Plan information
For your convenience, below are important forms and documents to help you easily manage your health coverage.
Summary of Benefits
2025 Summary of Benefits — updated 10/1/2024
- Keystone 65 Basic Rx HMO, Keystone 65 Essential Rx HMO-POS, Keystone 65 Focus Rx HMO-POS, Keystone 65 Liberty Medical-Only HMO, Keystone 65 Essential Rx HMO-POS, and Keystone 65 Select HMO Summary of Benefits
- Keystone 65 Preferred HMO Summary of Benefits
- Personal Choice 65 PPO Summary of Benefits
Call us at 1-877-393-6733 (711 for the speech- and hearing-impaired), 8 a.m. to 8 p.m., seven days a week. However, please note that on weekends and holidays from March 31 through September 30, your call may be sent to voicemail.
Extra Help is available for those who need it most. Find out whether you qualify for Low Income Subsidy.
Evidence of Coverage and Outline of Coverage
The Evidence of Coverage (EOC) 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.
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.
2025 Evidences of Coverage
- Keystone 65 Medical-Only HMO Evidence of Coverage — updated 11/21/2024
- Keystone 65 Rx HMO/HMO-POS Evidence of Coverage — updated 5/20/2025
- Personal Choice 65SM Medical-Only PPO Evidence of Coverage — updated 11/21/2024
- Personal Choice 65SM Rx PPO Evidence of Coverage — updated 5/20/2025
- Select Option® PDP Evidence of Coverage — updated 5/28/2025
MedigapFreedom Outlines of Coverage
- MedigapFreedom Direct Sales Outline of Coverage - effective 3/1/2025
- MedigapFreedom Private Exchange Outline of Coverage - effective 3/1/2025
- MedigapFreedom Group Outline of Coverage
- MedigapFreedom Group Outline of Coverage - effective 7/1/2025
- MedigapSecurity Group Outline of Coverage
Annual Notice of Changes
2025 Keystone 65 HMO Annual Notice of Changes (ANOC) – updated 10/1/2024
- Keystone 65 Basic Rx HMO (Chester, Delaware, Montgomery counties)
- Keystone 65 Basic Rx HMO (Philadelphia, Bucks counties)
- Keystone 65 Focus Rx HMO/HMO-POS (Chester, Delaware, Montgomery counties)
- Keystone 65 Focus Rx HMO/HMO-POS (Philadelphia, Bucks counties)
- Keystone 65 Liberty Medical-Only HMO (Philadelphia, Bucks, Chester, Delaware, Montgomery counties)
- Keystone 65 Preferred Medical-Only HMO (Chester, Delaware, Montgomery counties)
- Keystone 65 Preferred Medical-Only HMO (Philadelphia, Bucks counties)
- Keystone 65 Preferred Rx HMO (Chester, Delaware, Montgomery counties)
- Keystone 65 Preferred Rx HMO (Philadelphia, Bucks counties)
- Keystone 65 Select Medical-Only HMO (Chester, Delaware, Montgomery counties)
- Keystone 65 Select Medical-Only HMO Philadelphia, Bucks counties)
- Keystone 65 Select Rx HMO (Chester, Delaware, Montgomery counties)
- Keystone 65 Select Rx HMO (Philadelphia, Bucks counties)
2025 Personal Choice 65 Annual Notice of Changes (ANOC) – updated 10/1/2024
- Personal Choice 65 Medical-Only PPO (Philadelphia, Bucks counties)
- Personal Choice 65 Prime Rx PPO (Chester, Delaware, Montgomery counties)
- Personal Choice 65 Prime Rx PPO (Philadelphia, Bucks counties)
- Personal Choice 65 Rx PPO (Chester, Delaware, Montgomery counties)
- Personal Choice 65 Rx PPO (Philadelphia, Bucks counties)
- Personal Choice 65 Elite Rx PPO (Philadelphia, Bucks, Chester, Delaware, Montgomery counties)
- Personal Choice 65 Saver Rx PPO (Philadelphia, Bucks, Chester, Delaware, Montgomery counties)
Star Ratings — updated 10/16/2024
Our Keystone 65 HMO plans were rated 4.5 out of 5 stars, and our Personal Choice 65 PPO plans were rated 4out of 5 stars for 2025.
What is the CMS Star Rating System?
The CMS Star Rating System is designed to improve health care quality and control health care costs. The ratings provide a scorecard on overall plan quality, as well as:
- Members' compliance with preventive care and screening recommendations
- Chronic condition management
- Customer service
- Access to care
How does the CMS Star Rating System benefit our members?
Our 2025 CMS Star Ratings reflect our ongoing commitment to put our members first. IBX is committed to providing high‐quality Medicare Advantage plans and prescription drug coverage that meets or exceeds all CMS quality benchmarks. To achieve this, we focus on many member initiatives including:
- Early detection and prevention measures
- Better customer service
- Support with chronic condition management
- Greater access to care
CMS rewards plans that perform well through increased funding to improve their plans. Examples of these product improvements include:
- Providing more robust supplemental benefits
- Reducing premiums
- Decreasing member cost-share
The CMS Star Ratings System rates all health and prescription drug plans each year based on their quality and performance. Medicare Star Ratings help you know how well our plan is doing. You can use these star ratings to compare our plan's performance to other plans.
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Website last updated: 7/2/2025