Independent Health Passport Plan® FAQs

How is Passport Plan (PPO) different than a Point of Service (POS) or Health Maintenance Organization plan?

A PPO plan is more like a blend between a POS plan and indemnity insurance. As with a POS plan, PPO members pay copayments for in-network services; deductibles, coinsurance and balance billing apply for out-of-network services.

Which providers can I use with Passport Plan?

There are different provider networks available to Passport Plan members depending upon which plan you are enrolled in. For providers located within Western New York and/or outside New York state, use the Independent Health Find a Doctor tool. You can also call the number listed on the back of your member ID card for information about participating providers.

Am I required to select a primary care physician?

No. You are not; however, we highly recommend that you designate a primary care physician. A primary care physician provides routine medical care and preventive health services, and is a valuable resource in coordinating all aspects of your medical 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.

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 and are generally less expensive than emergency rooms for non-emergency care.

Why do I have to precertify for inpatient hospitalization and some outpatient services?

Certain services under your Passport 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.

Can’t my physician just precertify for me on my behalf?  I don’t know what information to provide.

In some cases, your physician will contact Independent Health prior to providing services. We ask that you, the member, contact us as well so we can get some background information about you as we coordinate your care. It is ultimately your responsibility to obtain precertification before you obtain certain services. Your may have higher out-of-pocket costs if you do not obtain precertification.

If my plan provides in-network coverage out-of-state, how will that provider know that I am a Passport Plan member?

When you obtain services through a provider, simply show your member ID card that indicates the network that has been assigned to you.

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

Yes. View a complete listing of $0 copay in-network preventive services on our site or by logging in to your online Independent Health account.

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 eyemedvisioncare.com.

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.

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