Starting January 1, 2019, Independence Blue Cross 
(Independence) will be offering several new and innovative benefits to our 
individual 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 will help increase the overall quality of benefits, especially in 
key areas like dental, vision, and hearing, while continuing to offer valuable 
benefits from years prior. We will also offer a new Medicare supplement 
plan.
Below is a summary of new offerings and changes.
New! MedigapFreedom plan
Independence will begin offering MedigapFreedom, an Independence-branded 
Medigap plan with low monthly premiums, which includes added discounts through 
GlobalFit?, TruHearing, and Davis Vision ? independent companies. 
For members interested in prescription drug coverage, Independence is offering 
Basic Blue Rx PDP as a standalone Part D plan on behalf of MII Life, Inc.
New! Choice Plus program for Keystone 65 HMO 
members*
The new Choice Plus program offers Medicare Advantage members* on select 
plans 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 will continue to offer our Choice program ($7 
monthly premium) in addition to the new Choice Plus program.
Better than ever: Keystone 65 Basic HMO
Keystone 65 Basic HMO 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.*
*These benefits are available to individual members 
only.
Keystone 65 Focus Rx
In 2019, Keystone 65 Focus Rx has a Point-of-Service (POS) option. Our plan 
will cover select services from either in-network or out-of-network providers, 
as long as the services are covered benefits and are medically necessary. For 
medically necessary covered services that members receive from an 
out-of-network provider, the members will be responsible for a 20 percent 
coinsurance for those services. The annual POS benefit maximum amount is 
$1,000.
For more information
If you have any questions regarding these changes, please call Provider 
Services at 1-800-ASK-BLUE.
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.
MII Life Insurance, Inc. and each Blue Cross? 
and/or Blue Shield? plan are independent licensees of the Blue Cross 
and Blue Shield Association.