The out of pocket limit on the Keystone 65 Select RX HMO.
What is $5,500?
100
Drugs that usually aren’t self-administered by the patient and are injected or infused while you are getting physician, hospital outpatient, or ambulatory surgical center services.
What is Part B drugs?
100
Keystone 65 Basic RX HMO co-payment for an observation stay.
What is $350?
100
Reason Supportive devices for the feet would be covered under our plans.
What is Diabetic foot disease?
100
The website our member can use to access the member portal.
The co-payment for the ambulance on the Keystone 65 Basic RX HMO.
What is $300?
200
If you have a body mass index of this number or more,
we cover intensive counseling to help you lose weight.
What is 30?
200
Co-payment for outpatient rehabilitation services on all of our Keystone 65 plans.
What is $40 copayment?
200
A group of practicing doctors and other health care experts paid by the Federal government to check and improve the care given to Medicare patients.
What is Quality Improvement Organization (QIO)?
200
Services, supplies, or drugs that are needed for the prevention, diagnosis, or treatment of your medical condition and meet accepted standards of medical
practice.
What is Medically Necessary?
300
Starting this date, Medicare Diabetes Prevention Program services will be covered for eligible Medicare beneficiaries under all Medicare health plans.
What is April 1, 2018?
300
Co-payment of radiation therapy under the Keystone 65 plans.
What is $60 copayment?
300
Co-payment for skilled nursing facility days 20-100 on the Keystone 65 Select RX HMO.
What is $165?
300
Personal care provided in a nursing home, hospice, or other facility setting when you do not need skilled medical care or skilled nursing care.
What is Custodial Care?
300
A risk assessment survey that helps us learn more about your health care needs.
What is Health Needs Assessment?
400
The amount of time covered for one-on-one counseling
services during your first year that you receive medical nutrition therapy services under Medicare.
What is 3 hours?
400
Our out-patient mental health provider.
What is Magellan Behavioral Health providers?
400
Co-payment for world wide urgent care on our Keystone 65 HMO plans.
What is $80?
400
A temporary institutional care of a dependent elderly, ill, or handicapped person, which provides relief for their usual caregivers.
What is Respite Care?
400
Time frame that you have to submit a claim to us after the date of service.
What is 12 months?
500
Lifetime benefit maximum for services in a freestanding psychiatric hospital.
What is 190-days?
500
A type of complaint you make about us or pharmacies, including a complaint concerning the quality of your care. This type of complaint does not involve coverage or
payment disputes.
What is Grievance?
500
The time frame an expedited appeal or "fast coverage decision" will be answered in.
What is 72 hours?
500
Our two discount programs that we offer to our members.
What is Blue InsiderSM and Blue365®?
500
Under the Medicare Coverage Gap Discount Program, you pay this percent of the negotiated price and a portion of the dispensing fee for brand name drugs.