As previously communicated in a
Partners in Health UpdateSM article, as of
January 1, 2021, Independence continues to offer innovative benefits to our Keystone 65 Basic HMO, Keystone 65 Focus HMO-POS, Keystone 65 Preferred HMO, Keystone 65 Select HMO, and Personal Choice 65SM Prime Rx PPO members for the 2021 benefit year. With little or no premium increases, these plans offer benefits centered around improving affordability for members – offering several ways to save on many of their copayments in 2021. Below is a summary of changes to our existing products.
New! COVID-19 (Coronavirus) member inpatient cost-sharing
Members who are admitted to the hospital due to a COVID-19 diagnosis have a $0 copayment for the inpatient hospital stay.
New! Acupuncture services
Routine acupuncture treatment is now available for Medicare Advantage members experiencing one of the following conditions:
- headache (migraine and tension)
- post-operative nausea and vomiting
- chemo-induced nausea and vomiting
- low back pain
- chronic neck pain
- pain from osteoarthritis of the knee and hip
Over-the-counter – More value!
Keystone 65 Basic Rx HMO, Keystone 65 Rx Focus HMO-POS, and Personal Choice 65 Prime Rx PPO members now have a $60 quarterly allowance for eligible over-the-counter (OTC) items. Members received an IBX Care Card that they can use to purchase eligible OTC items in-store at participating retail locations. Members can also purchase eligible OTC items via catalog for delivery through our dedicated vendor.
Vital Care & Vital Care Plus Programs
The Vital Care Program is available to all eligible Keystone 65 Basic HMO, Keystone 65 Select HMO, and Keystone 65 Preferred HMO members. Keystone 65 Focus HMO-POS plan members residing in Chester, Delaware, and Montgomery counties in Pennsylvania are also eligible. This program is for members who have been diagnosed with both congestive heart failure and diabetes. Specific to this program is a reduced copayment for eligible members when visiting their cardiologist, endocrinologist, or podiatrist.
For Keystone 65 Focus HMO-POS plan members residing in Philadelphia and Bucks counties in Pennsylvania, we offer the Vital Care Plus Program. Eligible members have the same benefits available to them as members in the Vital Care Program; however, a lower copayment for pulmonologist visits is also included. In addition, these members have an extra $20 per quarter added to their OTC benefit allowance and only need to be diagnosed with diabetes – there is no requirement for the member to have been diagnosed with congestive heart failure.
Eligible members are automatically enrolled into these programs, but they may opt out if they choose to do so.
Dental, vision, and hearing benefits – new and improved!
Dental, vision, and hearing benefits are now included in the benefits package and no longer require an additional premium.
- Dental benefits include:
- exam/cleaning (every 6 months) and X-rays (Bitewing - once per year, Periapical/Full Mouth X-rays every three years)
- combined $2,000 allowance per year for comprehensive dental services for HMO and HMO-POS plans*
- combined $1,500 allowance per year for comprehensive dental services for PPO plans
- Vision benefits include:
- routine eye exam every year
- If members purchase glasses (frames and lenses) from Visionworks, they are covered up to $200.
- Members are covered up to $150 per year for contact lenses in lieu of routine eyewear (frames and lenses).
- If members purchase glasses (frames and lenses) outside of the Davis Vision Collection but at a Davis Vision provider, they are covered up to $150.
- Hearing benefits include:
- routine hearing exam covered once every year
- three hearing aid fittings and evaluations covered every year†
- Keystone 65 Select HMO, Keystone 65 Preferred HMO, and Personal Choice 65 PPO:
- $499 copayment per Standard hearing aid per year
- $799 copayment per Premium hearing aid per year
- Keystone 65 Basic Rx HMO, Keystone 65 Focus Rx HMO-POS, and Personal Choice 65 Prime Rx PPO:
- $699 copayment per Standard hearing aid per year
- $999 copayment per Premium hearing aid per year
*Keystone Preferred does not include Comprehensive Dental Services
†Members must use a TruHearing provider to use this benefit.
Removal of tiering for medical benefits
For 2021, primary care physician (PCP) tiering for all Keystone 65 HMO & HMO-POS plans
has been removed, and PCP copayments are
$0 for all individual Keystone 65 HMO & HMO-POS plans! This includes:
- Keystone 65 Basic RX HMO
- Keystone 65 Focus RX HMO-POS
- Keystone 65 Preferred HMO
- Keystone 65 Select HMO
Also, tiering (preferred or standard) for our Personal Choice 65 Prime Rx PPO
has been removed. This change affects the cost-sharing for the following services:
- primary care provider visits
- specialist visits
- inpatient hospital acute
- inpatient mental health
- outpatient hospital services
- observation services
If you have any questions regarding these changes, please call Provider Services at
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