Nova / Independent Health Option B

 
Summary of Benefits & Coverage Option B

Summary of Benefits and Coverage (SBC)


Effective January 1, 2017, includes benefit change to out-of-pocket out-of-network


Please contact the benefit administrator at your district / school to determine if you need to use the POS or PPO. Note: If you live outside the 8-county WNY area, you would use the PPO.
SPD
Summary Plan Description (SPD)
The Nova/IH Summary Plan Description Option B is the legal document outlining the complete plan offerings through NY44 Health Benefits Plan Trust. Please note, in the case of discrepancies between the information on the NY44 Health Trust website and the Board approved Summary Plan Description, the Summary Plan Description is primary.
Effective Jan. 1, 2017
 
Fitness Activity Reimbursement

FORMS  -  NY44 Living Healthy Wellness Program

We offer two wellness programs: the fitness activity reimbursement and the annual physical exam reward. We encourage enrollees to stay healthy by getting an annual physical and by engaging in sustained, on-going physical activities.
Get the Forms
Medical Plan
Find a Medical Provider
Use the online provider search page to locate a medical or vision provider.
Go to the Medical Provider page now
Vision Vision Plan
A vision plan is offered with our medical plan that provides a cost savings to you. Information about the vision plan is in the Summary Plan Description on pages 55-56.
Pharmacy Benefit Dimensions  

Prescription Plan
The prescription plan from Pharmacy Benefit Dimensions includes:

  •  $0 co-payment for Tier 1 generic prescriptions, Tier 1 & 2 diabetic medications, diabetic supplies such as insulin needles, syringes, lancets, test strips.

  • $25 co-payment:  Tier 2

  • $60 co-payment:  Tier 3

  • Tier IV Injectables and Specialty Drugs (JCodes): 7% copayment with a maximum copayment of $120 per 30day supply $0 copayment for insulin and other oral agents

 
Dental Plan
Dental Pay Plus Plan
Not every district participates in the dental plan. This is a negotiated item.
See the
Dental tab for information about the plan.
Contact MVP
Nova/IH Customer Service     
Please refer to the information on the back of your health card.
 
 
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