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
2018
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 2018.
Providers whose benefit tier is changing will receive a letter indicating
their new benefit tier assignment. The new benefit tier will remain in place
from January 1, 2018, through December 31, 2018.
Note: If you do not receive a letter regarding your benefit tier
placement, then your benefit tier is not changing for 2018.
Benefit tier placement criteria for
professional providers
Like last year, benefit tier placement for professional providers is based
upon 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 email us at
provinquiry@ibx.com.