HMO Proactive Tiered Network Hospital List

Save with Keystone HMO Proactive, our most popular plans Keystone HMO Proactive health plans are our most popular for good reason: You get access to high-quality care and save money. Not only do you pay less for your monthly premiums, but you can save even more by choosing doctors and hospitals in Tier 1 – Preferred. Save with Tier 1 – Preferred Tier 1 – Preferred includes more than 50 percent of the network. Keystone HMO Proactive offers the same essential health benefits as our other health plans, including doctor visits, Tier 1 – Preferred hospital stays, prescription drug coverage, blood tests, and X-rays. The difference is its tiered provider network, which gives you the option to pay less for care by choosing Tier 1 –Preferred providers. Here are the most important things to know about Keystone HMO Proactive: • You can visit any doctor or hospital in the Independence Blue Cross network once you have a referral. Tier 2 – Enhanced Tier 3 – Standard • You will select a PCP to coordinate your care and refer you to specialists. • Some services cost the same no matter what provider you Save even more choose — like preventive care, emergency room visits, and Keystone HMO Silver Proactive Select and Keystone HMO Silver urgent care. Proactive Value: These lower-premium options are only available • When you use doctors and hospitals in Tier 1 – Preferred, when you purchase directly from Independence Blue Cross. you pay the lowest out-of-pocket costs. Keystone HMO Silver Proactive Value includes a deductible for • The choice is always yours. You can choose Tier 1 providers Tiers 1 – 3 for some services. HMO Silver Proactive Select has for some covered services and Tiers 2 or 3 for others. no deductible for any services with Tier 1 providers. • For some services, like surgery, you’ll pay out-of-pocket Keystone HMO Silver Proactive Lite: This plan offers a lower costs for both the facility where it’s performed and the premium for those shopping with a tax credit on Pennie, the performing doctor. To save the most, make sure both are in Pennsylvania Insurance Exchange. It includes a deductible for Tier 1 – Preferred. Tiers 1 – 3 for some services. LEARN MORE WHAT IS A DEDUCTIBLE? ibx.com/applynow A deductible is the amount you pay for certain covered 1-866-346-2081 (TTY: 711) services (e.g., hospital stays) each year before your health plan starts paying. Once you have paid this amount, your health plan will pay a portion or all of your health care costs, depending on the health plan. 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 Germantown Campus Delaware Jefferson Frankford Hospital Crozer-Chester Medical Center Jefferson Torresdale Hospital Delaware County Memorial Hospital Prime Healthcare — Springfield Hospital Roxborough Memorial Hospital Taylor 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 $$ Pennsylvania New Jersey Delaware Philadelphia Camden New Castle Children’s Hospital of Philadelphia Virtua Our Lady of Lourdes Hospital A.I. DuPont Hospital for Children Shriner’s Hospital for Children Temple Health — Fox Chase Cancer Center Gloucester Tower Health — St. Christopher’s Hospital for Children Inspira Medical Center — Woodbury Tier 3 – Standard $$$ Pennsylvania New Jersey Berks Montgomery Burlington Salem St. Joseph Medical Center Main Line Health — Virtua Marlton Hospital Inspira Medical Center — Elmer Tower Health — Reading Hospital Bryn Mawr Hospital Virtua Memorial Hospital and Medical Center Main Line Health — Warren St. Luke’s Health Network — Lankenau Medical Center Camden Bucks Kennedy University Hospitals — Warren Hospital Trinity Health — St. Mary Philadelphia Medical Center Cherry Hill Division Jefferson Methodist Hospital Kennedy University Hospitals — Delaware Chester Penn Medicine — Hospital of the Stratford Division Main Line Health — Paoli Hospital University of Pennsylvania Kennedy University Hospitals — New Castle Delaware Penn Medicine — Washington Township Division Christiana Care Health System — Main Line Health — Riddle Hospital Penn Presbyterian Medical Center Virtua Voorhees Hospital Christiana Hospital Trinity Health — Penn Medicine — Christiana Care Health System — Hunterdon Mercy Fitzgerald Hospital Pennsylvania Hospital Wilmington Hospital Hunterdon Medical Center Lancaster Temple Health — Northeastern St. Francis Hospital Ephrata Community Hospital Campus Mercer Temple University Hospital Penn Medicine — Capital Health System — Fuld Campus Maryland Thomas Jefferson University Lancaster General Hospital Capital Health System — Hospital Cecil Lehigh Hopewell Campus Trinity Health — Nazareth Hospital Union Hospital Lehigh Valley 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. Independence Blue Cross offers products through its subsidiaries Independence Hospital Indemnity Plan, Keystone Health Plan East, and QCC Insurance Company, and with Highmark Blue Shield — independent licensees of the Blue Cross and Blue Shield Association. 19573 1326807 (3/21).

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