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How Keystone HMO Proactive — Our Tiered Network Plans — Work

A Keystone HMO Proactive plan works just like a typical HMO in that you can visit any doctor or hospital in the Independence Blue Cross network, and you select a primary care physician to refer you to specialists. But with our Keystone HMO Proactive plans, you can save on your out-of-pocket costs when you visit certain health care providers.

All HMO providers are grouped into one of three tiers based on cost and, in many cases, quality measures. While all of the doctors and hospitals in our network must meet high quality standards, some are able to offer the same services at a lower cost. The good news is that nearly 50 percent of doctors and hospitals are in Tier 1 – Preferred, so you have plenty of choices.

keystone hmo tiered network groupings

See How Our Keystone HMO Proactive Plans Differ from Standard HMO Plans

Save More Money with Keystone HMO Proactive

Two of our most affordable plans, pdf icon Keystone HMO Gold Proactive and pdf icon Keystone HMO Silver Proactive save you money while giving you the freedom to choose each time you receive care.

  • Save money on monthly premiums. When you choose a Keystone HMO Proactive plan, you save money because your monthly premiums are lower than our regular HMO plans.
  • Save money on out-of-pocket costs. When you choose Tier 1 – Preferred providers, you’ll save on out-of-pocket costs every time you receive care.
  • Choose quality providers that offer the best value. High quality doesn’t have to mean high cost. While all of the doctors and hospitals in our network must meet high quality standards, many offer the same services at a lower cost. If they cost less, then you pay less.
  • Choose providers from any tier. You have the freedom to choose from any tier each and every time you receive care. So you 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 you go. Even though you can save money by choosing providers in Tier 1 – Preferred, there are some services that cost the same across all tiers, such as:
  • preventive care
  • emergency room
  • emergency ambulance
  • urgent care
  • prescription drugs
  • physical and occupational therapy
  • pediatric dental and vision
  • mental health
  • outpatient lab/pathology
  • routine radiology


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