Eligibility

Basic Health Hawai‘i is a health insurance program. It is for non-pregnant adults, age 19 or older. You must live in Hawai‘i. You must be an immigrant legally residing in the United States for less than five years or a non-immigrant. You must not be eligible for Federal Medicaid programs.

Coverage

• 12 Outpatient physician visits per year
  (6 of these visits can be used as mental health visits)
• 6 Additional mental health visits per year
• 10 Inpatient hospital days per year
• 10 inpatient physician visits for medically necessary medical care, surgery, psychiatric care
  or substance abuse treatment
• 4 prescriptions per month, either brand or generic to include insulin and chemotherapy, plus
  specific contraceptives and diabetes supplies
• Emergency room services

Other Covered Services

• Dental Services only for emergencies to eliminate dental pain, infection and acute injuries
• Dialysis

Do I Have To Pay For These Services?

• No

Enrollment

Enrollment procedures are the same as with QUEST.

How To Apply

Using the link below print out and complete the application form and mail or fax it to the nearest Med-QUEST office listed on page 12 in the application.

Click here for the Medical Assistance Application – DHS 1100