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KeystoneBlue Health Maintenance Organization (HMO)
KeystoneBlue, an HMO from Keystone Health Plan West, covers most health care expenses…without any financial surprises later. Most routine and preventive care is covered, and there are no deductibles and no complicated claim forms to worry about. Members pay only a copayment for certain services, so they have lower out-of-pocket expenses, too. Under KeystoneBlue, the majority of care is coordinated by the member's Primary Care Physician (PCP), so each member needs to choose a PCP from the KeystoneBlue provider network. Because KeystoneBlue uses the largest managed care network in western Pennsylvania, it's very likely that the hospitals and physicians your employees use now are part of this network. KeystoneBlue also includes these important features for maximum member convenience:
Benefits at a glanceTo receive care, services must be performed or referred by your PCP or Blues On CallSM Health Information and Support Line. Exceptions apply for emergency room, Ob/Gyn, and mental health and substance abuse services. Following a referral from your PCP or through Blues On CallSM, network specialists may continue to provide follow-up care and refer for diagnostic services for a 60-day time period. All care must be provided by network providers. Below are specific benefit levels. Wish to have a printable version of this benefit grid? A simple click will open a pdf version...KeystoneBlue The following benefits are effective January 1, 2004. Please click on the Site Map to view benefit information for the 2003 plan year.
1A female member may self-refer to a network ob/gyn or nurse midwife of her choice for any gynecological and maternity care. These services do not require authorization or a referral from your PCP. 2Treatment includes coverage for the correction of a physical or medical problem associated with infertility. Infertility drug therapy may or may not be covered depending on your group's prescription drug program. 3Prescription are covered as long as they are listed on the prescription drug formulary applicable to your plan. Under the mandatory generic provision, the member is responsible for the payment differential when a generic drug is available and the doctor or patient specifies a brand name drug. The member payment is the price difference between the brand drug and the generic drug in addition to the brand drug Co-Pay or coinsurance amounts, which may apply. Provider NetworkTo locate a participating provider in your area, please click on the link below. RatesTo determine premium rates, Highmark Blue Cross Blue Shield uses a demographic rating method based on the following factors: business location, the number of eligible employees enrolling, the average age of all covered employees, and industry classification. Please contact the Council's Employee Benefits Group to determine your specific rates. If you have any further questions, please Highmark DisclaimerHighmark Blue Cross Blue Shield® is an independent licensee of the Blue Cross and Blue Shield Association serving businesses and residents in western Pennsylvania. Highmark® is a registered service mark of Highmark Inc. Blue Cross and Blue Shield® and the cross and shield symbols are registered service marks of the Blue Cross and Blue Shield Association, an Association of Independent Blue Cross and Blue Shield Plans. Blues on CallSM is a service mark of the Blue Cross and Blue Shield Association. This information is not intended for use without professional advice. While we have attempted to make this site as accurate as possible, it is only a summary. For more information, see our disclaimer.
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