INDIVIDUAL HMO SUBSCRIBER AGREEMENTIndividual 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.
INDIVIDUAL HMO SUBSCRIBER AGREEMENTIndividual Hmo Subscriber Agreement • October 3rd, 2018
This HMO Subscriber Agreement sets forth a comprehensive program of Inpatient and Outpatient health care Benefits for Subscribers and their eligible Dependents who reside in the following Pennsylvania counties: Adams, Berks, Centre, Columbia, Cumberland, Dauphin, Franklin, Fulton, Juniata, Lancaster, Lebanon, Lehigh, Mifflin, Montour, Northampton, Northumberland, Perry, Schuylkill, Snyder, Union and York. Subscribers and their eligible Dependents may obtain the full range of Covered Services from Participating Providers only in Keystone’s Approved Service Area, which consists of the counties listed, 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 Provider. Preauthorization by Keystone is required for any services requiring a Referral to a Provider who is not a Participating Provider. Certain Benefits are subject to cost sharing pr
