Eligibility, Coverage and Payments

• Eligibility
• Coverage
• Payment
• Termination of Coverage
• Impartial Eligibility Review

Using Your Child's 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
  • Medical Technology Assessment is Performed by 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 Child’s 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?
  • What is Follow-Up Care?
  • Urgent Care and Follow-Up Care Outside Keystone’s Service Area — The BlueCard® Program’s Urgent and Follow-Up Care Benefits

Summary of Benefits

Benefits

• Outpatient & Inpatient 
  
  
  • Outpatient Services
  • Inpatient Services
  
  
• Prescription Drug 
  
  
  • Prescription Drug Benefits—What is Covered
  • Prescription Drug Limitations
  • 96-Hour Urgent Temporary Supply Program
  • Prescription Drug Exclusions—What is Not Covered
  
  
• Dental Benefits  
  
  
  • How to Access Dental Services
  • Dental Services—What is Covered
  • Dental Care Benefit Limitations
  • Dental Exclusions—What is Not Covered
  
  
• Mental Health and Substance Abuse 
  
  
  • How to Access Mental Health, Serious Mental Illness and Substance Abuse Benefits
  • Your Child’s Mental Health and Serious Mental Illness Benefits—What is Covered
  • Your Child’s Substance Abuse Benefits—What is Covered
  • Mental Health, Serious Mental Illness and Substance Abuse Exclusions—What is Not Covered
  • Complaints and Grievances
  
  
• Vision 
  
  
  • How to Access Vision Care Benefits
  • Vision Care—What is Covered
  • Vision Care Exclusions—What is Not Covered
  
  
• What is Not Covered?

Rights and Responsibilities

• Your Child’s Rights as a Member 
  
  
  • Your Child’s Rights
  • You Can File a Complaint or Grievance For Your Child
  • You Can Accept or Refuse Treatment For Your Child
  • Confidentiality and Disclosure of Medical Information
  
  
• Your Responsibilities as a Parent/Guardian 
  
  
  • It is Your Responsibility to:
  • Subrogation
  
  
• Required Disclosure of Information

Definitions