Keystone Direct Point of Service (POS) — HCR 100% Preventive Options: Groups 51+IBC Forms Online — Benefit Summaries

Notice!

Benefit summaries have been updated to reflect 100% Preventive values in alignment with Health Care Reform.

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Option	PCP Copay	Last Updated
Direct POS C1-F1-O1	$10	2011-09
Direct POS C1-F1-O2	$10	2011-09
Direct POS C1-F2-O1	$10	2011-09
Direct POS C1-F2-O2	$10	2011-09
Direct POS C1-F3-O1	$10	2011-09
Direct POS C1-F3-O2	$10	2011-09
Direct POS C1-F4-O1	$10	2011-09
Direct POS C1-F4-O2	$10	2011-09
Direct POS C2-F1-O1	$15	2011-09
Direct POS C2-F1-O2	$15	2011-09
Direct POS C2-F2-O1	$15	2011-09
Direct POS C2-F2-O2	$15	2011-09
Direct POS C2-F3-O1	$15	2011-09
Direct POS C2-F3-O2	$15	2011-09
Direct POS C2-F4-O1	$15	2011-09
Direct POS C2-F4-O2	$15	2011-09
Direct POS C3-F1-O1	$20	2011-09
Direct POS C3-F1-O2	$20	2011-09
Direct POS C3-F2-O1	$20	2011-09
Direct POS C3-F2-O2	$20	2011-09
Direct POS C3-F3-O1	$20	2011-09
Direct POS C3-F3-O2	$20	2011-09
Direct POS C3-F4-O1	$20	2011-09
Direct POS C3-F4-O2	$20	2011-09
Direct POS C3-F5-O2	$20	2011-09
Direct POS C4-F3-O1	$30	2011-09
Direct POS C4-F3-O2	$30	2011-09
Direct POS C4-F4-O1	$30	2011-09
Direct POS C4-F4-O2	$30	2011-09
Direct POS C4-F5-O2	$30	2011-09
Direct POS D1-N1	$20	2011-09
Direct POS D1-N2	$20	2011-09
Direct POS D2-N1	$20	2011-09
Direct POS D2-N2	$20	2011-09
Direct POS D3-N1	$20	2011-09
Direct POS D3-N2	$20	2011-09
Direct POS D4-N1	$20	2011-09
Direct POS D4-N2	$20	2011-09