New for 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). However, Keystone 65 Advantage HMO will no longer be offered after
December 31, 2011.
Keystone 65 Select HMO features many of the same benefits as Keystone 65
Advantage HMO. The main difference between the plans is that Keystone 65 Select
HMO features a select network of providers, which has allowed us to sharply
reduce premiums for this product.
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 Benefit Highlights
Service
Cost to member
Primary Care Physician (PCP)
$20 copay
Specialist
$45 copay
Emergency Room
$50 copay (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 per day for days 1-8 ($1,720 per stay maximum);
$0 copay/day for 9+ days; unlimited days each benefit period
Hearing, Dental, Vision
Benefits 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.