Manuals, Guides, and Forms

Notice of Privacy Practices describes how medical information about you may be used and disclosed and how you can get access to this information.

HIPAA Privacy Practices and Forms contains privacy information and documentation related to HIPAA (the Health Insurance Portability and Accountability Act of 1996).

The Summary of Benefits tells you about some of the plan’s features, including conditions and limitations, premiums, and cost-sharing.

The Evidence of Coverage is a comprehensive resource guide to your health care coverage. It explains your benefits, exclusions, and plan rules.

If you wish to change plans, please use one of the following forms:

Keystone 65 HMO Change Form
Personal Choice^SM PPO Change Form