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Wellness

Keeping your life in step with good health doesn't have to be tricky. Explore the wide range of information, services, and events available to you.


Alerts

New for 2018! No referrals required to see a specialist

Effective January 1, 2018, we no longer require referrals from your primary care physician (PCP) to see a specialist in the Keystone 65 HMO network.

Here are some other key features of your Keystone 65 HMO plan to remember:

Network PCP

You must choose a PCP and other plan providers that are part of the plan's network. This is most important for Keystone 65 Focus Rx HMO members because Keystone 65 Focus uses a defined network of doctors and hospitals that is a subset of our Keystone 65 HMO plan network.

If at any point, you’d like to check whether a doctor or specialist is in your plan's network, you can use the Provider Finder Tool online or call the Member Help Team at the number on the back of your ID card.

Designated sites

Since your PCP is responsible for coordinating and arranging most of your health care services, he or she has identified designated sites, or specific providers, for certain services such as laboratory, radiology, occupational therapy, and physical therapy services.

Prior authorization

In some cases, for specific covered services, your PCP may need to get approval in advance from our plan (this is called getting "prior authorization"). Covered services that need approval in advance are noted in your Evidence of Coverage. Services that require prior authorization include:

  • Non-emergency ambulance transport
  • Proton Beam Therapy
  • Sleep studies
  • Transplants
  • Certain durable medical equipment and related supplies
  • Home health agency care, including home infusion therapy
  • Hospice care
  • Inpatient hospital care
  • Inpatient mental health care
  • Select complex radiology, certain durable medical equipment, and prosthetic items
  • Certain Part B and chemotherapy injectable drugs when administered in the physician's office or outpatient setting
  • Certain outpatient diagnostic tests and therapeutic services and supplies
  • Certain outpatient hospital services
  • Certain outpatient surgery
  • Partial hospitalization services
  • Certain prosthetic devices and related supplies
  • Skilled nursing facility care

Reminder: Choose a primary care dentist for your routine care

If you are a Keystone 65 HMO member and have DHMO dental coverage through the plan, you must select a Primary Dental Office (PDO) for your routine exam and cleaning benefit.

You must use a participating United Concordia provider. You can find a network dentist with our online Provider Finder. If you have not selected or want to change your PDO, call the Customer Service number on the back of your ID card.

Note: If you are a member of Keystone 65 Select or Keystone 65 Focus, you have the routine dental exam and cleaning only if you have selected the Choice Program optional supplement benefits package. Employer group members should check with your benefits administrator to see if a routine dental benefit is included in your plan.

Update Magazine

Published twice a year – in April and October – our Update magazine for Medicare members focuses on a variety of health and wellness topics, and provides members with important information regarding their health plan and benefits. The magazine covers topics ranging from recipes to informative stories on common health issues to detailed information about Medicare plans. View our latest issues of Update Magazine online by clicking on the image below - now including coupons!

Update Magazine


Health Programs and Services

We offer a full range of innovative benefits, programs and services to give our members the information, programs, and support they need to live healthy and stay healthy.

SilverSneakers® fitness program

Keystone 65 HMO and Personal Choice 65SM PPO members are eligible for the SilverSneakers Fitness Program, designed exclusively for Medicare individuals. Membership in SilverSneakers is offered at no additional cost to members beyond their monthly premium.

Work out when, where and how you want with SilverSneakers

Did you know Keystone 65 HMO and Personal Choice 65SM PPO members are eligible for SilverSneakers at no additional cost beyond their monthly premium? Designed exclusively for Medicare individuals, Healthways SilverSneakers® Fitness Program is an exercise program for active older adults. Nearly 2 million SilverSneakers members are already enjoying the health benefits of physical activity, and you can be one of them.

Get fit your way

With SilverSneakers, you get options. Check out all the ways to use this innovative program.

Work out indoors

  • More than 13,000 fitness locations
  • All basic amenities and SilverSneakers group exercise classes
  • Easy enrollment with your SilverSneakers ID card

Go outside with FLEX

If you're looking for options outside the traditional fitness location, try SilverSneakers FLEX. FLEX offers classes and activities in local neighborhood parks, recreation centers, shopping centers and even at the beach. While participating in FLEX, you can still access the network of SilverSneakers locations across the country. It's a great way to gather with friends and get fit your way!

To find fitness locations, request your SilverSneakers ID card, enroll in FLEX classes or get additional details, visit www.silversneakers.com or call 1-888-423-4632 (TTY: 711), Monday through Friday, 8 a.m. to 8 p.m. EST.

**SilverSneakers is a registered mark of Healthways, Inc., an independent company.

*Class offerings, services, and amenities vary by location.

Personal Health Visit program

The Personal Health Visit is a helpful and convenient way to get personalized health advice in a relaxed setting. You can schedule your appointment at any of the following locations: a conveniently located partner center, the Philadelphia Inovalon Member Center or you can request to have a licensed nurse practitioner see you right in your own home. You're eligible to receive the choice of a $50 gift card from an Independence Blue Cross preferred retailer when you complete a Personal Health Visit with no cost to you.

  • The visit lasts about an hour and includes a detailed health assessment.
  • You can ask the nurse practitioner as many questions as you like.
  • Your doctor will receive a summary of the Personal Health Visit.
  • We will mail the gift card within 30-60 days of your completed Personal Health Visit.

Why should I schedule a Personal Health Visit?

At Independence Blue Cross, we believe that your good health is the result of good teamwork, so we want to make sure that your doctor has up-to-date information about your health status. Having the results from your Personal Health Visit can be really helpful when your doctor sees you at your next appointment.

This assessment is all about you and your health. Your Medicare Advantage plan will not change in any way because of your health assessment. Your monthly costs will not be affected either. This resource is provided simply as a way to keep your doctors informed so that they can deliver the best care possible.

Independence Blue Cross has contracted with Inovalon, an independent company, to perform Personal Health Visits for Keystone 65 members and Personal Choice 65 members. For more information about the program or to schedule your appointment directly with Inovalon, call toll-free: 1-877-809-9473 (TTY/TDD: 1-866-954-3277) Monday - Friday, 8 a.m.to 7 p.m.

The Personal Health Visit program is only available to current Keystone 65 members and Personal Choice 65 members.

Download Frequently Asked Questions about Personal Health Visits
Y0041_HM_15_28554b Accepted 2/21/2015

Healthy LifestylesSM Solutions programs*

Blue365®* — With exclusive discounts and offers on programs and services from leading national companies, Blue365 gives you an easy-to-use valuable resource to save on health-related products and services. For more information click here

Stress Management* — Get a free stress relief audio guide.

*The products and services indicated with an asterisk above are neither offered nor guaranteed under our contract with the Medicare program. In addition, they are not subject to the Medicare appeals process. Any disputes regarding these products and services may be subject to the plan grievance process.

Condition Management program

Modern medicine allows doctors to offer you a variety of options for your care. The trick is to figure out what makes sense for you. And that's what the condition management program is all about.

In addition to offering access to Health Coaches, condition management provides you with resources that can help you get the information and support you need to make the health decisions that are right for you.*

Condition management provides resources and support for the following:

  • asthma
  • coronary artery disease (CAD)
  • chronic kidney disease
  • chronic obstructive pulmonary disease (COPD)
  • diabetes
  • heart failure
  • high risk pregnancy
  • HIV
  • hyperlipidemia
  • hypertension
  • inflammatory bowel disease
  • Maternity Management
  • metabolic syndrome
  • musculoskeletal pain
  • migraine
  • obesity
  • osteoporosis
  • upper gastrointestinal disease

To reach a Health Coach, call 1-800-ASK-BLUE (1-800-275-2583; TTY 711), after you provide the requested information, say Health Coach.

*Condition Management is available at no cost to Keystone 65 HMO and Personal Choice 65SM PPO members. Please refer to your member materials for the terms, limitations, and exclusions of your health care coverage, or call Customer Service at the number on the back of your medical ID card to find out if you are eligible.

Case Management

Get ongoing help managing your health

If you are facing serious illness or medical condition, then case management may be right for you.

Independence case management is a free, confidential program offered to Keystone 65 HMO and Personal Choice 65SM PPO members. Our case managers, referred to as Health Coaches, are registered nurses and social workers who pair their occupational expertise with knowledge of Independence benefits to offer you support and guidance in dealing with your complex health concerns.

What a Health Coach can do for you

Your Health Coach will work with you, your physicians, and your family to ensure your care is on the right track and you're getting the most out of the covered benefits and resources available to you.

A Health Coach can help you to:

  • understand your condition and current health status;
  • learn skills to keep yourself as healthy as possible;
  • learn about your medications;
  • manage your symptoms and side effects of treatments;
  • stay on track with your health care provider's plan of care;
  • transition between the hospital and home;
  • cope with the emotional impact of your illness or condition;
  • navigate the health care system;
  • refer you to other plan programs or benefits-related resources available to you such as nutrition counseling or mental health services;
  • find support groups and community resources.

Getting started with case management

Most often our Health Coaches will reach out to you by telephone or letter to offer their assistance. This generally happens after you've had a hospital or rehabilitation stay.

However, if you feel you need help from a Health Coach about a health-related issue, call 1-800-ASK-BLUE (1-800-275-2583; TTY 711), after you provide the requested information, say Health Coach.

Health management

The ibxpress.com member website helps take the guesswork out of making important health decisions. From bee stings to back surgery, referrals to reimbursements, you can find the information you need quickly and easily — experience ibxpress.com for yourself. Register today.

Stay on top of your health with these schedules of recommended well visits, immunizations, and health screenings.

Wellness Guide (age 65+)

Wellness Guide (ages 18 to 64)

Wellness Tools

Online tools help our members manage their health and health care activities.

24/7 health information line

Keystone 65 HMO and Personal Choice 65SM PPO members have round-the-clock access to a Health Coach for all of their health related questions and concerns. To reach a Health Coach, call 1-800-ASK-BLUE (1-800-275-2583; TTY 711), after you provide the requested information, say Health Coach.

Health Coaches

Health Coaches are registered nurses who are available to Keystone 65 HMO and Personal Choice 65SM PPO members to answer your health-related questions and address your concerns.

What a Health Coach can do for you

Available 24/7, year-round, Health Coaches can help you to:

  • Understand your diagnosis.
  • Educate yourself about your condition.
  • Learn to actively manage your health.
  • Make lifestyle choices that can reduce your health risks.
  • Learn self-care skills and how to follow your treatment plan.
  • Prepare for visits and discussions with your doctor.
  • Weigh the pros and cons of important decisions using evidence-based information they can provide.
  • Address everyday health concerns.

Contact a Health Coach

To reach a Health Coach, call 1-800-ASK-BLUE (1-800-275-2583; TTY 711), after you provide the requested information, say Health Coach.

Preapproval/Precertification for Services

Certain services require preapproval/precertification from Independence Blue Cross (IBC) prior to being performed.

If you or your patient needs services that require preapproval/precertification, please call 1-800-ASK-BLUE. Providers registered with the NaviNet® web portal may submit requests electronically for services to be rendered at an acute care facility or ambulatory surgical center.

The Care Management and Coordination (CMC) department will evaluate your request and will notify your office once a decision has been reached for those cases that require clinical review. You will be provided with a preapproval/precertification reference number based on the determination of your request. Failure to complete required preapproval/precertification may result in a reduction in payment or nonpayment for the services not preapproved/precertified.

Your office or your patient may appeal our decision or provide additional information to support the request at any time during the evaluation process. Please refer to the CMC section of the Provider Manual for Participating Professional Providers or the Hospital Manual for Participating Hospitals, Ancillary Facilities, and Ancillary Providers for more information.

Medical Policy

For more information regarding our medical policies, visit our Medical Policy Portal.

Drugs, alcohol, and tobacco

Spouses and families play a crucial role in helping loved ones stay drug-, alcohol-, and tobacco-free — and fortunately, there are a number of resources and tools that can help.

Immediate Assistance

Help quitting

Tobacco: Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.
Alcohol: Alcoholics Anonymous (212-870-3400) is open to anyone affected by an alcohol-related disorder. There are no age or education requirements.
Drugs: Narcotics Anonymous is an international, community-based association that provides a recovery process and support network for those affected by substance abuse disorders.


Events

You are encouraged to attend one of our "Healthy Mind, Healthy Spirit" member health expos. Here, you can ask questions about your plan's benefits, visit vendors, receive free health screenings, and so much more! If you would like more information or to register for an expo in your area, please contact Independence at 1-877-393-6729 seven days a week, 8 a.m. to 8 p.m. (TTY/TDD: 711)

You can also register for an expo online.

Website last updated: 10/17/2017
Y0041_HM_18_56568b Pending