KeyCare Preferred,
KeyCare HSA, KeyCare HealthSmart, KeyCare HealthSmart with Enhanced Drug Benefit,
Basic BlueCare Basic BlueCare , Lumenos HSA, Lumenos HIA, and Lumenos HIA Plus

KeyCare Flexible Choice and Essential KeyCare

Benefits covered in base policy

Benefits covered in base policy

Optional Benefit available at an additional cost

Services covered at 100% of the allowable charge, with no deductible or coinsurance when you visit a participating provider. If you do not visit a participating provider, you will be required to pay the amount over the allowable charge for the covered service. 

X  

X  

For Flexible Choice, you pay 20% coinsurance in-network, prior to the deductible. If you visit an out-of-network provider, you pay 30% coinsurance after a separate deductible is met. 

For Essential KeyCare, you pay 30% coinsurance in-network after the deductible is met. If you visit an out-of-network provider, you pay 40% coinsurance after a separate deductible is met. 

X  

Covers routine and necessary immunizations from birth to 36 months of age 

X  

X  

X  

Covers preventive care for children from birth through age 6, and immunizations over the age of 36 months 

X  

X  

Routine Medical Visits

Newborn Physical Exam 

X  

X  

History, Measurements of Height & Weight, Physical Exam, Development & Behavioral Assessment 

X  

X  

Laboratory Screenings

Machine Vision Test - (e.g. Titmus) 

X  

X  

Pure Tone Audiogram Screening for Hearing, Infant Hearing Screenings and other audiological exams 

X  

X  

Thyroxine, Coombs test 

X  

X  

Hematocrit, Hemoglobin, Lead testing 

X  

X  

Tuberculin Test, Skin Test, Tine 

X  

X  

Urinalysis 

X  

X  

Newborn Metabolic Screening 

X  

X  

Hydroxyprogesterone 

X  

X  

Immunizations

Diptheria, Pertussis, Tetanus (DPT or DtaP) 

X  

X  

X  

Measles, Mumps, Rubella (MMR) 

X  

X  

X  

Hemophilus Influenza Type B (HIB) 

X  

X  

X  

Hepatitus A, Hepatitus B, Hepatitus B/HiB (Comvax) 

X  

X  

X  

Polio Vaccine 

X  

X  

X  

Varicella Virus Vaccine
(chicken pox vaccine) 

X  

X  

X  

Prevnar 

X  

X  

X  

Influenza 

X  

X  

X