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retiree-WNY-pre-65-options

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Western NY Medical Options Comparison

Below is a high-level comparison of the 2019 Western New York medical options for non-Medicare eligible participants who retired before December 31, 2015​. For details, visit the Independent Health or BCBS of Western NY websites.

Plan Features

  Independent Health HMO BCBS of Western NY
Annual Deductible Network Non-network Network Non-network
Retiree Only None $500 $500 $2,000
Retiree + One/Family None $1,000 $1,000 $4,000
Out-of-Pocket (OOP) Maximum
Retiree Only $6,350 $10,000 $5,000 $10,000
Retiree + One/Family $12,700 $20,000 $10,000 $20,000
Coinsurance/Copay Copay required for most services 25%
See plan summary for details		 Copay or coinsurance required for most services 50%
See plan summary for details

Covered Services

  Independent Health HMO BCBS of Western NY
  Network Network
  What You Pay
Outpatient  
Office visits Primary care physician: $20 copay
Specialist: $35 copay		 $20 copay
Preventive care 100% covered 100% covered
X-rays and lab work Lab: 100% covered
X-ray $20 copay		 10%
Physical therapy
(combined with occupational and speech therapy)		 $20 copay; max 20 visits/calendar year   10%; max 30 visits/calendar year
Chiropractor $35 copay $20 copay for medically necessary treatment only
Vision Care
Eye examinations $20 copay for routine eye exam;
$35 copay for medical		 100% covered, once every other year
Lenses $50 copay for single vision Discounts available on lenses and frames at participating providers
Frames 40% discount at EyeMed providers
Inpatient Hospital
Room and board $250 copay per admission 10% after deductible
Ancillary charges 100% covered after inpatient hospital copay 10% after deductible
Skilled Nursing
Skilled nursing facility 100% covered after $250 copay; up to 45 days/calendar year 10% after deductible
Surgery
Inpatient 100% covered after inpatient hospital copay 10% after deductible
Outpatient $75 copay outpatient facility
$20 copay physician office
$35 copay specialist office		 10%
Cosmetic Not covered Covered when medically necessary
Maternity Care
Obstetrical visits 100% covered after $20 copay first visit   100% covered after $20 copay first visit  
Hospitalization $250 copay per admission 10%
Mental Health
Inpatient $250 copay per admission 10% after deductible
Outpatient $20 copay 10%
Alcohol / Chemical Dependency
Inpatient detox/rehab 100% covered after inpatient hospital copay 10% after deductible
Outpatient detox/rehab $20 copay 10%
Other Services
Ambulance $100 copay 10% after deductible
Hospice care 100% covered 10%
Home health care PCP: $20 copay
Specialist: $35 copay,
40 visits/year max 		$20 copay/visit;
unlimited visit max
(out-of-network max: 365 visits)
Durable medical equipment 50% (no annual dollar limit) 50%
Emergency / Urgent Care
Emergency room $150 copay, waived if admitted 10% after deductible
Urgent care $35 copay 10%

Prescription Drugs

  Independent Health HMO
 BCBS of Western NY
(provided through Express Scripts)
  What You Pay
Retail (30-day supply)
Generic $10 copay $10 copay
Formulary brand $50 copay $30 copay
Nonformulary brand $100 copay $50 copay
Mail order (90-day supply)
Generic $25 copay $30 copay
Formulary brand $125 copay $90 copay
Nonformulary brand $250 copay $150 copay

 

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