[
In 2014, IBC introduced Keystone HMO Proactive, a lower-cost, tiered
provider network product available
both on and off the Health Insurance Marketplace. For this product, 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 reviews provider benefit tier placements
annually for Keystone HMO Proactive. We recently concluded our re-evaluation of
benefit tier placements for our facility, ancillary, and professional providers
for 2015.
Only providers whose benefit tier will change will be mailed a letter in the
coming weeks with 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 by the end of September, then your benefit tier is not changing for
2015.
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 IBC 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.
]