Independence offers Keystone HMO Proactive, a lower-cost, tiered provider
network product available both on and
off the Health Insurance Marketplace. For this product, providers in
Independence?s commercial HMO network are
categorized into one of three benefit tiers:
- Tier 1 – Preferred: Members pay the lowest
cost-sharing for most services.
- Tier 2 – Enhanced: Members pay a higher cost-sharing
for most services compared to Tier 1 – Preferred.
- Tier 3 – Standard: Members pay the highest
cost-sharing for most services.
Re-evaluation of benefit tier placements for
2017
Independence reviews provider benefit tier placements annually for Keystone
HMO Proactive. As such, we recently
concluded our re-evaluation of benefit tier placements for our facility,
ancillary, and professional providers for 2017.
Only providers whose benefit tier is changing will receive a letter in the
coming weeks indicating their new benefit tier
assignment. The new benefit tier will remain in place from January 1, 2017,
through December 31, 2017.
Note: If you do not receive a letter regarding your benefit tier
placement by the end of October, then your benefit tier is
not changing for 2017.
Benefit tier placement criteria for
professional providers
Like last year, benefit tier placement for professional providers is based
on criteria that include relative cost (i.e.,
contracted fee schedule), minimum quality standards (if applicable), and the
tier of the facilities to which a provider?s
Independence patients are typically referred for hospital and outpatient
surgical services.
Questions
If you have questions specific to Keystone HMO Proactive or your benefit
tier placement, please contact your
Network Coordinator.