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Frequently Asked Questions

Frequently Asked Questions About What Health Insurance Covers

What Services Do All Health Insurance Plans Cover?

All plans offered to people who purchase their own health insurance must include a core set of Essential Health Benefits, as shown in the chart below.

Essential Health Benefit

Example

Preventive, wellness, and disease management services

Yearly physical, flu shot, gynecological exam, birth control

Emergency care

Treatment for broken bones, heart attacks, and more at a hospital emergency room

Ambulatory services

Minor surgeries, blood tests, X-rays

Hospitalization

Treatment at a hospital for a condition that requires you to stay overnight or multiple days

Maternity and newborn services

Care through the course of a pregnancy, delivery of the baby, and checkups after the baby is born

Pediatric services, including dental1 and vision

Well visits, shots to prevent serious health conditions, teeth cleanings and exams, frames, lenses

Prescription drugs

High blood pressure medicine, insulin, antibiotics, birth control pills

Laboratory services

Blood tests

Mental health and substance abuse services, including behavioral health treatment

Getting help to deal with conditions like depression, alcohol abuse, and drug abuse

Rehabilitation and habilitation services

Physical therapy, speech therapy, occupational therapy

Scroll or swipe to reveal all table data.

In addition, insurers will cover 100 percent of the cost of many preventive services, such as wellness visits, immunizations, screenings for cancer, and other diseases if the services are received from an in-network provider. That means you will not pay any deductible, copayments, or coinsurance for many preventive services that can help you stay healthy.

What Do the Metallic Levels Mean?

With the Affordable Care Act, the federal government created four categories of coverage — metallic levels — for health plans offered to small businesses (2 – 50 employees) and for people who purchase their own insurance. Plans are assigned one of these metallic levels based on what percentage of the cost of health care services is covered by the health insurance company. These categories — bronze, silver, gold, and platinum — make it easier for you to compare health plans across health insurance companies. All products cover Essential Health Benefits like doctor visits, prescription drugs, X-rays, and hospital stays. The major differences are in what you pay when you need these services and the monthly cost of the health plan. Learn how to shop for health insurance plans.

How the metallic levels compare on costs:

metallic levels comparison

Is Routine Eye Care Covered?

Routine eye care for adults is covered in Personal Choice® PPO Silver. Other Independence Blue Cross health plans do not cover routine eye care for adults. Routine eye care for children under age 19 is considered an essential health benefit and is available with all plans. To learn more, refer to the Benefits at a Glance for each plan. You can also explore the Adult Vision care plans that can be purchased in addition to medical coverage. These plans offer comprehensive benefits such as routine eye care, frames, and lenses.

How Do I Use My Pediatric Vision Benefit?

Pediatric vision benefits cover in-network care only for children up to age 19. In-network benefits are covered when you visit a Davis Vision provider. Independence Blue Cross Vision Care is administered by Davis Vision, an independent company.

Will I Receive a Separate ID Card For My Pediatric Vision Benefit?

A separate card is not provided for pediatric vision coverage.

What Happens to the Pediatric Vision Benefit When My Child Turns 19 Years Old?

Pediatric vision coverage will be terminated the last day of the month in which he or she turns 19. You can purchase an Adult Vision plan for a dependent who turns 19 and is no longer eligible for pediatric vision coverage.

Is Routine Dental Care Covered?

Routine dental care for adults is not covered in our individual health plans. Routine dental care for children under age 19 is considered an essential health benefit and is available with all plans, except Personal Choice® Bronze Basic. To learn more, refer to the Benefits at a Glance for each plan. You can also explore the Adult Dental plans that can be purchased in addition to medical coverage. These plans offer the benefits you need to support prevention, early diagnosis, and treatment for good oral health.

How Do I Use My Pediatric Dental Benefit?

Pediatric dental benefits are in-network coverage only for children up to age 19. In-network benefits are only paid when visiting a United Concordia provider. Independence Blue Cross dental plans are administered by United Concordia, an independent company.

Will I Receive a Separate ID Card For My Pediatric Dental Benefits?

A separate card is not provided for pediatric dental coverage.

What Happens to the Pediatric Dental Benefit When My Child Turns 19 Years Old?

Pediatric dental coverage will be terminated the last day of the year in which he or she turns 19. Adult Dental plans can be purchased for these dependents.

Are Emergency Services Covered?

Yes. You are covered for medically necessary services for unexpected illnesses or emergency care no matter where you are. Learn more about your emergency care options.

Are Maternity Services Covered?

Maternity and newborn services are considered an essential health benefit and are covered by all Independence Blue Cross health plans.

Are Mental Health Care Services Covered?

Mental health and substance abuse services, including behavioral health treatment, are considered an essential health benefit and available with all plans.

How Do I Get Support For Chronic Conditions?

Our condition management program, which supports members with chronic conditions, is available to you free of charge. Condition Management support includes:

  • Information and support when you are facing medical decisions or treatment options
  • Help when you are living with chronic conditions such as diabetes or asthma
  • Access to Independence Blue Cross Health Coaches, a 24/7 point of contact that provides individualized and coordinated advice and support. Independence Blue Cross Health Coaches can look at your condition(s), prescription drugs, recent diagnostic or therapeutic activities, and patterns of treatment and offer meaningful assistance as they support you through the health care spectrum. Health Coaches can provide:
    • Information on everyday health concerns, such as headaches and joint pain
    • Personalized calls about chronic conditions or health concerns
    • Information about what types of questions to ask the doctor

What Is the Preventive Plus Benefit?

All health plans include a Preventive Plus benefit with $0 member cost-sharing (no copayment, deductible, or coinsurance) when a member receives a preventive colonoscopy to screen for colorectal cancer at a Preventive Plus provider — which are providers that are not hospital-based — and it is performed by a Preventive Plus professional (a gastroenterologist or a colon and rectal surgeon). To find participating Preventive Plus providers, use our Find a Doctor tool.

What Is Telemedicine (offered by MDLIVE2)?

With telemedicine from MDLIVE, you can access a board-certified doctor via secure online video, phone, or the MDLIVE App — anytime, anywhere, 24/7/365. MDLIVE was designed as an alternative to expensive urgent care visits or waiting days to get an appointment with your primary care physician for non-emergency medical conditions. Our doctors can diagnose your symptoms, prescribe non-narcotic medication (if needed), and send e-prescriptions to your pharmacy of choice.3

Who Is MDLIVE?

MDLIVE is a national vendor that connects individuals to board-certified physicians via HIPAA-secure video, telephone, or mobile app 24/7, 365 days a year.

Is Telemedicine Appropriate For Every Medical Condition?

No. Telemedicine from MDLIVE is designed to handle non-emergency medical conditions and can often substitute for a doctor’s office, urgent care center, or emergency room visit for common conditions like the flu or pink eye. However, it is not intended to replace your primary care physician or to be used in life-threatening emergencies. You should not use MDLIVE if you are experiencing a medical emergency. In case of a life-threatening emergency, dial 911 immediately.

How Do I Sign Up For Telemedicine or Activate My MDLIVE Account?

You can easily sign up or activate your account by using one of the following methods:

  • Download the MDLIVE app on your smartphone
  • Visit mdlive.com/ibx
  • Call 1-877-764-6605

1 Personal Choice Bronze Basic does not cover pediatric dental and is only available through the Federal Health Insurance Marketplace at Healthcare.gov.

2 MDLIVE is an independent company providing telemedicine services for Independence Blue Cross.

3 Some state laws require that a doctor only prescribe medication in certain situations and subject to certain limitations.