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Benefit tier re-evaluation for Keystone HMO Proactive  

October 1, 2015    

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 2016

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 2016.

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, 2016, through December 31, 2016.

Note: If you do not receive a letter regarding your benefit tier placement, then your benefit tier is not changing for 2016.

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 contact your Network Coordinator.

New offering for 2016

Beginning January 1, 2016, a new option, Keystone HMO Silver Proactive Value, will be added to our Keystone HMO Proactive tiered provider network product. This new offering is similar to the current Silver Proactive plan; however, it will include a deductible on Tier 1 to help lower the cost of the member’s premium. Silver Proactive Keystone HMO sample card





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