Starting January 1, 2014, you may begin to see patients who are covered under
Keystone HMO Proactive, our lower cost, tiered provider network product (see
sample ID cards below). Keystone HMO Proactive has benefit designs with
different member cost-sharing by tier and offers members lower out-of-pocket
costs (e.g., copayment) for most services when they select or are referred to a
provider in the Preferred benefit tier.
Our HMO network providers have been categorized into one of three benefit tiers
for Keystone HMO Proactive:
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.
Note: Certain services have the same cost-sharing for all benefit tier
levels, including emergency room, ambulance, urgent care, pharmacy, behavioral
health, transplants, outpatient laboratory, imaging, and physical/occupational
therapy.
Resources available online
Visit our provider-specific
Keystone HMO Proactive web page. This page
explains the criteria used for benefit tier placement. In addition, it answers
some frequently asked questions about Keystone HMO Proactive, including how to
refer members with this product and where to find benefit tier information for
specialists.
If you have questions about this new product or about your benefit tier
placement, please contact your Network Coordinator.