Independent Health’s Encompass Plus® FAQs

What is Independent Health’s Encompass Plus® (POS) plan?

Like an HMO, a POS plan uses a primary care physician to coordinate your medical services. A POS plan also gives you the option to seek care from out-of-network providers. In doing so, you will be required to do paperwork and submit claims to Independent Health for reimbursement. Services received out of network are also subject to coinsurance.

What payments am I responsible for?

You are responsible for a copayment and/or coinsurance for the medical services you receive. Copayment and coinsurance amounts for specific services are listed in the Benefit Summary for your plan.

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 Independent Health Find a Doctor tool. You may also call Member Services at (716) 631-8072 or 1-800-501-3439 for assistance.

Can I change my primary care physician?

Yes. Log in to your online Independent Health account, and on the member home page you will find a link that allows you to change your primary care physician. You may also call Member Services at (716) 631-8072 or 1-800-501-3439 if you prefer to change your physician with the help of a Member Services representative.

Do I need a referral to seek care from a specialist?

No. You do not need a referral.

If I become ill and my primary care physician’s office is not open, what can I do?

Independent Health’s 24-Hour Medical Help Line is available 24 hours a day, 7 days a week to answer your call – day or night. Our registered nurses will listen to your concerns and advise you on next steps you can choose to take, depending upon the severity of the problem. If your problem is so severe that immediate medical care is needed, seek help at the nearest medical facility.

If I am traveling and need emergency care, am I covered?

Yes. With Independent Health, you have the security of knowing that you have worldwide emergency coverage.

What medical conditions are considered an emergency?

Conditions that are so severe that they may cause serious disability if not treated are considered emergencies. Some examples of emergencies that require immediate attention at an emergency room include a heart attack or severe chest pain, uncontrollable bleeding, broken bones, convulsions or choking, serious burns, poisoning, acute abdominal pain and severe shortness of breath.

What about urgent care coverage?

An urgent care situation is the sudden onset of an illness, injury or condition that is not a medical emergency, but requires immediate outpatient, medically necessary services at a physician’s office. You can access care from a variety of urgent care centers  that offer shorter wait times than emergency rooms for non-emergency care. Check your provider directory or contact the urgent care center directly to ensure that they are participating with Independent Health.

Am I able to access $0 preventive care services without paying a deductible or coinsurance?

Yes. View a complete listing of $0 in-network preventive care services  (also listed in your Benefit Summary).

Do I have any vision coverage?

Yes. Your plan includes vision coverage through EyeMed Vision Care – offering affordable copayments and discounts up to 40 percent off frames. For a current list of providers, call EyeMed’s Member Services toll-free at 1-866-739-3633, Monday – Saturday, 8 a.m. to 11 p.m., and Sundays, 11 a.m. to 8 p.m. You may also reach EyeMed’s TDD at 1-866-308-5375. For more information, visit

EyeMed should be contacted only for routine vision questions – not for any medical-related eye treatments for which you would see an ophthalmologist.

Do I have any dental coverage?

Dental coverage is generally offered through your employer as a rider to your medical plan. Without a dental rider, specific or only medically necessary dental conditions are covered. Please refer to your contract for details.

Does Independent Health offer member discounts on gym memberships?

Yes. Independent Health offers member discounts on a select group of businesses that promote a healthy lifestyle. Discounts can be used for gym memberships, dental cleanings, massage therapy, vitamins and more. This program is an exclusive benefit of your membership and comes at no additional cost. View the latest member wellness discounts.

I’ve heard that I can keep my child on my plan until age 26. How does that work?

Groups enrolled with an effective date prior to 10/2010 will continue to have dependent coverage as defined through the coverage option chosen at the time of enrollment. Upon your group’s renewal, coverage will be extended to age 26.

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