adultBasicSM
Adults between 19 and 65 years of age |
| Monthly cost |
$35.00 for low-cost adultBasic
$313.18 for at-cost adultBasic |
| Type of coverage |
Keystone Health Plan East HMO
limited-benefit plan |
| Eligibility based on |
Family size and income, and uninsured 3 months, unless uninsured as a direct result of being unemployed |
| Wait period (if eligible) |
29 mo. wait (as of 2/07) for $35.00 premium
No wait for At Cost $313.18 premium, if eligible |
| Pre-existing condition rule |
No |
| Copays |
$5 PCP/$10 specialist/$25 ER |
| Benefits
|
| Doctor office visits |
unlimited ($5 PCP/$10 specialist) |
| Hospitalization |
unlimited |
| Surgery and anesthesia |
covered |
| Emergency accident and medical care |
covered ($25 copay, waived if admitted) |
| Diagnostic services |
covered |
| Chemotherapy and radiation therapy |
covered |
| Maternity care |
covered |
| Newborn care |
covered for up to 31 days following birth |
| Dental |
not covered |
| Vision and hearing |
not covered |
| Prescription drugs |
not covered, except for diabetic supplies and insulin and immunosuppressants related to transplants which are covered 100%* |
| Durable medical equipment |
not covered, except for diabetic supplies and insulin* |
| Mental health |
not covered |
| Serious mental illness |
not covered |
| Substance abuse |
not covered |
