adultBasic Phase-out: Frequently Asked Questions


 
Below you will find information regarding the phase-out of adultBasic coverage. If you still have questions or would prefer to speak to someone online, feel free to click the icon above and talk electronically with an adultBasic representative. You may experience a 10-second delay while the "live chat" connects. 

Frequently Asked Question Topics:

Details about Other Health Options and How to Apply
General Questions

What to Expect during the adultBasic Phase-out
What to Expect with Your Current Care and Coverage

Details about Other Health Options and How to Apply:

 

There are a number of health care options that adultBasic enrollees should explore immediately. If employer-based group coverage is available to you, and you have a pre-existing condition, we urge you to explore that option now, so that you get coverage before May 2, 2011. See above for how your “HIPAA Certificate of Creditable Coverage” works. 

Medical Assistance:
You may apply for health care coverage at www.compass.state.pa.us to see if you qualify for Medical Assistance (MA). If your circumstances have changed since enrolling in adultBasic - for example, if you’ve become disabled, turned 65, or your income has decreased - you may qualify for MA. To learn more, go to www.compass.state.pa.us and click on “Do I Qualify?” to find out if you may be eligible or call the PA DPW Helpline at 1-800-692-7462.

 

Medicare:
If you have turned 65, are disabled or meet other eligibility requirements, you may qualify for Medicare. For more information, go to: http://www.ssa.gov/medicareonly/  If you do not wish to apply online you may make an appointment by calling 1-800-772-1213. People who are deaf or hard of hearing may call the "TTY" number, 1-800-325-0778, between and on business days.

 

SpecialCare Health Insurance:
Pennsylvania’s Blue Cross and Blue Shield plans offer SpecialCare, a subsidized health insurance plan for individuals and families. Eligibility for SpecialCare is similar to that for adultBasic. SpecialCare differs from adultBasic both in the level of benefits and the cost. To simplify the transition from adultBasic to SpecialCare, the Blue plans have agreed to waive pre-existing condition exclusions for adultBasic members who enroll directly into SpecialCare by May 2, 2011 .

 

For more information or to enroll in SpecialCare, contact the plan that provides services in your county.

 

Note:  Special Care is not offered by the Pennsylvania Insurance Department, nor does identifying it here serve as an endorsement or sponsorship or other affiliation by or with the Pennsylvania Insurance Department. The SpecialCare products are offered by the Blue Cross and Blue Shield Plans, and  these products and the website links are identified here as a resource  to assist adultBasic enrollees in finding alternative coverage .    

Blue Cross of Northeastern Pennsylvania, 1-888-445-7930

http://www.bcnepa.com/ohpSpecialCare.aspx


Capital BlueCross, 1-800-682-2393

https://www.capbluecross.com/Products/ForIndividuals/HealthConditions/SpecialCare/


Highmark Blue Cross Blue Shield,
1-800-544-6679, TTY 1-800-452-8086

www.highmarkbcbs.com/SpecialCare


Highmark Blue Shield,
1-877-986-4571, TTY 1-800-562-0591  

www.highmarkblueshield.com/SpecialCare


Independence
Blue Cross, 1-866-282-2702, TDD/TTY 215-241-2622

http://www.ibx.com/health_plans/low_income/special_care.html


What benefits are covered by SpecialCare?
SpecialCare offers hospitalization and health care benefits that are more limited than the adultBasic benefit package. If you would like more details on what is covered by SpecialCare, please contact the Blue Cross and Blue Shield plan that provides services in your county.

 

Will I be eligible for SpecialCare?
The Blue Cross and Blue Shield plans have agreed to make SpecialCare available to all adultBasic enrollees who are losing adultBasic coverage and who meet the SpecialCare criteria. SpecialCare health insurance is available to uninsured lower-income individuals and families who fall into the same income guidelines as the adultBasic program. You must apply for SpecialCare with the Blue Cross and Blue Shield plan that provides services in your county, and should do so before May 2, 2011 if you wish to have youre pre-existing conditions included in your coverage You may apply after May 2, 2011, but your coverage likely will not include and pre-existing conditions that you have. Please see the list above for phone numbers and websites where you can receive more information and apply.

 

Am I eligible for SpecialCare if I have a pre-existing condition?
Yes. The Blue plans have agreed to waive pre-existing condition exclusions for adultBasic members who enroll directly into SpecialCare by May 2, 2011. For more information or to enroll in SpecialCare, contact the plan that provides services in your county

 

What will SpecialCare cost me?
Rates for SpecialCare vary among Blue plans, but are generally higher than adultBasic rates. Please see the list above for phone numbers and websites where you can receive more information and apply.

 

With SpecialCare, will I be able to see my same doctor?
Many of the same doctor’s that participated with adultBasic also participate with SpecialCare. To find out if your doctor participates, please contact the Blue Cross and Blue Shield plan that provides services in your county.

Employer-based Coverage:
You may have the option to select coverage provided through your employer, or another family member’s employer if applicable. In many cases, an employer subsidizes the cost of such coverage. If employer-based group coverage is available to you, and you have a pre-existing condition, we urge you to explore that option now, so that you get coverage before May 2, 2011.  See above for how your “HIPAA Certificate of Creditable Coverage” works. 
 

PA Fair Care:
PA Fair Care is Pennsylvania ’s health insurance program for uninsured people with pre-existing medical conditions. To be eligible, the federal Affordable Care Act says you must be uninsured for six months and have a pre-existing condition. This means you would be eligible for PA Fair Care in September if you are not covered by health insurance for the six months between February 28 (when adultBasic ends) and September 1, 2011. For information of PA Fair Care visit www.PAFairCare.com or call 1-888-767-7015.

 

Community Health Centers:
There are approximately 200 community health centers across the state that provide free or low-cost comprehensive, high quality medical health care for all ages on an ability-to-pay basis. In some locations, a full range of services such as dental care and prescription drugs may be available. Services may be free or low-cost, based on your household income. To find the health centers nearest you, call the PA Association of Community Health Centers, Monday through Friday, , at 1-866-944- CARE (2273), or go to http://www.pachc.com/health_find.html for a list of Pennsylvania health centers.

 

Financial Assistance with Hospital Bills:
Most hospitals offer financial assistance for uninsured patients who need treatment but cannot afford to pay their bills. Patients who qualify will have their bills reduced or eliminated. If you have hospital bills that you cannot afford to pay, call the hospital’s billing department and ask how you may apply for financial assistance.

 

Other Specialized Programs:

Prescription Drug Financial Assistance - Pennsylvanians who do not participate in any other state or federally funded prescription program may be able to receive free or low-cost prescriptions. Call 1-800-955-0989 for The Pennsylvania Patient Assistance Program Clearinghouse or go to www.aging.state.pa.us, “Prescription Assistance” and “Other Pharmaceutical Programs.” The Clearinghouse will help you apply for free or low-cost prescription medicines available from drug manufacturing companies and other sources. 
 

Medical Assistance for Workers with Disabilities (MAWD) - MAWD is a health insurance program for working individuals with a disability. There is no set requirement for how many hours you must work or how much you must earn, but you must work and receive wages to qualify. For more information, call 1-800-692-7462 or go to www.dpw.state.pa.us , type in “MAWD” in the Site Search box in the top right corner, then click on the first link to “Medical Assistance Benefits for Workers with Disabilities”. 
 

SelectPlan for Women – Pennsylvania’s SelectPlan for Women is a free, confidential health care program for women between the ages of 18 and 44 that pays for family planning services and related preventive health screens provided by participating health care professionals. Family planning-related prescriptions are free at any participating pharmacy. For more information and to see if you are eligible, call 1-800-842-2020 or go to www.selectplanforwomen.com
 

HealthyWoman Breast and Cervical Screening Program (HWP) - HWP offers breast and cervical exams at no cost for eligible women. These exams include mammograms, clinical breast exams, pelvic exams and Pap tests. You qualify if you are 40 to 64 years old; have no or limited insurance; and have low to moderate household income. For more information and to find the HWP check-up site near you, call 1-800-215-7494 or go to www.pahealthywoman.org
 

Breast and Cervical Cancer Prevention and Treatment Program (BCCPT) - If you have been diagnosed with breast or cervical cancer or a pre-cancerous condition of the breast or cervix, you may be eligible for free care through BCCPT. The care covers your breast or cervical cancer treatment, as well as any other unrelated conditions while receiving your cancer treatment. You qualify if you are female; under age 65; meet the income requirements; and have no or limited insurance. For more information, call 1‑800-842-2020 or click here for more information. 
 

Pregnancy/High-Risk Pregnancy (Healthy Beginnings/Healthy Beginnings Plus) - If you are pregnant, you may be eligible for Healthy Beginnings or Healthy Beginnings Plus – free programs that provide comprehensive health care coverage to pregnant women and their babies for a full year. Call 1-800-842-2020 for more information on how to apply and for locations near you or click here for more information.

General Questions: 

Why did the the coverage under the adultBasic program end?
The adultBasic health coverage program did not have funding to provide coverage to enrollees beyond February 28, 2011 . As a result, coverage ended on February 28, 2011 . As discussed below, adultBasic enrollees do have other options for coverage.

adultBasic termination noitces were sent out in January and February 2011.

Coverage termination notices were sent out at the end of January 2011 by adultBasic insurance companies.


Where can I get more information on the termination of the adultBasic program?
Information and updates will continue to be posted on the Insurance Department’s website at www.insurance.pa.gov, click on “adultBasic,” or call 1-800-GO-BASIC (1-800-462-2742) from Monday through Friday from to or Saturday from to

 

Will any other program take its place?
There are no plans to replace adultBasic with another government-sponsored health care program at this time. However, there are other options available. Please see the list above for health care options.

 

Will the adultBasic program be restarted?

Proposals have recently been made to authorize funding that would permit the restoration of coverage under the adultBasic program. Please check this website periodically for information regarding any devlopements that would result in the restoration of adultBasic coverage. 

 

I applied for adultBasic in the past and received a letter that I’m on the adultBasic wait list. Should I  continue to wait to be offered adultBasic coverage in the future? 
No. adultBasic coverage ended on February 28, 2011. This means that coverage under the adultBasic program ended for everyone and all wait listed applicants and enrollees should look for other health care coverage options. Please see the list above for health care options.

 

I’m on the adultBasic wait list and have been purchasing the coverage. Can I continue to purchase coverage?
No. adultBasic coverage ended on February 28, 2011 and the program does not have funding to enable the insurance companies providing the coverage to administer the program for people on the wait list. However, there are other options available to you. Please see the list above for health care options.

 

My child is on CHIP or needs CHIP coverage. Is CHIP affected by this?
No! Applications and benefits for CHIP are not affected in any way and are not affected by the termination of the adultBasic program in any way. Uninsured children and teens (up to age 19) not eligible for Medical Assistance are eligible for CHIP. If your child has CHIP coverage, nothing will change. If your child is uninsured, you may apply for CHIP by going to www.compass.state.pa.us.

What to Expect During the adultBasic Phase-out:

What will I get in the mail from my adultBasic insurance company?
Please look for this important documents from your adultBasic insurance company in the mail: HIPAA Certificate of Creditable Coverage notice (second week in March 2011) 
  

If you do not receive these documents by the dates listed above, please call your adultBasic insurance company (using the toll-free phone number listed on your ID card).

 

What is a HIPAA Certificate of Creditable Coverage?
A HIPAA Certificate of Creditable Coverage is an important document that shows your prior health care coverage. This certificate usually reduces how long your new group health care plan may exclude you from coverage for a pre-existing health condition. The insurance company providing your adultBasic coverage will be mailing this very important Cerificate to you. Please keep it for your records. If you do not receive a Certificate in the mail by the end of March, contact your adultBasic insurance company and verify your mailing address.

 

Why is this HIPAA Certificate of Creditable Coverage so important?
You will need this “HIPAA Certificate of Creditable Coverage” if you want to apply for group health insurance coverage, such as coverage provided by your employer.  If you have a pre-existing condition and want to have coverage for that condition included in your new group coverage, you need to use this Certificate by the end of April, as it is only useful within 63 days (May 2, 2011) of your adultBasic insurance ending on February 28, 2011.  You may, of course, get individual coverage, or get group coverage after May 2, but if you do, this Certificate will not help you and any pre-existing conditions you may have may not be covered.

 

What should I do with the HIPAA Certificate of Creditable Coverage?
When you receive a HIPAA Certificate of Creditable Coverage from your adultBasic insurance company, check it for accuracy. It must include the name of each person covered under the former policy, along with the starting date and ending date of coverage. Simply forward a copy to your new health insurance company, but remember to keep a copy for your own records. You might want to store the certificate inside the cover of the new health insurance policy itself for easy reference later.

 

What should I do with the HIPAA Certificate of Creditable Cvoerage?

When you receive a HIPAA Certificate of Creditable Coverage from your adultBasic insurance company, check it for accuracy. It must include the name of each person covered under the formal policy, along with the starting date and ending date of coverage. Simply forward a copy to your new health insurance company, but remember to keep a copy for your own records. You might want to store the certificate inside the cover of the new health insurance policy itself for easy reference later.

 

What information will be on the Certificate of Creditable Coverage?
Sample of a Certificate of Creditable Coverage:

http://www.delawareinsurance.gov/departments/consumer/seisample.pdf

 

Should I apply for new health insurance within a certain period of time?
Yes, you should apply for new coverage by May 2, 2011.  If you move from one plan to another one that is subject to the HIPAA requirement concerning pre-existing condition exclusion (that is, a group plan, such as an employer’s plan), and you have proof of prior coverage (a Certificate of Creditable Coverage) and your break in coverage has been less than 63 days, your new insurance company will not be able to exclude coverage for any pre-existing conditions for a number of months. You need to apply for coverage by the end of April, as the Certificate of Creditable Coverage is only useful within 63 days (May 2, 2011) of your adultBasic insurance ending on February 28, 2011 to protect you from pre-existing condition exclusions in the new group’s coverage.

What to Expect with Your Prior Coverage:  

What should I do if I had adultBasic coverage and I was in the hospital when coverage ended on February 28?
If you were a hospital inpatient when adultBasic coverage ended on February 28th, your adultBasic plan will continue to cover you through your hospitalization until you are discharged or for 90 days after coverage has ended, whichever comes first.

 

I have medical procedures scheduled beyond February – what should I do?
Unfortunately, if you have doctor appointments or medical procedures scheduled after February 28, 2011, those services will no longer be covered. There are other health care options available. Please see the list below for health care options. 

 

I am in the middle of a treatment plan for (cancer, dialysis…), what happens to the rest of my scheduled procedures?
Unfortunately, medical services provided after February 28, 2011 cannot be paid for by the adultBasic program. We urge you to explore other coverage options right away that may cover these treatments.

 

I am pregnant and need to have health coverage. What should I do now that my adultBasic coverage is ending?
Because you are pregnant, you most likely are eligible for the Medical Assistance Healthy Beginnings Program, which provides comprehensive prenatal and postpartum coverage, as well as health coverage for your child. Contact your adultBasic insurance company right away at the toll-free number listed on the back of your ID card and ask them to immediately transfer your application to your local County Assistance Office.

 

Could I be responsible to pay any of my medical claims? If so, starting on what date?
Yes. Since your adultBasic coverage ended on February 28, 2011, any medical claims for services that you received after that date will be denied unless your insurance company agrees in advance to pay for any continuing services. Please call your adultBasic insurance company using the toll-free number listed on the back of your ID card.

 

If I had a medical procedure on or before February 28, 2011, but my claim is submitted after that date, will my claim be covered?
Yes. All benefits and services that are eligible under your adultBasic coverage will be covered, as long as they occurred before February 28, 2011.

 

I received my adultBasic renewal notice in the mail and sent it in to my adultBasic insurance company. Will I have coverage in March? 
No, adultBasic coverage ended on February 28, 2011.

 

I paid my March monthly premium bill a few days ago. Does that mean I’ll have coverage for March? If not, will I receive a refund and when can I expect it?
adultBasic coverage ended on February 28, 2011. If you received an invoice for March coverage from your adultBasic insurance company, please disregard the notice. If you paid your March premium, your adultBasic insurance company will be sending you a refund for that payment in a few weeks. If you do not receive a refund, please call your adultBasic insurance company at the toll-free number listed on the back of your ID card.

 

My insurance company mentioned a HIPAA plan. What does that mean and what are the costs? What about my pre-existing condition?
A HIPAA plan is an insurance plan that guarantees coverage. That means you will not be denied coverage due to a pre-existing health condition. However, a pre-existing condition may still be excluded for a period of time. Some plans may limit or waive that exclusion if you have had coverage with the same company; if your adultBasic insurance company offers you a HIPAA plan or a “conversion” plan ask them if the pre-existing condition exclusion will be waived or limited.