Get the free Keystone 65 HMO Enrollment Form

This document serves as an enrollment form for the Keystone 65 HMO plan, including personal information, choice of plan, and payment options.

How to fill out keystone 65 hmo enrollment

How to fill out Keystone 65 HMO Enrollment Form

1. Obtain the Keystone 65 HMO Enrollment Form from the official website or your local insurance office.
2. Fill out personal information such as your name, address, and date of birth.
3. Provide your Medicare number, if applicable.
4. Choose the coverage you desire by selecting the appropriate plan option provided in the form.
5. Complete any additional sections regarding dependents or beneficiaries, if required.
6. Sign and date the form to verify that the information provided is accurate.
7. Submit the completed form via mail or online, depending on the submission options available.

Who needs Keystone 65 HMO Enrollment Form?

1. Individuals who are eligible for Medicare and are looking for a managed care plan.
2. Seniors seeking comprehensive health coverage that includes additional services.
3. Those who prefer coordinated care through a network of healthcare providers.

People Also Ask about

Does Keystone 65 Select HMO require referrals?

You do not need a referral from a physician for covered specialty care services. You will have to choose one of our network providers listed in this directory to be your Primary Care Provider (PCP).

Do you need a referral for HMO POS?

With an HMO-POS you can go outside of the network for care, but you'll pay more. You'll need to choose a primary care physician (PCP) to coordinate all your care. You typically don't need a referral to see a specialist, but your doctor can sometimes help you get in to see one more quickly.

Do all HMO plans require referrals?

With an HMO, you choose a primary care physician (PCP) who coordinates your care using in-network doctors and hospitals. When visiting most specialists, a referral from your PCP is often required for the services to be covered. You won't need a referral for OB/GYN, mammograms, mental health, or emergency care.

Is Keystone 65 a good plan?

Our Keystone 65 HMO plans have earned 4.5-out-of-5 Stars and our Personal Choice 65SM PPO plans have earned 4 Stars in the 2025 Medicare Star Ratings, including a perfect rating for the customer service and member's rating of health plan measures.

Does Keystone 65 HMO require referrals?

This enrollment form allows individuals to apply for group health and dental coverage. It's designed for employees to provide necessary personal information, dependent details, and coverage choices.

For pdfFiller’s FAQs

What is Keystone 65 HMO Enrollment Form?

The Keystone 65 HMO Enrollment Form is a document used to enroll individuals in the Keystone 65 Health Maintenance Organization (HMO) plan, specifically designed for Medicare-eligible individuals.

Who is required to file Keystone 65 HMO Enrollment Form?

Individuals who are eligible for Medicare and wish to enroll in the Keystone 65 HMO plan are required to file this form.

How to fill out Keystone 65 HMO Enrollment Form?

To fill out the Keystone 65 HMO Enrollment Form, individuals should provide personal information such as name, address, Medicare number, and other relevant details, ensuring all sections are completed accurately.

What is the purpose of Keystone 65 HMO Enrollment Form?

The purpose of the Keystone 65 HMO Enrollment Form is to formally request enrollment in the Keystone 65 HMO plan so that eligible individuals can receive health insurance coverage tailored for Medicare beneficiaries.

What information must be reported on Keystone 65 HMO Enrollment Form?

The information required on the Keystone 65 HMO Enrollment Form includes the applicant's name, address, Medicare number, date of birth, and any additional health information as specified by the form's instructions.