Independence Blue Cross Keystone Health Plan East Formulary
Find greater peace of mind with health care that's more carefree.
Welcome, and thanks for choosing Keystone 65 HMO as your health plan in 2022! In times like these, it's more important than ever to have affordable health care coverage that works hard to protect you. At Independence Blue Cross (Independence), we've been looking after our members in the Philadelphia area for more than 80 years. So if there's one thing you can really count on, it's that we're here for you. We've taken care of everything…so you can take good care of yourself.
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Tips for using your Keystone 65 HMO plan in 2022
- Know your network. Use doctors and hospitals in your network. As an HMO member, your health plan only covers care received from in-network providers. However, out-of-network emergency care is covered in the case of an emergency. Keystone 65 Focus HMO-POS members have an annual point-of-service maximum that can be used towards out-of-network care, but they'll pay less for in-network care. Please note that the Keystone 65 Focus plan uses a defined network that is a subset of our Keystone 65 HMO network.
- Choose a primary care physician (PCP). You are required to choose an in-network PCP, or family doctor, to treat your general health needs and coordinate your care. No matter which PCP you choose, your copay will be $0 and you won't need a referral to see a specialist.
- Visit designated sites to receive care. You are required to receive in-network laboratory services (e.g., blood work) at a site your PCP chooses. You can view your PCP's designated site on the front of your member ID card or by logging in to ibx.com.
- Dental, hearing, and vision coverage are included. We've got you covered for routine care and more.
- $0 copay for routine dental, hearing, and vision exams
- Generous dental allowance every year for fillings, root canals, crowns, partial bridges, dentures, and more*
- Unlimited hearing aid fittings and evaluations with up to two hearing aids every year (one per ear, per year)
- One pair of eyeglass frames and lenses or one pair of contact lenses are covered every year up to the covered allowance amount when purchased from Visionworks® or a Davis Vision provider
- Save with your IBX Care Card. Lower your out-of-pocket costs by using your IBX Care Card on eligible over-the-counter (OTC) health and wellness items at participating retail locations, including CVS, Walgreens, Walmart, and more. Simply swipe your card at the register — it's that easy! Your IBX Care Card is prepaid and automatically reloaded each quarter. Visit ibxmedicare.com/carecard to learn more about your IBX Care Card.
- Emergency and urgent care. You're covered for emergency care no matter where you are, but you can save time and money by using telemedicine, a retail clinic, or an urgent care center for non-emergencies. These are great options for minor injuries and illnesses such as allergies, sore throats, etc. when your doctor isn't available.
If you have any questions about your plan or benefits, please call our Member Help Team at 1-800-645-3965 (TTY/TDD: 711), seven days a week, 8 a.m. to 8 p.m. Please note that on weekends and holidays from April 1 through September 30, your call may be sent to voicemail.
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Y0041_H3952_KS_101868_2022 Website last updated: 10/1/2021
Notice of nondiscrimination
*Benefit is not available for Keystone 65 Preferred HMO members.
IBX Care Card allowance is provided quarterly (every three months) and does not carry forward to the next quarter if it is not used. You must use your IBX Care Card to purchase eligible OTC items at a participating retailer. OTC items purchased from non-participating retailers will not be covered.
Vision benefits are underwritten by Keystone Health Plan East and administered by Davis Vision, an independent company. An affiliate of Independence Blue Cross has a financial interest in Visionworks, an independent company.
Dental benefits are underwritten by Keystone Health Plan East and administered by United Concordia Companies, Inc., an independent company.
TruHearing® is a registered trademark of TruHearing, Inc., an independent company.
Source: https://www.ibxmedicare.com/htdocs/custom/welcome/ks65.html
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