In plain English
In a tiered network, providers are grouped by what the member pays. Tier 1 names the group tied to the lowest share of costs under that plan. It is lower-cost for the member than the plan's other network tiers.
In context
Here, Tier 1 indicates that the provider is in the network tier with the plan's lowest member cost sharing.
- Situation
- Checking provider networks, authorization, referrals, eligibility, and preapproval states
- What it communicates
- labels a provider's tier level in network filters or results.
Meaning limits
The term alone does not state the exact amount the member will pay or how the plan's other tiers are arranged.
Examples
“Under her plan, the local clinic is Tier 1, but the specialist group across town is in a higher network tier with more member cost sharing.”
“Before booking the test, she checked whether the lab was in Tier 1.”