Save with Keystone HMO Proactive

Keystone HMO Proactive health plans use a tiered network, so you save on monthly premiums. Plus, you have the option to save even more on your out-of-pocket costs each time you receive covered services.

How you’ll save Tier 1 – Preferred Like a typical HMO, you select a primary care physician who can refer you to specialists. You can visit any doctor or hospital in the Keystone Health Plan East network. We grouped our network into 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, many offer services at a lower cost. You’ll pay the lowest out-of-pocket costs when you visit doctors Tier 2 – Enhanced Tier 3 – Standard and hospitals in Tier 1 – Preferred, which includes more than 50 percent of doctors and hospitals in the Keystone Health Plan East network. But the choice is always yours, and you can choose Tier 1 – Preferred for some services, and Tiers 2 or 3 for others. Also keep in mind: 50% of doctors and hospitals are • For some services, your out-of-pocket costs are the same in Tier 1 – Preferred. no matter what doctor or hospital you use, including preventive care, emergency room visits, and urgent care. Visit ibx.com/providerfinder, and select • For some services, like surgery, you pay out-of-pocket Keystone HMO Proactive under Your costs for both the facility and the performing doctor. To save the most money, you’ll want to make sure both Plan to find Tier 1 providers and save. are in Tier 1 – Preferred.

See the back for a list of Keystone HMO Proactive hospitals by tier.

lue Solutions

Benefits are underwritten or administered by Keystone Health Plan East, a subsidiary of Independence Blue Cross — independent licensees of the Blue Cross and Blue Shield Association. Keystone HMO Proactive hospital tier placements

Tier 1 – Preferred $

Pennsylvania New Jersey

Bucks Montgomery Burlington Doylestown Hospital Albert Einstein Medical Center — Virtua Willingboro Hospital Grand View Hospital Montgomery Campus Camden Jefferson Bucks Hospital Holy Redeemer Hospital and Medical Center Cooper Hospital University Medical Center Prime Healthcare — Lower Bucks Hospital Jefferson Health — Abington Hospital Rothman Orthopaedic Specialty Hospital Jefferson Health — Abington — Lansdale Hospital Mercer St. Luke’s Health Network — Quakertown Campus Suburban Community Hospital Robert Wood Johnson University Hospital Tower Health — Pottstown Memorial at Hamilton Chester Medical Center Penn Medicine — Chester County Hospital Salem Tower Health — Brandywine Hospital Philadelphia Memorial Hospital of Salem County Tower Health — Jennersville Regional Hospital Albert Einstein Medical Center Warren Tower Health — Phoenixville Hospital Albert Einstein Medical Center — Hackettstown Community Hospital Delaware Germantown Campus Crozer-Chester Medical Center Jefferson Frankford Hospital Delaware County Memorial Hospital Jefferson Torresdale Hospital Springfield Hospital Prime Healthcare — Taylor Hospital Roxborough Memorial Hospital Temple University Hospital — Jeanes Campus Lehigh Tower Health — Chestnut Hill Hospital St. Luke’s Health Network — Allentown Campus Wills Eye Hospital St. Luke’s Health Network — Bethlehem Campus

Tier 2 – Enhanced $$

Pennsylvania New Jersey Delaware

Philadelphia Camden New Castle Children’s Hospital of Philadelphia Virtua Our Lady of Lourdes Hospital A.I. DuPont Hospital for Children Shriner’s Hospital for Children Gloucester Temple Health — Fox Chase Cancer Center Inspira Medical Center — Woodbury Tower Health — St. Christopher’s Hospital for Children

Tier 3 – Standard $$$

Pennsylvania New Jersey

Berks Montgomery Burlington Salem St. Joseph Medical Center Main Line Health — Virtua Marlton Hospital Inspira Medical Center — Elmer Virtua Memorial Hospital Tower Health — Reading Hospital Bryn Mawr Hospital Warren and Medical Center Main Line Health — Camden St. Luke’s Health Network — Lankenau Medical Center Bucks Kennedy University Hospitals — Warren Hospital Trinity Health — St. Mary Philadelphia Cherry Hill Division Medical Center Jefferson Methodist Hospital Kennedy University Hospitals — Delaware Stratford Division Chester Penn Medicine — Hospital of the Main Line Health — Paoli Hospital New Castle University of Pennsylvania Kennedy University Hospitals — Washington Township Division Christiana Care Health System — Delaware Penn Medicine — Main Line Health — Riddle Hospital Penn Presbyterian Medical Center Virtua Voorhees Hospital Christiana Hospital Christiana Care Health System — Trinity Health — Penn Medicine — Hunterdon Mercy Fitzgerald Hospital Wilmington Hospital Pennsylvania Hospital Hunterdon Medical Center Lancaster Temple Health — Northeastern Campus St. Francis Hospital Ephrata Community Hospital Mercer Temple University Hospital Penn Medicine — Capital Health System — Fuld Campus Maryland Lancaster General Hospital Thomas Jefferson University Hospital Capital Health System — Trinity Health — Cecil Lehigh Hopewell Campus Mercy Philadelphia Hospital Union Hospital Lehigh Valley Hospital Trinity Health — Nazareth Hospital Lehigh Valley Hospital — Muhlenberg Sacred Heart Hospital

Updates are made periodically to our network and provider tiering. To get the latest information, visit ibx.com/providerfinder. Select Keystone HMO Proactive under Your Plan for the tiers to display. 19637 1118200 (09/20)