Understanding Your KeyCare Benefits
Overview
KeyCare builds upon the preventive care and virtual healthcare benefits available in all plans by adding coverage for primary care doctor visits, prescription drugs, and virtual behavioral health services.
If you're comparing plans, KeyCare introduces several healthcare services that are not available under the WellCare plan, including office visits with a primary care physician and prescription drug coverage.
What's Included With KeyCare?
KeyCare includes five primary benefit categories:
Preventive Care
Primary Care Visits
Prescription Drug Coverage
Virtual Urgent Care
Virtual Behavioral Health
Preventive Care Coverage
Preventive care services are covered when received from participating providers. These services help identify potential health concerns early and support overall wellness.
Examples include:
- Annual wellness visits
- Preventive screenings
- Blood pressure screenings
- Cholesterol screenings
- Cancer screenings
- Immunizations and vaccines
- Well-woman visits
- Well-child visits
Preventive care is included in all available plans.
Primary Care Visits
One of the most significant benefits added with KeyCare is access to primary care physician (PCP) visits.
Your Cost
$25 Copay Per Visit
What Is A Primary Care Doctor?
A primary care physician is often your first stop for routine healthcare needs.
Examples include:
- Cold and flu symptoms
- Minor illnesses
- High blood pressure management
- Follow-up care
- General health concerns
- Routine medical consultations
For many members, access to a primary care doctor is one of the most important differences between WellCare and KeyCare.
Prescription Drug Coverage
KeyCare includes prescription drug benefits through the PureRx program.
Prescription Copays
Prescription costs are based on the medication tier.
| Drug Tier | Member Cost |
|---|---|
| Tier 1 | $15 |
| Tier 2 | $30 |
| Tier 3 | $50 |
| Tier 4 | $75 |
Actual medications covered are determined by the plan's formulary (approved drug list).
Participating Pharmacies
Members can fill prescriptions at more than 60,000 participating retail pharmacies nationwide using their medical ID card.
Virtual Urgent Care
KeyCare includes unlimited access to Recuro Virtual Urgent Care with a $0 copay. Members can connect with a licensed physician 24 hours a day, 7 days a week through phone, video, or messaging.
Common Conditions Treated
Examples include:
- Colds and flu
- Allergies
- Fever
- Headaches
- Rashes
- Respiratory infections
- Gastrointestinal issues
- Urinary tract infections (UTIs)
When medically appropriate, prescriptions can be sent directly to your preferred pharmacy.
Virtual Behavioral Health
KeyCare also includes access to virtual counseling services through Recuro at a $0 copay.
Members can schedule appointments with a licensed therapist or counselor through secure video or phone sessions.
Common Reasons Members Use Behavioral Health Services
- Anxiety
- Stress management
- Depression
- Grief and loss
- Relationship concerns
- Anger management
Behavioral health appointments are available by appointment and can be accessed from the privacy of your home. Psychiatric services may be available for an additional cost.
Services Not Included Under KeyCare
Understanding what is not covered is important when comparing plans.
KeyCare generally does not include coverage for:
Specialist Visits
Examples include:
- Cardiologists
- Dermatologists
- Orthopedic specialists
- Gastroenterologists
In-Person Urgent Care Centers
Although Virtual Urgent Care is included, visits to a physical urgent care facility are generally not covered.
Diagnostic Imaging
Examples include:
- MRI scans
- CT scans
- Diagnostic ultrasounds
- Diagnostic X-rays
Hospital and Emergency Services
Examples include:
- Emergency room visits
- Ambulance transportation
- Hospital admissions
- Surgery
- Inpatient care
These services are generally excluded under the KeyCare plan.
How To Access Your Benefits
Find A Doctor
Use the PHCS network through MultiPlan to locate participating providers.
Access Virtual Care
Virtual Urgent Care and Virtual Behavioral Health services can be accessed through:
- The HealthWallet mobile app
- Recuro Health
Fill Prescriptions
Present your ID card at participating pharmacies to access your prescription benefits.
Quick Summary
Included
✓ Preventive care
✓ Primary care visits ($25 copay)
✓ Prescription drug coverage
✓ Virtual urgent care ($0 copay)
✓ Virtual behavioral health counseling ($0 copay)
Not Included
✗ Specialist visits
✗ In-person urgent care
✗ Diagnostic imaging
✗ Hospital services
✗ Emergency room services
✗ Surgery
KeyCare adds meaningful day-to-day healthcare benefits, including doctor visits, prescriptions, and behavioral health support, while maintaining access to preventive care and virtual healthcare services.