• Nova / Independent Health Option A

     
    Summary of Benefits & Coverage

    Summary of Benefits and Coverage (SBC)


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

    SBC - Nova A - POS
    SBC - Nova A - PPO

     
    Please contact your 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 A 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

    SPD - Nova A         
     
    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 53-54.
    Pharmacy  Benefit Dimensions  

    Prescription Plan
    The prescription plan from Pharmacy Benefit Dimensions includes:

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

    •  $15 co-payment:  Tier 2

    •  $30 co-payment:  Tier 3

    • Mail order (90 day supplies) are available. Call Customer Service at 1-888-878-9172.

    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.