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Eligibility, Coverage and Payments
Eligibility | Coverage | Payment
and the Waiting List | Termination
of Coverage | Impartial
Eligibility Review
Payment and the Waiting List
Low Cost adultBasic Premium
A Low Cost adultBasic member is required to pay a monthly
premium which is a portion of the actual cost of the Low
Cost adultBasic insurance. (The balance of the cost is paid
for by state funds.)
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| NOTE: |
Enrollment in the Low Cost adultBasic program is now capped due to state funding limitations. Eligible applicants will be placed on a waiting list and enrolled should state funds become available. Eligible applicants have the option to purchase coverage at full cost while waiting for state-funded coverage. The cost of this coverage is $210.67 per month. |
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What Happens if a Low Cost adultBasic Premium is
Paid Late?
If a member fails to pay their Low Cost adultBasic premium
by the due date, coverage will be terminated at the end
of the last month the premium was paid. There is no grace
period for late payments. The person terminated will
be responsible for any adultBasic medical costs incurred
after that date.
If coverage is terminated for Low Cost adultBasic because
a member fails to pay the premium on time, the terminated
member will have to go through the application process
from the beginning in order to re-enroll. Eligibility
will be subject to all the terms of the new agreement,
including waiting periods.
Waiting List Provisions
Continuation of Low Cost adultBasic coverage depends upon
adequate funding from the Commonwealth of Pennsylvania.
If at any time state funds are not available, the applicant
will be notified and informed of the following options.
An applicant who has been determined by the Caring Foundation
to be eligible for adultBasic but due to the lack of state
funds, Low Cost insurance is not available, has the option
to:
- Purchase At Cost coverage while waiting for Low Cost
coverage to become available. While paying for this
coverage, the applicant will retain his or her spot
on the waiting list for Low Cost coverage; or
- Not purchase coverage and be placed on the waiting
list for Low Cost coverage until state funds become
available.
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| NOTE: |
There is
only one waiting list. All eligible
applicants, whether they choose to
purchase At Cost coverage or not, will be
placed on the same waiting list and enrolled
on a first-come, first-served basis, as state
funds become available. |
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At Cost adultBasic Premium
If state funds for the Low Cost adultBasic program are not
available, an applicant will be placed on a waiting list.
While on the waiting list, the applicant will have the option
to purchase At Cost coverage at the actual cost of the adultBasic
premium.
What Happens if an At Cost adultBasic Premium is
Paid Late?
If someone enrolled in the At Cost adultBasic program fails
to pay their premium by the due date, coverage will be terminated
at the end of the last month for which the premium was paid.
There is no grace period for late payments. The person
terminated will be responsible for any medical costs incurred
after that date.
If someone fails to pay their At Cost premium, they will,
however, retain their spot on the waiting list for the
Low Cost adultBasic program until state funds become available.
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