Krapf offers a choice between three medical plans, all of which are administered by Independence Blue Cross (IBX). Medical benefits are not just for when you are sick… For example, if you use preventive benefits when you are well, you might actually be able to avoid getting sick!
Understanding your prescription drug benefit, and knowing how different types of medications will be covered, can help you save money and learn how to talk with your doctor about your options. Your prescription drug benefit gives you options for paying more or less for your prescription. When you fill a prescription from your doctor, you and the company share the cost. How you share costs depends on how your plan is set up.
To learn more about some of the key plan details that are important to understand, like deductible and coinsurance, click here.
To learn how the medical plans compare, review the plan similarities and differences, click here.
There are additional ways to save on your prescription costs:
- Mail order copays are only 2x the retail copay for a 90-day supply.
- Some medications are available at Wal-Mart or Target at a discounted rate rather than using insurance.*
- Your pharmacy may offer discount programs for a 90-day supply of generics.**
- Mail Order Pharmacy vendor is Future Scripts.
*Do not show your insurance card to receive the discount.
**Please check your local pharmacy for discounts.
Please find the HSA Fund Transfer Form under the Plan Documents tab. This form cannot be submitted until after 1/1/26.
-
Plan Definition
Highest employee premium, lowest deductible in-network, copays before deductible for some services.
-
Deductible
The amount of covered expenses you must pay before the Plan starts paying benefits.
In-network:
Individual: $1,000
Family: $2,000Out-of-network:
Individual: $3,000
Family: $9,000
-
Coinsurance
Cost-sharing between you and the company. This is applied after you meet your deductible.
In-network:
You pay 0% (after deductible) Plan pays 100%
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Out-of-Pocket Maximum
The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.
In-network:
Individual: $6,600
Family: $13,200Out-of-network:
Individual: $10,000
Family: $30,000
-
Doctor’s Office Visit
In-network:
You pay a $30 copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Specialist Office Visit
Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).
In-network:
You pay $50 copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Preventive/Well Child Care
Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.
In-network:
Covered 100%; No deductible or copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Laboratory Services
In-network:
Covered 100%; No deductible or copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)
In-network:
$50 copay / $100 copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Emergency Room
Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.
In-network:
Covered 100% after deductible
Out-of-network:
Covered at In-network level
-
Urgent Care
Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.
In-network:
You pay $50 copay (no deductible)
Out-of-network:
Covered 50% after deductible
-
Hospitalization
Inpatient In-network:
Plan pays $400/day; maximum of 5 days
Inpatient Out-of-network:
You pay 50% (after deductible) Plan pays 50%
Outpatient In-network:
Plan pays $50/visit
Outpatient Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Are you required to use network providers?
No (but your costs will be lower when you do)
-
Do you need a referral to a specialist?
No
-
Can I use a Health Savings Account (HSA)?
A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.
No
-
Can I use a Health Care Flexible Spending Account (FSA)?
An account you contribute to before taxes, then use the money for qualified health-related expenses.
Yes
-
Prescription Drug
Deductible - See Deductible above
Rx Deductible:
None
Retail (Up to 30-day supply)
In-network Only
Generic: $20 copay
Brand: $40 copay
Non Formulary: $75 copay
Retail (Up to 30-day supply)
Out-of-network Only
Generic: 30% reimbursement
Brand: 30% reimbursement
Non Formulary: 30% reimbursement
Mail Order (Up to 90-day supply)
In-network Only
Generic: $40 copay
Brand: $80 copay
Non Formulary: $150 copay
Mail Order (Up to 90-day supply)
Out-of-network Only
Generic: Not covered
Brand: Not covered
Non Formulary: Not covered
-
Click To Download Plan Documents:
PPO High Plan
Provider: Independence Blue Cross
Phone: 844-258-3463
Website: https://www.ibx.com/
To search for an in-network provider, go to www.ibx.com
(instructions below) or call your Benefit Guardian, Mary Gannon at 856-316-7300.
IBX – Find a Provider
- Go to www.ibx.com.
- Click on “Find a Doctor”.
- Click on “Find doctors, hospitals, medical equipment, and specialty services”.
- Enter the location that you want to search around.
- Select your plan (the same for all four plans):
- If you are searching around the Philadelphia, PA area, select Personal Choice PPO as your plan.
- If you are searching outside of the Philadelphia, PA area, select National BlueCard PPO as your plan.
- You can search by Provider Name, Specialty, or Type of Facility.
COVID-19 Over-the-Counter(OTC) Test Coverage
The COVID-19 pandemic is an evolving situation. The answers provided below, which are subject to change, are current as of January 21, 2022. We will continue to provide updates, as they become available.
Independence worked with our Pharmacy Benefits Manager, FutureScripts, an OptumRx company, to establish a new preferred network to cover the cost of the COVID-19 test at the point-of-sale without member cost sharing. Rite Aid, Walmart, and Sam’s Club pharmacies will be the initial retail Preferred Network Partners. We are looking to expand our preferred network in the days ahead as other retailers become operationally ready. We are also working to expand our direct coverage offering with a direct to-consumer shipping option with the OptumRx Store by the end of January.
If members choose to pay at the point of purchase outside of Rite Aid, Walmart, or Sam’s Club, they will need to submit a pharmacy claim form to FutureScripts for reimbursement. Members will be reimbursed for the cost they paid for the test or $12 per test, whichever amount is lower.
Independence continues to cover FDA-authorized COVID 19 diagnostic tests with no cost share for any member when ordered or administered by a health care provider following an individualized clinical assessment.
| PPO High Plan | PPO Low Plan | HDHP with HSA |
|---|---|---|
Plan DefinitionHighest employee premium, lowest deductible in-network, copays before deductible for some services. |
Plan DefinitionLower deductible than the HDHP plan but copays before deductible for some services. |
Plan DefinitionLowest employee premium, high deductible, employee funded HSA. |
DeductibleIn-network: Individual: $1,000 |
DeductibleIn-network: Individual: $2,000 |
DeductibleIn-network: Individual: $6,350 |
CoinsuranceIn-network: You pay 0% (after deductible) Plan pays 100% |
CoinsuranceIn-network: You pay 10% (after deductible) Plan pays 90% |
CoinsuranceIn-network: You pay 0% (after deductible) Plan pays 100% |
Out-of-Pocket MaximumIn-network: Individual: $6,600 |
Out-of-Pocket MaximumIn-network: Individual: $6,600 |
Out-of-Pocket MaximumIn-network: Individual: $6,350 |
Doctor’s Office VisitIn-network: You pay a $30 copay |
Doctor’s Office VisitIn-network: You pay a $30 copay |
Doctor’s Office VisitIn-network: You pay 0% (after deductible) Plan pays 100% |
Specialist Office VisitIn-network: You pay $50 copay |
Specialist Office VisitIn-network: You pay $50 copay |
Specialist Office VisitIn-network: You pay 0% (after deductible) Plan pays 100% |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesCovered 100% after deductible |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)In-network: $50 copay / $100 copay |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)In-network: $50 copay / $100 copay |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)Covered 100% after deductible |
Emergency RoomIn-network: Covered 100% after deductible |
Emergency RoomIn-network: Covered 90% after deductible |
Emergency RoomIn-network: Covered 100% after deductible |
Urgent CareIn-network: You pay $50 copay (no deductible) |
Urgent CareIn-network: You pay $50 copay (no deductible) |
Urgent CareIn-network: Covered 100% after deductible |
HospitalizationInpatient In-network: Plan pays $400/day; maximum of 5 days |
HospitalizationInpatient In-network: Covered 90% after deductible |
HospitalizationInpatient In-network: Covered 100% after deductible |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Do you need a referral to a specialist?No |
Do you need a referral to a specialist?No |
Do you need a referral to a specialist?No |
Can I use a Health Savings Account (HSA)?No |
Can I use a Health Savings Account (HSA)?No |
Can I use a Health Savings Account (HSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?You may only participate in the limited purpose FSA for qualified dental and vision expenses. |
Prescription DrugRx Deductible: Generic: $20 copay Brand: $40 copay Non Formulary: $75 copay
Generic: 30% reimbursement Brand: 30% reimbursement Non Formulary: 30% reimbursement
Generic: $40 copay Brand: $80 copay Non Formulary: $150 copay
Generic: Not covered Brand: Not covered Non Formulary: Not covered
|
Prescription DrugRx Deductible: Generic: $20 copay Brand: $40 copay Non Formulary: $75 copay
Generic: 30% reimbursement Brand: 30% reimbursement Non Formulary: 30% reimbursement
Generic: $40 copay Brand: $80 copay Non Formulary: $150 copay
Generic: Not covered Brand: Not covered Non Formulary: Not covered
|
Prescription DrugRx Deductible: Generic: Covered 100% after deductible Brand: Covered 100% after deductible Non Formulary: Covered 100% after deductible
Generic: 100% reimbursement Brand: 100% reimbursement Non Formulary: 100% reimbursement
Generic: Covered 100% after deductible Brand: Covered 100% after deductible Non Formulary: Covered 100% after deductible
Generic: Not covered Brand: Not covered Non Formulary: Not covered |
-
Plan Definition
Lower deductible than the HDHP plan but copays before deductible for some services.
-
Deductible
The amount of covered expenses you must pay before the Plan starts paying benefits.
In-network:
Individual: $2,000
Family: $4,000Out-of-network:
Individual: $4,000
Family: $12,000
-
Coinsurance
Cost-sharing between you and the company. This is applied after you meet your deductible.
In-network:
You pay 10% (after deductible) Plan pays 90%
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Out-of-Pocket Maximum
The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.
In-network:
Individual: $6,600
Family: $13,200Out-of-network:
Individual: $10,000
Family: $30,000
-
Doctor’s Office Visit
In-network:
You pay a $30 copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Specialist Office Visit
Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).
In-network:
You pay $50 copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Preventive/Well Child Care
Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.
In-network:
Covered 100%; No deductible or copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Laboratory Services
In-network:
Covered 100%; No deductible or copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)
In-network:
$50 copay / $100 copay
Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Emergency Room
Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.
In-network:
Covered 90% after deductible
Out-of-network:
Covered at in-network level
-
Urgent Care
Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.
In-network:
You pay $50 copay (no deductible)
Out-of-network:
Covered 50% after deductible
-
Hospitalization
Inpatient In-network:
Covered 90% after deductible
Outpatient In-network:
Plan pays $50/visit
Inpatient Out-of-network:
You pay 50% (after deductible) Plan pays 50%
Outpatient Out-of-network:
You pay 50% (after deductible) Plan pays 50%
-
Are you required to use network providers?
No (but your costs will be lower when you do)
-
Do you need a referral to a specialist?
No
-
Can I use a Health Savings Account (HSA)?
A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.
No
-
Can I use a Health Care Flexible Spending Account (FSA)?
An account you contribute to before taxes, then use the money for qualified health-related expenses.
Yes
-
Prescription Drug
Rx Deductible:
$250
Retail (Up to 30-day supply)
In-network Only
Generic: $20 copay
Brand: $40 copay
Non Formulary: $75 copay
Retail (Up to 30-day supply)
Out-of-network Only
Generic: 30% reimbursement
Brand: 30% reimbursement
Non Formulary: 30% reimbursement
Mail Order (Up to 90-day supply)
In-network Only
Generic: $40 copay
Brand: $80 copay
Non Formulary: $150 copay
Mail Order (Up to 90-day supply)
Out-of-network Only
Generic: Not covered
Brand: Not covered
Non Formulary: Not covered
-
Click To Download Plan Documents:
PPO Low Plan
Provider: Independence Blue Cross
Phone: 844-258-3463
Website: https://www.ibx.com/
To search for an in-network provider, go to www.ibx.com
(instructions below) or call your Benefit Guardian, Mary Gannon at 856-316-7300.
IBX – Find a Provider
- Go to www.ibx.com.
- Click on “Find a Doctor”.
- Click on “Find doctors, hospitals, medical equipment, and specialty services”.
- Enter the location that you want to search around.
- Select your plan (the same for all four plans):
- If you are searching around the Philadelphia, PA area, select Personal Choice PPO as your plan.
- If you are searching outside of the Philadelphia, PA area, select National BlueCard PPO as your plan.
- You can search by Provider Name, Specialty, or Type of Facility.
COVID-19 Over-the-Counter(OTC) Test Coverage
The COVID-19 pandemic is an evolving situation. The answers provided below, which are subject to change, are current as of January 21, 2022. We will continue to provide updates, as they become available.
Independence worked with our Pharmacy Benefits Manager, FutureScripts, an OptumRx company, to establish a new preferred network to cover the cost of the COVID-19 test at the point-of-sale without member cost sharing. Rite Aid, Walmart, and Sam’s Club pharmacies will be the initial retail Preferred Network Partners. We are looking to expand our preferred network in the days ahead as other retailers become operationally ready. We are also working to expand our direct coverage offering with a direct to-consumer shipping option with the OptumRx Store by the end of January.
If members choose to pay at the point of purchase outside of Rite Aid, Walmart, or Sam’s Club, they will need to submit a pharmacy claim form to FutureScripts for reimbursement. Members will be reimbursed for the cost they paid for the test or $12 per test, whichever amount is lower.
Independence continues to cover FDA-authorized COVID 19 diagnostic tests with no cost share for any member when ordered or administered by a health care provider following an individualized clinical assessment.
| PPO Low Plan | PPO High Plan | HDHP with HSA |
|---|---|---|
Plan DefinitionLower deductible than the HDHP plan but copays before deductible for some services. |
Plan DefinitionHighest employee premium, lowest deductible in-network, copays before deductible for some services. |
Plan DefinitionLowest employee premium, high deductible, employee funded HSA. |
DeductibleIn-network: Individual: $2,000 |
DeductibleIn-network: Individual: $1,000 |
DeductibleIn-network: Individual: $6,350 |
CoinsuranceIn-network: You pay 10% (after deductible) Plan pays 90% |
CoinsuranceIn-network: You pay 0% (after deductible) Plan pays 100% |
CoinsuranceIn-network: You pay 0% (after deductible) Plan pays 100% |
Out-of-Pocket MaximumIn-network: Individual: $6,600 |
Out-of-Pocket MaximumIn-network: Individual: $6,600 |
Out-of-Pocket MaximumIn-network: Individual: $6,350 |
Doctor’s Office VisitIn-network: You pay a $30 copay |
Doctor’s Office VisitIn-network: You pay a $30 copay |
Doctor’s Office VisitIn-network: You pay 0% (after deductible) Plan pays 100% |
Specialist Office VisitIn-network: You pay $50 copay |
Specialist Office VisitIn-network: You pay $50 copay |
Specialist Office VisitIn-network: You pay 0% (after deductible) Plan pays 100% |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesCovered 100% after deductible |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)In-network: $50 copay / $100 copay |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)In-network: $50 copay / $100 copay |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)Covered 100% after deductible |
Emergency RoomIn-network: Covered 90% after deductible |
Emergency RoomIn-network: Covered 100% after deductible |
Emergency RoomIn-network: Covered 100% after deductible |
Urgent CareIn-network: You pay $50 copay (no deductible) |
Urgent CareIn-network: You pay $50 copay (no deductible) |
Urgent CareIn-network: Covered 100% after deductible |
HospitalizationInpatient In-network: Covered 90% after deductible |
HospitalizationInpatient In-network: Plan pays $400/day; maximum of 5 days |
HospitalizationInpatient In-network: Covered 100% after deductible |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Do you need a referral to a specialist?No |
Do you need a referral to a specialist?No |
Do you need a referral to a specialist?No |
Can I use a Health Savings Account (HSA)?No |
Can I use a Health Savings Account (HSA)?No |
Can I use a Health Savings Account (HSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?You may only participate in the limited purpose FSA for qualified dental and vision expenses. |
Prescription DrugRx Deductible: Generic: $20 copay Brand: $40 copay Non Formulary: $75 copay
Generic: 30% reimbursement Brand: 30% reimbursement Non Formulary: 30% reimbursement
Generic: $40 copay Brand: $80 copay Non Formulary: $150 copay
Generic: Not covered Brand: Not covered Non Formulary: Not covered
|
Prescription DrugRx Deductible: Generic: $20 copay Brand: $40 copay Non Formulary: $75 copay
Generic: 30% reimbursement Brand: 30% reimbursement Non Formulary: 30% reimbursement
Generic: $40 copay Brand: $80 copay Non Formulary: $150 copay
Generic: Not covered Brand: Not covered Non Formulary: Not covered
|
Prescription DrugRx Deductible: Generic: Covered 100% after deductible Brand: Covered 100% after deductible Non Formulary: Covered 100% after deductible
Generic: 100% reimbursement Brand: 100% reimbursement Non Formulary: 100% reimbursement
Generic: Covered 100% after deductible Brand: Covered 100% after deductible Non Formulary: Covered 100% after deductible
Generic: Not covered Brand: Not covered Non Formulary: Not covered |
-
Plan Definition
Lowest employee premium, high deductible, employee funded HSA.
Krapf 2025 HSA Contributions - $250/$500 Krapf 2026 HSA Contributions – $500/$1,000
-
Deductible
The amount of covered expenses you must pay before the Plan starts paying benefits.
In-network:
Individual: $6,350
Family: $12,700Out-of-network:
Individual: $6,350
Family: $12,700
-
Coinsurance
Cost-sharing between you and the company. This is applied after you meet your deductible.
In-network:
You pay 0% (after deductible) Plan pays 100%
Out-of-network:
You pay 0% (after deductible) Plan pays 100%
-
Out-of-Pocket Maximum
The most you are required to pay out of your own pocket in a plan year. Some expenses may not apply.
In-network:
Individual: $6,350
Family: $12,700Out-of-network:
Individual: $6,350
Family: $12,700
-
Doctor’s Office Visit
In-network:
You pay 0% (after deductible) Plan pays 100%
Out-of-network:
You pay 0% (after deductible) Plan pays 100%
-
Specialist Office Visit
Specialists include doctors trained in a specific area or function of the body, or a specific age group (cardiologist, pediatrician, orthopedic surgeon, neurologist, etc.).
In-network:
You pay 0% (after deductible) Plan pays 100%
Out-of-network:
You pay 0% (after deductible) Plan pays 100%
-
Preventive/Well Child Care
Care focused on prevention or early detection of health conditions. Includes routine physical exam, immunizations, cancer screenings, vision and hearing exams, etc.
In-network:
Covered 100%; No deductible or copay
Out-of-network:
Covered 100%; No deductible or copay
-
Laboratory Services
Covered 100% after deductible
-
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)
Covered 100% after deductible
-
Emergency Room
Provides accidental injury and medical emergency care. Note: Call your plan immediately if you are admitted to the hospital.
In-network:
Covered 100% after deductible
Out-of-network:
Covered 100% after deductible
-
Urgent Care
Non-emergency care received from an urgent care clinic or other medical facility; typically used after hours or when your regular doctor is not available.
In-network:
Covered 100% after deductible
Out-of-network:
Covered 100% after deductible
-
Hospitalization
Inpatient In-network:
Covered 100% after deductible
Outpatient In-network:
Covered 100% after deductible
Inpatient Out-of-network:
Covered 100% after deductible
Outpatient Out-of-network:
Covered 100% after deductible
-
Are you required to use network providers?
No (but your costs will be lower when you do)
-
Do you need a referral to a specialist?
No
-
Can I use a Health Savings Account (HSA)?
A feature of high-deductible or consumer-driven medical plans, this is a tax-advantaged savings account you can use for medical expenses now or save for later.
Yes
-
Can I use a Health Care Flexible Spending Account (FSA)?
An account you contribute to before taxes, then use the money for qualified health-related expenses.
You may only participate in the limited purpose FSA for qualified dental and vision expenses.
-
Prescription Drug
Rx Deductible:
Medical deductible applies
Retail (Up to 30-day supply)
In-network Only
Generic: Covered 100% after deductible
Brand: Covered 100% after deductible
Non Formulary: Covered 100% after deductible
Retail (Up to 30-day supply)
Out-of-network Only
Generic: 100% reimbursement
Brand: 100% reimbursement
Non Formulary: 100% reimbursement
Mail Order (Up to 90-day supply)
In-network Only
Generic: Covered 100% after deductible
Brand: Covered 100% after deductible
Non Formulary: Covered 100% after deductible
Mail Order (Up to 90-day supply)
Out-of-network Only
Generic: Not covered
Brand: Not covered
Non Formulary: Not covered
-
Click To Download Plan Documents:
HDHP with HSA
Provider: Independence Blue Cross
Phone: 844-258-3463
Website: https://www.ibx.com/
To search for an in-network provider, go to www.ibx.com
(instructions below) or call your Benefit Guardian, Mary Gannon at 856-316-7300.
IBX – Find a Provider
- Go to www.ibx.com.
- Click on “Find a Doctor”.
- Click on “Find doctors, hospitals, medical equipment, and specialty services”.
- Enter the location that you want to search around.
- Select your plan (the same for all four plans):
- If you are searching around the Philadelphia, PA area, select Personal Choice PPO as your plan.
- If you are searching outside of the Philadelphia, PA area, select National BlueCard PPO as your plan.
- You can search by Provider Name, Specialty, or Type of Facility.
COVID-19 Over-the-Counter(OTC) Test Coverage
The COVID-19 pandemic is an evolving situation. The answers provided below, which are subject to change, are current as of January 21, 2022. We will continue to provide updates, as they become available.
Independence worked with our Pharmacy Benefits Manager, FutureScripts, an OptumRx company, to establish a new preferred network to cover the cost of the COVID-19 test at the point-of-sale without member cost sharing. Rite Aid, Walmart, and Sam’s Club pharmacies will be the initial retail Preferred Network Partners. We are looking to expand our preferred network in the days ahead as other retailers become operationally ready. We are also working to expand our direct coverage offering with a direct to-consumer shipping option with the OptumRx Store by the end of January.
If members choose to pay at the point of purchase outside of Rite Aid, Walmart, or Sam’s Club, they will need to submit a pharmacy claim form to FutureScripts for reimbursement. Members will be reimbursed for the cost they paid for the test or $12 per test, whichever amount is lower.
Independence continues to cover FDA-authorized COVID 19 diagnostic tests with no cost share for any member when ordered or administered by a health care provider following an individualized clinical assessment.
| HDHP with HSA | PPO High Plan | PPO Low Plan |
|---|---|---|
Plan DefinitionLowest employee premium, high deductible, employee funded HSA. |
Plan DefinitionHighest employee premium, lowest deductible in-network, copays before deductible for some services. |
Plan DefinitionLower deductible than the HDHP plan but copays before deductible for some services. |
DeductibleIn-network: Individual: $6,350 |
DeductibleIn-network: Individual: $1,000 |
DeductibleIn-network: Individual: $2,000 |
CoinsuranceIn-network: You pay 0% (after deductible) Plan pays 100% |
CoinsuranceIn-network: You pay 0% (after deductible) Plan pays 100% |
CoinsuranceIn-network: You pay 10% (after deductible) Plan pays 90% |
Out-of-Pocket MaximumIn-network: Individual: $6,350 |
Out-of-Pocket MaximumIn-network: Individual: $6,600 |
Out-of-Pocket MaximumIn-network: Individual: $6,600 |
Doctor’s Office VisitIn-network: You pay 0% (after deductible) Plan pays 100% |
Doctor’s Office VisitIn-network: You pay a $30 copay |
Doctor’s Office VisitIn-network: You pay a $30 copay |
Specialist Office VisitIn-network: You pay 0% (after deductible) Plan pays 100% |
Specialist Office VisitIn-network: You pay $50 copay |
Specialist Office VisitIn-network: You pay $50 copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Preventive/Well Child CareIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesCovered 100% after deductible |
Laboratory ServicesIn-network: Covered 100%; No deductible or copay |
Laboratory ServicesIn-network: Covered 100%; No deductible or copay |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)Covered 100% after deductible |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)In-network: $50 copay / $100 copay |
Diagnostic Radiology / Complex Imaging (MRI/PET/CT)In-network: $50 copay / $100 copay |
Emergency RoomIn-network: Covered 100% after deductible |
Emergency RoomIn-network: Covered 100% after deductible |
Emergency RoomIn-network: Covered 90% after deductible |
Urgent CareIn-network: Covered 100% after deductible |
Urgent CareIn-network: You pay $50 copay (no deductible) |
Urgent CareIn-network: You pay $50 copay (no deductible) |
HospitalizationInpatient In-network: Covered 100% after deductible |
HospitalizationInpatient In-network: Plan pays $400/day; maximum of 5 days |
HospitalizationInpatient In-network: Covered 90% after deductible |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Are you required to use network providers?No (but your costs will be lower when you do) |
Do you need a referral to a specialist?No |
Do you need a referral to a specialist?No |
Do you need a referral to a specialist?No |
Can I use a Health Savings Account (HSA)?Yes |
Can I use a Health Savings Account (HSA)?No |
Can I use a Health Savings Account (HSA)?No |
Can I use a Health Care Flexible Spending Account (FSA)?You may only participate in the limited purpose FSA for qualified dental and vision expenses. |
Can I use a Health Care Flexible Spending Account (FSA)?Yes |
Can I use a Health Care Flexible Spending Account (FSA)?Yes |
Prescription DrugRx Deductible: Generic: Covered 100% after deductible Brand: Covered 100% after deductible Non Formulary: Covered 100% after deductible
Generic: 100% reimbursement Brand: 100% reimbursement Non Formulary: 100% reimbursement
Generic: Covered 100% after deductible Brand: Covered 100% after deductible Non Formulary: Covered 100% after deductible
Generic: Not covered Brand: Not covered Non Formulary: Not covered |
Prescription DrugRx Deductible: Generic: $20 copay Brand: $40 copay Non Formulary: $75 copay
Generic: 30% reimbursement Brand: 30% reimbursement Non Formulary: 30% reimbursement
Generic: $40 copay Brand: $80 copay Non Formulary: $150 copay
Generic: Not covered Brand: Not covered Non Formulary: Not covered
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Prescription DrugRx Deductible: Generic: $20 copay Brand: $40 copay Non Formulary: $75 copay
Generic: 30% reimbursement Brand: 30% reimbursement Non Formulary: 30% reimbursement
Generic: $40 copay Brand: $80 copay Non Formulary: $150 copay
Generic: Not covered Brand: Not covered Non Formulary: Not covered
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