Evidence of Coverage

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After you’ve joined the plan, you will receive the Evidence of Coverage in the mail. This is a legal document that should be kept in a safe place.

The Evidence of Coverage is a comprehensive resource guide to your health care coverage. It explains your benefits, premiums, and cost-sharing; conditions and limitations of coverage; and plan rules.

Download Keystone 65 Value, Advantage, and Preferred – Medical Only
Download Keystone 65 Value, Advantage, and Preferred – Medical plus Prescription Drug
Download Keystone 65 Complete – For people who have full Medicare and Medicaid benefits.
Download Keystone 65 Complete – For members with effective date prior to June 1, 2005, who do not have full Medicare and Medicaid benefits.
Download Personal Choice 65^SM Standard – Medical Only
Download Personal Choice 65 Standard – Medical plus Prescription Drug
Download Select Advantage Silver – Medical Only
Download Select Advantage Silver – Medical plus Prescription Drug