QUEST-NET

Eligibility Assets Income Application Coverage For Individuals Age 21 Or Older
Coverage For Individuals Under The Age of 21 QUEST-NET FAQ's

The QUEST-Net program provides medical coverage to individuals who do not qualify for QUEST or Medicaid Fee-For-Service benefits.   Individuals age 19 and older must have prior QUEST or Medicaid Fee-For-Service eligibility in order to participate in QUEST-Net.  In addition, QUEST recipients with premium shares can also voluntarily terminate QUEST coverage and request QUEST-Net coverage.  QUEST-Net coverage for individuals age 19 and older is less than coverage in the QUEST or the Medicaid FFS programs.  Individuals under age 19 receive the same coverage as QUEST or the Medicaid FFS programs.

QUEST-Net eligible adults and children under age 19 who are not blind or disabled shall be enrolled in a QUEST-Net health plan that will provide coverage of medical services. Children who are blind or disabled shall receive coverage on a fee-for-service basis.

QUEST-NET Eligibility

Individuals eligible for QUEST-Net benefits shall be enrolled in a QUEST-Net health plan that will provide coverage of medical services.  The exception is that individuals under age 19 who are blind or disabled shall receive coverage on a fee-for-service basis.

Eligibility for Individuals Under Age 19

Prior QUEST or Medicaid Fee-For-Service coverage is not a prerequisite for an individual under age 19 to participate in the QUEST-Net program. These individuals must meet the following QUEST-Net requirements:

• Not eligible for or covered by any other medical insurance including Medicare or military coverage such as CHAMPUS 
• Have income within the QUEST-Net limits;
• Eligibility for Individuals 19 Years and Older

QUEST-Net individuals must be QUEST or Medicaid FFS recipients who became ineligible because their assets or income exceeded allowable limits. These individuals must meet the following QUEST-Net requirements:

• Not eligible for health insurance from their employer, with the exception of a financial assistance recipients
• Not eligible for or covered by any other medical insurance including Medicare or military coverage such as CHAMPUS
• Have assets and income within the QUEST-Net limits

Individuals who have assets that exceed the asset limit will be ineligible for QUEST-Net.  This provision does not apply to individuals under age 19. Countable assets include cash, bank accounts, stocks, bonds, real property and other personal property.  Exempt assets include the home property, motor vehicles, clothing and household furnishing and appliances.

The asset standards are $5,000 for a household of one, $7,000 for two, and $500 for each additional family member.

Back To Top

Income

Income cannot exceed 300% of the current Federal Poverty Level (FPL).

Back To Top

QUEST-NET Application

Individuals must be a Hawaii QUEST or Medicaid FFS recipient before they can be enrolled in QUEST-Net.  Individuals under age 19 are not subject to this requirement.  The eligibility worker will ask recipients if you want to apply for QUEST-Net when the QUEST or Medicaid FFS eligibility is terminated.  Recipients with premium shares who want to terminate QUEST coverage for QUEST-Net coverage must inform their eligibility worker.

Coverage For Individuals Age 21 Or Older

Per benefit year, QUEST-Net covers:

• Ten inpatient hospital days for medically necessary medical care, surgery, psychiatric care and substance abuse treatment (procedures such as cataract and heart surgery are not covered)
• Ten inpatient physician visits
• Twelve outpatient medical visits
• Six mental health visits
• Limited prescription drugs (certain antibiotics and some contraceptives only)
• Emergency room services for actual emergencies
• Dental services are provided on a fee for service basis and there is an annual payment limit for non-emergency services
Back To Top

Coverage For Individuals Under The Age Of 21

Individuals under age 21 who are not blind or disabled and who are covered by QUEST-Net will receive the full medical, dental, and behavioral health benefits of the Hawaii QUEST program. Blind or disabled individuals who are under age 21 and covered by QUEST-Net will receive the full medical, dental, and behavioral health benefits of the Medicaid Fee-For-Service program.

In addition to the coverage provided by QUEST and the Medicaid FFS programs, individuals under age 21 receive Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) health services.  These services include:

• Complete medical and dental exams;
• Hearing and vision tests, laboratory tests;
• Immunizations and skin tests for tuberculosis (TB);
• Assistance with necessary scheduling and transportation upon request.
• Unlimited mental health benefits.