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New provider resource for Keystone HMO Proactive 

November 1, 2013    

IBC has begun offering new qualified health plans both on and off the Health Insurance Marketplace. These commercial products are available to small groups and individuals for coverage beginning January 1, 2014, and include a lower-cost tiered provider network product called Keystone HMO Proactive.

Keystone HMO Proactive

We want to help members become informed consumers of health care by making them aware that there are cost differences among providers in our network for the same service depending on the physician or facility they choose. 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:

  • 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.

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.

New resource available online

Visit the new page on our website that is dedicated to provider-specific information for Keystone HMO Proactive. This page explains the criteria used for benefit tier placement and answers some frequently asked questions about Keystone HMO Proactive.

To access this page, go to www.ibx.com/providers, select Tools and Resources from the Providers tab, and then select Tiered and Limited Network Products.

If you have questions about these new products or about your benefit tier placement, please contact your Network Coordinator.

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