What is adultBasic?
How is adultBasic administered?
What is the monthly premium?
What are the copays?
Is there a preexisting condition rule?
Can a parent apply for adultBasic and CHIP at the same time?
If a person cannot be insured for three months, does a CHIP child who turns 19 need to wait three months before applying?
How long does coverage last?
Does adultBasic have an annual renewal policy requirement?
What happens when the program fills up?
If a person suffers a layoff but has insurance, is he or she eligible?
Can a person enroll in Special CareSM while they are waiting for a slot to open up in adultBasic?
How can a person get more information about the adultBasic waiting list?
What is adultBasic?
adultBasic is an insurance program for low-income, uninsured adults between 19 and 65 years of age who fit the eligibility guidelines. The adultBasic program provides Keystone Health Plan East (KHPE) HMO coverage to enrollees.
How is adultBasic administered?
The Pennsylvania Insurance Department creates and enforces policies and procedures including benefits and exclusions. The Caring Foundation and KHPE have contracted with the PA Insurance Department to administer this program in southeastern Pennsylvania.
What is the monthly premium?
$35.00 per person. An applicant on the waiting list has the option to purchase adultBasic at the full cost of $313.18 while waiting for funding to become available.
What are the copays?
$5 for PCP/$10 for specialist/$25 for Emergency Room care (waived if admitted).
Is there a preexisting condition rule?
No, there is no preexisting condition rule.
Can a parent apply for adultBasic and CHIP at the same time?
Yes. The same application can be used for adults and/or children. Apply now.
If a person cannot be insured for three months, does a CHIP child who turns 19 need to wait three months before applying?
No.
How long does coverage last?
Coverage will last until the applicant no longer meets the eligibility guidelines or no longer pays the required premium.
Does adultBasic have an annual renewal policy requirement?
Yes, a member must fill out a renewal form and provide updated income documentation annually. However, if changes in income or eligibility occur before the annual renewal date, the applicant is responsible for informing us immediately.
What happens when the program fills up?
A person will be placed on a waiting list until a slot becomes available. He or she can choose to pay the full cost of the adultBasic premium of $313.18 to be enrolled while still remaining on the waiting list for the $35.00 per month program. A person’s ability to pay for coverage will have no effect on their place on the waiting list. Slots in the low-cost program will be filled on a first come, first served basis regardless of whether the person is waiting or enrolled and paying the full cost premium.
If a person suffers a layoff but has insurance, is he or she eligible?
To be eligible for adultBasic, a person must be uninsured for 90 days, except if uninsured as a direct result of being unemployed.
Can a person enroll in Special CareSM while they are waiting for a slot to open up in adultBasic?
No. Someone who enrolled in Special Care would not be eligible to enroll directly into adultBasic when a slot opens up, but would have to abide by the three months without insurance rule.
How can a person get more information about the adultBasic waiting list?
For additional information, visit the Pennsylvania Insurance Department’s adultBasic Q&A page: www.insurance.state.pa.us/html/abwlqa.html.
