Independence Administrators 90/10 Personal Choice Coinsurance Plan
Doctors, Specialist, and Hospital Coverage
A 90/10 Coinsurance means that the total cost of any In-Network service is shared between the Fund and the Participant at a percentage of the bill. When a Participants visit providers who are in-network with Independence Administrators, the Fund pays 90% of the total Independence Administrator's allowance leaving the Participant with a coinsurance of only 10%. Participants are responsible for the coinsurance until they have met their out-of-pocket maximum* (see graphic below). Once an individual or family has reached their OOP Max, the Plan will pay 100% for all further In-Network claims for the duration of the Plan Year (May 1 through April 30).
Access your Independence Administrators personalized health care resource by visiting www.MyIBXTPAbenefits.com
*The $2,000 annual out-of-pocket maximum is a combined total between medical and mental health claims.
90/10 Plan Explanation Video
Have Eligible Out-of-Pocket Expenses?
Medical Coverage FAQs
All Primary Care and Specialist visits at a Participating Independence Administrator's (IA) provider are covered at 90% of IA's allowed amount, leaving you responsible for only the 10% coinsurance. All testing and procedures done during your visit will also be covered at 90% of IA's allowed amount. 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 visit a Participating Chiropractor, the copay is $5.
Coinsurance is the set percentage of the allowed amount you are required to pay for health care services. Currently, the coinsurance amount of an office visit through a Participating Independence Administrator provider is 10%.
Out-of-Pocket Max means the total amount of money you can spend of your pocket in a Plan Year (May 1st through April 30th). The out-of-pocket maximum for In-Network Services through Independence Administrators (IA) and MHC is $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 is $15,000.00 for an individual and $30,000.00 for a family after the Out of Network Deductible is met.
If you utilize Out-of-Network Facilities, after the deductible ($10,000.00 individual/$20,000.00 family) is met, your Out of Pocket Maximum is a combination of your copays and coinsurances with a limit of $15,000.00 for individuals and $30,000.00 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 at 90% 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) there is a $10,000.00 deductible for an individual and a $20,000.00 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 1-800-810-BLUE.
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.