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:
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.
- 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.
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.