Medical Plan Information for SPAP
Keystone Health Plan East HMO
Keystone Health Plan East is a Health Maintenance Organization (HMO) that provides you with a complete range of medical benefits through a select group of doctors and hospitals. An HMO is a type of health insurance plan that requires you to select a family doctor, often called a primary care physician or PCP, to coordinate your care. Your PCP will treat you for general health needs and refer you to specialists as needed. In other words, you need a referral from your PCP to see a specialist in the HMO network. 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. Typically, only emergency services are covered if you go outside the health plan network.
Don’t have a PCP yet? Use the Find a Doctor tool. To register or change your PCP, call the customer service number on the back of your ID card.
Learn more about how your Keystone HMO plan works:
Plan Details
Personal Choice® PPO
Personal Choice, our popular Preferred Provider Organization (PPO), lets you choose your own providers from a network of quality doctors and hospitals, known as the Personal Choice network. When you use a Personal Choice network doctor or hospital, there is very little to pay out-of-pocket. Additional advantages are no claim forms and no balance bills.
With Personal Choice, you can choose to use a doctor or hospital that is not in the Personal Choice network; however, you’ll pay more for these services and will have to submit a claim for reimbursement.
Dental Plan Information
- Pediatric HMO Dental (included with the Keystone HMO 20 medical plan)
Vision Plan Information
- HMO Vision (included with Keystone HMO 20 medical plan)
- PPO Vision (included with Personal Choice 25-35-50 medical plan)