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  • General
  • Account Installation Forms
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  • Blue Solutions: Groups 2-50
    • HMO
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  • Blue Solutions: Groups 51-99
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Keystone Health Plan East (HMO)Groups 2 – 50

Benefits  |  Contracts

Forms are in pdf format.

Blue Solutions

Option PCP Copay
HMO 1 Rx $10/$20/$35 Vision $100 $10
HMO 2 Rx $10/$20/$35 Vision $100 $15
HMO 3 Rx $7/50%/$125 Vision $100 $20
HMO 4 Rx $7/50%/$125 Vision $100 $20
HMO 5 Rx $7/50%/$125 Vision $100 $30
HMO 6 Rx $250/$20/$40/$60 Vision $100 $20
HMO 7 Rx $250/$20/$40/$60 Vision $100 $20
HMO 1.1 Rx $10/$40/$70 Vision $100 $10
HMO 2.1 Rx $10/$40/$70 Vision $100 $15
HMO 3.1 Rx $10/$45/$75 Vision $100 $20
HMO 4.1 Rx $10/$45/$75 Vision $100 $20
HMO 5.1 Rx $10/$45/$75 Vision $100 $30
HMO 6.1 Rx $250/$10/$45/$75 Vision $100 $20
HMO 7.1 Rx $4 generic only Vision $100 $20

Blue Solutions Choice

Option PCP Copay
BC HMO 1.1 Rx $10/$40/$70 Vision $100 $10
BC HMO 2.1 Rx $10/$40/$70 Vision $100 $15
BC HMO 3 Rx $7/50% ($125) Vision $100 $20
BC HMO 4 Rx Rx $7/50% ($125) Vision $100 $20*
BC HMO 5 Rx $7/50% ($125) Vision $100 $30
BC HMO 6 Rx $250/$20/$40/$60 Vision $100 $20*
BC HMO 7.2 Rx $7/50% ($125) Vision $100 $20*

* no deductible

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Independence Blue Cross is an independent licensee of the Blue Cross and Blue Shield Association, serving the health insurance needs of Philadelphia and southeastern Pennsylvania.