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Upcoming Medicare Advantage HMO and PPO benefits changes

November 1, 2012

Effective January 1, 2013, there will be several changes to our current Medicare Advantage HMO and PPO plans in addition to the introduction of our $0 premium medical-only plan, Keystone 65 Select HMO. The following tables highlight some of these changes. Please note that this is a list of our significant benefits changes, not a comprehensive list of all benefits changes.

Keystone 65 Preferred HMO benefits changes

Keystone 65 Preferred HMO Benefit Current (2012) Changes for 2013 Depression screening Not covered No copayment Emergency care $50 copayment for emergency care; emergency care is offered in the United States. $65 copayment for emergency care; worldwide coverage for emergency and urgently needed care (not waived if admitted). Inpatient hospital care $190 copayment per day for days 1 ? 8; $0 copayment for additional days per stay; $1,520 maximum per stay. $215 copayment per day for days 1 ? 7; $0 copayment for additional days per stay; $1,505 maximum per stay. Obesity screening and therapy to promote sustained weight loss Not covered No copayment Outpatient Hospital $350 copayment for Outpatient Hospital (per date of service); $100 copayment for Ambulatory Surgical Centers (per date of service). $350 copayment for Outpatient Hospital (per date of service); $100 copayment for Ambulatory Surgical Centers (per date of service). Primary care physician $10 copayment per visit $5 copayment per visit Screening and counseling to reduce alcohol misuse Not covered No copayment Services to treat kidney disease and conditions $25 copayment per visit for outpatient dialysis 20% per visit for outpatient dialysis Urgently needed care $10 ? $40 copayment for urgently needed care. The copayment amount depends on the provider type: $10: PCP $40: Specialist $5 . $40 copayment for urgently needed care. The copayment amount depends on the provider type: $5: PCP $20: Network Urgent Care Center $40: Specialist Urgently needed care is covered worldwide. For urgently needed care received outside of the United States, the emergency room copayment will apply.

Personal Choice 65SM PPO benefits changes

Personal Choice 65SM PPO Benefit Current (2012) Changes for 2013 Annual physical exam Not covered No copayment Cardiovascular disease risk reduction visit (therapy for cardiovascular disease) Not covered No copayment Out-of-network: 30% coinsurance Cervical and vaginal cancer screening Pap tests and pelvic exams are covered once every 12 months Pap tests and pelvic exams are covered once every 24 months Depression screening Not covered No copayment Out-of-network: 30% coinsurance Dialysis $25 copayment per dialysis visit 20% coinsurance per dialysis visit Emergency care $50 copayment $65 copayment (not waived if admitted) Obesity screening and therapy to promote sustained weight loss Not covered No copayment Out-of-network: 30% coinsurance Primary care physician $10 copayment per office visit $5 copayment per office visit Screening and counseling to reduce alcohol misuse Not covered No copayment Out-of-network: 30% coinsurance Urgently needed care $10 - $40 copayment $5 - $40 copayment

Optional supplemental benefits package available to Keystone 65 Select HMO members

Our Keystone 65 Select HMO members will have the option to purchase the Choice Care program, an optional supplemental benefits package, for an additional $10 a month. The optional supplemental benefits package will cover vision, dental, and hearing. See the table below for details about the supplemental benefits package. Covered Services Member pays Dental services ? Preventive dental One exam and cleaning every six months $15 copayment per visit Hearing services Non-Medicare-covered routine hearing exams, including fitting and evaluation for two hearing aids, covered every three years $45 copayment for non-Medicare-covered hearing exams and evaluation Medicare-covered hearing exams $45 copayment for Medicare-covered hearing exams and evaluations Hearing aids, covered every three years Covered up to $500 for two hearing aids Vision care Non-Medicare-covered routine eye exams, every two years $0 copayment for routine eye exams, once every two years Eyewear not covered by Medicare, every two years Covered up to $100 for eyewear Note: Vision, dental, hearing, and SilverSneakers? are still included in the benefits packages for Keystone 65 Preferred HMO and Personal Choice 65 PPO members. Please contact your Network Coordinator if you have any questions about these 2013 benefits changes for Medicare Advantage HMO and PPO members.

SilverSneakers? is a registered mark of Healthways, Inc.


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