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Keystone HMO Proactive Plans with a Tiered Network

Our most popular plan, Keystone HMO Proactive, works just like a typical Health Maintenance Organization (HMO) in that you can visit any doctor or hospital in the Keystone Health Plan East network, and you select a primary care physician to refer you to specialists. These HMO plans also let you save on your out-of-pocket costs when you visit certain health care providers.

How a Tiered Network Provides Choice and Savings

All HMO providers are grouped into one of three tiers based on cost and, in some cases, quality measures. While all of the doctors and hospitals in the Keystone Health Plan East 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 our network are in the most affordable tier, Tier 1 – Preferred, so you have plenty of choices.

A tiered network is different from a limited network. Other health insurers may offer plans with a limited network, which does not give you access to the full network of doctors and hospitals. But our tiered network gives you access to the entire Keystone Health Plan East network. And the choice to save is yours — you can choose providers in Tier 1 for some covered services and providers from Tier 2 or 3 for other covered services.

Is a Keystone HMO Proactive Plan Right For You?

One of our Keystone HMO Proactive plans may be the best health insurance option for you and your family if you live within one of these five counties and are looking for an affordable coverage option that still gives you access to a wide variety of providers within the Independence Keystone Health Plan East network.

Keystone HMO Proactive Plan Options and Benefits

Three of our most affordable health insurance plans for individuals and families, Keystone HMO Gold Proactive, Keystone HMO Silver Proactive, and Keystone HMO Silver Proactive Value can help 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 health care 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 covered services, and providers from the other two tiers for other covered 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 covered 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

How Keystone HMO Proactive Plans Work

Resources

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Additional information

Review important information to get a better understanding of our individual and family health insurance policies and guidelines and the steps Independence Blue Cross takes to help you receive appropriate covered services.

1 Amount shown reflects copay per day. There is a maximum of 5 copays per admission.

2 Deductible is combined for Tiers 2 and 3.