Independent Health’s Evolve® FAQs

What is Independent Health’s Evolve® plan?

Evolve is an innovative and low-cost health plan that rewards you for engaging in meaningful health and wellness activities that help you achieve healthy, long-lasting lifestyle changes. Benefits include the FitWorksSM rewards program, $0 copay for preventive care, built-in vision discounts (glasses, contacts, eye exams and Lasik), dependent coverage up to age 26, worldwide emergency and urgent care, and maternity coverage in full after deductible.

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. Diagnostic medical services and prescription drugs may be subject to the deductible. Once your deductible has been met, additional member liability may apply.

In-network preventive services, routine vision and dental (if applicable) are not subject to your deductible. View the listing of $0 preventive care services on our website or by logging in to your online Independent Health account (also listed in your Benefit Summary). 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 four months after the original date of service for a claim to be processed.

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
  • Having Member Services at (716) 631-8701 or 1-800-501-3439
  • Havng 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.

Does the deductible apply to all of my medical services?

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

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

Yes, only in-network preventive services, routine vision and dental (if applicable) can be waived from the deductible requirement on a qualified HDHP plan.

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.

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

To ensure 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 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 processed.

Can a provider ask for full payment at the actual time of service when I’m still in the deductible phase of my plan?

Yes, some provider offices have adopted the business practice of asking for up-front payment until their patient’s deductible requirement is satisfied. This charge should be limited to the negotiated contract rate for the services rendered, and never the retail cost of services. If a member is required to pay for services before they are rendered, the office staff may have to estimate the amount that is owed, and then adjust for the actual services rendered once the claim has processed.

Do I have the option of seeing any doctor I want?

Yes. Independent Health offers an extensive network of providers. You still have the flexibility of using non-participating providers; however, you can minimize your out-of-pocket costs by using a participating physician, which in turn allows you to take advantage of Independent Health’s negotiated rates. Our negotiated rates are generally lower than what the provider may normally charge.

What happens if I’m overcharged incorrectly for a medical service?

Your physician or provider will be responsible for refunding the difference. If you pay the physician out of your HSA (health savings account) funds and are overcharged, your physician must return the overpayment amount to you so that you can put it back into your HSA. If you don’t redeposit the money you’ve taken out of the HSA, you may be responsible for tax penalties. Consult with your HSA custodian/bank for guidance on re-depositing overpayments.

Are referrals required under the plan?

No, you have the freedom to see in-network specialists with Independent Health’s Evolve plan, without obtaining a referral.

Do I need to get approval for services?

Certain services under your Evolve plan will require you to call for approval or “precertification.” A detailed list of services requiring precertification is included in your Contract (“Certificate of Coverage”). Failure to obtain precertification when necessary may result in a penalty and higher out-of-pocket costs. Call Member Services at (716) 631-8701 or 1-800-501-3439 to obtain written approval for services requiring precertification.

What is FitWorks?

FitWorks is an online wellness program that features a Well-Being Assessment, goal setting and tracking tools. It includes individual and group challenges, peer support tools and links to wellness programs and services. FitWorks allows users to track and redeem points for engaging in healthy activities.

How do I access FitWorks?

Visit on or after your group’s effective date.

How do I earn points in FitWorks?

You can earn points by doing things like:

  • Completing a Well-Being Assessment
  • Visiting your doctor for preventive services
  • Participating in challenges
  • Maintaining a healthy weight
How do I redeem points in FitWorks?

As you earn points, enter and track your points at Once you reach the first reward level of 150 points, an Gift Card claim code will be e-mailed to you. Once you reach the second reward level of 250 points, you will receive another Gift Card claim code – both of which can be used for a wide variety of health and wellness items.

Do my FitWorks points expire?

Yes, any unused points will be forfeited at the end of your group’s contract year. Your points do not carry over from year to year.

Can my children participate in FitWorks?

No. Only you and your covered spouse can participate.

Can my spouse and I combine/share our points in FitWorks?

No. Each account is set up separately.

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