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Reminder: Benefit tier re-evaluation for Keystone HMO Proactive  

August 28, 2014    

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.


If you have questions specific to Keystone HMO Proactive or your benefit tier placement, please contact your Network Coordinator.

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