In 2012, we are introducing a new Medicare Advantage plan ? Keystone 65 Select
HMO. This new plan will be offered in addition to Keystone 65 Preferred HMO and
Personal Choice 65SM PPO (in Philadelphia and Bucks counties only). Keystone 65
Advantage HMO will no longer be offered after December 31, 2011.
Members currently enrolled in the discontinued Keystone 65 Advantage HMO
plan were recently sent an Annual Notice of Change/Evidence of Coverage
(ANOC/EOC) explaining that they will be moved into the Keystone 65 Preferred
HMO plan starting January 1, 2012. These members, like all Medicare
beneficiaries, can enroll in a new plan for 2012 any time between October 15
and December 7. We encourage these Keystone 65 Advantage HMO members to
consider the new lower-cost Keystone 65 Select HMO for their 2012 health care
needs.
Keystone 65 Select HMO benefits highlights
Service
Cost to member
Primary care physician
$20 copayment
Specialist
$45 copayment
Emergency Room
$50 copayment (not waived if admitted)
Outpatient surgery (performed in an ambulatory surgical center)
$100 copayment (per date of service)
Outpatient surgery (performed in a hospital setting)
$350 copayment (per date of service)
Inpatient hospital
$215 copayment/day for days 1-8 ($1,720 per stay maximum); $0 copayment/day for
9+ days; unlimited days each benefit period
Hearing, dental, vision
Benefits package available for additional $10 per month in plan premiums
Note: All Keystone 65 HMO and Personal Choice 65 PPO plans will include
the SilverSneakers? fitness benefit in 2012. Please contact your Network
Coordinator if you have any questions.