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2018 Blue Solutions Renewal Guide

Tiered network plans offer more choice and savings Our Keystone HMO Proactive tiered network plans give members access to the full Keystone network at a lower premium and the choice to lower out-of-pocket costs when they need care. Providers are grouped into three tiers based on cost and quality measures. Members must choose a PCP to coordinate their care and refer them to specialists. They save the most by choosing providers in Tier 1 — Preferred but are always free to choose providers in any of the three tiers. These services have the same cost-sharing across all tiers: 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 Savings on specialty care with Keystone HMO Proactive plans Hospitals designated as a Blue Distinction Center+ (BDC+) are recognized for their expertise and efficiency in delivering specialty care, such as knee and hip replacements. Our Keystone HMO Proactive plans give members the option to save on specialty care by choosing a BDC+ hospital in Tier 1 — Preferred, while being confident that it: • Has extensive experience in one or more categories of specialty care • Meets rigorous quality standards • Consistently demonstrates positive care results Keystone HMO Proactive hospital tier placements and BDC+ hospitals 4


2018 Blue Solutions Renewal Guide
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