Keystone Health Plan East, our Health Maintenance Organization (HMO), provides a complete range of medical benefits through a select group of doctors and hospitals. Your overall medical needs are coordinated by one doctor, the primary care physician (family doctor or pediatrician). All specialty care needs are referred by your primary care physician. Our wide network of participating physicians and hospitals in Pennsylvania, New Jersey and Delaware make the HMO an easy-to-use and cost-effective program for you.
With Keystone HMO, there are no claim forms, no deductibles and low out-of-pocket expenses.
HMO Plan Features:
- NCQA accreditation — KHPE has received the highest standard of measurement from NCQA — Excellent;
- choose a primary care physician from our large network of more than 30,000 doctors and nearly 200 hospitals;
- all referrals for specialty care are coordinated by the primary care physician;
- Direct Access OB/GYNSM — no referrals required to see a network OB/GYN for routine or maternity care¹;
- Wellness Programs, including fitness reimbursement and discounts on alternative health care services, at no additional cost;
- enhanced programs to control and manage chronic conditions;
- comprehensive benefits for students and travelers out of the area;
- worldwide recognition of the Blue Cross® and Blue Shield® symbols on member ID cards.
¹Non-routine care provided by Reproductive Endocrinologists/Infertility Specialists and Gynecologic Oncologists continues to require a referral form from your primary care physician.
- Download a Summary of Benefits