State law requires that Keystone Health Plan East, Inc. (Keystone) make the following information available to you when you make a request in writing to Keystone.

1. A list of names, business addresses and official positions of the membership of the Board of Directors or Officers of Keystone
2. The procedures adopted to protect the confidentiality of medical records and other enrollee information
3. A description of the credentialing process for health care providers
4. A list of the participating health care providers affiliated with participating hospitals
5. Whether a specifically identified drug is included or excluded from coverage
6. A description of the process by which a health care provider can prescribe any of the following when either: (1) the drug formulary’s equivalent has been ineffective in the treatment of the enrollee’s disease; or (2) the drug causes or is reasonably expected to cause adverse or harmful reactions to the enrollee:
   • Specific drugs
   • Drugs used for an off-label purpose
   • Biologicals and medications not included in the drug formulary for prescription drugs or biologicals
7. A description of the procedures followed by Keystone to make decisions about the experimental nature of individual drugs, medical devices or treatments
8. A summary of the methodologies used by Keystone to reimburse for health care services (This does not mean that Keystone is required to disclose individual contracts or the specific details of financial arrangements with health care providers.)
9. A description of the procedures used in Keystone’s quality assurance program
10. Other information that the Pennsylvania Department of Health or the Pennsylvania Insurance Department may require