As previously communicated, as of January 1, 2019, Independence offers several new and innovative benefits to our Keystone 65 Basic HMO, Keystone 65 Focus HMO-POS, Keystone 65 Preferred HMO, Keystone 65 Select HMO, and Personal Choice 65SM PPO members. These new benefits are centered around improving affordability for members and help to increase the overall quality of benefits, especially in key areas like dental, vision, and hearing, while continuing to offer valuable benefits from years prior. Below is a summary of new offerings and changes.
New! MedigapFreedom plan
Independence now offers MedigapFreedom, an Independence-branded Medigap plan with monthly premiums as low as $75.37, which includes added discounts through GlobalFit®, TruHearing, and Davis Vision – independent companies. In addition, Independence is offering Basic Blue Rx PDP as a standalone Part D plan on behalf of MII Life, Inc., an independent licensee of the Blue Cross and Blue Shield Association.
New! Choice Plus program*
The new Choice Plus program offers Medicare Advantage members* improved coverage for dental, vision, and hearing benefits for the small fee of $20 per month in addition to their monthly premium. The following provides a summary of the Choice Plus program offerings:
- Dental benefits include:
- $0 copay for one dental X-ray every year and one oral exam/cleaning every six months
- $500 allowance per year for restorative services
- Vision benefits include:
- $200 allowance for eyewear purchased from VisionWorks®, an independent company
- a $150 allowance for eyewear purchased at Davis Vision network providers but outside of the Davis Vision Collection
- a $150 allowance for contact lenses purchased in lieu of frames and lenses
- Hearing benefits include:
- $0 copayment for up to three hearing aid fittings and evaluations per year
- $499 copayment per aid for standard digital hearing aids or $799 copayment per aid for premium digital hearing aids, when purchased through TruHearingTM providers
Note: Independence continues to offer our Choice program ($7 monthly premium) in addition to the new Choice Plus program.
Better than ever: Keystone Basic
Keystone 65 Basic is now better than ever, offering a $0 monthly premium, a $0 Preferred PCP copay, a $0 medical deductible, and a $0 drug deductible to provide members with reliable and convenient coverage.*
Keystone 65 Focus Rx
As of 2019, Keystone 65 Focus Rx has a Point-of-Service (POS) option. Our plan covers services from either in-network or out-of-network providers, as long as the services are covered benefits and are medically necessary. Members pay a 20 percent coinsurance for the services they receive out of network. The annual POS out-of-network benefit maximum amount is $1,000.
Improvements to affordability and convenience for members
Keystone 65 members have a $0 copay for Preferred primary care physician (PCP) visits. Capitation payments are higher for members who have a $0 copay to compensate for what would have been collected with higher copays. In addition, the following benefits that focus on affordability and convenience are available to both Keystone 65 and Personal Choice 65 members:
Important information on identifying capitated services
Please note: The Eligibility and Benefits transaction on the NaviNet® web portal currently displays all four disciplines (i.e., physical therapy, occupational therapy, radiology, and laboratory services) in error. The NaviNet display will be updated in the coming weeks to display only laboratory capitation site requirements.
- 90-day preferred pharmacy benefit: The new 90-day preferred pharmacy benefit allows members to fill up to a 90-day supply of generic and preferred generic prescription drugs for only two copayments at preferred pharmacies. A 90-day prescription written by the provider is required.*
- Limited capitated services: Capitation site requirements have been removed for physical therapy, occupational therapy, and radiology services, giving members greater flexibility and choice. Note: Laboratory services will continue to require a capitated site.
- Preventive screening: Members have a $0 copay for a preventive screening, such as colonoscopy or mammography, even if that screening becomes diagnostic.
- OTC benefit: The new over-the-counter (OTC) benefit provides members with up to $120 per year ($30 per quarter) towards various OTC medical supplies, such as cold medicine, vitamins, and more, when purchased through a catalog provided by ConveyTM.* Note: Unused OTC amounts will not roll into the next benefit year.
- Telemedicine session: Members now have access to telemedicine sessions through MDLIVE®, for a $5 copay. Services are available through MDLIVE 24 hours a day, 7 days a week, either by toll-free phone number, or on a secure connection over the Internet via a smartphone, tablet, or computer.*
- Meal plan: Members with congestive heart failure, diabetes, and chronic kidney disease (stages 4 and 5) qualify for a $0 copay meal plan when discharged from an inpatient acute care facility to their home or a general community setting. The program includes three meals a day, seven days a week, for up to four weeks, provided by MANNA (a Philadelphia-based non-profit organization that delivers healthy meals and provides nutritional support to chronically ill individuals in Philadelphia and the surrounding counties). Members can receive this benefit twice annually, but it will not be offered more than once in a 30-day period. Note: This program is not available to members who are discharged to a skilled nursing, rehabilitation, or hospice facility.*
- Diabetic supplies: $0 copay for diabetic shoes and inserts are available through any durable medical equipment supplier.*
- Medical nutritional therapy: Members are offered up to four additional visits for Medicare-covered services, as well as four visits for routine medical conditions, such as high blood pressure, high cholesterol, or gluten intolerance.*
*These benefits are available to individual members only.
For more information
If you have any questions regarding these changes, please call Provider Services at 1-800-ASK-BLUE.
NaviNet is a registered trademark of NaviNet, Inc., an independent company.
An affiliate of Independence Blue Cross has a financial interest in Visionworks, an independent company.
TruHearing is a registered trademark of TruHearing, Inc., an independent company.
Telemedicine is provided by MDLIVE, an independent company.
The Independence Blue Cross OTC benefit is administered by Convey Health Solutions, Inc., an independent company.
MII Life Insurance, Inc. and each Blue Cross® and/or Blue Shield® plan are independent licensees of the Blue Cross and Blue Shield Association.