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Keystone Health Plan East (HMO) — Groups 51+IBC Forms Online — Benefit Summaries
Forms are in pdf format.
| Option | PCP Copay | Last Updated |
|---|---|---|
| HMO C1-F1-HCR | $10 | 2012-03 |
| HMO C2-F2-HCR | $15 | 2012-02 |
| HMO C3-F4-HCR | $20 | 2012-02 |
| HMO C4-F5-HCR | $30 | 2012-02 |
| HMO D2-N1-HCR | $20 | 2012-02 |
| HMO D3-N1-HCR | $20 | 2012-02 |
| HMO D4-N2-HCR | $20 | 2012-02 |
