Keystone Point of Service (POS)Groups 100+

Forms are in pdf format.

Option	PCP Copay
KPOS 2A	$ 2
KPOS 2B	$ 2
KPOS 2C	$ 2
KPOS 2D	$ 2
KPOS 2E	$ 2
KPOS Choice	$ 2
KPOS 5A	$ 5
KPOS 5B	$ 5
KPOS 5C	$ 5
KPOS 5D	$ 5
KPOS 5E	$ 5
KPOS 5S	$ 5
KPOS 105D	$ 5
KPOS 505F	$ 5
KPOS 10A	$10
KPOS 10B	$10
KPOS 10C	$10
KPOS 10D	$10
KPOS 10E	$10
KPOS 10S	$10
KPOS 510F	$10
KPOS Select A	$10
KPOS Select B	$10
KPOS Select C	$10
KPOS Select D	$10
KPOS Select E	$10
KPOS 15A	$15
KPOS 15B	$15
KPOS 15C	$15
KPOS 15D	$15
KPOS 15E	$15
KPOS 15S	$15
KPOS IIG	$20
KPOS IVG	$20
POS C1-F1-O1	$10
POS C1-F1-O2	$10
POS C1-F2-O1	$10
POS C1-F2-O2	$10
POS C1-F3-O1	$10
POS C1-F3-O2	$10
POS C1-F4-O1	$10
POS C1-F4-O2	$10
POS C2-F1-O1	$15
POS C2-F1-O2	$15
POS C2-F2-O1	$15
POS C2-F2-O2	$15
POS C2-F3-O1	$15
POS C2-F3-O2	$15
POS C2-F4-O1	$15
POS C2-F4-O2	$15
POS C3-F1-O1	$20
POS C3-F1-O2	$20
POS C3-F2-O1	$20
POS C3-F2-O2	$20
POS C3-F3-O1	$20
POS C3-F3-O2	$20
POS C3-F4-O1	$20
POS C3-F4-O2	$20
POS C3-F5-O2	$20
POS C4-F3-01	$30
POS C4-F3-02	$30
POS C4-F4-01	$30
POS C4-F4-02	$30
POS C4-F5-O2	$30
KPOS Student 515E	$15
KPOS Student 515S	$15
KPOS Student Select C	$10
KPOS Student Select E	$10
KPOS Student Select IIE	$15