All Primary Care and Specialist visits at a Participating Independence Administrator's (IA) provider are covered under the Plan's coinsurance.

• Gold Level: 90/10 Coinsurance
• Silver Level 70/30 Coinsurance

All testing and procedures done during your visit will also be covered under the Plan's respective coinsurance. Please visit www.MyIBXTPABenefits.com for a list of Participating Providers.

A deductible is the initial amount of money you must pay for health care services before your insurance starts to pay for covered services. For all In Network Claims through Independence Administrators or Mental Health Consultants, your coverage does not have a deductible.

A co-pay is a fixed dollar amount you are required to pay for health care services. For example, if you fill a 30-day generic prescription you would have a $5 co-pay.

Coinsurance is the set percentage of the allowed amount you are required to pay for health care services. For example, Gold Level pays 10% and Silver Level would pay 30%

Out-of-Pocket Max means the total amount of money you can spend of your pocket in a Plan Year (April 1st through March 31st). The out-of-pocket maximum for In-Network Services through Independence Administrators (IA) and MHC is as follows:

• Gold Level: $1,000.00 for an individual and $2,000.00 for a family.
• Silver Level: $2,000.00 for an individual and $4,000.00 for a family.

Please note, there is a separate out-of-pocket maximum for Out of Network Services through IA and MHC:

• Gold Level $15,000.00 for an individual and $30,000.00 for a family after the Out of Network Deductible is met.
• Silver Level $30,000 for an individual and $60,000.00 for a family after the Out of Network Deductible is met.

If you utilize Out-of-Network Facilities, the deductible is:

• Gold Level ($10,000.00 individual/$20,000.00 family)
• Silver Level ($20,000.00 individual/$40,000.00 family) 

After the deductible is met, your Out-of-Pocket Maximum is a combination of your copays and coinsurances (50/50 coinsurance) with a limit of:

• Gold Level $15,000.00 for individuals and $30,000.00 for family.
• Silver Level $30,000.00 for individuals and $60,000.00 for family.

Yes, you may utilize an Urgent Care Facility or a Minute Clinic at a pharmacy as long as they are participating with Independence Administrators (IA). Urgent Care visits and all testing and procedures are covered under the coinsurance of IA's allowed amount. Please visit www.MyIBXTPABenefits.com for a list of Participating Providers.

For In-Network claims processed through Independence Administrators (IA) and Mental Health Consultants (MHC) there is currently NO DEDUCTIBLE.

For Out-of-Network claims processed through Independence Administrators (IA) and Mental Health Consultants (MHC) the deductible is as follows:

• Gold Level - $10,000.00 deductible for an individual and a $20,000.00 deductible for a family.
• Silver Level - $20,000.00 deductible for an individual and a $40,000.00 deductible for a family.

If you are seeking services and the provider is Out-of-Network, contact IA or MHC and ask for alternative physicians.

You may find a list of Participating Providers for Health Care Professionals on the Independence Administrators Website at www.MyIBXTPABenefits.com.  

You may also contact Independent Administrators directly at 1-833-242-3330.

Preventative Care encompasses procedures such as: Vaccinations, Immunizations, and Wellness Visits. Preventative Care eligibility will be determined by your Primary Care Physician based on medical necessity and your unique individual situation. All preventative care is covered at 100%.

If you visit a Independence Administrator's Participating Provider, there shouldn't be any claims forms for you to submit. As long as you are supplying your Independence Administrators Card, the provider will submit the claim for you.