Eligibility, Coverage and Payments

• Eligibility
• Coverage
• Payment and the Waiting List
• Termination of Coverage
• Impartial Eligibility Review

Using Your Insurance

• The Keystone Plan  
  
  
  • How to Get Basic Health Care
  • How to See a Specialist
  • How to Deal With a Need For Emergency Medical Care
  • How to Get Continuing Care After Emergency Medical Care
  • What Medical Services Need Preapproval
  • Keystone Participating Providers
  • How to Change Your Primary Care Physician or Referred Specialist
  • Prescription Drug Discount Program
  • Interpreter Services
  • Other Important Information About Keystone
   
  
• How to See a Specialist 
  
  
  • How to See a Specialist
  • Direct Access to Obstetrical/Gynecological Care
  • How to Obtain a Standing Referral
  • How to Have a Referred Specialist Designated as Your Primary Care Physician
  • How to Plan For Hospital Care
  • Continuity of Care
   
  
• Emergency, Urgent and Follow-Up Care  
  
  
  • What are Emergency Services?
  • What is Urgent Care?
  • Emergency Services Inside and Outside Keystone’s Service Area
  • Inside Keystone’s Service Area
  • Outside Keystone’s Service Area
  • Payment for Immediate Care Services
  • Medical Screening Evaluation
  • Follow-Up Care Benefits
  • Auto or Work-Related Accidents

Summary of Benefits

Benefits

• Covered Services 
  
  
  • Primary and Preventive Health Services
  • Outpatient Services
  • Inpatient Services
   
  
  
• What is Not Covered?

Rights and Responsibilities

• Your Rights as a Member 
  
  
  • Your Rights
  • You Can File a Complaint or Grievance
  • You Can Accept or Refuse Treatment
  • Confidentiality and Disclosure of Medical Information
   
  
  
• Your Responsibilities as an adultBasic/Keystone Member 
  
  
  • It is Your Responsibility to:
  • Subrogation
   
  
  
• Required Disclosure of Information

Definitions