If you own a house, a car or even a smartphone, you may already be familiarwith how a deductible plan works. You purchase insurance, but you pay a certain amount of money for services you need before your insurance coversthe rest – that is called your deductible. Once you’ve reached the deductible,your insurance coverage kicks in.

Your deductible health plan operates in a similar fashion. Deductible health plansgenerally have lower premiums (the amount you pay for health insurance) withhigher deductibles (the amount you must spend before Independent Healthstarts to contribute).

Although you’re responsible for paying more upfront, you immediately begin saving through the advantage of negotiated rates (see next page) Independent Health has with providers. Plus, there are a variety of ways you can save money on health care services. For example, seeing your primary care physician is usually a much lower out-of-pocket expense than visiting the emergency room.

How a Typical Deductible Plan Works

100%Independent

Health

Preventive Services Health Care Services

Independent Healthprovides full coverageregardless of whetheror not you have met

your deductible

F O R I L L U S T R A T I V E P U R P O S E S O N LY.

$20

Once the deductibleamount is reached,

you pay a copay

Independent Health pays

You pay

You pay a deductibleup to a certain amount

for medical care(e.g., a hospital stay)

100%Plan copays and benefitsvary by plan

Understanding How Your Deductible Health PlanWorks

Note: You may be able to use a tax-free account to help pay for your portion of the costs.

F O R I L L U S T R A T I V E P U R P O S E S O N LY.

Once the deductibleamount is reached, you pay copayment

or coinsurance

Independent Health pays

You pay

You pay a deductibleup to a certain amount

for medical care(e.g., a hospital stay)

100%Plan coverageamounts and benefits vary

by plan

100%

What am I covered for?

• Primary care and specialist visits • Inpatient/outpatient hospital care

• Urgent care • Prescription drugs

• Emergency coverage • And more

Log in to your account at independenthealth.com to view your benefits. If I’m paying upfront and in full for services, why do I need insurance?

Independent Health has contracts with its providers. That means when you receive a covered health care service (e.g., MRI, PET scan, etc.) from an in-network provider, you’re paying for it at a negotiated rate that’s usually less than what the provider charges. People without health insurance, on average, pay twice as much for health care*.

Having coverage through Independent Health also means that you receive FREE preventive care**, regardless of yourdeductible. You’ll pay $0 for a number of preventive services, such as:

• Routine checkups • Diabetes screenings

• Vaccinations • Cholesterol and high blood pressure screenings

• Cancer screenings

Visit independenthealth.com/preventive for a list of more than 60 free preventive services. What happens when I reach my deductible?

Once you’ve reached your deductible, you only have to pay either a percentage of the cost, which is called coinsurance, or a fixed amount, called a copayment or copay. Keep in mind that deductible amounts vary based on the health plan you’re in.

Here’s a typical example of a high-deductible health plan with copays after deductible:

You’ve now hit your deductible, meaning

you’re in the copayment phase

of your plan.Independent Health covers the rest ($80).

If your copay is $20 and the next doctor visit costs $100, you pay only

$20

You have adeductible of

$2,000

You visit the emergency room for a broken arm and pay

$1,000for the visit, reducing your deductible by half the amount. $1,000

You continue to see the doctor when sick, a physical therapist, and other specialists throughout the year. Each visit is paid for by you in full, adding up to another

What are the benefits of having a deductible plan?

There are many advantages to being in an Independent Health deductibleplan, which include:

• Lower Premiums — Because you pay more upfront at the time of service, you enjoy predictable, lower-monthly premiums throughoutthe year.

• Deductible Tracker† — You’ll always know where you are in your deductible with the help of our online deductible tracker. It keeps track of your spending so you don’t have to.

• High-Cost Protection — Out-of-pocket maximums give you financial protection by limiting how much you’re expected to spend during a benefit year, aside from your annual premium.

• Tax-Free Savings — Depending on your plan, you may be able to setaside dollars in a tax-free account to use toward out-of-pocket expensesassociated with your deductible.

— If offered by your employer, you can pair your deductible plan with a Health Reimbursement Account(HRA) and/or a Flexible Spending Account (FSA).

— If your plan qualifies, you can also pair your high-deductible plan with a Health Savings Account (HSA)that can be funded by you, your employer, or a combination of both — up to a yearly contribution limit. Any unused funds deposited can earn interest, tax free, carry over year-to-year and move with you if youswitch jobs.

How can I reduce my out-of-pocket costs?

With Independent Health, you get exclusive member benefits that can help you get and stay healthy:

• 24-Hour Medical Help Line – Get FREE medical advice from a registered nurse.

• $0 Preventive Services** – Take charge of your health with 60+ FREE health screenings.

• Telemedicine Benefit – Connect with a doctor 24/7, for a $0 copay on most services.††

• Wellness Discounts – Show your member ID card to SAVE on health goods and services.

Find even more tools, resources and ways to save:

• Check out potential savings when seeking care at a freestanding facility vs. a hospital

• Compare the cost savings of generic prescription drugs vs. brand name

Learn more at independenthealth.com/waystosave.

We’re here to help

If you have questions about your plan benefits, call our Member Services Department at (716) 631-8701 or 1-800-501-3439, Monday – Friday, 8 a.m. – 8 p.m., or email at memberservice@servicing.independenthealth.com.

The money you depositinto a health savings

account (HSA) could bematched up to a certain

amount by your employer, if applicable.

Visit your Human Resources Departmentfor more information.

MAKE IT COUNT

Glossary of Terms

COINSURANCE – Once you’ve reached your deductible, you begin to pay only a percentage of the cost and Independent Health pays the rest. For example, if your doctor visit is $100 and you’ve met your deductible, your coinsurance payment of 20% would be $20 and Independent Health pays $80.

COPAYMENT (COPAY) – A fixed dollar amount that you pay for a covered health care service. For example, if yourcopay is $15 for a doctor visit but the visit itself costs $100, Independent Health pays the difference of $85.

COVERED IN FULL – Independent Health covers 100% of the cost. You are not responsible for any of the expense**.

DEDUCTIBLE – The amount you must spend out of pocket before Independent Health starts to contribute. For example, if your deductible is $1,000, Independent Health doesn’t pay anything until you’ve met your $1,000 deductible for covered health care services that are subject to the deductible. A deductible does not apply to all services, such as preventive care**.

HEALTH SAVINGS ACCOUNT (HSA) – Available as an option through qualified deductible health plans, an HSA allows you to set aside tax-free dollars to help you pay for out-of-pocket health care expenses. The money you depositinto a bank account you create could be matched up to a certain amount by your employer, if applicable.

IN-NETWORK PROVIDERS – The group of physicians, facilities and other health care providers that participate withIndependent Health. Receiving care from an in-network provider means you pay Independent Health’s negotiated rates.While going out of network is allowed on some plans, doing so may cost more. Use Independent Health’s “Find a Doctor” toolat independenthealth.com/findadoc to search for participating providers based on name, specialty, location and more.

OUT-OF-POCKET MAXIMUM – This is the most you will have to pay for covered medical expenses in a plan year, including your deductible, copayments and coinsurance amounts. Once you reach the out-of-pocket maximum, all services are covered in full.

* Source: https://www.healthcare.gov/blog/6-things-to-know-about-deductibles-in-the-health-insurance-marketplace/

** Please keep in mind, a well visit or preventive service can sometimes turn into a “sick visit,” in which you will be responsible for paying all charges until your deductible level is met, on an office visit copay or coinsurance once you have met your deductible.

† The tracker applies to your in-network deductible and reflects claims that have been submitted by your provider(s) and processed by Independent Health. Dependent claims information is tracked and reflected in the dollar amounts displayed through your deductible tracker. Note: HIPAA requirements do not permit you to view “Claims Details” information for dependents who are 13 years of age or older.

†† HSA-qualified plans by law require member liability (a low copay for Teladoc services), until a deductible is satisfied. Telemedicine services as described in this brochure exclude Medicare Advantage Plans. Benefits vary by plan. Check summary of benefits for plan details.

©2018 Independent Health Association, Inc. IH26125