Pennsylvania grant & resource directory - pa house

PENNSYLVANIA DEPARTMENTS
PENNSYLVANIA INSURANCE DEPARTMENT
www.insurance.pa.gov
INSURANCE PROGRAMS
adultBasic Health Insurance – adultBasic provides basic
health insurance for adults meeting certain income and other
eligibility requirements and who do not have health insurance
coverage, including Medicaid. The program is administered
by the Pennsylvania Insurance Department though contracts
with six insurance companies throughout the state. adultBasic
offers basic benefits, including preventative care, physician
services, diagnosis and treatment of illness or injury, in-patient
hospitalization, out-patient hospital services, emergency
accident and medical care.
Individuals enrolled in the program pay a premium of $36 per
month and modest co-payments for primary, specialist and
emergency care services. There is a 10 percent coinsurance for
certain specified services, with a $1,000 maximum per year for
all coinsurance costs combined.
Catastrophic Loss Benefits Continuation Fund (AUTO
CAT FUND) – The Catastrophic Loss Benefits Continuation
Fund (Auto CAT Fund) continues benefits for medical
treatment and rehabilitative services, previously provided by
the Catastrophic Loss Trust Fund, for injuries arising out of
the maintenance or use of a motor vehicle between October 1,
1984 and December 31, 1989.
In addition to other eligibility criteria and before being eligible
for benefits, the claimant must incur $100,000 in medically
necessary and reasonable medical and/or rehabilitative
expenses. Benefits are capped at $50,000 per year with a
$1,000,000 lifetime maximum.
CHIP (Children’s Health Insurance Program) – This
program provides free or low-cost comprehensive health care
to children under the age of 19 whose families make too much
money to qualify for Medicaid and are not otherwise covered
by health insurance. CHIP has expanded to cover all kids and
that means that now, no family makes too much to be eligible.
The cost of coverage is based on family income. Families with
household incomes below 200 percent of the federal poverty
guidelines (e.g., $44,100 for a family of four) receive CHIP
coverage at no cost. Families with household incomes above
300 percent of the federal poverty guidelines (e.g., $66,151)
pay the actual cost of coverage. Families with incomes in
between pay between 25 percent and 40 percent of the cost,
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ELIGIBILITY/REQUIREMENTS
Additional information, including eligibility
criteria is available on the department’s
website at: www.insurance.pa.gov.
Interested individuals may apply on-line at:
www.compass.state.pa.us, by phone at
1 (800) GO-BASIC or by calling 1 (800) GO-
BASIC to receive a paper application, which
will be mailed.
****Currently, there is a waiting list for enrollment.
However, individuals determined to be eligible for
adultBasic who are placed on a waiting list, have
the option to purchase adultBasic coverage at the
Insurance Department’s cost for non-subsidized
adultBasic coverage and will receive the same
benefits as those offered through the program. As of
July 1, 2010, the cost of purchasing adultBasic while
on the waiting list is $629 per person per month.
Except for workers’ compensation the Auto
CAT Fund is the primary payor for eligible
claimants and coordinates benefits with
health and other insurance carriers. Insurers
may confirm whether the Auto CAT Fund
is the primary payor on a particular claim
by contacting the current third party
administrator.
Additional information on filing a claim,
benefits and eligibility requirements are
available on the department’s website at
www.insurance.pa.gov or calling the Auto
CAT Fund at: (717) 787-4919.
Additional information is available on the
department’s website at:
www.chipcoverspakids.com.
Currently, there is no waiting list for the
CHIP Program.
Families may apply on-line at:
www.compass.state.pa.us, by phone at:
1 (800) 986-KIDS or by calling 1 (800) 986-
KIDS to receive a paper application, which
will be mailed.
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