adultBasic Health Insurance
for Adult Pennsylvanians

First Priority Health

This is an example of the benefits and services offered with adultBasic.

Covered Benefits and Services Sample Copayments
Annual deductible per individual/family None
Annual out-of-pocket maximum None
Outpatient Primary Care Physician (PCP) office visits $5
Specialists doctor office visits $10
Emergency and Urgent Care Services
Ambulance (non-emergency not covered) No charge in emergency
Emergency room visit (copayment waived if admitted to hospital) $25
Urgent care through your PCP $5
Inpatient Services
Inpatient hospital services (facility and professional) No charge
Skilled nursing facility care - in lieu of inpatient hospital stay 
(60 days per calendar year)
No charge
Preventive Services in Primary Care Physician's Office
Immunizations $5
Routine care $5
Other Services
Diabetic supplies (blood glucose monitors, insulin, etc.)
($2,500 max/year)
No charge
Home health services - in lieu of inpatient hospital stay No charge
Home infusion - in lieu of inpatient hospital stay No charge
Outpatient Services
Cardiac rehabilitation (36 sessions for a 12-week period) No charge
Chemotherapy, dialysis, or radiation No charge
Diagnostic services (X-rays, lab tests, etc.) No charge
Physicial, speech, or occupational therapy ($2,500 max/year combined) No charge
Pulmonary rehabilitation (18 sessions per calendar year) No charge
Respiratory therapy (18 sessions per calendar year) No charge
Surgery No charge
Women's Health Care  
Annual routine gynecological exam No charge
Mammography screenings/diagnostics No charge
Maternity care including delivery No charge

This summary is an abridged overview of the benefits covered by adultBasic. This summary highlights general features and is not intended to be a substitute for the terms, provisions, limitations, exclusions and conditions imposed by the controlling contract(s). Since benefits are reviewed annually and are often modified, if there is a condition that you are treated for on a regular basis, be sure to inquire about your specific coverage needs. This managed care plan may not cover all of your health care expenses. Read your contract carefully to determine which health care services are covered. 1-800-543-7199.


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Serving Bradford, Carbon, Clinton, Lackawanna, Luzerne, Lycoming, Monroe, Pike, Sullivan, Susquehanna, Tioga, Wayne and Wyoming Counties.
Copyright © 2008, Blue Cross of Northeastern Pennsylvania is an Independent
Licensee of the BlueCross BlueShield Association. All rights reserved.