Affordable Care Act and Marketplace FAQ

For a general overview of how the Affordable Care Act affects you, visit here.

Any Marketplace plan you wish to enroll in must still meet the University's insurance criteria for acceptable coverage.

  • Please note that not all Marketplace plans will meet the University's insurance criteria.
  • Generally, HMO exchange plans from states other than Pennsylvania will not be accepted because they have limited or no out of state coverage. Alternate acceptable coverage must provide in-patient and out-patient medical coverage in the Philadelphia area, including rountine office visits, specialists visits, diagnotic testing, imaging and physical therapy.
  • Exchange plans that provide Catastrophic coverage may not meet the University's insurance criteria.


General FAQ

Will PSIP enrollment fulfill the insurance coverage mandated by the Affordable Care Act?

Yes.

Can I waive PSIP with a Marketplace plan in 2014-2015?

You can waive PSIP in 2014-2015 with a Marketplace plan, provided the plan meets the University's insurance criteria.

Please note that not all Marketplace plans will meet the University's insurance criteria. Generally, HMO exchange plans from states other than Pennsylvania will not be accepted. The Catastrophic exchange plans do not meet the University's insurance criteria either. Your plan must fully cover you in the Philadelphia area. Students who sign up for Marketplace coverage must choose a plan in the state in which they file taxes. Many HMOs operate their networks within a specific region and will not extend their full coverage outside their network's region, which means you may not be covered in Philadelphia as University insurance criteria dictates. In some cases you may be able to obtain a guest membership in an affiliated network in the Philadelphia area. Please check with the insurance company.

Can I enroll in PSIP and cancel it mid-year in favor of a marketplace plan?

No. PSIP is an annual plan and can only be cancelled mid-year under very special circumstances. Buying Marketplace coverage would not qualify.

How can I enroll in Marketplace coverage and waive PSIP next year? The Marketplace open enrollment period ends on February 15, 2015 but the 14-15 PSIP doesn't expire until July 31, 2015?

Although the Marketplace open enrollment period will have ended, you would be eligible to a Special Enrollment (SEP) due to the fact that PSIP for 14-15 expires on July 31, 2015.  You would have to enroll within 60 days of PSIP expiring. 

Will PSIP be offered on the Insurance Marketplace?

No. PSIP will be available for enrollment through the University's enrollment website.

Will PSIP be eligible for subsidies under the Affordable Care Act?

No. PSIP is not currently eligible for the subsidies.

How do I verify the plan meets the criteria?

We strongly recommend that you obtain a full policy document that lists the exclusions before you purchase an ACA exchange plan. When you are shopping for plans on the Marketplace, you will be presented with summaries of the plan's benefits. In many cases these plans may contain exclusions which are not in the summary. Also pay close attention to the "out of area" coverage if you are purchasing a plan outside of the Southeastern Pennsylvania region.

I cannot find a full policy document online.

You may need to contact the insurance company directly. Please print out the waiver criteria and confirm each item. You may send them a copy of the Insurance Criteria. They can use this to verify the coverage. You can also contact the Penn Insurance Office. We would be happy to help you analyze the plan.

Can I choose an HMO on the Marketplace?

Your plan must fully cover you in the Philadelphia area. Students who sign up for Marketplace coverage must choose a plan in the state in which they file taxes. Many HMOs operate their networks within a specific region and will not extend their full coverage outside their network's region, which means you may not be covered in Philadelphia as University insurance criteria dictates. In some cases you may be able to obtain a guest membership in an affiliated network in the Philadelphia area. Please check with the insurance company.

Please choose carefully.

Many Marketplace plans with low premiums have high levels of out of pocket expenses.