Keystone HMO Proactive Plans

Keystone HMO Gold and Silver Proactive, our tiered network plans, offer your employees full access to the Keystone network at a lower premium. As with any HMO plan, your employees select a PCP who refers them to specialists. They can save even more money by choosing certain health care providers when they seek care.

How Keystone HMO Proactive Plans Work

All Keystone HMO providers are grouped into one of three tiers based on cost and, in many cases, quality measures. The three tiers are: Tier 1 – Preferred, Tier 2 – Enhanced, and Tier 3 – Standard. All doctors and hospitals in the Keystone HMO network are accessible in the Proactive plans.

When your employees choose providers in Tier 1 – Preferred or Tier 2 – Enhanced, they will save on out-of-pocket costs each time they receive care for certain services. While all of the doctors and hospitals in our Keystone HMO network must meet high quality standards, some are able to offer the same services at a lower cost. The good news is that more than 50 percent of doctors and hospitals in the Keystone HMO provider network are in Tier 1 – Preferred, so your employees will have plenty of choices.

tiered network groupings


Your Employees Can Save More Money

With our Keystone HMO Proactive plans, your employees can:

  • Save money on monthly premiums. Premiums are lower than our regular HMO plans in their respective tiers.
  • Save money on out-of-pocket costs. When they choose Tier 1 – Preferred providers, they’ll save on out-of-pocket costs every time they receive care.
  • Choose quality providers that offer the best value. All of the doctors and hospitals in our network must meet high quality standards, and many offer the same services at a lower cost.
  • Choose providers from any tier. Your employees will have the freedom to choose from any tier each and every time they receive care. So they can choose providers in Tier 1 – Preferred for some services, and providers from the other two tiers for other services.
  • Pay the same cost for select services, no matter where they go. The following services cost the same across all tiers:
    • Preventive care
    • Emergency room
    • Emergency ambulance
    • Urgent care
    • Prescription drugs
    • Pediatric dental and vision
    • Mental health
    • Physical and occupational therapy
    • Outpatient lab and pathology
    • Routine radiology
    • Spinal manipulations