Keystone Health Plan Central (KHPC or Keystone) is a Capital Blue Cross health maintenance organization or HMO. Participants must work within the provider network, use their primary care providers (PCP), and get referrals to see other doctors. In exchange, they enjoy lower premiums and the maximum coverage levels of the four plans available to Lehigh employees.
- Covered individuals are required to select a primary care physician (PCP).
- All services are received from the PCP or by referral from the PCP to another provider.
- The HMO is not obligated to pay for any care that is not initiated through the PCP.
- If Urgent Care (UC) services are needed, the member should contact their PCP first; if they are not able to be seen, the PCP should issue a referral to a participating UC center. If the member is not able to contact their PCP prior to the UC visit, they should contact them the next business day to have the referral issued.
- The provider network includes providers in a 21-county area. View the map of the 21-county area here.
Behavioral (Mental) Health Benefits
Capital Blue Cross administers the behavioral health coverage under this plan, and will preauthorize behavioral inpatient care and partial hospitalization benefits. To receive reimbursement, services must be preauthorized. Services received out of the plan’s network will be subject to higher deductibles, higher coinsurance payments, and are likely to result in balance billing, as well. Keystone participants should call 866-322-1657 to preauthorize visits if services are needed. Participating providers can be found at www.capbluecross.com. More information on this transition can be found here.
For More Information
- The highlights of this medical plan, pre-authorization procedures, and preventive care services can be found here: