professionals/join-aetna-network/join-provider-network.html
Plan types offered: Individual
Assurant Health
Plan Website: http://www.assuranthealth.com/corp/ah/AHHome.htm
Provider Enrollment: http://www.assuranthealth.com/corp/ah/Providers/health-care-provider.htm
Plan types offered: Individual
Blue Cross of Northeastern Pennsylvania
Plan Website: https://www.bcnepa.com/
Provider Enrollment: https://www.bcnepa.com/Providers/TelephoneDirectory.pdf
Plan types offered: Individual, SHOP
Capital BlueCross
Plan Website: https://www.capbluecross.com/
Provider Enrollment: https://www.capbluecross.com/wps/wcm/connect/CBC-Public/CBC/ForHealthProfessionals/Join+Our+Network
Plan types offered: Individual, SHOP
Geisinger Health Plans
Plan Website: http://www.thehealthplan.com/Marketplace/
Provider Enrollment: http://www.thehealthplan.com/providers_us/providerjoin.cfm
Plan types offered: Individual, SHOP
Highmark Health Insurance Company
Plan Website: https://www.highmark.com/hmk2/index.shtml
Provider Enrollment: https://www.highmark.com/hmk2/index.shtml
Plan types offered: Individual, SHOP
Highmark Inc.
Plan Website: https://www.highmark.com/hmk2/index.shtml
Provider Enrollment: https://www.highmark.com/hmk2/index.shtml
Plan types offered: SHOP
Independence Blue Cross
Plan Website: http://www.ibx.com/index.jsp
Provider Enrollment: http://www.ibx.com/providers/interactive_tools/caqh.html
Plan types offered: Individual, SHOP
Keystone Health Plan Central, A Capital BlueCross Company
Plan Website: https://www.capbluecross.com/
Provider Enrollment: https://www.capbluecross.com/wps/wcm/connect/CBC-Public/CBC/ForHealthProfessionals/Join+Our+Network
Plan types offered: Individual, SHOP
UnitedHealthcare
Plan Website: http://www.uhc.com/health_reform_guide.htm
Provider Enrollment: http://www.uhc.com/physicians/join_our_network.htm
Plan types offered: Individual
UPMC Health Plan
Plan Website: http://www.upmchealthplan.com/
Provider Enrollment: http://www.upmchealthplan.com/providers/request.html
Plan types offered: Individual, SHOP