Personal Choice vs. Keystone HMO
Medical Plan Comparison
Compare coverage options, premiums, and benefits to make an informed decision about your healthcare coverage.
Overview
Choosing the right plan for you
PFT members have access to two comprehensive medical plan options: Personal Choice (PPO) and Keystone HMO. Both plans offer excellent coverage with different features and cost structures to meet your healthcare needs.
Personal Choice (PPO)
Flexible network with in-network and out-of-network coverage. Higher cost share, but greater provider choice and no referrals required.
Keystone HMO
Comprehensive coverage through a network of providers. Lower cost share with coordinated care through a primary care physician.
Employee Contributions
What you pay for coverage
Contribution Tier Levels
Your contribution depends on your plan choice, hire date, and coverage tier. All members pay 1.5% of salary, plus additional amounts based on plan tier.
| Tier Level | Plan Type | Member Contribution |
|---|---|---|
| PHMO | Keystone 20 PFT | 1.5% of Salary |
| PPO | Personal Choice 25/35/50% | 0% PFT + 1.5% of Salary |
| PPO3 | Personal Choice 25/35/50% | 3% PFT + 1.5% of Salary* |
| PPO5 | Personal Choice 25/35/50% | 5% PFT + 1.5% of Salary** |
| PPO8 | Personal Choice 25/35/50% | 8% PFT + 1.5% of Salary*** |
* Those hired before 9/1/10 and switching to Personal Choice will pay 3% of premium + 1.50% of salary.
** Those hired on or after 9/1/10 will pay 5% + 1.50% of salary.
*** Those switching to Personal Choice on or after 9/1/25 will pay 8% of the premium + 1.50% of salary.
Spouse/Domestic Partner Surcharge
Employees covering a spouse or domestic partner will be subject to a $75.00 monthly surcharge (spread over 26 paychecks) if the spouse/domestic partner is eligible for employee group coverage from their own job and continues to be enrolled in District Medical Coverage. Those whose spouse or domestic partner is a District employee are NOT subject to this charge.
Detailed Benefit Comparison
Coverage comparison between Personal Choice and Keystone HMO
New Employee Enrollment
Effective 9/1/2010 — all new employees shall be enrolled in Keystone for a period of four (4) years from the date of appointment. This chart is a basic overview of the benefits available. Please see plan brochures for more details.
Deductibles & Out-of-Pocket Maximums
| Benefit | Personal Choice Plan 20/30/70 | Keystone HMO 15 |
|---|---|---|
| Deductible Individual/Family | In-Network: $0/$0 Out of Network: $2,000/$6,000 | N/A |
| After deductible, plan pays: | In-Network: 100% Out of Network: 50% | N/A |
| Out of Pocket Individual/Family | Co-payment max: $1,000/$2,000 OON max: $3,000/$6,000 | Co-payment max: $1,000/$2,000 |
| Overall Lifetime Maximum | Unlimited | Unlimited |
Office Visits & Preventive Care
| Benefit | Personal Choice | Keystone HMO |
|---|---|---|
| Office Visits | PCP: $25 / Specialist: $35 (OON: 50% after deductible) | PCP: $20 / Specialist: $30 |
| Pediatric Immunization | 100%, no co-pay (OON: 50%, no deductible) | N/A |
| Mammogram | 100% (OON: 50%, no deductible) | 100% |
| Maternity | 100%, First OB visit $20 (OON: 50% after deductible) | 100%, First OB visit $25 |
Hospital & Emergency Care
| Benefit | Personal Choice | Keystone HMO |
|---|---|---|
| Inpatient Hospital Days | 100% (OON: 50%) | 100% |
| Hospital Care Inpatient/Outpatient | 100% (OON: 50%) | 100% |
| Emergency Room | $100 co-pay (waived if admitted) | $100 (waived if admitted) |
| Urgent Care | $35 (OON: 50% after deductible) | $30 |
Diagnostic & Lab Services
| Benefit | Personal Choice | Keystone HMO |
|---|---|---|
| Laboratory | 100% (OON: 50%) | 100% |
| Outpatient X-Ray/Radiology | $30 co-pay (OON: 50%) | 100% |
| Chemo/Radiation Therapy | 100% (OON: 50% after deductible) | 100% |
Therapy & Rehabilitation
| Benefit | Personal Choice | Keystone HMO |
|---|---|---|
| Physical, Speech & Occupational Therapy | Visits 1-30: $20 co-pay Visits 31-60: $30 co-pay (60 visits/year; OON: 50% after deductible) | 100% (60 visits per calendar year) |
| Cardiac Rehabilitation | $20 co-pay (OON: 50% after deductible) | 100% |
Mental Health & Substance Abuse Treatment
| Benefit | Personal Choice | Keystone HMO |
|---|---|---|
| Substance Abuse Treatment | Outpatient/Partial: $30 co-pay Rehab/Detox: 100% (OON: 50% after deductible) | $25 co-pay, 100% |
| Mental Health Care | Outpatient: $30 co-pay / Inpatient: 100% (OON: 50% after deductible) | $25 co-pay Outpatient |
| Serious Mental Health Care | Outpatient: $30 co-pay / Inpatient: 100% (OON: 50% after deductible) | 100% (35 days per calendar year) |
Additional Benefits
| Benefit | Personal Choice | Keystone HMO |
|---|---|---|
| Nutrition Counseling | 6 visits per year/100% (OON: 50% after deductible) | N/A |
| Assisted Reproductive Technologies | 100% (OON: 50% after deductible) | N/A |
Important Information
Key details about your coverage
New Employee Requirement
All employees hired on or after 9/1/2010 must enroll in Keystone HMO for their first four (4) years of employment.
Plan Details
This comparison is a basic overview. For complete benefit information, please review the official plan brochures and Summary of Benefits document.
Understanding Your Options
Keystone HMO Benefits:
- Lower employee contributions (1.5% of salary only)
- No out-of-network deductibles or coinsurance
- Coordinated care through your primary care physician
- 100% coverage for most services with low co-pays
- Must use network providers except in emergencies
Personal Choice Benefits:
- Flexibility to see any provider (in or out of network)
- No referrals required for specialists
- Out-of-network coverage available (higher costs)
- Higher employee contributions based on hire date
- Additional coverage options (nutrition counseling, ART)
Questions or Concerns?
Our member services team is here to help with eligibility, benefits, claims, and everything in between. Reach out — we'll point you to the right person.