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Home > Brokers > Broker Resources

Broker Resources

Whether you need to help a member with interpreter services or order more supplies, you'll find all the resources you need in this section.

  • 2023 broker sales presentation PDF
  • 2023 extra benefits brochure PDF
  • Authorization for Disclosure of Health Information PDF
  • Provider request form PDF
  • Sales supply order form PDF
  • Scope of appointment PDF
  • Scope of appointment (Spanish) PDF
  • Pre-enrollment checklist PDF
  • Pre-enrollment checklist (Spanish) PDF

Broker resources for members

  • Member benefits
  • Multi-language insert PDF
  • 2023 Over-the-Counter (OTC) catalog and order form PDF
Brokers
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  • Broker resources
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Keystone First VIP Choice
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  • Non-discrimination notice (PDF)

Copyright © 2013-2023 KEYSTONE FIRST VIP CHOICE. All rights reserved.

Last Update: Wednesday, April 17, 2019 9:52:25 AM

Coverage by Vista Health Plan, Inc. Independent Licensee of the Blue Cross and Blue Shield Association.

This site contains links to other internet sites. Keystone First VIP Choice (HMO SNP) is not responsible for the content of these sites. Please see Terms of Use and Privacy Notice.

Keystone First VIP Choice is an HMO-SNP plan with a Medicare contract and a contract with the Pennsylvania Medicaid program. Enrollment in Keystone First VIP Choice depends on contract renewal. This information is not a complete description of benefits. Call 1-800-450-1166 (TTY 711), Monday through Friday, 8 a.m. – 8 p.m., from April 1 to September 30; or seven days a week, 8 a.m. – 8 p.m., from October 1 to March 31 for more information.

Out-of-network/non-contracted providers are under no obligation to treat Keystone First VIP Choice members, except in emergency situations. Please call our Member Services number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. You must continue to pay your Medicare Part B premiums, unless otherwise covered by your Pennsylvania Medicaid benefits.

Every year, Medicare evaluates plans based on a 5-star rating system.

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