What is an HMO (Health Maintenance Organization)?
An HMO is an organized system of health care using a designated panel of physicians and other health care personnel that provides comprehensive medical services for a fixed dollar amount per enrolled person. An HMO provides a complete range of medical benefits through a network of doctors and hospitals. One doctor, the Primary Care Physician (PCP, family doctor, or pediatrician), coordinates overall medical needs. The PCP refers most specialty care needs.
I’m a new member of KHPE and I have some questions about my coverage. Who should I call?
Call the number on your ID card. If this number is not available, call Keystone Member Services at 215-241-CARE or 1-800-227-3114 (outside the Philadelphia area). Our hours of operation are Monday through Friday, 8 a.m. to 6 p.m.
I have just moved and now need a new PCP. What should I do?
There are two ways to change your PCP:
- Online: To change your doctor, visit ibxpress.com, our simple, convenient, and secure member portal. To find a new doctor, use the online provider search.
- Phone: Call the number on your ID card. If this number is not available, call Keystone Member Services at 215-241-CARE or 1-800-227-3114 (outside the Philadelphia area).
PCP changes become effective on the first day of the following month.
I have dental coverage through KHPE, but I’ve never selected a dentist. What should I do?
It is important to select a dentist as soon as your dental coverage becomes effective to avoid interruption or delay in your dental care. Contact Member Services to request a directory of dentists. When you’ve made your selection, call Member Services to register your choice. The Member Services associate will explain when you will be enrolled with the dentist. You need to select one dentist for your entire family. If you have the pediatric dental program only, choose one dentist for all your children age 12 and younger.
What should I do if I need a doctor and my PCP is unavailable?
As a member of KHPE, you have medical care available to you 24 hours a day, seven days a week, through your PCP’s office. If your PCP is unavailable, there will be a physician on call in the event of an emergency. When you call your PCP and get an answering service, be sure to tell the operator what your problem is and if it is an emergency. The service will have the covering physician call you promptly.
My ID card lists my doctor’s office name, not his/her individual name. Do I still see the same doctor?
Yes, you still see the same doctor. If you receive a new ID card and your doctor practices with a group of doctors in an office, the group name will be on your card instead of the individual doctor’s name. You may, however, still see the same doctor as before.
We are expecting our first child. How do we enroll our baby in KHPE?
For the first 31 days after the birth of your baby, your new baby is covered under KHPE. You must contact your benefits office and complete an application to enroll your child with KHPE within those 31 days. If you are a federal employee with a family plan, simply contact Member Services and give us your child’s name, birth date, and the name of your child’s physician to enroll your new child under your plan.
See your member handbook for additional information regarding adding a new family member.
How do I get a prescription filled for my newborn baby before I get his/her ID card?
If you have a prescription drug plan, you can get your baby’s prescription filled by paying for it at the pharmacy and calling Member Services for a reimbursement form. Once your child is permanently enrolled as a KHPE member, you will be reimbursed for any prescriptions, minus your applicable copayment.