Do I qualify?
Every plan Pro Health Plans places is underwritten. Nobody here can promise you a policy before the underwriter has looked at your answers. What follows is exactly how the underwriting works, so you know what you are walking into before you call.
People these plans tend to fit
Pro Health Plans's coverage tends to make the most sense for a specific set of people, and Mike Garvey will tell you plainly if you are not one of them:
- People with no employer coverage.
- People who do not qualify for a Marketplace subsidy.
- Small business owners covering themselves, or their employees, directly.
- Adults who have aged off a parent's plan at 26.
If none of that describes you, say so on the call. Mike would rather tell you a Marketplace plan is the better fit than sell you something that isn't.
The pre-existing condition rule
You do not qualify if a medical treatment was rendered or recommended by a physician, or if drugs or medicine were prescribed, within the 12 months prior to a covered person's effective date, for certain medical conditions.
This is a standard underwriting rule, not a Pro Health Plans policy choice. It is how the underwriter decides who the plan can take on, and it is applied the same way to every applicant.
Exclusions and limitations
Abortion is excluded, except where the covered person's or a dependent spouse's life would be in peril if the pregnancy were carried to term, or where medical complications arose from an abortion.
Pregnancy of a dependent child is excluded, unless required by law.
These are policy terms, set by the underwriter, not by Pro Health Plans. They are written here plainly so you have them before you apply, not after.
Who underwrites the plan
Coverage is underwritten by Philadelphia American Life (PALIC). The underwriter decides who qualifies, on what terms, and at what rate, based on the answers on your application.
You, your spouse and your children may qualify for an STD Rate, or a Rate Up from the STD Tobacco User Rates, depending on how the application is answered.
Pro Health Plans is owned and operated by a group of licensed, independent insurance agents who have met the financial and ethical standards set by New Era - Philadelphia American Life Insurance Company. Pro Health Plans has also completed the licensing standards set by each state in which we engage the insurance business.
This page summarises the plan's own stated eligibility terms. The policy and its exclusions govern, not this page. The quickest way to know where you stand is a short phone call.