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Facts about adultBasic
Introduction/Summary
Pennsylvania is committed to quality health care for all of its residents.
In June 2001, Governor Tom Ridge signed into law the Health Investment Insurance Act (Act 77 of 2001). Act 77 is a dramatic initiative that invests the proceeds of the state's tobacco settlement in the health of Pennsylvania consumers. The state is expected to receive approximately $11 billion over the course of 25 years.
The largest single component of the settlement will provide health insurance to a number of uninsured Pennsylvanians between the ages of 19 and 64. The program will provide health insurance for adults meeting certain income requirements and who do not have health care coverage.
This new program -adultBasic- is administered by the Pennsylvania Insurance Department and offers basic benefits, including, preventive care, physician services, diagnosis and treatment of illness or injury, in-patient hospitalization, out-patient hospital services and emergency accident and medical care.
Who qualifies for the adultBasic Program?
Participation in the adultBasic Program is based on certain eligibility requirements, which include:
- Having no other health care coverage (including Medicaid or Medicare);
- Having no coverage under any other insurance plan for at least 90 days prior to enrollment; except for a person (and their spouse) who has been laid off his/her job;
- Being between the age of 19 through 64;
- Having family income below 200 percent of the Federal Income Guidelines (see table below); and
- Having lived in Pennsylvania for at least 90 days prior to enrollment; and
- U.S. Citizenship or a permanent legal alien status.
What are the eligible income limits in order to participate in the program?
The following chart explains the number of people in the family versus the maximum income in order to be eligible for the program:
| Eligibility Requirements | |
| Number in Family | Maximum Income |
| 1 | $17,960 |
| 2 | $24,240 |
| 3 | $30,520 |
| 4 | $36,800 |
| 5 | $43,080 |
| 6 | $49,360 |
| 7 | $55,640 |
| 8 | $61,920 |
Income Guidelines according to February 7, 2003 Federal Register
What if a person has a pre-existing condition?
The program will not exclude coverage based on a pre-existing health condition.
What medical benefits are available?
The adultBasic Program is designed to provide basic insurance benefits, including:
- Hospitalization (unlimited days)
- Physician Services (primary care and specialists)
- Emergency Services
- Diagnostic Tests (e.g. x-rays, mammograms and laboratory tests)
- Maternity care
- Rehabilitation and skilled care (in lieu of extended hospitalization)
Any costs/co-pays involved?
A monthly premium of $30.00 must be made prior to enrollment and each month thereafter for coverage to continue.
Modest co-pays for certain benefits are required. They are:
- Doctor Visit- $5.00
- Emergency Room-$25.00 (waived if admission occurs)
- Specialists - $10.00
How can I enroll?
Applications for enrollment in the adultBasic Program are available from adultBasic contractors or by calling the toll-free number 1-800-G0-BASIC. On-line application is also available. See "application for adultBasic" or reference www.compass.state.pa.us. Coverage will begin July 2002.
What is the funding source and how much is available?
Funding for this program comes from a portion of the Commonwealth's share of the Tobacco Settlement money. Under this agreement with the country's major tobacco companies, the Commonwealth is slated to receive an estimated $11.5 billion over the next 25 years, or approximately $400 million a year.
Is this the same as CHIP?
No, The Children's Health Insurance Program (CHIP) offers children of low-income families affordable, or even free, health care coverage. The adultBasic Program provides basic health care coverage for eligible adults. Families, however, may apply for either or both programs (CHIP and adultBasic) using the same application.
Article reference: http://www.ins.state.pa.us/ins/cwp/view.asp?a=1278&q=527068
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