Section 3088 - Health insurance coverage(a) Establishment.-- Pursuant to the requirements of section 6, the Commonwealth shall establish a plan to provide basic health care benefits insurance coverage, on a copayment basis, to successful participants of the program who lose their Medicaid coverage due to entering regular employment and who elect to obtain the insurance coverage.(b) Exclusions.--No basic health care benefits pursuant to this act shall be provided to:(1) An individual, or the individual's immediate family, unless that individual participated in the program and no longer qualifies for Medicaid due to having accepted employment.(2) An individual who is otherwise eligible for medical assistance pursuant to the State plan established under Title XIX of the Social Security Act ( Public Law 74-271, 42 U.S.C. § 1396 et seq.) or who is eligible for benefits under Title XVIII of the Social Security Act ( 42 U.S.C. § 1395 et seq.).(3) An individual who is covered under a group health plan of the individual or the individual's spouse, a contribution toward the cost of which is being made by an employer, former employer, union or any entity other than the individual's spouse, or an individual who could have been so covered if, after the effective date of this section, an election had been made and partial premiums had been paid on a timely basis.(c) Health care services available.--The basic health care services to be offered through the program shall, at a minimum, include: (1) Inpatient hospital services.(2) Emergency outpatient hospital services.(3) Routine and emergency physician services, including those provided in health clinics but excluding those provided in nursing care or intermediate care facilities.(4) Prenatal, delivery and postpartum care.(5) Laboratory and diagnostic X-ray services.(6) X-ray, radium and radioactive isotope therapy.(7) Services of a nurse midwife.(8) Home health services in cases where it is determined that the coverage of such services is cost effective.(9) Ambulatory and institutional services.(10) Drugs or biologicals that are provided as part of any inpatient hospital services.(d) Service exceptions.--The basic health care services to be offered under the program shall not include:(1) Drugs or biologicals provided outside of an inpatient hospital program.(3) Any services that exceed the amount, duration or scope of services included under the State plan for medical assistance for individuals described in section 1902(a)(10)(A) of the Social Security Act ( Public Law 74-271, 42 U.S.C. § 1396a(a)(10)(A) ).(e) Election of coverage.--Participation in the health insurance coverage plan shall be optional for a person who would qualify under the provisions of subsection (b). Persons who elect health insurance coverage under the plan shall signify their election in writing with a statement consenting to the payment of premium copayments for benefits.(f) Premium copayments.--Upon completing the program and obtaining employment, a program participant who elects to obtain health care insurance pursuant to this section shall:(1) Not be required to pay any of the cost of the premium for such health insurance policy during the fifth and sixth months of employment.(2) Pay 25% of the cost of such premium during the next six months of employment.(3) Pay 50% of the cost of such premium during the next six months of employment.(4) Pay 75% of the cost of such premium during the next six months of employment.(5) Pay 100% of the cost of such premium thereafter. No deductible or copayment shall be imposed for prenatal, delivery or postpartum care.
(g) Use of Federal funds.--In the event that Federal funds are made available to the Commonwealth for the payment of premiums and expenses incurred through the provision of health care benefits for program participants who elect such coverage, the costs to the Commonwealth shall be reduced by the maximum amount provided for by the Federal Government.(h) Duration of insurance.--Health care coverage pursuant to this section begins on the date of the payment of the first premium or the end of coverage under Medicaid, whichever is later. Coverage under the plan ends on the last day of the last week for which the premium has been paid.(i) Selection of a private carrier.--Basic health care benefits insurance coverage available through this section may be provided by a company, association, nonprofit organization or exchange authorized to do business within this Commonwealth and selected by the department for the purpose of providing such coverage. Selection of any insurance carrier to provide this basic health care benefits insurance coverage shall be done pursuant to current bidding procedures applicable to administrative agencies.1987, July 13, P.L. 332, No. 62, § 8, effective 7/1/1987.