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Upcoming Medicare Advantage HMO and PPO benefits changes 

November 1, 2011    


Effective January 1, 2012, there will be several changes to our current Medicare Advantage HMO and PPO plans in addition to the introduction of our new limited network HMO 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
Benefit Keystone 65 Preferred HMO
Current Changes for 2012
Smoking and tobacco use cessation Not covered No copayment
Diabetes screening Not covered No copayment
Inpatient hospital care $175 copayment per day, days 1-8; $1,400 maximum per stay $190 copayment per day, days 1-8; $1,520 maximum per stay
Skilled nursing facility care $20 copayment per day for days 1-20 $100 copayment per day for days 21-100 $30 copayment per day for days 1-20 $110 copayment per day for days 21-100
Physician services, including doctor’s office visit $15 copayment for each primary care physician office visit $10 copayment for each primary care physician office visit.
Outpatient hospital services $150 copayment in ambulatory surgical center $300 copayment in outpatient hospital facility $100 copayment in ambulatory surgical center $350 copayment in outpatient hospital facility
Urgently needed care $15 - $40 copayment $10 - $40 copayment
Radiation therapy $25 copayment $40 copayment
Complex radiology $80 copayment for complex radiology, which includes MRI/ MRA, CTA/CT scans, PET scans, and nuclear cardiology studies $100 copayment for complex radiology, which includes MRI/ MRA, CTA/CT scans, PET scans, and nuclear cardiology studies

Personal Choice 65SM PPO benefits changes
Benefit In-network Out-of-network
Current Changes for 2012 Current Changes for 2012
Smoking and tobacco use cessation Not covered No copayment Not covered No copayment
Diabetes screening Not covered No copayment Not covered No copayment
Primary care visit $20 copayment $10 copayment Member responsible for 30% of charges after $500 deductible is met Member responsible for 30% of charges after $500 deductible is met
Outpatient hospital services $125 copayment in ambulatory surgical center $250 copayment in outpatient hospital facility $100 copayment in ambulatory surgical center $350 copayment in outpatient hospital facility Member responsible for 30% of charges after $500 deductible is met Member responsible for 30% of charges after $500 deductible is met
Ambulance services $100 copayment $75 copayment $100 copayment $75 copayment
Urgently needed care $20 - $40 copayment $10 - $40 copayment $20 - $40 copayment $10 - $40 copayment

Optional supplemental benefits package available to Keystone 65 Select HMO members

Our new Keystone 65 Select HMO members will have the option to purchase the Choice Program, an optional supplemental benefits package, for an additional $10 a month. The optional supplemental benefits package will cover vision, dental, and hearing, as these benefits are no longer included for Keystone 65 Select HMO members. 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
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 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 $100 for eyewear

Note: Vision, dental, and hearing 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 2012 benefits changes for Medicare Advantage HMO and PPO members.





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