Common Contracts

3 similar Individual Hmo Subscriber Agreement contracts

INDIVIDUAL HMO SUBSCRIBER AGREEMENT
Individual Hmo Subscriber Agreement • October 9th, 2015

This HMO Subscriber Agreement sets forth a comprehensive program of Inpatient and outpatient health care benefits for Subscribers and their eligible Dependents who reside and obtain Covered Services from Participating Providers within Keystone’s Approved Service Area, which is a geographical area consisting of the following twenty-one (21) Pennsylvania counties: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York.

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INDIVIDUAL HMO SUBSCRIBER AGREEMENT
Individual Hmo Subscriber Agreement • October 8th, 2015

This HMO Subscriber Agreement sets forth a comprehensive program of Inpatient and outpatient health care benefits for Subscribers and their eligible Dependents who reside and obtain Covered Services from Participating Providers within Keystone’s Limited Network Area, which is a geographical area consisting of the following eight (8) Pennsylvania counties: Berks, Cumberland, Dauphin, Lancaster, Lebanon, Lehigh, Northampton and Perry. Keystone’s Limited Network Area is a limited geographic area within the full twenty- one (21) county area in which Keystone is approved to operate as an HMO. (“Keystone’s Approved Service Area”). Subscribers and their eligible Dependents may obtain the full range of Covered Services from Participating Providers only in Keystone’s Limited Network Area, subject to the terms and conditions of this Subscriber Agreement. In most cases, Members must obtain Referrals for Covered Services, and benefits are provided only for services performed by a Participating Pro

INDIVIDUAL HMO SUBSCRIBER AGREEMENT
Individual Hmo Subscriber Agreement • November 21st, 2014

This HMO Subscriber Agreement sets forth a comprehensive program of Inpatient and outpatient health care benefits for Subscribers and their eligible Dependents who reside and obtain Covered Services from Participating Providers within Keystone’s Approved Service Area, which is a geographical area consisting of the following twenty-one (21) Pennsylvania counties: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York. In most cases, Members must obtain Referrals for Covered Services, and benefits are provided only for services performed by a Participating Provider.

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