Keystone - Keystone HMO Gold Proactive

Pennsylvania, 2019

  • Plan Type

    HMO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $7,900

  • Deductible

    $0

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $0
Deductible (Family) $0
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $350 Copay per day
Inpatient Physician No charge
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services No charge
X-Ray and Diagnostic Imaging Data Not Available

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $350 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery No charge

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Pennsylvania

Plan Keystone HMO Platinum Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan Keystone HMO Silver Proactive Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan Keystone HMO Gold Deductible $0 Coinsurance Not applicable Out of Pocket $6,500
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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $0
Deductible (Family) $0
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,900
Out of Pocket Maximum (Family) $15,800

Doctor Visits

Primary Care Visit Data Not Available
Specialist Visit Data Not Available
Inpatient Facility $350 Copay per day
Inpatient Physician No charge
Emergency Room Services Data Not Available

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services No charge
X-Ray and Diagnostic Imaging Data Not Available

Health Management Programs

Asthma Available
Depression Not available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $350 Copay per day
Mental / Behavioral Health Outpatient Data Not Available
Rehabilitative Speech Therapy Data Not Available
Rehabilitative Occupational & Physical Therapy Data Not Available
Outpatient Facility Data Not Available
Outpatient Surgery No charge

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

Other Plans in Pennsylvania

Plan Keystone HMO Platinum Deductible $0 Coinsurance Not applicable Out of Pocket $5,000
Plan Keystone HMO Silver Proactive Deductible $0 Coinsurance Not applicable Out of Pocket $7,900
Plan Keystone HMO Gold Deductible $0 Coinsurance Not applicable Out of Pocket $6,500