Plans for Independence Blue Cross

107,208 Total Members

Prescription Hearing Aid Coverage
Company Plan name Plan type OTC Supplement OTC Rolls Over? Annual OTC Supplement Coverage? Covered Amount Coinsurance? Copay? Prior Authorization? Need Referral? Enrollees
Independence Blue Cross Keystone 65 Basic Rx (HMO)
H3952-055-0 		HMO $70 per Quarter No $280 Yes No Yes No No 21,601
Independence Blue Cross Keystone 65 Basic Rx (HMO)
H3952-056-0 		HMO $70 per Quarter No $280 Yes No Yes No No 16,919
Independence Blue Cross Keystone 65 Select Rx (HMO)
H3952-049-0 		HMO $30 per Quarter No $120 Yes No Yes No No 11,528
Independence Blue Cross Personal Choice 65 Prime Rx (PPO)
H3909-015-0 		Local PPO $70 per Quarter No $280 Yes No Yes No No 9,429
Independence Blue Cross Keystone 65 Select Rx (HMO)
H3952-051-0 		HMO $30 per Quarter No $120 Yes No Yes No No 8,349
Independence Blue Cross Keystone 65 Focus Rx (HMO-POS)
H3952-053-0 		HMOPOS $70 per Quarter No $280 Yes No Yes No No 8,265
Independence Blue Cross Personal Choice 65 Prime Rx (PPO)
H3909-014-0 		Local PPO $70 per Quarter No $280 Yes No Yes No No 7,082
Independence Blue Cross Keystone 65 Focus Rx (HMO-POS)
H3952-054-0 		HMOPOS $70 per Quarter No $280 Yes No Yes No No 3,602
Independence Blue Cross Keystone 65 Preferred Rx (HMO)
H3952-020-0 		HMO $30 per Quarter No $120 Yes No Yes No No 3,566
Independence Blue Cross Personal Choice 65 Rx (PPO)
H3909-009-0 		Local PPO $30 per Quarter No $120 Yes No Yes No No 2,710
Independence Blue Cross Keystone 65 Preferred Rx (HMO)
H3952-045-0 		HMO $30 per Quarter No $120 Yes No Yes No No 2,085
Independence Blue Cross Personal Choice 65 Elite Rx (PPO)
H3909-017-0 		Local PPO $125 per Quarter No $500 Yes No Yes No No 2,049
Independence Blue Cross Keystone 65 Group Rx (HMO)
H3952-804-0 		HMO No $0 No 1,615
Independence Blue Cross Personal Choice 65 Rx (PPO)
H3909-001-0 		Local PPO $30 per Quarter No $120 Yes No Yes No No 1,483
Independence Blue Cross Personal Choice 65 Saver Rx (PPO)
H3909-016-0 		Local PPO $30 per Quarter No $120 Yes No Yes No No 1,288
Independence Blue Cross Personal Choice 65 Group Rx (PPO)
H3909-802-0 		Local PPO No $0 No 1,179
Independence Blue Cross Keystone 65 Select Medical Only (HMO)
H3952-048-0 		HMO $30 per Quarter No $120 Yes No Yes No No 1,038
Independence Blue Cross Keystone 65 Group Medical Only (HMO)
H3952-802-0 		HMO No $0 No 960
Independence Blue Cross Keystone 65 Select Medical Only (HMO)
H3952-050-0 		HMO $30 per Quarter No $120 Yes No Yes No No 899
Independence Blue Cross Personal Choice 65 Group Medical Only (PPO)
H3909-801-0 		Local PPO No $0 No 617
Independence Blue Cross Keystone 65 Preferred Medical Only (HMO)
H3952-008-0 		HMO $30 per Quarter No $120 Yes No Yes No No 434
Independence Blue Cross Keystone 65 Preferred Medical Only (HMO)
H3952-044-0 		HMO $30 per Quarter No $120 Yes No Yes No No 247
Independence Blue Cross Keystone 65 Liberty Medical Only (HMO)
H3952-059-0 		HMO $30 per Quarter No $120 Yes No Yes No No 134
Independence Blue Cross Personal Choice 65 Medical Only (PPO)
H3909-007-0 		Local PPO $30 per Quarter No $120 Yes No Yes No No 129
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