Independent Health’s Empower® FAQs

What is Independent Health’s Empower® plan?

Independent Health’s Empower® plan has two benefit levels: Enhanced and Standard. You are automatically enrolled in the Enhanced level for the first three months of coverage. As part of your roadmap to a healthier lifestyle, you and your covered spouse can choose to actively maintain or work toward your healthy lifestyle to remain in the Enhanced option, or do nothing and receive Standard benefits.

With most Empower options, a deductible must be met before coverage for diagnostic, medical or pharmacy services begins. However, select in-network preventive services are covered in full right from the start. View a complete listing of $0 copay in-network preventive services.

How much will I save by qualifying for the Enhanced benefit level?

Enhanced benefits equate to lower out-of-pocket costs. Please refer to your Benefit Summary for potential savings associated with enrollment in the Enhanced level.

What health risk factors are reviewed to determine eligibility for the Enhanced benefit level?
  • Tobacco use 
  • Blood pressure
  • Body Mass Index (BMI)

You and your covered spouse can remain in the Enhanced option if you complete your Health Assessment and, if required, meet with your physician to complete the Empower Provider Confirmation Form and return it to Independent Health.

Why target these health risk factors?

Independent Health believes that proactive identification and treatment of conditions can reduce the risk of the chronic diseases often associated with tobacco use, high blood pressure and excess weight (BMI). Disease states associated with these risk factors include hypertension and heart disease, obesity, certain cancers and diabetes. Early prevention and treatment keep minor problems from turning serious.

What health risks are associated with blood pressure that is higher than 140/90?

High blood pressure can lead to serious health conditions including:

  • Hypertension
  • Heart disease and stroke
  • High-risk pregnancy
  • High-risk surgeries
  • Vascular conditions (e.g., peripheral artery or vein disease)
What if I am unable to see my primary care physician within the first three months of coverage to have my Provider Confirmation Form completed? Can I get an extension?

No. You and your covered spouse are required to complete the Health Assessment and, if required, meet with your physician to complete and return the Empower Provider Confirmation Form to Independent Health within the first three months of your enrollment period. If you are having trouble scheduling an appointment with your physician, please call Member Services at (716) 631-8701 or 1-800-501-3439.

What is Body Mass Index (BMI)?

Body Mass Index is a formula used to express body weight in relation to height. The number calculated gives a general indication if an individual’s weight falls within a healthy range.
Note: The standard weight categories indicate that an adult who has a BMI between 25 and 29.9 is considered overweight and a BMI of 30 or higher is considered obese.

If my covered spouse or I smoke, have high blood pressure or a Body Mass Index over 30, will we automatically be enrolled in the Standard benefit after three months?

No. It is important to remember that you and your covered spouse can qualify for the Enhanced option and save money – as long as you meet with your physician to complete and submit the Empower Provider Confirmation Form  to Independent Health within the first three months of your enrollment period.

How do I complete the Health Assessment?

The Health Assessment is completed online. Go to www.empowersurvey.com, create a new account and answer the questions. Once you complete the assessment you will be given recommendations to maintain or improve your health.

What happens if I complete my Health Assessment but my covered spouse does not?

You and your covered spouse are BOTH required to complete and return the Health Assessment and, if necessary, meet with your physician to complete and submit the Empower Provider Confirmation Form to Independent Health within the first three months of enrollment in order to remain in the Enhanced option.

How does the Empower Provider Confirmation Form get returned to Independent Health?

You may mail or fax the form to 511 Farber Lakes Drive, Attn: Membership Operations,
Buffalo, NY 14221, or fax it to (716) 631-4059.

If your provider sends the Empower Provider Confirmation Form to Independent Health, be sure to ask him or her for a printed copy for your records.

What is a deductible?

A deductible is the initial out-of-pocket amount that you are responsible for when receiving covered services. Your deductible amount includes costs for services received both in-network and out-of-network. You are responsible for meeting your deductible each year. Once your deductible has been met, your applicable member liability applies.

Some in-network preventive services are not subject to your deductible. View the listing of $0 preventive care services. The amount of your deductible is listed on your Benefit Summary and Contract.

How is the deductible calculated?

Independent Health determines the deductible as of the date(s) claims are processed, not the date that services were rendered. Because providers have up to 120 days to file claims, it could possibly take up to three months after the original date of service for a claim to be processed.

Do all of my medical services count toward my deductible?

No. The deductible does not apply to in-network $0 preventive care services, routine vision and dental (if applicable).

Before I reach my deductible, will I be billed for my medical services or will I have to pay for them up front?

If your provider exercises his/her right to request payment up front, he/she will be required to reimburse you any overpayment received, once the claim has been processed.
 
To ensure that your medical records are kept up-to-date and that your benefits are tracked correctly, all participating providers are required to submit claims to Independent Health, regardless of whether your deductible has been met.

If I needed surgery, would that be subject to my deductible?

Yes, only in-network preventive services are waived from the deductible requirement.

Do I show my Independent Health ID card when visiting a doctor or filling a prescription even before my deductible is met?

Yes. Showing your ID card allows Independent Health to track your deductible and out-of-pocket maximum, and gives you access to Independent Health’s negotiated rates when seeking services from an in-network provider.

How do I know whether I’ve met the deductible?

You can track your claims and/or get your deductible balance by:

  • Referring to the Explanation of Benefits (EOB) you receive
  • Calling Member Services at (716) 631-8701 or 1-800-501-3439
  • Having your provider’s office check online if they have access to WNYHealtheNet.

We encourage you to keep a record of all your health care expenditures.

What is coinsurance?

Coinsurance is the percentage of the medical bill that you are responsible for once you’ve met your deductible. The amount of your coinsurance is listed as a percentage on your Benefit Summary and contract. You are responsible for paying your coinsurance amount.

Am I required to select a primary care physician?

Yes. Primary care physicians provide routine medical care and preventive health services and will coordinate your care. A list of participating primary care physicians can be found through the Find a Doctor tool.  You may also call Member Services at (716) 631-8072 or 1-800-501-3439 for assistance.

What is the Mental Health Parity and Addiction Equity Act?

Congress passed the Mental Health Parity and Addiction Equity Act that requires large group health plans (51 employees or more across the United States) to provide the same treatment limits and financial requirements for mental health and substance use disorder services as they do for medical and surgical services.

As a result, beginning on your group's renewal date, on or after July 1, 2010, the following mental health and substance abuse disorder benefits will have the same member liability (copayments, coinsurance and deductibles) as your medical and surgical benefits:

  • Inpatient coverage for mental health diagnoses
  • Outpatient coverage for mental health diagnoses
  • Partial hospitalization coverage for mental health diagnoses
  • Pharmacological management coverage for mental health diagnoses
  • Inpatient detoxification coverage
  • Outpatient substance abuse rehabilitation
  • Inpatient substance abuse rehabilitation