HMO Not Available SNP Includes Rx
Plan Details
Plan NameCapital Blue Cross Group Custom Rx (CY) (HMO)
OrganizationCapital Blue Cross
Legal EntityKEYSTONE HEALTH PLAN CENTRAL, INC.
Plan TypeHMO
Service AreaNational
Contract IDH3962
Plan ID813
In-Network MOOP$9,350
Prescription Drug CoverageYes (Part D Included)
About This Plan
Capital Blue Cross Group Custom Rx (CY) (HMO) is a HMO Medicare plan offered by Capital Blue Cross (KEYSTONE HEALTH PLAN CENTRAL, INC.). This plan is available to eligible Medicare beneficiaries in National.
This is a Special Needs Plan (SNP) designed for Not Available beneficiaries. This plan includes Medicare Part D prescription drug coverage.
The in-network maximum out-of-pocket (MOOP) for this plan is $9,350, which is the most you would pay for covered services in a plan year. After reaching this amount, the plan pays 100% of covered services.
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