Major Medical

HEALTH DEPARTMENT

Independence Administrators (IA) are the Fund's major medical insurance provider for doctors, hospitals, and specialists. When Participants visit providers who are in-network with Independence Administrators, the Fund pays the coinsurance percentage (80%) of the total IA allowance, leaving the Participant responsible for the their coinsurance portion of 20%, plus the individual deductible (if applicable). Participants are responsible for the coinsurance until they have met their out-of-pocket maximum (OOP). 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 (January 1 through December 31).

Website

MyIBXTPAbenefits.com

Phone

1-833-242-3330

Personal Choice Coinsurance Coverage

Major Medial Coverage Plan

80/20 Coinsurance

Active Eligibility - 800 or 1600 hours per corresponding work period
Members must have either 800 or 1600 hours during the cooresponding 6-month or 12-month Work Periods.
Out-of-Pocket Maximums - $3,250 / $9,750
$3,250 Individual / 9,750 Family. Plan pays 100% of in-network claims for the remainder of the Plan Year, once your out-of-pocket maximum has been met.
Individual Deductible - $250 with a max of three per family
The Participant pays all costs from providers up to the $250 individual deductible amount before the Plan begins to pay. There is a maximum of three individual $250 deductibles per family in a Plan Year.

Find an In-Network Provider

Summary of Benefits and Coverage

(Including out-of-network benefits)

Click Here to Download

Additional Benefits Covered Through Independence Administrators

Diagnostic or Imaging Tests

Chiropractic Care

Acupuncture Treatment

Ambulance Services

Diagnostic or Imaging Tests

In-network lab, doctor or hospital diagnostic or imaging tests (Lab Work, X-Ray, CT/PET scans, MRIs) are covered under your 80/20 coinsurance coverage. Plus the induvial deductible (if applicable).

All testing must be done on an outpatient basis except when hospitalization is medically necessary.

Chiropractic Care

In-network Chiropractic Care is covered with a limit of $62.50 per visit.

If you go out-of-network, services will be covered under the 70/30 Coinsurance with separate $250 deductible.

Acupuncture Treatment

Use the Independence Administrators insurance card at any in-network acupuncture treatment facility to be covered under the 80/20 Coinsurance Plan.

If you go out-of-network, services will be covered under the 70/30 Coinsurance with separate $250 deductible.

Ambulance Services

Both ground and air Ambulance benefits are covered through Independence Administrators.

Medical Coverage FAQs

Are Doctor and Specialist visits covered?

Do you need a referral to see a specialist?

What is the difference between a deductible, a co-pay, and coinsurance?

A deductible is the initial amount of money you must pay for health care services before your insurance starts to pay for covered services. Your Plan has an In-Network individual deductible of $250. With a max of three individual deductibles per family.

A co-pay is a fixed dollar amount you are required to pay for health care services. For example, if you fill a 30-day generic prescription you would have a $10 co-pay.

Coinsurance is the set percentage of the allowed amount you are required to pay for health care services. For example, the Plan pays 80% and the Participant pays 20%.

Is there an "Out-of-Pocket Maximum," and what does that mean?

What are the "Out-of-Network" Benefits?

Can I use an Urgent Care Facility, or a Minute Clinic at a pharmacy?

Where can I find a list of Participating Independence Administrator's Providers?

What is considered Preventative Care?

Where do I send my Independence Administrators Claims to?

Key Terms and Definitions

Active Participant or Participant

Covered Employment

Covered Person

Eligible Dependent

Preferred Provider Organization (PPO)

“Preferred Provider Organization” is a group of Hospitals and/or Physicians or other providers selected by the Fund to be utilized by Covered Persons to receive benefits on an “In-Network” basis as described in the Comprehensive Schedule of Major Medical Benefits. You are encouraged to utilize the PPO network whenever possible. Receiving care on an “In-Network” basis is generally more cost effective for yourself and the Plan than receiving care on an “Out-of-Network” basis.

Reasonable and Customary

Want to Know More About Your Benefits?

Find out what's covered under the Fund's extensive Benefit Plan.

BENEFIT COVERAGE