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Benefit tier re-evaluation for Keystone HMO Proactive 

July 31, 2014    

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.

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