Independence Blue Cross plans at Roosevelt

The following Independence Blue Cross plans are accepted at our Roosevelt primary care clinic.
The following plans are accepted in 2022. Accepted plans for 2023 will be updated shortly.
Plan NameEffective YearBenefit PackageSummary
Keystone 65 Basic Rx (HMO)2022H3952-056 Download
Keystone 65 Basic Rx (HMO)2022H3952-055 Download
Keystone 65 Focus Rx (HMO-POS)2022H3952-054 Download
Keystone 65 Focus Rx (HMO-POS)2022H3952-053 Download
Keystone 65 Group Medical Only (HMO)2022H3952-802
Keystone 65 Group Rx (HMO)2022H3952-804
Keystone 65 Preferred Medical Only (HMO)2022H3952-044 Download
Keystone 65 Preferred Medical Only (HMO)2022H3952-008 Download
Keystone 65 Preferred Rx (HMO)2022H3952-045 Download
Keystone 65 Preferred Rx (HMO)2022H3952-020 Download
Keystone 65 Select Medical Only (HMO)2022H3952-050 Download
Keystone 65 Select Medical Only (HMO)2022H3952-048 Download
Keystone 65 Select Rx (HMO)2022H3952-051 Download
Keystone 65 Select Rx (HMO)2022H3952-049 Download
Keystone First VIP Choice (HMO D-SNP)2022H4227-001 Download
Personal Choice 65 Elite Rx (PPO)2022H3909-017 Download
Personal Choice 65 Group Medical Only (PPO)2022H3909-801
Personal Choice 65 Group Rx (PPO)2022H3909-802
Personal Choice 65 Medical Only (PPO)2022H3909-007 Download
Personal Choice 65 Prime Rx (PPO)2022H3909-014 Download
Personal Choice 65 Prime Rx (PPO)2022H3909-015 Download
Personal Choice 65 Rx (PPO)2022H3909-009 Download
Personal Choice 65 Rx (PPO)2022H3909-001 Download
Personal Choice 65 Saver Rx (PPO)2022H3909-016 Download

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