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Effective January 1, 2014, there will be several changes
to our current Medicare Advantage HMO and PPO plans including the following
highlights:
- Keystone 65 Select HMO with Rx will now be available with a $0 premium in
Philadelphia and Bucks counties.
- Keystone 65 Select HMO plan will feature a $0 premium for medical-only
plans in Philadelphia, Bucks, Chester,
Delaware, and Montgomery counties.
- Our Personal Choice 65SM PPO coverage area has expanded to
Chester, Delaware, and Montgomery counties, where members can choose a medical
plan with prescription drug coverage for a $98.50 monthly premium.
Medicare Advantage HMO and PPO members should have already received their 2014
Annual Notice of Changes/
Evidence of Coverage. They will have until December 7, 2013, to make any
changes to their health care plans.
We are also pleased to introduce the Member Help Team, IBC?s new Medicare
Customer Service program. Recognizing
that Medicare-eligible members have unique needs, the Member Help Team ensures
they receive special care and
attention. This dedicated service team is designed to work closely with other
areas within IBC ? as well as with billing
agencies, pharmacies, and doctor?s offices ? to respond to members? concerns
quickly and resolve their issues the first
time around. Members will experience this new service when they call the
Customer Service number on the back of their
ID cards.
The following tables highlight some of the Medicare Advantage HMO and PPO
benefits changes for 2014. Please note
that this is a list of our significant benefits changes, not a comprehensive
list of all benefits changes.
Please contact your Network Coordinator if you have any questions.
Medicare Advantage HMO and PPO monthly plan premiums
Plan type
Keystone 65 Select HMO
Keystone 65 Preferred HMO
Personal Choice 65SM PPO
Medical Only
Philadelphia/Bucks: $0
Chester/Delaware/
Montgomery: $0
Philadelphia/Bucks: $125.40
Chester/Delaware/
Montgomery: $184.80
Philadelphia/Bucks: $145
Medical with
Choice Program
(hearing/dental/vision)
Philadelphia/Bucks: $7
Chester/Delaware/
Montgomery: $7
Not available
Not available
Medical with Rx
Philadelphia/Bucks: $0
Chester/Delaware/
Montgomery: $43
Philadelphia/Bucks: $182.60
Chester/Delaware/
Montgomery: $252
Philadelphia/Bucks: $222.50
Chester/Delaware/
Montgomery: $98.50
Medical with Rx and
Choice Program
Philadelphia/Bucks: $7
Chester/Delaware/
Montgomery: $50
Not available
Not available
Medicare Advantage HMO and PPO benefits highlights
Service category
Keystone 65 Select HMO
Keystone 65 Preferred HMO
Personal Choice 65SM PPO
Primary care physician visits
$15 copay per visit for medical only
$18 copay per visit for medical with Rx
$5 copay per visit
$10 copay per visit
Specialist visits
$45 copay per visit
$40 copay per visit
$40 copay per visit
Emergency room (United States and worldwide)
$65 copay per visit (not waived if admitted)
$65 copay per visit (not waived if admitted)
$65 copay per visit (not waived if admitted)
Urgent care
$15 - $45 copay; not waived
if admitted to the hospital
(urgent care center: $25
copay)
$5 - $40 copay; not waived if
admitted to the hospital
(urgent care center: $20 copay)
$10 - $40 copay; not waived
if admitted to the hospital
(urgent care center: $20
copay)
Outpatient surgery
$75 copay per visit for
ambulatory surgical centers;
$0 - $400 copay per visit for
outpatient hospital facility
$75 copay per visit for
ambulatory surgical centers;
$0 - $400 copay per visit for
outpatient hospital facility
$75 copay per visit for
ambulatory surgical centers;
$0 - $400 copay per visit for
outpatient hospital facility
Inpatient hospital
$245 per day for days 1 ? 7
($1,715 per stay maximum);
unlimited days each benefit
period
$215 per day for days 1 ? 7
($1,505 per stay maximum);
unlimited days each benefit
period
$850 per admission;
unlimited days per admission
Dental, vision, hearing
Benefits available for
additional $7 per month in
plan premiums
Dental: $15 copay for exams and cleanings once every 6 months
Vision: $40 copay; up to $100
for eyewear every 2 years
Hearing: $40 copay; up to $500
for hearing aids (2 aids) every
3 years
Not covered
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