[
In 2014, IBC introduced Keystone HMO Proactive, a lower-cost, tiered
provider network plan available both on and off the Health Insurance
Marketplace. For this plan, providers in IBC's HMO network were 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 2015
As previously communicated, IBC will review provider benefit tier placements
annually for Keystone HMO Proactive. We are currently re-evaluating the benefit
tier placements for our professional providers for 2015 using more recent
data.
All providers whose benefit tier is changing for 2015 will be notified by
mail in the coming weeks of their new benefit tier assignment. The new benefit
tier will remain in place from January 1, 2015, through December 31, 2015.
Note: If you do not receive a letter regarding your benefit tier
placement, then your benefit tier will not change in 2015.
Benefit tier placement criteria
Like last year, benefit tier placements for professional providers are based
upon criteria that include relative cost (i.e., contracted fee schedule),
minimum quality standards (if applicable), and the tier of the facilities in
which a provider's IBC patients are typically referred for hospital and
outpatient surgical services.
If you have questions specific to Keystone HMO Proactive or your benefit
tier placement, please email us.
]