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Independence Blue Cross (IBX) has offered affordable high-quality health insurance plans to Pennsylvania residents for almost 80 years. They are the region’s biggest medical coverage provider and serves the Philadelphia area and Southeastern Pennsylvania. We help you compare Keystone and Personal Choice health insurance quotes so you can enroll at the lowest possible cost. IBX participates in the Pa Health Exchange and Open Enrollment. However, you can also purchase plans without a federal subsidy. To qualify for coverage, you must reside in Bucks, Montgomery, Chester, Delaware, or Philadelphia County. Senior Medicare coverage is also available.

We proudly represent individual and family medical options, and offer coverage at the best available pricing. We spend time to review each policy, and determine which option best provides the coverage you need, with the lowest out-of-pocket cost. You can easily apply for a policy online from this website. Upon request, we can send or email specific benefit and coverage details. Free quotes can be obtained from the top portion of this page for all HMO, PPO, and EPO plans. Out-of-network coverage is offered on PPO plans. Tiered networks and HSA options help lower your premium.

Applying For 2018 Under 65 Coverage

Applications submitted for 2018 effective dates do not require answering any medical questions or providing any details of medical history. For the Pa Marketplace, some of the popular plan options IBX is offering include Personal Choice catastrophic, Personal Choice PPO, Keystone HMO, and PPO Multi-State and Keystone HMO Proactive (Silver, Gold and Platinum Metal plans). Of course, federal tax subsidies could drastically reduce rates for these plans. Philadelphia health insurance rates have remained fairly steady in recent years.

 

Catastrophic Plans

Personal Choice Catastrophic - $50 copay for first three pcp office visits. Telemedicine visits are provided at no charge. Substance abuse and mental health outpatient visits are also included. Additional visits and all specialist visits must meet deductible. Policy deductible is $7,350 with maximum out-of-pocket expenses of $7,350 and 0% coinsurance.

 

Bronze Plans

Personal Choice EPO Bronze Reserve - $6,650 deductible with maximum out-of-pocket expenses of $6,650 and 0% coinsurance. All drugs are subject to deductible.

Personal Choice PPO Bronze - $50 copay for pcp office visits and $40 for telemedicine calls. Specialist visits are subject to deductible and coinsurance. Deductible is $5,500 with maximum out-of-pocket expenses of $7,350 and 50% coinsurance. All drugs are subject to deductible and coinsurance. Generic drugs are subject to deductible and $15 copay only. Out-of-network benefits are provided, although the deductible increases to $15,000.

Personal Choice EPO Bronze Basic - $40 copay for first three pcp office visits. Specialist visits are subject to deductible and coinsurance. Deductible is $7,350 with maximum out-of-pocket expenses of $7,350 and 0% coinsurance. All drugs are subject to deductible. This is an "off-Exchange" plan.

Keystone HMO Bronze - $50 and $100 office visit copays and $40 for telemedicine calls. Deductible is $6,850 with maximum out-of-pocket expenses of $7,350 and 50% coinsurance. Routine radiology is subject to $120 copay, and MRIs and PET and CT scans are subject to $250 copay. $80 copay for physical and occupational therapy visits. Generic drug copay of $15 after the deductible.  This is an "off-Exchange" plan. 

 

IBX Pa Silver Tier coverage from Independence Blue Cross. View rates for individuals and families, with or without a federal subsidy.

 

Silver Plans

Personal Choice PPO Silver - $30 and $70 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $70 copay. Speech therapy office visits receive a $60 copay. The policy deductible is $2,500 with $6,500 maximum out-of-pocket expenses and 30% coinsurance. Generic drugs receive $15 copay ($30 mail-order). The out-of-network deductible is $10,000.

Keystone HMO Silver Proactive - $40 and $80 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $80 copay. Speech therapy office visits also receive an $80 copay. The Urgent Care and ER copays are $100 and $550. Diagnostic tests are subject to a $120 copay, and imaging is subject to a $250 copay per scan. 20 spinal manipulation visits per year with a $50 copay are allowed. Outpatient surgery copays for hospital-based and ambulance surgical facilities are $250. The policy deductible is $0 with $7,350 maximum out-of-pocket expenses and 50% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 50% coinsurance.

Keystone HMO Silver Proactive Select - $40 and $80 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $80 copay. Speech therapy office visits also receive an $80 copay. The Urgent Care and ER copays are $100 and $550. Diagnostic tests are subject to a $120 copay, and imaging is subject to a $250 copay per scan. The policy deductible is $0 with $7,350 maximum out-of-pocket expenses and 50% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 50% coinsurance. Similar to previous plan, although offered off-Exchange.

Keystone HMO Silver Proactive Value - $40 and $80 office visit copays with $40 for telemedicine calls.  Physical and occupational therapy office visits also receive $80 copay. Speech therapy office visits also receive an $80 copay. The Urgent Care and ER copays are $100 and $550. Diagnostic tests are subject to a $120 copay, and imaging is subject to a $250 copay per scan. The policy deductible is $1,500 with $7,350 maximum out-of-pocket expenses and 50% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 50% coinsurance. 

Keystone HMO Silver - $35 and $70 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $80 copay. Speech therapy office visits also receive an $60 copay. Urgent Care and ER visits must meet the deductible. The mental health, behavioral health, and substance abuse outpatient services copay is $70.  The policy deductible is $2,500 with $6,500 maximum out-of-pocket expenses and 30% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 50% coinsurance. 

Personal Choice Silver Reserve - $2,700 deductible with maximum out-of-pocket expenses of $6,650 and 30% coinsurance. Coinsurance and deductible applies to all non-preventative expenses.

Personal Choice Silver Reserve Select - $2,700 deductible with maximum out-of-pocket expenses of $6,650 and 30% coinsurance. Coinsurance and deductible applies to all non-preventative expenses. Similar to previous plan, although offered off-Exchange.

 

Gold Plans

Keystone HMO Gold Proactive - $15 and $40 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $60 copay. Speech therapy office visits also receive an $60 copay. The Urgent Care and ER copays are $100 and $400. Diagnostic tests are subject to a $60 copay, and imaging is subject to a $120 copay per scan. The policy deductible is $0 with $7,350 maximum out-of-pocket expenses and 50% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 50% coinsurance. 

Keystone HMO Gold - $35 and $65 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $60 copay. Speech therapy office visits also receive an $60 copay. The Urgent Care and ER copays are $100 and $350. Diagnostic tests are subject to a $60 copay, and imaging is subject to a $120 copay per scan. The policy deductible is $0 with $6,000 maximum out-of-pocket expenses and 20% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 50% coinsurance.  

Personal Choice PPO Gold - $30 and $65 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $60 copay. Speech therapy office visits also receive an $60 copay. The Urgent Care and ER copays are $100 and $350. Diagnostic tests are subject to a $60 copay, and imaging is subject to a $120 copay per scan. The policy deductible is $0 with $6,000 maximum out-of-pocket expenses and 20% coinsurance. Generic drugs receive $15 copay ($30 mail-order). Preferred and non-preferred drugs are subject to 40% and 50% coinsurance.   

 

Platinum Plans

Keystone HMO Platinum - $20 and $40 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $40 copay. Speech therapy office visits also receive an $40 copay. The Urgent Care and ER copays are $100 and $250. Diagnostic tests are subject to a $30 copay, and imaging is subject to a $60 copay per scan. The policy deductible is $0 with $4,500 maximum out-of-pocket expenses and 10% coinsurance. Generic drugs receive $10 copay ($20 mail-order). Preferred and non-preferred drugs are subject to $50 and $100 copays ($100 and $200 mail order).

Personal Choice EPO Platinum - $15 and $50 office visit copays with $40 for telemedicine calls. Physical and occupational therapy office visits also receive $50 copay. Speech therapy office visits also receive an $50 copay. The Urgent Care and ER copays are $100 and $250. Diagnostic tests are subject to a $30 copay, and imaging is subject to a $60 copay per scan. The policy deductible is $0 with $4,000 maximum out-of-pocket expenses and 10% coinsurance. Generic drugs receive $10 copay ($20 mail-order). Preferred and non-preferred drugs are subject to $50 and $100 copays ($100 and $200 mail order).

Three network tiers are available (Tier 1 - Preferred, Tier 2 - Enhanced, and Tier 3 - Standard). When utilizing Tier 1 physicians, specialists, hospitals, and medical facilities, your out-of-pocket expenses will be the smallest. ER, Urgent Care, and preventative expenses offer identical costs. Blue Distinction Center (BDC) hospitals are available in Tier 1. View the complete list of Tier 1 hospitals in Pennsylvania below:

Albert Einstein Medical Center, Aria Health, Chestnut Hill, Hahnemann University, Jeanes, Roxborough Memorial, Wills Eye, Doylestown, Grand View, Lower Bucks, Rothman Orthopaedic Specialty, St Luke's Health Network, Brandywine, Chester County, Jennersville Regional, Phoenixville, Crozier-Chester Medical Center, Springfield, Delaware County Memorial, Taylor, Abington Memorial, Holy Redeemer, Pottstown Memorial Medical Center, and Suburban Community.  

 

Independence Blue Cros offers affordable Senior Medicare plans in the Philadelphia area. Advantage and Part D prescription drug plans are available with many flexible options.

 

Independence Blue Cross Medicare Plans For Seniors

 

Medicare Advantage With Prescriptions

MA contracts allow private insurers (IBX) to provide your healthcare benefits. Coverage includes Parts A and B, along with preventative care. Depending upon the carrier and plan, vision and hearing, prescription drugs, and YMCA and fitness club memberships may also be provided. Part B premiums must be paid if you enroll in an Advantage plan. Shown below are the current available plans.

 

Keystone 65 Focus RX HMO - $0 deductible and $6,700 maximum out-of-pocket expenses. Office visit copays are $10 and $40. The inpatient hospital copay is $210 for the first six days. The outpatient hospital copay is $350 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $45-$200 copay, and outpatient x-rays are subject to a $45 copay. Skilled nursing facility coverage has no copay for days 1-20. A $164 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $275 (one way).

There is a $200 prescription drug deductible for Tiers 3, 4, and 5. The one month drug copays are $2 (Tier 1), $15 (Tier 2), $47 (Tier 3), $100 (Tier 4) and 29% (Tier 5). The three-month mail order drug copays are $4 (Tier 1), $30 (Tier 2), $94 (Tier 3), $200 (Tier 4) and 29% (Tier 5).

 

Keystone 65 Basic RX HMO - $475 deductible and $6,700 maximum out-of-pocket expenses. Office visit copays are $15 and $50. The inpatient hospital copay is $300 for the first six days. The outpatient hospital copay is $350 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $75 or $250 copay, and outpatient x-rays are subject to a $75 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $300 (one way).

There is a $300 prescription drug deductible for Tiers 3, 4, and 5. The one month drug copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4) and 27% (Tier 5). The three-month mail order drug copays are $6 (Tier 1), $24 (Tier 2), $94 (Tier 3), $200 (Tier 4) and 27% (Tier 5).

 

Keystone 65 Select RX HMO - $0 deductible and $5,500 maximum out-of-pocket expenses. Office visit copays are $15 and $45. The inpatient hospital copay is $300 for the first six days. The outpatient hospital copay is $400 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $75 or $200 copay, and outpatient x-rays are subject to a $45 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $300 (one way).

There is no drug deductible. The one-month drug copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4) and 33% (Tier 5). The three-month mail order drug copays are $9 (Tier 1), $36 (Tier 2), $141 (Tier 3), $300 (Tier 4) and 33% (Tier 5).

 

Keystone 65 Preferred RX HMO - $0 deductible and $4,000 maximum out-of-pocket expenses. Office visit copays are $5 and $40. The inpatient hospital copay is $250 for the first six days. The outpatient hospital copay is $400 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $40 or $150 copay, and outpatient x-rays are subject to a $40 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $150 (one way).

There is no drug deductible. The one-month drug copays are $2 (Tier 1), $10 (Tier 2), $47 (Tier 3), $100 (Tier 4) and 33% (Tier 5). The three-month mail order drug copays are $6 (Tier 1), $30 (Tier 2), $141 (Tier 3), $300 (Tier 4) and 33% (Tier 5).

 

Personal Choice 65 RX HMO - $0 deductible and $6,200 maximum out-of-pocket expenses. Office visit copays are $15 and $40. The inpatient hospital copay is $300 for the first six days. The outpatient hospital copay is $400 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $50 or $175 copay, and outpatient x-rays are subject to a $50 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $175 (one way).

There is a $400 prescription drug deductible for Tiers 3, 4, and 5. The one-month drug copays are $3 (Tier 1), $12 (Tier 2), $47 (Tier 3), $100 (Tier 4) and 25% (Tier 5). The three-month mail order drug copays are $9 (Tier 1), $46 (Tier 2), $141 (Tier 3), $300 (Tier 4) and 25% (Tier 5).

 

Medicare Advantage Without Prescriptions

Keystone 65 Select Medical Only - $0 deductible and $5,500 maximum out-of-pocket expenses. Office visit copays are $15 and $45. The inpatient hospital copay is $300 for the first six days. The outpatient hospital copay is $400 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $75 or $200 copay, and outpatient x-rays are subject to a $45 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $300 (one way).

 

Keystone 65 Preferred Medical Only - $0 deductible and $4,000 maximum out-of-pocket expenses. Office visit copays are $5 and $40. The inpatient hospital copay is $250 for the first six days. The outpatient hospital copay is $400 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $40 or $150 copay, and outpatient x-rays are subject to a $40 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $150 (one way). 

 

Personal Choice 65 Medical Only - $0 deductible and $6,200 maximum out-of-pocket expenses. Office visit copays are $15 and $40. The inpatient hospital copay is $300 for the first six days. The outpatient hospital copay is $400 per visit. The ER copay is $80 and the Urgent Care copay is $10-$40. Diagnostic tests and procedures, and lab services have a $0 copay while diagnostic radiology services are subject to a $50 or $175 copay, and outpatient x-rays are subject to a $50 copay. Skilled nursing facility coverage has no copay for days 1-20. A $165 copay applies to days 21-100. Physical therapy is subject to a $40 copay, and the ambulance copay is $175 (one way). 

 

Dental Plans For Adults

Coverage is administered by United Concordia, who is independent of IBX. QCC underwrites each policy. Preventative benefits are covered at 100%, and a large network of dentists is provided. The two available plans are listed below:

Adult Dental Preferred - $50 deductible per person and $150 deductible per family. $1,000 maximum annual benefits per person. Exams, cleanings, x-rays, consultations, and emergency treatment covered at 100% with no waiting period. An annual exam and cleaning is allowed, along with bitewing x-rays every 2-3 years, depending on age. Extractions, root canals, fillings, periodontics and oral surgery are covered at 50% after the deductible has been met. No waiting period for fillings and extractions. Crowns and dentures are not covered. However, repairs to crowns and dentures are covered at 50% after 12-month waiting period.

Monthly rates are $17.55 (ages 19-25), $18.65 (ages 26-39), $21.94 (ages 40-49), $25.78 (ages 50-63), and $26.33 (ages 64 and above).

Adult Dental Premier With Preventive Incentive - $50 deductible per person and $150 deductible per family. $1,000 maximum annual benefits per person. Benefits paid for cleanings, exams, x-rays, and emergency treatment are not applied towards annual maximum. Exams, cleanings, x-rays, consultations, and emergency treatment covered at 100% with no waiting period. A semi-annual exam and cleaning is allowed, along with bitewing x-rays every 18 months. Extractions, root canals, fillings, periodontics and oral surgery are covered at 80% after the deductible has been met. No waiting period for fillings and extractions. Crowns and dentures are covered at 50% after deductible and waiting period. However, repairs to crowns and dentures are covered at 80% after 12-month waiting period.

Monthly rates are $31.42 (ages 19-25), $33.38 (ages 26-39), $39.27 (ages 40-49), $46.14 (ages 50-63), and $47.12 (ages 64 and above).

 

Vision Plans For Adults

Davis Vision administers plans, and a 30-day waiting period applies to all contracts (supplies and services). The two available plans are listed below:

Adult Vision Care 100 - One annual eye exam is covered with a $0 copay. Davision Vision provides the selection of frames. Fashion, Designer, and Premier frames are subject to copays of $0, $15, and $40. A $100 non-collection frame allowance is included. Lens copays are $0 for clear plastic single vision, trifocal, and lined bifocal, $15 for tinted lens, $0 for scratch-resistant coating, $35 for polycarbonate lenses, $0 for ultraviolet coating, $40, $55, and $69 for anti-reflective coating, $65, $105, and $140 for progressive lenses, $60 for high index lenses, $70 for transition lenses, and $75 for polarized lenses.

Additional contact lense benefits include four multi-pack boxes of disposable lenses, two multi-pack boxes of planned replacement, evaluation, fitting and follow-up visits. Non-collection contacts receive a material allowance of $100 and a 15% discount. Medically necessary contacts (materials, evaluation, fitting, and follow-up) are covered. Out-of-network reimbursement is $40 (eye examination), $50 (frames), $40 (single lense), $60 (bifocal/progressive lense), $80 (trifocal lense), $80 (elective contact lense), and $225 (medically necessary contacts). Monthly rates are $13.21 for an individual, $26.41 for an individual and one dependent, and $39.62 for an individual and two or more dependents.

 

Adult Vision Care 180 - One annual eye exam is covered with a $0 copay. Davision Vision provides the selection of frames. Fashion, Designer, and Premier frames are subject to copays of $0, $15, and $25. A $130-$180 non-collection frame allowance is included. Lens copays are $0 for clear plastic single vision, trifocal, and lined bifocal, $0 for tinted lens, $0 for scratch-resistant coating, $0 for polycarbonate lenses, $0 for ultraviolet coating, $35, $48, and $60 for anti-reflective coating, $50, $90, and $140 for progressive lenses, $55 for high index lenses, $65 for transition lenses, and $75 for polarized lenses.

Additional contact lense benefits include four multi-pack boxes of disposable lenses, two multi-pack boxes of planned replacement, evaluation, fitting and follow-up visits. Non-collection contacts receive a material allowance of $130 and a 15% discount. Medically necessary contacts (materials, evaluation, fitting, and follow-up) are covered. Out-of-network reimbursement is $40 (eye examination), $50 (frames), $40 (single lense), $60 (bifocal/progressive lense), $80 (trifocal lense), $105 (elective contact lense), and $225 (medically necessary contacts).  Monthly rates are $14.17 for an individual, $28.33 for an individual and one dependent, and $42.50 for an individual and two or more dependents.

 

Small Business Plans

"Blue Solutions" provides many options for medical coverage, including HMO, EPO, POS, and PPO plans. High deductible health plans (HDHP) are also offered for employees that prefer lower premiums, spending accounts, and tax deductions when paying for qualified expenses. Dental benefits for children, and vision benefits for adults and children are provided on all plans. The drug formulary offers low-cost generic, brand, and specialty options, while a preferred pharmacy network features more than 50,000 locations. Self-service tools allow employees to better customize and track their coverage. Several popular Group policies are listed below:

 

Personal Choice PPO Platinum Preferred $10/$20/$150 - $0 deductible with $3,500 maximum out-of-pocket expenses. Office visit copays are $10 and $20, with Urgent Care and ER copays of $70 and $125. The inpatient hospital services copay is $150 per day (maximum five days). Generic, preferred brand, and non-preferred brand prescription copays are $7, $40, and $70.

Keystone HMO Platinum Preferred $10/$20/$100 - $0 deductible with $3,500 maximum out-of-pocket expenses. Office visit copays are $10 and $20, with Urgent Care and ER copays of $75 and $125. The inpatient hospital services copay is $100 per day (maximum five days). Generic, preferred brand, and non-preferred brand prescription copays are $7, $40, and $70. 

Personal Choice PPO Gold Classic $1,000/$15/$30/80% - $1,000 deductible with $5,500 maximum out-of-pocket expenses. Office visit copays are $15 and $30, with Urgent Care and ER coinsurance of 20% after the deductible. The inpatient hospital services coinsurance is 20% after the deductible. Generic, preferred brand, and non-preferred brand prescription copays are $7, $50, and $150.  

Keystone HMO Gold Classic $1,000/$25/$50/90% - $1,000 deductible with $5,500 maximum out-of-pocket expenses. Office visit copays are $25 and $50, with Urgent Care and ER coinsurance of 10% after the deductible.  The inpatient hospital services coinsurance is 10% after the deductible. Generic, preferred brand, and non-preferred brand prescription copays are $7, $50, and $150.

Personal Choice PPO Silver Classic $3,000/$30/$60/70% - $3,000 deductible with $7,350 maximum out-of-pocket expenses. Office visit copays are $30 and $60, with Urgent Care copay of $125 and ER coinsurance of 30% after the deductible. The inpatient hospital services coinsurance is 30% after the deductible. Generic, preferred brand, and non-preferred brand prescription copays are $7, 50%, and 50%.   

Keystone HMO Silver Classic $4,000/$25/$50/70% - $4,000 deductible with $7,350 maximum out-of-pocket expenses. Office visit copays are $25 and $50, with Urgent Care and ER coinsurance of 30% after the deductible.  The inpatient hospital services coinsurance is 30% after the deductible. Generic, preferred brand, and non-preferred brand prescription copays are $7, 50%, and 50%.

Keystone HMO Bronze Essential $6,850/$50/$100/700 - $6,850 deductible with $7,350 maximum out-of-pocket expenses. Office visit copays are $50 and $10, with Urgent Care and ER copays of $150 and $500 after the deductible.  The inpatient hospital services copay is $700 after the deductible. Generic, preferred brand, and non-preferred brand prescriptions are subject to a deductible. 

Personal Choice PPO Bronze HSA 0 $6,650/100% - HSA-eligible plan with $6,650 deductible, $6,650 maximum out-of-pocket expenses and 0% coinsurance.

Personal Choice PPO Bronze HSA 0 $5,200/50% - HSA-eligible plan with $5,200 deductible, $6,650 maximum out-of-pocket expenses and 50% coinsurance. 

 

Grandfathered Contracts

The descriptions of plans below refer to various "grandfathered" policies that are no longer made available for purchase. They are not ACA-compliant and do not include the 10 required "Essential Health Benefits." Also, maximum out-of-pocket expenses are sometimes higher than allowed under Obamacare. However, if these policies were issued before March 23 2010, and have not been terminated, they may be kept in-force.

Since these types of policies are exempt from current reforms, they may not be materially altered or you risk losing its favored status. For example, by substantially raising or lowering the deductible, the policy may not be renewed. If you do receive written notification that your policy is being canceled, you have 60 days to enroll in an Exchange plan with federal subsidies available (Special SEP).

Older Plans

The two available types of Keystone HMO policies were “deductible” and “copay." The Blue Cross “deductible” contracts were the HMO $8,000 (introduced in 2012), HMO $5,000, HMO $2,500 and HMO $1,500 plans. “Deductible” plans were the most affordable type of coverage, since the policyowner incurred a higher out-of-pocket expense on expensive claims. After the deductible, the insured was responsible for 30% of medical expenses, subject to maximum limits. Office visits were covered with a low $30 copay. Outpatient lab tests were covered at 100% and maternity benefits were also included once the deductible had been met.

Get cheap Keystone health insurance in Southeastern Pa. Individual and family plans are easy to apply for.

The Blue Cross “copay” plans were the HMO $20, HMO $15 and HMO $10. “Copay” policies were more expensive since there is no major deductible to meet. Instead of a deductible, a small ($100-$400) copay per day is charged. However, to reduce your expenses, there was a maximum of five copays per admission. This plan was one of the most popular policies in the state and also mirrored many more expensive corporate plans.

Preventative Services Covered At 100%

Both types of Keystone contracts feature preventative services that are not subject to a deductible. Some of the covered services include mammograms (no referral required), pediatric immunizations, outpatient lab/pathology and routine gyn exams. Routine eye exams are also included (one every two years and subject to a copay). And since there is no waiting period, once the policy is effective, you can begin to use benefits. Prior to 2014, often there was a 30-90 day waiting period to use these free services.

The number and scope of free benefits gradually expands each year. Now, many diagnostic tests and procedures are considered preventative, along with the standard physical every year.

Symptomatic Medical Expenses

Routine primary care and specialist office visits are covered with copays ranging from $10-$50. The “HMO Copay” plans will feature slightly lower copays than the “HMO Deductible” plans. Spinal manipulations and physical/occupational therapy are also covered expenses with copays starting as low as $20. Both HMO options allow one routine eye care exam every two years.

These plans also offer very comprehensive prescription coverage. However, the “HMO deductible” plans do not require that you meet a deductible before using RX benefits. Copays range from $10 to $50. However, “HMO Copay” plans have deductibles ranging from $100 to $250 on each of their policies. Out-of-pocket expenses tend to be slightly less on non-generic prescriptions. Both types have a yearly RX maximum of $2,500 per person and $5,000 per family.

IBX Pa Health Insurance Plans

Keystone HMO exclusions are typical for standard Pennsylvania health insurance plans and include services not medically necessary, treatment of substance abuse or mental illness, acupuncture, dental care, cosmetic services and private duty nursing. A complete list can be found in the "summary of benefits."

Keystone PPO Individual And Family Plans That Are No Longer Offered

There are also five different individual PPO (Personal Choice) policies. Two of the options are Health Savings Account (HSA) plans that offer either a $5,000 or $3,000 deductible option. The coinsurance is a low 0% and 20% respectively, and these are ideal for persons that are self-employed and/or looking for options to pay for health care with tax-free dollars. Small business owners should always consider this type of policy. Or if you are on a limited budget, but want to protect against unforeseen large events, it is a good choice.

Three additional PPO plans (PPO $5000 Deductible, PPO $2,500 Deductible & PPO $30 Copay) are also available. Each of the policies features a $30 copay for office visits and a $50 copay for specialist visits. Preventive benefits, prescription coverage and major medical coverage are all included. 

For the international traveler, GeoBlue Travel Medical And International Health coverage is a new coverage that is now available. Previously, this plan was offered on a group basis, but now it can be purchased on a private basis. It will cover policyholders who relocates to another country and also if they travel to a completely different country.

Almost 200 countries would be included in benefits and there would be a listing of participating doctors and related facilities that would be furnished. If only temporary benefits are needed, a special policy is available if you have existing coverage here in the US.

 

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IBX features two HMO "Proactive" options on the Pa Health Insurance Exchange that give Philadelphia-area consumers a low-cost choice. If they choose provider treatment in the least of three available tiers, they pay much less for treatment. Outpatient surgery, for example, could cost as much as 50%-80% less. About half of Blue Cross' physicians and hospitals participate in this specific tier.

The out-of-pocket maximums required by the ACA will still be met. Abington Memorial Hospital is one of the hospitals participating in Tier 1. Area residents can change back to their original plans every year during Open Enrollment.

The IBC Center for Health Care Innovation is now open. Located on Market Street in Philadelphia, this facility hopes to become the hub of medical initiatives, new ideas, and of course, innovation. Research with other local facilities along with New York University Langone Medical Center have already begun. The University of Pennsylvania has also begun collaboration involving a mobile technology project.

Plan rates and descriptions have changed. When you request a current quote, you can easily review the specific differences in benefits and costs from previous years. The Silver-tier policies are very popular, especially if you qualify for financial aid.

Pennsylvania now recognizes same-sex marriages as being legal. Also, HHS has adopted the same stance. Therefore, on IBX plans, when enrolling, same-sex spouses should be entered on applications as either "spouse" or domestic partner." Specific instructions will be sent to employers within the next seven days.

Annual net income for 2014 reduced for the third consecutive year for non-profit IBX. However, total revenue increased almost 20% and 2 million additional consumers were added. Much of the lost revenue is due to the Obamacare legislation, which hit many carriers hard beginning in 2014 when state and federal Exchanges began offering plans. However, other corporate investments and new ventures also impacted key financial data.

Many new members and first-time enrollments were Medicare-related or affiliated with government employee plans. 2016 numbers are expected to improve, as many "preparation" expenses for Marketplace products will decline.