Below is a high-level overview of the Independent HMO available only to Western New York retirees age 65 and older who retired before December 31, 2015. For details, visit the Independent Health website.
Annual Deductible
None
Out-of-Pocket (OOP) Maximum
$3,400
$5,100
Coinsurance/Copay
Copay required for most services
20% See plan summary for details
Office visits
Primary care physician: $10 copay Specialist: $20 copay
Preventive care
100% covered
X-rays and lab work
Lab: 100% covered X-ray $20 copay
Physical therapy
$20 copay
Chiropractor
Eye examinations
$20 copay for routine eye exam; $20 copay/visit for treatment due to illness or injury
Eyeglasses
Up to $150 allowance annually
Room and board
$250 copay/admission
Ancillary charges
100% covered after inpatient hospital copay
Intensive Care, Cardiac Care Unit
Skilled nursing facility
100% covered after inpatient hospital copay; up to 100 days/calendar year
Inpatient
Outpatient
$75 copay
Cosmetic
Not covered
$250 copay/admission, 190 days lifetime max
$40 copay
Inpatient detox/rehab
Outpatient detox/rehab
Ambulance
$50 copay
Hospice care
100% covered under Medicare
Home health care
Durable medical equipment
20%; must be medically necessary
Emergency room
$50 copay, waived if admitted
Urgent care
$35 copay
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