Page 25 - 2023-small-group-brochure

Keystone HMO Proactive hospital tier placements
Keystone HMO Proactive hospital tier placements
Keystone HMO Proactive hospital tier placements
w
Keystone HMO Proactive hospital tier placements
Tier 1 – Preferred $
Tier 1 – Preferred $
Tier 1 – Preferred $
Keystone HMO Proactive hospital tier placements
Tier 1 – Preferred $
Pennsylvania New Jersey
Pennsylvania
Pennsylvania Ne
Pennsylvania
Bucks Montgomery
Tier 1 – Preferred $
Bucks
Montgomery
Burlington
Bucks
Montgomery
Burlington
Doylestown Hospital
Einstein Medical Center Montgomery
Virtua Willingboro Hospital
Bucks
Montgomery
Burlington
DoyllessttoownnHHoospspitiatal l
GPraenndnVsieywlvHaonsipaital
Doylestown Hospital
GrandVieiewHHoospspitiatlal
Jefferson Bucks Hospital
Grand View Hospital JeBeffufecrrsksoosnnBuucckkssHHosopsiptiatlal
Prime Healthcare — Lower Bucks Hospital Jefferson Bucks Hospital PriDimoeyelHeHseetaoalwtlhtnhccaHaroerse—p—itaLlLowowereBr uBcukcskHs oHsopistpailtal Rothman Orthopaedic Specialty Hospital Prime Healthcare — Lower Bucks Hospital
EinEstienisnteMinedMiceadliCcaenl tCeernMteornMtgomntegroymery (part of Jefferson Health)
VirtuaVWiritluliangWboilrloinHgboospriotaHl ospital New Jersey
RotGhrmanadn VOiretwhoHpaoesdpictaSl pecialty Hospital
Rothman Orthopaedic Specialty Hospital
St. Luke’s Health Network — Quakertown Campus Rothman Orthopaedic Specialty Hospital St.JLeuffker’soHneBalutchkNs eHtwosoprikta—l Quakertown Campus St. Luke’s Health Network — Quakertown Campus
Jefferson Abington Hospital Jeffe(rpsaornt Loaf nJsedffaelresHonosHpeitaallth)
Mercer
CShte.PLsritumeker’HsHeaelathltchaNree—twoLrokw—erQBuackesrHtoowspnitCaalmpus
Tower Health — Pottstown Memorial Medical Center
Robert Wood Johnson University Hospital atHamatilHtoanmilton
Chester
Chester
MJTeofdwfiecerarsloHCneLnaatltenhrsd—alePHototsptiotwaln Memorial PShuMibluaerdbieacnlaplChCoiemanmteurnity Hospital
MeSrcaaeletrmHamilton Salem
PeRnnotMhmeadnicOinreth—opaCehdeicstSerpeCcoiaulntytyHHosopsiptiatlal CPheennstMeerdicine—ChesterCountyHospital MedicalCenter
Salem
Penn Medicine — Chester County Hospital ToSwte.rLHukeea’lstHh e—altPh hNoeetnwioxrvkil—le QHuoaskpeirttaolwn Campus TPoewnenrMHeadlitchin—e —PhCoehneisxtveirllCe oHuonstpyitHalospital Tower Health — Phoenixville Hospital
RobMeretmWooroiadlJHoohsnpsoitnalUonfivSearlseitmy HCosupnityal
DTeColwahewersaHtreralth — Phoenixville Hospital
Tower Health — Pottstown Memorial Einstein Medical Center
WMaermroernial Hospital of Salem County Warren
Delaware
EiPnshtieliandMeeldpihcailaCenter
Warren
SaleHmackettstown Community Hospital
Delaware
Einstein Medical Center Medical Center
Penn Medicine — Chester County Hospital Crozer-Chester Medical Center
(part of Jefferson Health)
HackWettastrorwenCommunity Hospital MemHoarcikaeltHtsotsopwitnalCoofmSmaluemnitCyoHunotsypital Hackettstown Community Hospital
DCerloazwer-aCrheester Medical Center
(pEairntsotef iJnefMfeerdsoicnaHl Ceaelnthte)r
CrToozwere-rCHhesatlethr —MePdhicoaelnCixevniltlerHospital Delaware County Memorial Hospital Delaware County Memorial Hospital Crozer-Chester Medical Center
(part of Jefferson Health) Jefferson Frankford Hospital
Delaware County Memorial Hospital TDayelolarwHaorsepital
Jefferson Frankford Hospital EJienfsfteerisnoMn TeodricraelsdCaelneteHrospital
Warren
Hackettstown Community Hospital
Taylor Hospital
Delaware County Memorial Hospital
Jefferson Torresdale Hospital Jefferson Frankford Hospital
Taylor Hospital
Crozer-Chester Medical Center
Jefferson Torresdale Hospital PrimP(repimaHretaHolftehJacelaftrfhecr—asoren —Health)
Lehiigh
Delaware County Memorial Hospital
Jefferson Torresdale Hospital
Taylor Hospital
Prime Healthcare — RJoexfRbfeorxrsobouongrFohruMagnhekmMforerdmiaHlooHrisoapsliptHaitloaslpital
Lehigh
Prime Healthcare —
St..Lukee’s’sHoossppitiatal l––AAllellnetnotwonwCnaCmapmupsus Lehigh
Roxborough Memorial Hospital TemJTepeflmfeeprUslenoinUveTnroisrvirteeyrsHditaoylsepHHitoaoslspp—ititaaJlle—anJeseaCnaemspCuasmpus
Taylor Hospital
St. Luke’s Hospital – Allentown Campus St..Lukee’s’sHoossppitiatal l––BBetehtlhelheehmemCaCmapmupsus St. Luke’s Hospital – Allentown Campus St. Luke’s Hospital – Bethlehem Campus
Roxborough Memorial Hospital
Lehigh
Temple University Hospital — Jeanes Campus
St. Luke’s Hospital – Bethlehem Campus
Tower Health — Chestnut Hill Hospital WilWlsRiEollxysebEoHyroeusHpgihotasMpl ietmalorial Hospital
St. Luke’s Hospital – Allentown Campus St. Luke’s Hospital – Bethlehem Campus
Tower Health — Chestnut Hill Hospital
Tier 2 – Enhanced $$
Tower Health — Chestnut Hill Hospital
Tier 2 – Enhanced $$
Einstein Medical Center Montgomery (pa(rpt aorftJoeffJeersfofenrHsoenalHthe)alth)
CVaimrtudaeWnillingboro Hospital
Holy Redeemer Hospital and Medical Center
CamdCeanmden
Cooper Hospital University Medical Center
(part of Jefferson Health) HMolHyoonRletygdReoemdermyHeorspHitoaslpaitnadl ManediMcaeldCiceanlteCrenter
BuCrlainmgdtoen
CoopeCr oHoopsepritHaloUspnitvaelrsUitnyivMeresditcyaMl Cednitcearl Center
Jefferson Abington Hospital
Holy Redeemer Hospital and Medical Center JefEfJeienrfsfoteenrisnAobMninAegdbtiiocnanglHtCooensnpHtietoraslMpiotanltgomery
VirtCuoaoWpeirlliHngobspoirtoaHl Uosnpiivtearlsity Medical Center Mercer
Jefferson Lansdale Hospital
Mercer
Jefferson Lansdale Hospital
Robert Wood Johnson University Hospital
Suburban Community Hospital
Mercer
Jefferson Lansdale Hospital SuHbuorlbyaRneCdeoemmeurnHitoyspHiotaslpaitnadl Medical Center
Robert Wood Johnson University Hospital
Suburban Community Hospital
Robert Wood Johnson University Hospital
Tower Health — Pottstown Memorial TowJSeufrfbeHurersaoblnatnhA—CbionmPgotmottnusntHoiotwysnpHiMtoaselpmitoarlial
at Hamilton
Cooper Hospital University Medical Center
Philadelphia
Memorial Hospital of Salem County
Philadelphia
Memorial Hospital of Salem County at Hamilton
JePffheir(lpsaoadnretFlorpafhnJikeafoferdrsHonosHpietalth)
Temple University Hospital — Jeanes Campus TowPTeroriwmHeeraHletehaal—tlthhcCa—hresC—thnuesttHnuiltl HoilslpHitoaslpital
Wills Eye Hospital
Temple University Hospital — Jeanes Campus
Wills Eye Hospital
Camden
Salem
Tier 2 – Enhanced $$ Wills Eye Hospital
Tier 2 – Enhanced $$
Pennsylvania New Jersey Delaware
Pennsylvania
Philadelphia
Camden
New Castle
Philadelphia PChPiledanrdenen’slspyHhlvoiasapnitial of Philadelphia
Camden
VNiCrteauwma OdJuernrLsaedyof Lourdes Hospital
New Castle
DA.eI.laDNwuePaworneCt Haosstplietal for Children
Children’s Hospital of Philadelphia
Virtua Our Lady of Lourdes Hospital
A.I. DuPont Hospital for Children
Philadelphia
Camden
New Castle
Shriner’s Hospital for Children
Children’s Hospital of Philadelphia
Shriner’s Hospital for Children
Children’s Hospital of Philadelphia TePmhpileaHdealplthi—aFoxChaseCancerCenter Camden Shriner’s Hospital for Children
Temple Health — Fox Chase Cancer Center Gloucester
NewCastle
Tower Health — St. Christopher’s Hospital for Children
St. Luke’s Hospital — SSatc.reLdukHe’asrHt Cosapmitpauls—
Temple Health — Fox Chase Cancer Center
Tower Health — St. Christopher’s Hospital for Children TemShprlieneHre’salHthos—pitaFlofxorCChahsiledrCeanncerCenter
Tower Health — St. Christopher’s Hospital for Children
Gloucester
TowTemrHpleaHlthea—lthS—t.CFhorxistCohpahseer’CsaHnocsepritCaelnfotrerChildren Tier 3 – Standard $$$
GIlonsupcireastMeerdical Center — Woodbury ea
Virtua Our Lady of Lourdes Hospital
A.I. DuPont Hospital for Children
Gloucester
GVloirutucaeOstuerrLady of Lourdes Hospital Inspira Medical Center — Woodbury
A.I. DuPont Hospital for Children
ShCrihnieldrr’esnH’soHspoistpailtafolrofCPhhilidlarednelphia VInirstpuiaraOMureLdaidcayloCfeLnotuerrde—sHWosopoidtablury A.I.DuPontHospitalforChildren
Inspira Medical Center — Woodbury
Pennsylvania
New Jersey Delaware
Berks
Burlington New Castle
Pennsylvania
New Jersey Delaware
Berks
VirBtuuarMlianrglttoonnHospital NewCastle
Pennsylvania
New Jersey
Delaware
St. Joseph Medical Center
Christiana Care Health System —
Berks
SSt.aLcurekde’Hs eHaorstpCitaaml p—us MonSSt.gaLocurmekde’rHsyeHaorstpCitaml —pus
Burlington
New Castle
TSotw. eJroHseepahltMh —ediRceaaldCinegntHerospital Berks
VirtuVairMtueamMoraiarltHoonsHpiotaspl ital Burlington
ChrisCtiharniastHiaonsapiCtalre Health System — New Castle
St. Joseph Medical Center
Virtua Marlton Hospital Virtua Memorial Hospital
Christiana Care Health System — ChNrisetwianCahaCrsiastrtleieaHneaaHlthosSpyitsatelm —
and Medical Center
Burlington
ToBweerrkHsealth — Reading Hospital St. Joseph Medical Center ToawnderMHeedailctahl—CeRnteearding Hospital
St. Luke’s Hospital —
BucSkt.sJoseph Medical Center Tower Health — Reading Hospital
Montgomery
Virtua Marlton Hospital
and Medical Center BTurincTioktwysHereHalethal—th —St.RMeardying Hospital
MoanintgLoinme eHreyalth — MMaMionanLintingLeoinHmeeeaHrletyhal—th —
VCiratmuadMeenmorial Hospital
and Medical Center BuMceakdniscdaMl Ceednitcearl Center
Bryn Mawr Hospital
Jefferson Stratford Hospital
Sacred Heart Campus
Montgomery
CamdVeirntua Marlton Hospital Virtua Memorial Hospital
Christiana Care Health System —
Main Line Health —
Sacred Heart Campus
Christiana Hospital WCihlrmiCsitnhigaritnsoatniCaHnaoarseCpHiatearael lHtheSayltshteSmys—tem —
Bryn Mawr Hospital
JeffCeVrasimortnudCaehMnerermy Horiilal lHHosopsiptiatlal
Christiana Hospital
St. FCrhaCrnihWcsritsisalHtmniaoaisnHpagiotCosapnalirtHealoHsepaitlathl System —
Wilmington Hospital TrinityHealth—St.Mary LaBnkreynaMuMawerdiHcaolsCpietnatler JeffersonCherryHillHospital ChriSsttia.nFaraCnacriesHeoaslpthitaSlystem—
Main Line Health —
Bucks Main Line Heallth— JeCffaeJmresfodfnerWnsoanshSintrgatotfnorTdowHnosshpipital Wilmington Hospital
CThrBMeinuseitdtcyeikcHrasel aClethnt—er St. Mary Bryn Mawr Hospital Jefferson Cherry Hill Hospital MaryWlaiSlmnt.dinFgrtaonnciHsoHspoistpailtal
MLBaairnynkLeiMnaeauwHrMeHaelodtshipc—iatlaCl enter HoJspefitfaelrson Stratford Hospital
Chester Penn Medicine — Hospital of the Virtua Voorhees Hospital MaiinnLLinineeHHeaelathlt—h —RidPdaloelHi Hosopsitpailtal Hospital
Jefferson Cherry Hill Hospital Trinity Health — St. Mary Philadelphia Jefferson Washington Township
MMaiendLicianleCHeenateltrh — Paoli Hospital Main Line Health — Jefferson Stratford Hospital Trinity Health — St. Mary Lankenau Medical Center
S
Chester MainLineHealth— VirJteuJfaefefVrfeosorosnrohSneteWrsaHtafsohrsdipniHtgatolosnpiTtaolwnship
Medical Center JPefhfeLirlasaondnkeMnlpaethuhioMadeisdtiHcaolsCpietnatler Hospital Ceci
Medical Center Maryland
DCMehlaeaiswntaLerirnee Health — Paoli Hospital Lankenau Medical Center Jefferson Washington Township Jefferson Washington Township
LanMcaisntLeirne Health — Riddle Hospital TrMineitrycyHFeiatlztghe—rald Hospital
PeUnnivMeresditcyinoef —PenHnosyplivtanl oiaf the Penn Medicine —
Hunterdon Medical Center
TErpihnritaytaHCeaomlthm—unity Hospital
University of Pennsylvania Penn Medicine —
HMuentrecredorn Medical Center Capital Health System —
MTreirnciytyFHitezaglethra—ld Hospital
Penn Presbyterian Medical Center
Hunterdon Medical Center
Lancaster
Pennsylvania Hospital Penn Medicine —
Mercer
MeMrceyrcFyiFtzigtzegrearladldHHosopsiptiatal l Penn Medicine —
PePnennMPedreicsibnyet—erian Medical Center Penn Medicine —
Capital Health System — Fuld Campus
LEapnhcratsateCrommunity Hospital Lancaster General Hospital
TempPlenUnnPivrerssbiytyteHrioasnpiMtael d—ical Center
HMopewrcelel rCampus Mercer
Lancaster General Hospital Thomas Jefferson University Hospital
LehiLgahncaster General Hospital Episcopal Campus
Lancaster General Hospital
Lehigh Valley Hospital — Cedar Crest Temple University Hospital
Jefferson Cherry Hill Hospital
Christiana Care Health System —
Camden
Philadelphia Hospital UnionMHaorspyiltalnd
Chester Jefferson Methodist Hospital Hunterdon
Maryland
Philadelphia Hospital
Delaware Philadelphia Virtua Voorhees Hospital
Cecil
Main Line Health — Paoli Hospital University of Pennsylvania
TrinMitayiHneLainltehH—ealth—PaoliHospital JeffersonMethodistHospital HunterdonMedicalCenter
UnionHospital
DMealainwLainreHealth — Riddle Hospital
Penn Medicine — Hospital of the
Virtua Voorhees Hospital
Cecil
Delaware
PeJnenfMferesdoicninMee—thodist Hospital
VHirutunateVrodorohnees Hospital Hunterdon
CeciUl nion Hospital Union Hospital
Mercy Fitzgerald Hospital
Jefferson Methodist Hospital Penn Medicine — Hospital of the
MDaeinlaLwinaerHeealth — Riddle Hospital Trinity Health —
Main Line Health — Riddle Hospital
University of Pennsylvania
MercHeurnterdon Medical Center HHunutnetredrodnon
Penn Presbyterian Medical Center Penn Medicine — Hospital of the
Union Hospital
PennUMnievdeircsiintey —of Pennsylvania
Capital Health System — Fuld Campus
Penn Presbyterian Medical Center
PePnenMnseydlviacinniae—Hospital CapitalHealthSystem—FuldCampus
L aLnacnacsatsetre r
Ephrata Community Hospital
PennMedicine— PennMedicine— CaCpaitpailtaHleHaletahlSthysStyesmte—m—FulFduCladmCpaumspus
Episcopal Campus Capital Health System — Pennsylvania Hospital Salem
LEephEhigprahtratCaoCmommunuintyityHHosopspitiatall Temple University Hospital — CaHpoitpaelwHelalltChaSmypstuesm—
PLenancMasetdeircGinen—eral Hospital TempPlenUnnsyivlvearsniitay Hospititall
LPehPniengnhMnVMeadleliecdyincHieno—esp—ital—17thStreet TeEmppislecoUpnailvCerasmitpyuHsospital— InspiHraoMpeewdeicllaClCaemnpteurs—Elmer
CaCpaitpailtaHleHaletahltShysStyesmte—m — Temple UniversiittyHoossppitiatal l— HSoHaploepwmeewlleCllaCmapmuspus
Episcopal Campus WarSreanlem
Lehigh TriniEtypHisceaolptahl—CaNmapzuasreth Hospital Inspira Medical Center — Elmer
Lehigh Valley Hospital — 17th Street Temple University Hospital Salem LLeLheighghihgVhalleyHospital— ThomasJeffersonUniversityHospitalSt.SLuakle’msHospital—
Temple University Hospital Inspira Medical Center — Elmer Lehigh Valley Hospital — 17th Street Temple University Hospital
LMehuihglhenVbaelrlegy Hospital — Cedar Crest Thomas Jefferson University Hospital Inspira Medical Center — Elmer Lehigh Valley Hospital — 17th Street WWaIrnarserpnriCeranamMpeudsical Center — Elmer
Lehigh Valley Hospital — 17th Street Thomas Jefferson University Hospital Trinity Health — Nazareth Hospital
Lehigh Valley Hospital — Cedar Crest Thomas Jefferson University Hospital Warren LeLheighhigVhaVlalellyeyHHosopspitiatall— Cedar Crest Trinity Health — Nazareth Hospital WaSrt.reLnuke’s Hospital — Lehigh Valley Hospital — Cedar Crest Trinity Health — Nazareth Hospital Warren
UpLdMeahtuieghshleaVnrebaelmlregaydHeopsepriotadlic—allytoournetworkTrainidtyprHoevaidltehr—tierNinagz.aTroetgheHttohseplitaatelstinforSmta.tLiounk,ev’sisHitoibspxi.tcaolm—/providerfinder. Lehigh Valley Hospital — Warren Campus
St. Luke’s Hospital — SeleMctuKhleynsbtoernge HMO Proactive under Your Plan for the tiers to display. StW. Laurkren’sCHaomspiutsal —
Lehigh Valley Hospital —
20621 2007282 (08/22)
20621 2007282 (08/22)
Muhlenberg
Warren Campus
Muhlenberg
Warren Campus
Updates are made periodically to our network and provider tiering. To get the latest information, visit ibx.com/providerfinder. Updates are made periodically to our network and provider tiering. To get the latest information, visit ibx.com/providerfinder.
SeUlepcdtaKtesysatroenmeaHdMe pOerPiorodaiccatlilvyetounoduerrnYetowuorrPklandfporotvhiedetrietriesrtiongd.isTpolagye.t the latest information, visit ibx.com/providerfinder.
Updates are made periodically to our network and provider tiering. To get the latest information, visit ibx.com/providerfinder. Select Keystone HMO Proactive under Your Plan for the tiers to display.
Select Keystone HMO Proactive under Your Plan for the tiers to display. Select Keystone HMO Proactive under Your Plan for the tiers to display.
20621 2007282 (08/22) 20621 2007282 (08/22)
New Jersey
Jersey
New Jersey
Burlington
Delaware
P eT ni en r s 2y l –v aE n n i ha a n c e d $ $ Pennsylvania
New Jersey
New Jersey New Jersey
Delaware Delaware
T i e T r o w 3 e r – H e S a t l t a h n — d S a t . r C d h r $ i s $t o $p h e r ’ s H o s p i t a l f o r C h i l d r e n Tier 3 – Standard $$$
Inspira Medical Center — Woodbury
Pennsylvania N
w Jersey Del
ware
Tier 3 – Standard $$$
Pennsylvania
Tier 3 – Standard $$$
New Jersey
Delaware
l
St. Francis Hospital
Maryland
t. Francis Hospital
Cecil
20621 2007282 (08/22)
24