PA Fair Care FAQ


PA Fair Care offers prescription drug coverage. Will this apply to just generic drugs or brand name?
PA Fair Care will cover generic drug prescriptions. The program will cover brand name drugs only if a generic substitute is not available or a generic substitute can not be used for medical reasons.  


What qualifies as a pre-existing condition?

For a list of pre-existing conditions, you may click here.


Will plans be able to backdate for charges incurred in the past?

Any services provided prior to your enrollment date will not be covered by PA Fair Care.


Given PA Fair Care is temporary, what happens when it terminates in 2014?

When PA Fair Care terminates on December 31, 2013, enrollees will transition into receiving health coverage through the state-based American Health Benefit Exchanges. Procedures will be developed to ensure that there are no lapses in coverage.


What out-of-pocket expenses will the state require as part of PA Fair Care?

To view the in network and out of network expenses, you may click here.


How will citizenship be verified?

PA Fair Care requires the applicant to provide evidence that they are a citizen or national of the United States or is lawfully present in the United States, as required by the federal act. Applicants will need to provide a Social Security Number and basic demographic information in their application. In addition, they must indicate whether they claim to be residents of Pennsylvania.


Social Security Numbers will be used to verify citizenship. The department will work with the Pennsylvania Department of Public Welfare, which is the single state agency currently allowed to access SSA databases.


For those not able to provide a valid Social Security Number, other documents or forms will be accepted as proof of citizenship and identification. Please refer to the approved high-risk pool proposal for more information.


How will PA Fair Care be funded?

The federal law appropriates $5 billion of federal funds to support the temporary state high-risk pool programs. Funds are being allotted to states using a combination of factors including nonelderly population, nonelderly uninsured and geographic cost as a guide. Pennsylvania was awarded $160 million over the life of the program.

HHS intends to reallocate allotments after a period of not more than two years, based on an assessment of state actual enrollment and expenditure experiences.


Where can I get a certified copy of my birth certificate?

Copies of birth certificates and other personal vital records can only be obtained from the state or US possession where the documents were originally filed. Most states provide a centralized source from which birth certificates and other vital records can be ordered.  Ordering instructions for birth certificates in states other than Pennsylvania may be found ‘Where to Write for Vital Records’ web page, maintained by the US Centers for Disease Control.


PA Birth Certificates

The Division of Vital Records maintains records of births and can issued certified copies of birth certificates (with a raised seal). There is a $10 fee for each certified copy. This fee may be waived for individuals who served or are currently serving in the Armed Forces or their dependents.


How to Get a Birth Certificate online or via mail, go to:

Select ‘Birth & Death Certificates’

Select ‘Birth Certificates’

Scroll down to the section titled ‘How to Get a Birth Certificate’ and choose either ‘Order Online’ or ‘Request by Mail’ and follow the instructions carefully.

You may apply in person at one of the regional public offices:

Division of Vital Records

1910 West 26th Street

Erie, PA 16508-1148

(814) 871-4261


Division of Vital Records

Room 129, Health & Welfare Building

625 Forster Street

Harrisburg, PA 17120-0012

(717) 772-3480


Division of Vital Records

Room 401 Central Building

101 South Mercer Street

New Castle, PA 16101

1-877-PA-HEALTH or (724) 656-3100


Division of Vital Records

110 North 8th Street; Suite 108

Philadelphia, PA 19107-2412

(215) 560-3054


Division of Vital Records

411 7th Avenue, Suite 360

Pittsburgh, PA 15219-1973

(412) 565-5113


Division of Vital Records

Room 112, Scranton State Office Building

100 Lackawanna Avenue

Scranton, PA 18503-1928

(570) 963-4595 


What information can is required to show proof of U.S. citizenship?

The following are acceptable forms of documentation to prove U.S. Citizenship:

U.S. Passport (current valid or one that has been expired no more than five years)
Valid U.S. Passport Card
Certificate of Naturalization
Certificate of Citizenship
U.S. Department of State consular report of birth abroad.
Original, certified birth certificate. The birth certificate must have been issued by a city, county or state and must have all of the following:

a registrar’s raised, embossed, impressed, or multicolored seal.
a control number that can be validated with the issuing authority.
a registrar’s signature.

the date the certificate was filed with the registrar’s office. The date must be within one year of birth.
Social Security card in conjunction with federal tax return & photo ID 

The following are acceptable forms of documentation to prove identification:

U.S. Passport
Naturalization Certificate
Valid PA driver's license or identification card
Current Government ID (city, state or federal)
Current Military ID (military and dependents) 

The following secondary identification will NOT be accepted:

Adjudication form or ticket citation
Bank account statement
Bank card or credit card
Baptismal certificate
Bus pass
Cell phone bill
College ID or Associated Student Body
Credit Card
Employee ID (non-Government)
Food handler card
Hunting or fishing license
Internet printout
Membership card (such as library, athletic club or store cards)
Personal check
Rental or lease agreement
Renters insurance policy
Vehicle insurance card
Utility bill
Vehicle registration 

What information is required to show lawful residence in the U.S. if a non-U.S. citizen?

A copy of immigration documents showing current lawful non-citizen status. will be required. At least one form of documentation must include your Alien Registration Number or I-94 Number, which will be used to verify your status. 

I-327 (Reentry Permit) 

I-551 (Permanent Resident Card) 

I-571 (Refugee Travel Document)

I-766 (Employment Authorization Document) 

Machine Readable Immigrant Visa (with Temporary I-551 Language) affixed to an Unexpired Foreign Passport 

Temporary I-551 Stamp (on passport or I-94) affixed to I-94 or Unexpired Foreign Passport 
I-94 (Arrival/Departure Record) with Unexpired Foreign Passport Unexpired Foreign Passport for Visa Waiver Program travelers 

I-20 (Certificate of Eligibility for Nonimmigrant (F-1) Student Status) accompanied by I-94 and an Unexpired Foreign Passport 

DS2019 (Certificate of Eligibility for Exchange Visitor (J-1) Status) accompanied by I-94 and an Unexpired Foreign Passport

How do I show proof that I have a pre-existing condition?

Proof of a pre-existing condition may be demonstrated in a number of ways:

Provide documentation from a health insurance company stating that you are ineligible for creditable coverage due to a medical condition; or

Provide documentation from a health insurance company offering health coverage with a rider that excludes coverage for your medical condition; or

Provide a written statement from a physician stating that you have an existing medical condition that may result in denial of creditable coverage by a health insurance company.

How soon will insurance benefits begin after I apply?

On average, it takes four to six weeks for an application to be processed after we receive your 1st monthly premium payment. If you’ve been enrolled in the program, you will receive a letter from Highmark, Pa Fair Care’s insurance company, notifying you of the insurance effective date.  Insurance benefits will be effective the first of the month following the month of eligibility determination. For example, if you’re notified that you’ve been enrolled in the program on the 13th of the month, your benefits won’t begin until the 1st of the following month.  


May my spouse and I apply together, on the same application?

PA Fair Care offers individual coverage – not family coverage. So, you will both need to apply separately.