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retiree-WNY-post-65-options

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Western New York Medical Option
For Retirees Age 65 and Older

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.

Plan Features

  In-Network Non-Network

Annual Deductible

None

None

Out-of-Pocket (OOP) Maximum

$3,400

$5,100

Coinsurance/Copay

Copay required
for most services

20%
See plan summary for details

Covered Services

  Network
Outpatient  What You Pay

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

$20 copay

Vision Care  

Eye examinations

$20 copay for routine eye exam;
$20 copay/visit for treatment due to illness or injury

Eyeglasses

Up to $150 allowance annually

Inpatient Hospital  

Room and board

$250 copay/admission

Ancillary charges

100% covered after inpatient hospital copay

Intensive Care, Cardiac Care Unit

100% covered after inpatient hospital copay

Skilled Nursing

Skilled nursing facility

100% covered after inpatient hospital copay; up to 100 days/calendar year

Surgery

Inpatient

100% covered after inpatient hospital copay

Outpatient

$75 copay

Cosmetic

Not covered

Mental Health

Inpatient  

$250 copay/admission, 190 days lifetime max

Outpatient

$40 copay

Alcohol and Chemical Dependency

Inpatient detox/rehab 

100% covered after inpatient hospital copay

Outpatient detox/rehab 

$20 copay

Other Services

Ambulance

$50 copay

Hospice care

100% covered under Medicare

Home health care

100% covered

Durable medical equipment

20%; must be medically necessary

Emergency / Urgent Care

Emergency room

$50 copay, waived if admitted

Urgent care

$35 copay

Prescription Drugs

  Independent Health HMO
  What you pay
Retail (30-day supply)  
Generic $10 copay
Formulary brand $30 copay
Nonformulary brand $50 copay
Mail order (90-day supply)  
Generic $25 copay
Formulary brand $75 copay
Nonformulary brand Not covered

 

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