How to Get the Most From Your HMO Plan

A Health Maintenance Organization (HMO) plan gives you access to a wide variety of doctors and hospitals in the Keystone Health Plan East network. Here’s how to get the most from your plan — and save money, too!

1. Choose a Primary Care Physician (PCP)

You are required to select an in-network PCP, or family doctor, to treat your general health needs and provide referrals for specialty care. Log in at to select or update your PCP.

2. Get Referrals for Specialty Care

Before you see a specialist, ask your PCP for a referral. They’re easy to get, because they’re electronic, and you can always check the status of your referrals at

Some specialty services don’t need a referral:

  • Emergency care
  • Maternity and gynecological care
  • Mammograms
  • Mental health treatment
  • Routine eye care

Stay in the network

Out-of-network benefits are available for emergency services only. When your injury or illness is serious, call 911 or go to the nearest emergency room. You don’t need a referral for emergency care.

Know Your Designated Sites

Your PCP has selected providers for some services, known as designated sites. When you need any of these services, you will need to visit your PCP’s designated site. You may also need a referral or prescription.

Visit designated sites for:

  • Labs
  • Radiology
  • Physical and occupational therapy.

Find your designated sites at

Have a Tiered Network Plan?

Keystone HMO Proactive plans use a tiered network. This means that providers are grouped into three tiers: Tier 1 – Preferred, Tier 2 – Enhanced, and Tier 3 – Standard. While all doctors and hospitals in our network must meet high quality standards, many offer the same services at lower cost.

Be sure to check the provider’s tier before you visit so you know how much you’ll pay. To check provider tier, visit


Paula Sunshine

About Paula Sunshine

As SVP and Chief Marketing Executive at Independence Blue Cross, Paula Sunshine is accountable for the Individual Under-65 market segment. In this capacity, she is directly responsible for developing and executing all direct-to-consumer marketing and sales capabilities. In addition, Ms. Sunshine is accountable for insuring the delivery of market-competitive products and pricing as well as operational readiness for the Consumer market.