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)
Keystone HMO
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.
Per-Paycheck Contribution Examples
Example for members hired on or after 9/1/2010 (5% tier):
| Coverage Tier | Keystone (1.5% salary) | Personal Choice (Per Pay + 1.5% salary) |
|---|---|---|
| Single | 1.50% of salary | $14.30 + 1.50% of salary |
| Parent/Child | 1.50% of salary | $20.02 + 1.50% of salary |
| Parent/Children | 1.50% of salary | $25.74 + 1.50% of salary |
| Couple | 1.50% of salary | $28.60 + 1.50% of salary |
| Family | 1.50% of salary | $42.90 + 1.50% of salary |
Effective 2019-2020 school year, all members pay 1.50% of salary for both Personal Choice and Keystone
Spouse/Domestic Partner Surcharge
Detailed Benefit Comparison
Coverage comparison between Personal Choice and Keystone HMO
New Employee Enrollment
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
Plan Details
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 Need Assistance?
For questions about plan options, enrollment, or to receive plan brochures, contact the PFT Health & Welfare Fund.
PFT Health & Welfare Fund
Phone: (215) 561-2722
Email: document@pfthw.org