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Medicare Advantage HMO and PPO benefit changes now in effect 

January 9, 2014    


As a reminder, effective January 1, 2014, there are several changes to our current Medicare Advantage HMO and PPO plans including the following highlights:

  • Keystone 65 Select HMO with Rx is now available with a $0 premium in Philadelphia and Bucks counties.
  • Keystone 65 Select HMO plan features 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.

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 Customer Service if you have any questions.
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
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

$18 – $45 copay for medical with Rx; 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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