Health Plans for Individuals and Families

Benefits Summary

Keystone Health Plan East HMO

There are six different Individual HMO options — three copay and three deductible plans. For more details on a single plan, click the plan name.

Medical Plan Benefits
Plan	Office Visit	Specialist Visit	Hospitalization
HMO $5000 Deductible	$30	$50	30%, after deductible
HMO $2500 Deductible	$30	$50	30%, after deductible
HMO $1500 Deductible	$30	$50	30%, after deductible
HMO $20 Copay	$20	$30	$400 copay per day; max. 5 copays/admission ($2,000)
HMO $15 Copay	$15	$25	$200 copay per day; max. 5 copays/admission ($1,000)
HMO $10 Copay	$10	$20	$100 copay per day; max. 5 copays/admission ($500)

Compare plans

See contract for additional details.

This summary represents only a partial listing of benefits and exclusions of the Keystone Health Plan East program described in this summary. Benefits and exclusions may be further defined by medical policy. This managed care plan may not cover all your health care expenses. Read your contract/member handbook carefully to determine which health care services are covered. If you need more information, please call 215-988-9257 (if calling within Philadelphia) or 1-888-580-9100 (outside Philadelphia).