Keystone HMO Proactive plan benefits at a glance

Hospital tier assignments

Keystone HMO Proactive Plans
Tiered Network Plan

Keystone HMO Proactive tiered network plans give your employees full access to the Keystone network at a lower premium. They can also save money by choosing health care providers in Tier 1 – Preferred, the lowest-cost tier, when they receive care.

How Keystone HMO Proactive Plans Work

As with any HMO plan, members select a PCP who will refer them to in-network specialists. All Keystone HMO providers are grouped into one of three tiers based on cost and, in many cases, quality measures.

All doctors and hospitals in the network must meet high quality standards, but some can offer the same services with a lower cost-share. 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 covered services. They will pay the highest cost by choosing Tier 3 – Standard providers.

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 have plenty of choices.

Certain health services have the same cost-share across all tiers, including:

  • Preventive care
  • Emergency room
  • Urgent care
  • Outpatient labs
  • Prescription drugs
  • Pediatric dental and vision
  • Mental health services
  • Physical and occupational therapy
  • Routine radiology
  • Spinal manipulations