All PDFs
Flex POS Copay Options
(may be paired with any Keystone Rx option)
Flex POS C1-F1-O1
Flex POS C1-F1-O2
Flex POS C1-F2-O1
Flex POS C1-F2-O2
Flex POS C1-F3-O1
Flex POS C1-F3-O2
Flex POS C1-F4-O1
Flex POS C1-F4-O2
Flex POS C2-F1-O1
Flex POS C2-F1-O2
Flex POS C2-F2-O1
Flex POS C2-F2-O2
Flex POS C2-F3-O1
Flex POS C2-F3-O2
Flex POS C2-F4-O1
Flex POS C2-F4-O2
Flex POS C3-F1-O1
Flex POS C3-F1-O2
Flex POS C3-F2-O1
Flex POS C3-F2-O2
Flex POS C3-F3-O1
Flex POS C3-F3-O2
Flex POS C3-F4-O1
Flex POS C3-F4-O2
Flex POS C3-F5-O2
(effective 7/1/2007)
Flex POS C4-F3-O1
(effective 7/1/2007)
Flex POS C4-F3-O2
(effective 7/1/2007)
Flex POS C4-F4-O1
(effective 7/1/2007)
Flex POS C4-F4-O2
(effective 7/1/2007)
Flex POS C4-F5-O2
(effective 7/1/2007)
Flex POS Direct Copay Options
(may be paired with any Keystone Rx option)
Flex Direct POS C1-F1-01
Flex Direct POS C1-F1-02
Flex Direct POS C1-F2-01
Flex Direct POS C1-F2-02
Flex Direct POS C1-F3-01
Flex Direct POS C1-F3-02
Flex Direct POS C1-F4-01
Flex Direct POS C1-F4-02
Flex Direct POS C2-F1-01
Flex Direct POS C2-F1-02
Flex Direct POS C2-F2-01
Flex Direct POS C2-F2-02
Flex Direct POS C2-F3-01
Flex Direct POS C2-F3-02
Flex Direct POS C2-F4-01
Flex Direct POS C2-F4-02
Flex Direct POS C3-F1-01
Flex Direct POS C3-F1-02
Flex Direct POS C3-F2-01
Flex Direct POS C3-F2-02
Flex Direct POS C3-F3-01
Flex Direct POS C3-F3-02
Flex Direct POS C3-F4-01
Flex Direct POS C3-F4-02
Flex Direct POS
C3-F5-O2 (effective 7/1/2007)
Flex Direct POS
C4-F3-O1 (effective 7/1/2007)
Flex Direct POS
C4-F3-O2 (effective 7/1/2007)
Flex Direct POS
C4-F4-O1 (effective 7/1/2007)
Flex Direct POS
C4-F4-O2 (effective 7/1/2007)
Flex Direct POS
C4-F5-O2 (effective 7/1/2007)
Flex Deductible POS Direct Options
(may be paired with Keystone Rx options 5, 6, 7, 8 or 9 only)
Keystone
Direct POS D1-N1 Benefit Summary
Keystone
Direct POS D1-N2 Benefit Summary
Keystone
Direct POS D2-N1 Benefit Summary
Keystone
Direct POS D2-N2 Benefit Summary
Keystone
Direct POS D3-N1 Benefit Summary
Keystone
Direct POS D3-N2 Benefit Summary
Keystone
Direct POS D4-N1 Benefit Summary
Keystone
Direct POS D4-N2 Benefit Summary
Keystone Health Plan East Pre- Authorization Information
Keystone POS Pre-Authorization
KPOS Flex Pre-Authorization
Keystone Prescription (Rx) Benefit Summaries
Select Drug Formulary Guide effective 7/1/07
Select Drug Program Key Discussion Points
Select Drug Program Q & A
Q & A for Injectable Coverage
Biotech/Specialty Injectables List
Procedures That Support Safe Prescribing
HMO/POS Select $5/$10/$25 with oral contraceptives (Option 1)
HMO/POS Select $5/$15/$25 with oral contraceptives (Option 2)
HMO/POS Select $5/$20/$35 with oral contraceptives (Option 3)
HMO/POS Select $10/$30/$50 with oral contraceptives (Option 4)
HMO/POS Select $10/$20/$35 with oral contraceptives (Option 5)
HMO/POS Select $15/$35/$50 with oral contraceptives (Option 6)
HMO/POS Select $20/$40/$60 with oral contraceptives (Option 7)
HMO/POS
Select $0/$25/$50 with oral contraceptives (Option 8)
HMO/POS
Select $5/$30/$50 with oral contraceptives (Option 9)
Keystone Dental/Vision Benefit Summaries
Keystone Basic Dental Program
$35 Vision Bi-Annual Program
$50 Vision Bi-Annual Program
$75 Vision Bi-Annual Program
$100 Vision Bi-Annual Program
$125 Vision Bi-Annual Program
$200 Vision Bi-Annual Program
$250 Vision Bi-Annual Program
$35 Corrective Eyewear Bi-Annual Benefit (Keystone Rider)
$100 Corrective Eyewear Bi-Annual Benefit (Keystone Rider)
The following Keystone plans are available for Renewals only:
Keystone POS 2B Benefit Summary
Keystone POS 5B Benefit Summary
Keystone POS 5C Benefit Summary
Keystone POS 10B Benefit Summary
Keystone POS 10C Benefit Summary
Keystone POS 15C Benefit Summary
Keystone POS 15S Benefit Summary
Keystone POS 105 D Benefit Summary
Keystone POS 505 F Benefit Summary
Keystone POS 510 F Benefit Summary
The following Keystone Rx plans are available for Renewals only:
HMO/POS Standard Rx $5/$20 with oral contraceptives
HMO/POS Standard Rx $6/$10 with oral contraceptives
HMO/POS Standard Rx $10/$15 with oral contraceptives
HMO/POS Standard Rx $10/$20 with oral contraceptives
HMO/POS Standard Rx 50% with oral contraceptives
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