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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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