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A Keystone HMO Proactive health plan
lets you see any in-network provider and and save money by using certain doctors and and hospitals Here are some key things you should know
Tiered network You can visit any doctor or or or or hospital in in in the the the network network but you’ll save the the the most with providers in in in in Tier 1 – Preferred which which includes more than half the the the the network network network Some services cost the the the same no matter which which in-network provider provider you choose including preventive urgent and emergency* care See the the benefits summary in in in in in in in this this kit kit for cost-sharing amounts by tier tier To see what tier tier a a a a a a a a provider is is is is in in in in in in in visit ibx com/findadoctor or or or review the flyer in in in in this this enrollment kit kit Primary Care Physician (PCP)
You must choose an an in-network PCP or or or or family doctor to to treat your your general health needs and coordinate your your care by providing referrals when necessary Search for a a a a a a a a a a a a a PCP PCP at at ibx com/findadoctor Using a a a a a a a a a a a a a Tier 1 – Preferred PCP PCP can keep your out-of-pocket costs lower when you you need care Specialist
You can see any in-network specialist when when your your PCP submits an an an electronic referral referral referral Check the status of your your referrals referrals when when you you you log log in in in in at at ibx com Some services don’t require referrals referrals including gynecology mammograms behavioral health and emergency care Designated sites
Your PCP has designated providers for lab services (e (e g g g g g blood testing) radiology (e (e g g g g g X-rays) and and physical and and occupational therapy You’ll need need to visit those providers providers when you you need need any of these services A referral or prescription may also be necessary View your PCP’s designated providers providers at ibx com/findadoctor Out-of-network benefits Out-of-network benefits are are are covered for for emergency care care only You must use in-network doctors and and hospitals for for routine care care and and planned procedures Precertification
Precertification
is an an approval that your doctor must receive from us us before you you get coverage for for certain services genetic tests and specialty drugs A complete list
of what requires precertification is is available at at at ibx com/precert Virtual care Most health plans include anytime access to to to to a a a a a a a a a a a a doctor by phone or or video chat Check your benefits summary to to to to see if virtual care is available to to to to you you * If If you you you are are are admitted to an an in-network in-network in-network in-network hospital hospital hospital from the the the the emergency room the the the the cost-sharing for your inpatient hospital hospital hospital care care including medical care care provided by an an an an an in-network in-network in-network in-network professional professional provider provider will will apply apply based on on on on the the the the the tier of of of of of the the the the the in-network in-network in-network in-network hospital hospital hospital hospital or or or or or or or in-network in-network in-network in-network professional professional provider provider If If you you you are admitted to an an an an out-of-network hospital hospital following an an an an emergency room admission the the the Tier 3 – Standard level of of of of of benefits will will apply apply