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Keystone HMO Proactive tiered network plans
Our suite of Keystone HMO Proactive plans gives members access to the full Keystone HMO network at a lower premium. These plans offer members more choice and control over their health care dollars. To maximize this benefit, members need to check the tier of the facility and the provider they want to use.
High-quality care, lower out-of-pocket costs
Members with Keystone HMO Proactive plans must choose a primary care physician to coordinate their care and refer them to specialists. Providers are grouped into three tiers based on cost and quality measures. Members are free to choose providers in any tier but save the most by using Tier 1 — Preferred providers.
Lower urgent care cost-share
We reduced the urgent care cost-share across all tiers in our Proactive plans to help members save by using urgent care centers instead of the ER for issues that are not emergencies.
These services have the same cost-sharing across all tiers:
Preventive care Pediatric dental and vision
Tier 1 – $ Preferred
$$
$$$
Emergency room Urgent care Outpatient labs Prescription drugs
Mental health services
Physical and occupational therapy Routine radiology
Spinal manipulations
Tier 2 – Enhanced
Tier 3 – Standard
50% OF DOCTORS AND HOSPITALS ARE IN TIER 1 - PREFERRED
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