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Benefit Information

Member Handbook

Keystone Mercy members receive all of the benefits provided under the Pennsylvania Medical Assistance Program, including:

  • Visits to the doctor
  • OB/GYN care for women
  • Medical care for pregnant women
  • Family Planning (through Keystone First)
  • Lab & x-ray services
  • Hospital services, including emergency services
  • Home health services
  • Routine eye exams
  • Dental exam and cleaning every six months
  • Assistance for those needing extra help getting care for illnesses or other special needs
  • Foot care
  • Physical therapy
  • Visits to a chiropractor
  • Prescription drugs*
  • Over-the-counter medications with a prescription*
  • Medical equipment like a wheelchair*
  • Member Services help available 24 hours a day, seven days a week

* may not be provided to everyone with an ACCESS card.

Children under 21 get all medically necessary services, such as:

  • Prescriptions
  • Eye exams and glasses
  • All dental care, including braces
  • Hearing exams and aids
  • Shots (immunizations) and
  • Health education

In addition, Keystone Mercy members receive:

  • Eye Exams for the entire family
    • Eye glasses and/or contacts are only covered for members up to age 21 and for certain medical conditions in members over age 21.
  • Vitamins *
    • All vitamins for members up to 21 years of age
    • Medically necessary vitamins for members over the age of 21
  • Special wellness and prevention programs for the entire family
    • WeeCare for expecting moms (including a home visit after delivery),
    • asthma and diabetes,
    • reminders for shots, check-ups
    • Breast Cancer Screening, and
    • Poison Prevention

*Only for members who receive prescription benefits through Medical Assistance.

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