Other Plans for Individuals

Medically Underwritten Plans

We offer a variety of plans to suit your individual health insurance needs through Keystone Health Plan East HMO or Personal Choice^® PPO. Since these are medically underwritten plans, your approval for coverage and final rate quote are based on your health history.

Copay Plans

It’s all about predictability — these plans have copays for most services to help manage your budget.

Deductible Plans

It’s all about affordability — you have copays for office visits and a deductible for services you’re less likely to use, like going to the hospital.

HSA Plans

It’s all about savings — save on monthly premiums and save for health care costs when you add a tax-advantaged health savings account (HSA) to your plan

Guaranteed Enrollment Plans

With a guaranteed enrollment plan, you get coverage as long as you meet eligibility requirements, such as residency and annual income, and pay your monthly bill. Your health history is not reviewed prior to accepting your application.

Personal Choice^® PPO Basic, Value HSA, and HospitalCare plans

With Personal Choice, our popular Preferred Provider Organization (PPO), you can receive care from any provider without a referral in-network or out-of-network.

Low-Income Health Plans

Free or low-cost insurance for uninsured children and low-cost coverage for uninsured adults is made available by the Independence Blue Cross and Highmark Blue Shield Caring Foundation. Medicaid recipients may be eligible for Keystone Mercy Health Plan coverage.

Children’s Health Insurance Program (CHIP)

Free or low-cost Keystone Health Plan East HMO coverage for uninsured children and adolescents through 18 years of age.

Special Care^SM

Traditional, fee-for-service health coverage for adults and children.

Keystone Mercy

Medical Assistance (Medicaid) managed care health plan.

HMO benefits are underwritten by Keystone Health Plan East (KHPE). PPO benefits are underwritten by QCC Insurance Company (QCC). KHPE and QCC are subsidiaries of Independence Blue Cross — independent licensees of the Blue Cross and Blue Shield Association. Serving the health insurance needs of Philadelphia and southeastern Pennsylvania.

You must continue to pay your Medicare Part B premium.

The Medicare Contract is renewed annually, and the availability of coverage beyond the end of the current year is not guaranteed.

The benefit information provided herein is a brief summary, not a comprehensive description of benefits. For more information contact the plan. Benefits, formulary, pharmacy network, premium and/or copayments/coinsurance may change January 1, 2013. Members may enroll in the plan during specific times of the year. Contact the plan for more information. Please reference the Evidence of Coverage for information on premiums, cost-sharing, out-of-network coverage, rights and responsibilities upon disenrollment and any applicable conditions associated with using the plan benefits, as well as limitations, copayments, and restrictions. Members must use network pharmacies to access their prescription drug benefit, except under non-routine circumstances, and quantity limitations and restrictions may apply.

You may be able to get Extra Help to pay for your prescription drug premiums and costs. To see if you qualify for extra help, call:

• 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048, 24 hours a day/7 days a week;
• The Social Security Office at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday through Friday. TTY users should call, 1-800-325-0778; or
• Your State Medicaid Office.

People with limited incomes may qualify for Extra Help to pay for their prescription drug costs. If you qualify, Medicare could pay for up to seventy-five (75) percent or more of your drug costs including monthly prescription drug premiums, annual deductibles, and co-insurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don’t even know it. For more information about this Extra Help, contact your local Social Security office or call 1-800-MEDICARE (1-800-633-4227), 24 hours per day, 7 days per week. TTY users should call 1-877-486-2048.”

You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. You must use plan providers except in emergency or urgent care situations or for out-of-are renal dialysis or other services. If you obtain routine care from out-of-network providers neither Medicare nor Keystone 65 HMO or Personal Choice 65 PPO will be responsible for the costs.

Please contact Keystone 65 HMO or Personal Choice 65 PPO Customer Service for more information.

Y0041_HM_12_300a Pending CMS Approval