Independent Health’s Traditional FAQs

What is Independent Health’s Traditional plan?

Independent Health’s Traditional plan allows you to choose physicians and hospitals from a nationwide network of preferred providers, or seek care outside the network from any doctor or hospital, anywhere in the country.

What payments am I responsible for?

You are responsible for a deductible and coinsurance for the medical services you receive. Deductible and coinsurance amounts for specific services are listed in the Benefit Summary for your plan.

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 are subject to the deductible. Once your deductible has been met, your applicable coinsurance and/or copayments apply.

Some in-network preventive services are not subject to your deductible. View the listing of $0 preventive care services (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 calculates Deductibles to include the Allowed Amounts for all Covered Services rendered by our Participating (in-network) Providers. Any charges of a Non-Participating (out-of-network) Provider for Covered Services that are in excess of the Allowed Amount do not apply towards the Deductible. Copays and Non-Covered Services are never applied towards the Deductible.

When is the deductible applied?

Deductibles must be applied to the same Plan Year in which the service was rendered. The calculation of the Deductible, however, may be delayed because Independent Health cannot calculate it until the date the claim is processed (and providers have up to 120 days to submit claims).

Do all of my medical services go toward my deductible?

No. Select in-network preventive services do not apply toward the deductible. View a complete listing of $0 preventive care services (also listed in your Benefit Summary).

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

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 your provider exercises his/her right to request payment up front, he/she will be required to reimburse you for any overpayment received once the claim has been processed.

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

Yes, only in-network preventive services can be 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?

Independent Health tracks your deductible and sends you an Explanation of Benefits (EOB) when you are liable for a portion of the payment. As benefits are rendered and claims are submitted by the provider, you will receive an EOB showing the amount processed against your deductible.

At any time you may check your current deductible and out-of-pocket totals by logging in to your online Independent Health account, calling Member Services at (716) 631-8701 or 1-800-501-3439, or asking your provider’s office staff to check online at 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.

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 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