Flex Deductible Series Plans
Keystone HMO
With the Keystone HMO plan each person in your family elects a Primary Care Physician (PCP) from the network to access care. Annual routine gynecologist exams do not require referrals. There are no out of network benefits. You are covered for Specialist Care, Hospitalizations, Maternity Care and an extensive array of Preventive Health Services.
Keystone Direct POS
Keystone Direct Point of Service (POS) is a plan that allows members to either elect care through a primary care physician or seek care directly from any provider - in or out of the network. Members only need referrals for the following services in network, physical/occupational therapy, podiatry, lab, x-ray and spinal manipulations.
Personal Choice
Choose your own doctors and hospitals without the necessity of a primary care physician or referrals. Maximum coverage is available by accessing preferred providers within the Personal Choice network. If you receive services from out-of-network providers, you will have higher out-of-pocket costs due to deductibles and co-insurance.
Plan Options...
Physician Visit Copays
- $20 Primary - $40 Specialist
Annual Deductible for Facility and Ancillary Services
- $500 Single / $1,500 Family
- $1,000 Single / $3,000 Family
- $2,000 Single / $6,000 Family
- $3,000 Single / $9,000 Family
Network Coinsurance Levels for Facility and Ancillary Services
- 80% / 20% Coinsurance to $3,000 Single / $9,000 Family Out of Pocket Maximum
- 70% / 30% Coinsurance to $5,000 Single / $15,000 Family Out of Pocket Maximum
Out of Network Benefits
- $5,000 Single / $15,000 Family Annual Deductible - 50% / 50% Coinsurance to $15,000 Single / $45,000 Family - $500,000 Lifetime Maximum
Prescription Drug Copays
All prescription drug options will be from the Select Drug Program. The Select Drug Program uses a prescription drug formulary and provides coverage based on a three tier copayment incentive. Members pay less when using formulary medications, but have access to covered non-formulary medications with a higher copayment.
- $10 Generic Formulary - $20 Brand Name Formulary - $35 Non-Formulary
- $0 Generic Formulary - $25 Brand Name Formulary - $50 Non-Formulary
- $5 Generic Formulary - $40 Brand Name Formulary - $60 Non-Formulary
- $15 Generic Formulary - $35 Brand Name Formulary - $50 Non-Formulary
- $20 Generic Formulary - $40 Brand Name Formulary - $60 Non-Formulary
- $250 Deductible - $20 Generic Formulary - $40 Brand Name Formulary - $60 Non-Formulary
A Formulary list of drugs is available at www.ibx.com.
Please contact us for more information. For pricing, please complete a Rate Request Form.