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As previously communicated, IBC has begun offeringnew health plans both on and off the Health InsuranceMarketplace. Coverage for these commercial productsbegan January 1, 2014, including our lower-costtiered provider network product called Keystone HMOProactive.
Our HMO network providers have been categorized intoone of three benefit tiers for Keystone HMO Proactive:
- Tier 1 ? Preferred: Members pay the lowestcost-sharing for most services.
- Tier 2 ? Enhanced: Members pay a highercost-sharing for most services compared toTier 1 ? Preferred.
- Tier 3 ? Standard: Members pay the highestcost-sharing for most services.
Note: Certain services have the same cost-sharing for allbenefit tier levels, including preventive care, emergencyroom, ambulance, urgent care, pharmacy, behavioralhealth, transplants, outpatient laboratory, imaging, andphysical/occupational/speech therapy.
Cost-sharing for Keystone HMO Proactive members
Cost-sharing (deductible, coinsurance, and/orcopayments) for Keystone HMO Proactive membersvaries based on the member?s benefit plan (i.e., Silver orGold) and the provider?s benefit tier placement.
If a Keystone HMO Proactive member presents toyou for service, use the NaviNet? web portal to viewa summary of the member?s benefits. Through theEligibility and Benefits Inquiry transaction, NaviNet willdisplay the appropriate cost-sharing amounts for allthree tiers. Therefore, you will need to know your benefittier placement to determine the appropriate amount ofcost-sharing to collect from the Keystone HMO Proactivemember.
To find your benefit tier placement, search for yourpractice/facility by selecting Reference Tools from thePlan Transactions menu, and then Provider Directory.Be sure to select Keystone HMO Proactive in the Selecta Plan drop-down menu as shown below.
For more information about Keystone HMO Proactive,visit our website.
NaviNet® is a registered trademark of NaviNet, Inc., an independent company.
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