Understanding your network

Getting care should be simple. Learn how your health plan works — and how to find the care you need.

Plan types: HMO, HMO-POS, and PPO

Health Maintenance Organization (HMO)

Keystone 65 Basic Rx HMO, Keystone 65 HMO, Keystone 65 Liberty Medical-Only HMO, Keystone 65 Preferred HMO, and Keystone 65 Select HMO

• You must use in-network providers for most care.
• You need to choose a primary care provider (PCP).
• Emergency care is always covered, even out of network.

HMO-Point of Service (HMO-POS)

Keystone 65 Focus Rx HMO-POS and Keystone 65 Essential Rx HMO-POS

• Keystone 65 Focus Rx HMO-POS: You have a smaller provider network that is a subset of our network.
• Keystone 65 Essential Rx HMO-POS: You can use some out-of-network services with a yearly limit that applies to non-Medicare-covered dental services.

Preferred Provider Organization (PPO)

Personal Choice 65 Achieve Rx PPO, Personal Choice 65 Plus Rx PPO, and Personal Choice 65 PPO

• You can go to any doctor or hospital.
• You pay less in-network.
• No referrals are needed.

The role of your primary care provider (PCP)

A PCP is your main doctor. They will get to know you and your health history and can provide:

• Annual health checkups
• Answer your health-related questions
• Coordinated services with specialists and other providers (no referrals needed)

HMO members

• You must choose a PCP
• Your PCP visits have a $0 copay
• No referrals are needed for specialists — but they must be in-network

PPO members

• It’s a good idea to select a PCP — but not required
• A PCP helps keep your care organized
• You can use an in-network or out-of-network PCP, but you will usually pay less if you use a PCP who is in our network

Find a PCP

Get care from home (telemedicine)

Teladoc Health

Connect virtually from home or when traveling via your computer, tablet, or smartphone, at no cost.

• General medical care (available 24/7): Access board-certified doctors who can diagnose and treat non-emergency conditions such as sinus infections, flu, sore throats, allergies, earaches, pink eye, and more.
• Mental health: Schedule visits with a licensed therapist, psychologist, or psychiatrist and get support for depression, anxiety, stress, grief, and other issues.
• Dermatology: Connect online with a board-certified dermatologist who can provide timely answers to questions about new or chronic skin conditions like rashes, acne, eczema, and rosacea.

Visits are available in multiple languages, including ASL.

Learn more

Telehealth through your doctor

You can also have virtual visits with your own providers, including your PCP and specialists — with the same cost as an office visit.

How to access telehealth

• Use the Find a Provider tool to locate in-network providers with telehealth capabilities
• Ask your provider for instructions on how to access their telehealth services

Notes

• Not all services can be provided as a telehealth visit.
• Medicare-covered telehealth services for mental health and substance abuse are covered out of network for Personal Choice 65 PPO and Keystone 65 Focus Rx HMO-POS health plans.
• Please see your Evidence of Coverage to learn more.

Care while traveling for Personal Choice PPO members

You are eligible for the optional Visitor/Traveler program.

• Visit places in the shared Blue Cross^®/Blue Shield visitor/traveler service area for up to 12 months without losing your coverage.
• Get care in 48 participating states and two territories¹ (Puerto Rico and the District of Columbia).
• Pay in-network costs for covered benefits while visiting participating providers in the service area.

To learn more:

• Call 1-800-810-BLUE
• Visit bcbs.com to find providers

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Website last updated: 5/20/2026