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:
 
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.
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.