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You will receive notice when necessary. Details Drug Coverage for the VISTA Health Plan Inc. Keystone First VIP Choice H4227-001 (HMO D-SNP) in Pennsylvania. For more information on how to fill your prescriptions, see the Keystone First VIP Choice Evidence of Coverage (PDF). Supported by certain reference books. This information is not a complete description of benefits. You will receive notice when necessary. This plan includes additional Medicare prescription drug (Part-D) coverage. You won’t have to pay a non-contracted provider … A "medically accepted indication" is a use of the drug that is one of the following: Approved by the Food and Drug Administration (FDA). Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Some members who are 21 years or older may have prescription coverage too. Enrollment in Keystone First VIP Choice depends on contract renewal. Drug lists (formularies) Web Content Viewer - Fixed Context. Types of restrictions we use for certain drugs: Copyright © 2013-2020 KEYSTONE FIRST VIP CHOICE. Keystone 65 Select Rx (HMO) (H3952-051) by Keystone 65 - Chester County, PA. The drug list tells you how to find out which drugs are covered under Medicaid. You may qualify for help with a low-income subsidy. This tool will help you find a pharmacy that takes Keystone First in your area. For more information, see the prescription drug frequently asked questions (FAQ). As a Keystone First VIP Choice member, your Medicare benefits are covered by an affordable, reliable plan. Keystone First members younger than 21 years old have prescription coverage. What is a coverage determination? Keystone First covers medically needed Food and Drug Administration (FDA)-approved medicines. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Learn more about plan monthly cost,premimum deductibles,prescription drug coverage, plan ratings, accepted doctors and more. You can search by typing part of the generic (chemical) or brand (trade) names. The formulary, pharmacy network, and/or provider network may change at any time. As part of Keystone First CHC, you receive the following dental benefits: Exams. The prescription also needs to be filled at a network pharmacy, and other plan rules need to be followed. Keystone First members younger than 21 years old have prescription coverage. Health maintenance organizations … Learn all about your benefits and other important plan information with the links below. The amount you pay for prescription drugs may depend on which pharmacy you use. Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. Keystone First is a medical assistance (Medicaid and Medicare) managed care health plan based in southeastern Pennsylvania. Keystone First was founded by the Sisters … Documents on this page may be updated monthly. This information is not a complete description of benefits. The formulary, pharmacy network, and/or provider network may change at any time. This site contains links to other Internet sites. For plans with Part D Coverage: You may be able to get Extra Help to pay for your prescription drug premiums and costs. Please complete the security check below. The Keystone 65 Basic Rx (HMO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $6,700 (MOOP). If you get a bill for the services, you may send the bill to Keystone 65 HMO for payment. Last Update: Wednesday, April 17, 2019 9:52:25 AM. This is an important legal … This site contains links to other Internet sites. You do not need a referral to see the dentist. Please see Terms of Use and Privacy Notice. Pennsylvania Medical Assistance Program Preferred Drug List (PDL) … Keystone First is Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan serving more than 400,000 Medical Assistance recipients in southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. Coverage by Vista Health Plan, Inc. Formulary medications are Food and Drug Administration (FDA) approved and have been chosen for their reported medical effectiveness and value. Use this form to send us your appeal. If there is a restriction on the drug you want to take, you should contact Member Services to learn what you or your provider would need to do to get coverage for the drug. (You can then ask us to reimburse you for our share.). Coverage by Vista Health Plan, an independent licensee of the Blue Cross and Blue Shield Association. As Pennsylvania's largest Medical Assistance (Medicaid) managed care health plan, Keystone First serves Medical Assistance recipients in Southeastern Pennsylvania including Bucks, Chester, Delaware, Montgomery, and Philadelphia counties. For members over 18 years old, copays may apply to prescriptions. The healthcare provider currently serves over 400,000 residents in the area. Plain Page Single Section DnD. Call 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., seven days a week for more information. You or your primary care provider (PCP) and other prescribers can ask for a coverage determination. This booklet gives you the details about your Medicare health care and prescription drug coverage from January 1 – December 31, 2021. Fax urgent: 1-855-516-6381 Fax standard: 1-855-516-6380 Call: 1-800-450-1166 (TTY/TDD 711), 8 a.m. to 8 p.m., Monday — Friday Write: Attn: Pharmacy Prior Authorization/Member Prescription Coverage Determination PerformRx 200 Stevens Drive … The Keystone First VIP Choice (HMO SNP) plan has a $415 drug deductible. A formulary is a list of drugs, or prescriptions, that a plan covers. You may search the Keystone First VIP Choice 2021 Drug Formulary in several ways: You can use the alphabetical list to search by the first letter of your medication. Keystone First VIP Choice has a network of pharmacies. Your Medicare Health Benefits and Services and Prescription Drug Coverage as a Member of Keystone 65 Rx HMO or Keystone 65 Rx HMO-POS . Fillings. Our plan uses different types of restrictions to help our members use drugs in the most effective ways. At Keystone First VIP Choice (HMO SNP), we understand the needs of people who are eligible for both Medicare and Medicaid. If you don't have your plan membership card with you when you fill your prescription, ask the pharmacy to call the plan to get the information. This is a 4-star Medicare Advantage plan. The formulary has been reviewed and approved by the Centers for Medicare & Medicaid Services (CMS), the agency that administers the Medicare Program. In most cases, your prescriptions are covered only if they are filled at 1 of our network pharmacies. Remember, your drug must be used for a medically accepted indication. prescription? Keystone First Community HealthChoices (CHC) may reimburse you, or pay you back. If you have any questions about this change, please call Member Services at 1-800-521-6860 (TTY 1-800-684-5505). Generic drugs have the same active ingredient as brand name drugs. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. It is best to ask a non-contracted provider to bill Keystone 65 HMO first, but if you already paid for the covered services, we will pay you for our share of the cost. This formulary is a list of prescription medications that are covered under Vista Health Plan, Inc.'s Medicare Advantage Plan in Pennsylvania. A drug formulary is a list of brand and generic medicines covered by … Keystone First VIP Choice (HMO D-SNP) is a Local HMO. 1 dental exam and 1 cleaning, per provider/group, every 180 days (6 months). X-rays. This site contains links to other internet sites. If Keystone First VIP Choice denies to cover or pay for a prescription drug, you or your representative can ask us to review our decision. Want regular information about your pharmacy benefits? Cleanings. Last Update: Wednesday, April 17, 2019 9:52:25 AM. Please see Terms of Use and Privacy Notice. * Participants: If you have any problems, call Participant Services at 1-855-332-0729 (TTY 1-855-235-4976) 24 hours a day, 7 days a week. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. The formulary is updated at times throughout the year, and the list of drugs may change. If you have questions about your prescription drug coverage: Keystone … You must continue to pay your Medicare Part B premiums, unless otherwise covered by your Pennsylvania Medicaid benefits. It explains how to get coverage for the health care services and prescription drugs you need. The Keystone First VIP Choice (HMO D-SNP) AE-H4227 is available to residents in Pennsylvania, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. We will pay the non-contracted provider for our share of the bill and will let you know what, if anything, you must pay. Please see the Copayment Schedule (PDF) for more information. If you want us to waive the restriction for you, you will need to use the Coverage Determination process and ask us to make an exception. Keystone First VIP Choice (HMO D-SNP) is a Local HMO. You can search by selecting the therapeutic class of the medication you are looking for. Keystone First Community HealthChoices is not responsible for the content of these sites. Keystone First VIP Choice (HMO SNP) will generally cover the drugs listed in our formulary as long as the drugs are medically necessary. History. Keystone First CHC gives your health care provider a tool, called a drug formulary, to help him or her prescribe medicines for you. A formulary is a list of drugs, or prescriptions, that a plan covers. To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact Keystone 65 Customer Service at 1-800-645-3965 or Personal Choice 65 Customer Service at 1-888-718-3333; TTY/TDD users should call 711, 7 days a week, 8 a.m. to 8 p.m.; or you can complete and submit online the Request for Medicare Prescription Drug Coverage Determination or … Books are the American Hospital formulary Service drug information ( AHFS-DI ) and other important information! Not need a referral to see the keystone First members younger than 21 years or older have! Faq ) accepted doctors and more limited, if any, cost-sharing responsibility depends on contract renewal pharmacy to your. 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