FAQ: What health insurance covers
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 dental 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 |
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. To learn more how deductibles, copayments, or coinsurance could play a role in your medical care, compare our health insurance plans.
You can review this information on the Plan Comparison page. Simply expand the plan details and click “Full Benefits Booklet” under the Plan Details section.
You can contact a customer service representative to learn more about what health care services, prescriptions, providers and benefits are covered under a health insurance plan by calling 1-844-BLUE-4ME (1-844-258-3463) (TTY: 711).
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. 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.
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.
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.
Mental health and substance abuse services, including behavioral health treatment, are considered an essential health benefit and available with all plans.
Independence Blue Cross (IBX) believes your overall health includes both your physical and emotional well-being. Visit our Behavioral Health pages for more information on the tools and programs we offer.
Our condition management program supports members who have chronic conditions at no additional cost. Condition management 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
- Personal 24/7 support from Independence Blue Cross Registered Nurse Health Coaches, who 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
Blood glucose meters are typically covered under Independence Blue Cross health plans. To understand your coverage for blood glucose meters and more, please log in to your account at ibx.com and select Coverage and Benefits within the Benefits tab on the Home page.
All health plans include a Preventive Plus benefit with $0 member cost-sharing (no copayment, deductible, or coinsurance) when a member receives a preventive colonoscopy1 to screen for colorectal cancer at a Preventive Plus provider. Preventive Plus providers are not hospital-based, and the preventive colonoscopy is performed by a Preventive Plus professional (a gastroenterologist or a colon and rectal surgeon). To find an in-network Preventive Plus providers, use our Find a Doctor tool.
The Preventive Plus benefit does not apply if you reside or travel outside our service area and access care through the BlueCard® Program or the Away From Home Care® Guest Membership Program. If this applies to you, a preventive colonoscopy to screen for colorectal cancer will be covered at no cost when you use an in-network provider. If you choose to use an out-of-network provider, cost-sharing for your plan’s out-of-network benefit applies, and your out-of-pocket costs may be significantly higher.
Most PPO plans, with the exception of the PPO Bronze Basic and Catastrophic Plans, include access to the BlueCard Worldwide® program.
Some of the benefits of BlueCard Worldwide® include:
- Cashless access available for inpatient participating hospitals.
- Member is responsible for plan’s non-covered services, and applicable deductible, copay, and coinsurance.
- Member pays outpatient, professional, and out-of-network services, and services not arranged through BlueCard Worldwide Service Center. Member submits international claim form to the BlueCard Worldwide Service Center
With virtual care from Teladoc Health (Teladoc), you have a quick, convenient, and affordable care option — you’ll pay $0 for a virtual visit.3 You can reach a board-certified doctor or behavioral health professional by phone, online, or through Teladoc’s award-winning mobile app. Virtual visits are available in several languages through an interpreter, including American Sign Language (ASL).
Teladoc General Medical
Talk to a board-certified doctor 24/7 for non-emergency conditions, such as sinus pain, flu, earache, pink eye, and sore throat. You’ll get a diagnosis and prescription (if needed).
Teladoc Health Dermatology
Get convenient and reliable skincare from a licensed dermatologist for a wide range of conditions. You can use your Teladoc account to request a dermatology consult, complete a short form, and upload images of your skin issue.
Teladoc Mental Health Care
Talk to a board-certified psychiatrist, licensed psychologist, or licensed therapist from the Teladoc network by phone or video chat. Teladoc’s network of behavioral health professionals can help with concerns like anxiety, depression, grief, work pressures, and more, and you can build an ongoing relationship with a provider of your choice.
No. Virtual care from Teladoc Health (Teladoc) is designed to handle non-emergency medical conditions and can be an alternative for a doctor’s office, urgent care center, or emergency room visit for common conditions like the flu, pink eye, or rash. However, it is not intended to replace your primary care doctor or to be used in life-threatening emergencies. You should not use Teladoc if you are experiencing a medical emergency. In case of a life-threatening emergency, dial 911 immediately.
Teladoc Health (Teladoc) is a national vendor that connects individuals to board-certified physicians using HIPAA-secure video, telephone, or their award-winning mobile app. With Teladoc, our members can access unlimited non-emergency care 24/7/365.
Members can register for Teladoc Health account starting January 1, 2024 using one of the following methods:
- Call 1-800-835-2362
- Visit teladochealth.com
- Download Teladoc mobile app on Apple or Android
Once registered, you’re ready to start using virtual care from Teladoc.
With Teladoc Mental Health Care, you can talk to a board-certified psychiatrist, licensed psychologist, or licensed therapist from the Teladoc network by phone or video chat. Teladoc’s network of behavioral health professionals can help with concerns like anxiety, depression, grief, work pressures, and more, and you can build an ongoing relationship with a provider of your choice. Virtual visits are secure and confidential.
Along with your health plan benefits, you have free access to a program called AblePay Health. Using AblePay, you can save up to 13% on out-of-pocket medical costs that your health plan doesn’t cover. That may include copays, coinsurance, and deductibles.
Enrolling in AblePay is simple! Visit ablepayhealth.com/savings to get started. To learn more, visit ablepayhealth.com, email info@ablepayhealth.com, or call 484-292-4000.
The College Tuition Benefit program helps offset the costs of a four-year college education for eligible family members. Through the College Tuition Benefit, Tuition Rewards points are earned and can be used at nearly 400 participating colleges across the United States. It works like a scholarship program, where subscribers can allocate Tuition Rewards across four years of the sponsored child’s undergraduate education.
Learn more about the College Tuition Benefit or check your Member Benefit Booklet to see if your plan qualifies for the College Tuition Benefit.
To learn more about the Indego Bike Share, and how Independence Blue Cross members can save, please refer to this article.
If you’re an expectant mother, you want to ensure you have the healthiest pregnancy and delivery possible. Baby BluePrints is our comprehensive, free maternity program that supports pregnant members from the first trimester through delivery to home and continues with the 24/7 availability and phone support of Registered Nurse Health Coaches. When you enroll in Baby BluePrints, a Health Coach will assess your pregnancy, screen for depression, and answer your questions about taking care of yourself and your baby at this special time.
High-risk pregnancies will be referred to a Registered Nurse Health Coach specially trained in maternity care for additional assessment and follow up.
To enroll in Baby BluePrints, call 1-800-598-BABY.
Independence Blue Cross provides access to a registered nurse Health Coach who can help you manage and improve your health. Health Coaches have a complete view of your health, including your medical claims history, so you can have a more informed conversation when you have health questions and concerns.
Available 24/7, a registered nurse Health Coach can help you:
- Address everyday health concerns.
- Understand a diagnosis.
- Make lifestyle choices that can reduce your health risks.
- Prepare for visits and discussions with your doctor.
- Weigh the pros and cons of important decisions, like having surgery.
To reach a Health Coach, call 1-800-ASK-BLUE.
Blue InsiderSM is a member discount program that offers savings of up to 60 percent on a wide range of national, regional, and local businesses, attractions, and events.
Find great deals for a wide range of national, regional, and local business, attractions, and events including:
- Amusement park tickets
- Broadway theatre
- Movie tickets
- Ski tickets
- Sporting events
- Family events
- Recreational activities
- Hotels
- Zoos and aquariums
- Museums
- Merchant gift certificates
- Online shopping and service discounts
Access Blue Insider deals by visiting www.ibx.com/discounts. Then click the “View offers” link.
Through Blue365® you can save on health-related products and services with exclusive value-added discounts and offers from leading national companies, such as CorCell, Reebok, Nutrisystem, and Healthways. Find weekly featured deals and ongoing deals on healthy products, along with discounts on health and fitness clubs, weight loss programs, fitness apparel, hearing aids, laser vision correction, and more.
To access discounts through Blue365, visit www.blue365deals.com.
1 Diagnostic colonoscopies are subject to the cost-sharing provision of your outpatient surgery benefit.
2 Virtual care from a designated virtual provider includes telemedicine, teledermatology, and telebehavioral health services offered through our virtual care provider, Teladoc Health, an independent company.
3 Cost-sharing may apply for Catastrophic and HSA-qualified health plans.