Frequently asked questions
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General FAQs
What is Pennie?
Pennie is the official online marketplace made possible by the State of Pennsylvania and the top private insurance companies to provide affordable, high quality health insurance plans to Pennsylvanians. Pennie really is the perfect mix of public and private entities collaborating to create a safe, trusted insurance marketplace.
How do I contact Pennie?
If you are a customer who would like to speak with one of Pennie’s friendly and knowledgeable Customer Service Representatives you can call the Pennie Contact Center at 1-844-844-8040.
If you are a Pennie Certified Broker or Assister and you need assistance you can call the Pennie Contact Center at 1-844-844-4440.
Click here for more information on free enrollment assistance options or how to send us an email.
Where can I find a full list of FAQs?
Click here to be taken to our FAQ central.
Common term definitions
- Deductible – The amount you pay for covered healthcare services before your insurance plan starts to pay a portion of these costs. For example, if your plan has a $2,000 deductible, you must pay the first $2,000 out-of-pocket for covered services.
- Out-of-pocket maximum – The most you have to pay for covered services in a plan year. After you spend this amount on costs should as deductibles, co-payments, and co-insurance, your health plan will pay 100% of the costs of covered benefits.
- Advanced Premium Tax Credit – A tax credit you can take in advance to lower your monthly health insurance payment, or premium. Your eligibility for a premium tax credit is based on the projected income and household information you provide on your Pennie application.
- Allowed Amount – The maximum amount a plan will pay for a covered healthcare service. This term may also be referred to as an “eligible expense,” “payment allowance,” or “negotiated rate.”
- Co-Payment – A fixed amount ($20, for example) you pay for a covered healthcare service after you’ve paid your deductible.
Additional FAQs
Can I change coverage outside of the Open Enrollment Period (Nov 1st - Jan 15th)?
In order to make changes to your current enrollment outside of the annual Open Enrollment Period, you must experience a Qualifying Life Event (QLE). A QLE is a change in circumstances that may make you eligible for a Special Enrollment Period, during which you may make changes to your enrollment.
- Loss of minimal essential coverage like job-based coverage or Medicaid;
- Change in household size (e.g. birth of a child, marriage, divorce);
- Change of residence; and
- Change in income that makes you newly eligible/ineligible for financial assistance.
If you are currently enrolled through Pennie and need to report a QLE, log into your Pennie account and click “Edit Application.” Once your application is updated, click “Confirm Event and Shop” to report your QLE and enroll into coverage.
You generally have 60 days to report your QLE and enroll into coverage.
What is a Qualifying Life Event?
A change in your circumstances – like getting married, having a baby, or losing health coverage – that can make you eligible for a Special Enrollment Period, which allows you to enroll in health insurance outside the yearly Open Enrollment Period. Click here to learn more.
What are Data Matching Issues and what documents should I submit to resolve one?
What are Data Matching Issues/Inconsistencies?
When a customer applies for health coverage through Pennie, Pennie is required by federal law to verify the information provided in their application. Most of this information is immediately verified by Pennie, in some cases though, the information provided does not match the information stored in Pennie’s verified data sources. These types of situations are called data matching issues or data matching inconsistencies (DMI). Examples include:
- Projected Annual Household Income
- Citizenship/Immigration Status
- American Indian/Alaska Native Status
- No eligibility for other Minimum Essential Coverage (MEC)
Click here to learn more about how to resolve a Data Matching Issue.
What documentation do I need to confirm a Qualifying Life Event?
When you apply for Pennie coverage through a Special Enrollment Period, you may be asked to provide documents to confirm the Qualifying Life Event (QLE) that makes you eligible. Click here for commonly reported QLEs that require documentation, what documents you can submit, and how to submit them.
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