Evidence of Coverage

The Evidence of Coverage (EOC) is a comprehensive resource guide to your health care coverage. It explains your benefits, premiums, and cost-sharing; conditions and limitations of coverage; and plan rules.

After you’ve joined the plan, you will receive the Evidence of Coverage in the mail. This is a legal document that should be kept in a safe place.

2014 Evidences of Coverage

• Keystone 65 Select Medical-Only HMO Evidence of Coverage
  Y0041_H3952_KS_14_9262 Accepted 9/12/2013
• Keystone 65 Select Medical with Prescription Drug HMO Evidence of Coverage
  Y0041_H3952_KS_14_9263 Accepted 9/12/2013
• Keystone 65 Preferred Medical-Only HMO Evidence of Coverage
  Y0041_H3952_KS_14_9264 Accepted 9/12/2013
• Keystone 65 Preferred Medical with Prescription Drug HMO Evidence of Coverage
  Y0041_H3952_KS_14_9265 Accepted 9/12/2013
• Personal Choice 65 Medical-Only PPO Evidence of Coverage
  Y0041_H3909_PC_14_8450 Accepted 9/12/2013
• Personal Choice 65 Medical with Prescription Drug PPO Evidence of Coverage
  Y0041_H3909_PC_14_8451 Accepted 9/12/2013

Website last updated: 12/16/2013
Y0041_HM_14_9866e Approved 1/27/2014