Doctor, Specialist, & Hospital Coverage – Sandbox.Carpenters.Fund

Independence Administrators (IA) are the Fund's major medical insurance provider for doctors, hospitals, and specialists. When Participants visit providers who are in-network with Independence Administrators, the Fund pays the coinsurance percentage (Gold Level 90%, Silver Level 70%) of the total IA allowance, leaving the Participant responsible for the their coinsurance portion (Gold Level 10%, Silver Level 30%). Participants are responsible for the coinsurance until they have met their out-of-pocket maximum (OOP). Once an individual or family has reached their OOP Max, the Plan will pay 100% for all further In-Network claims for the duration of the Plan Year (April 1 through March 31).

ibxtpa.com

(833) 242-3330

Find a Medical Provider

Personal Choice Coinsurance Coverage Levels

GOLD LEVEL

90/10 Coinsurance

Active Eligibility - 600 or 1200 hours
April 1st Eligibility - 600 hours from 7/1-12/31 or 1,200 hours from 1/1-12/31 October 1st Eligibility - 600 hours from 1/1-6/30 or 1,200 hours from 7/1-6/30
Out-of-Pocket Maximums $1,000 / $2,000
$1,000 Individual / $2,000 Family
Cigna Dental
90/10 Coinsurance Plan (separate from the IA and MHC coinsurance) $2,500 Annual Family Allowance $3,200 Lifetime Orthodontia
Davis Vision
Annual eye exams covered 100% $100 Allowance for eyewear (additional $50 at Visionworks)

Summary of Benefits and Coverage

SILVER LEVEL

70/30 Coinsurance

Active Eligibility 450 or 900 Hours
April 1st Eligibility - 450 hours from 7/1-12/31 or 900 hours from 1/1-12/31 October 1st Eligibility - 450 hours from 1/1-6/30 or 900 hours from 7/1-6/30
Out of Pocket Maximums $2,000 / $4,000
$2,000 Individual / $4,000 Family
No Dental Coverage
Silver Level does not include dental coverage
No Vision Coverage
Silver Level does not include vision coverage

Summary of Benefits and Coverage

RETIREE HEALTH

90/10 Coinsurance

Retire with Gold Level based on Credit System
Gold Level is the only coverage option for Retiree Health. You are eligible to retire with health coverage if you reach 25 or 30 credits. However, if you retire with 25 to 29 credits, your monthly copayment will be higher than if you retire with 30+ credits.
1 Gold Eligibility Period = 0.50 Credit
You will receive a 0.5 credit for every Gold Level eligibility period you qualify for.
1 Silver Eligibility Period = 0.25
You will receive a 0.25 credit for every Silver Level eligibility period you qualify for.
Maximum of 1 Credit in a Plan Year
There are two eligibility period in a Plan Year, so the maximum credit you can earn is 1. There is no credit for a missed eligibility period.

Click here for Retiree Health Coverage page

Prescription Coverage is the same for both Gold and Silver Levels

Major Medical Insurance Card

Use this card when visiting any in-network doctor, hospital, specialist. If you need a replacement card please call 1-833-242-3330.

FIND AN IN-NETWORK PROVIDER

Addtional Benefits Covered Through Independence Administrators

Lab Work

Chiropractor Coverage

Acupuncture Treatment

Air Ambulance

Lab Work

Lab Work is covered 100% if processed through LabCorp. If processed through an in-network lab, doctor or hospital, it would be covered under your respective coinsurance coverage level (Gold Level 90/10, Silver Level 70/30).

Chiropractor Coverage

Show your Independence Administrators insurance card at any in-network chiropractor.

Acupuncture Treatment

Use the Independence Administrators insurance card at any in-network acupuncture treatment facility.

Air Ambulance

Air Ambulance is covered through Independence Administrators.

Medical Coverage FAQs

Are Doctor and Specialist visits covered?

All Primary Care and Specialist visits at a Participating Independence Administrator's (IA) provider are covered under the Plan's coinsurance.

Gold Level: 90/10 Coinsurance
Silver Level 70/30 Coinsurance

All testing and procedures done during your visit will also be covered under the Plan's respective coinsurance. Please visit www.MyIBXTPABenefits.com for a list of Participating Providers.

What is the difference between a deductible, a co-pay, and coinsurance?

A deductible is the initial amount of money you must pay for health care services before your insurance starts to pay for covered services. For all In Network Claims through Independence Administrators or Mental Health Consultants, your coverage does not have a deductible.

A co-pay is a fixed dollar amount you are required to pay for health care services. For example, if you fill a 30-day generic prescription you would have a $5 co-pay.

Coinsurance is the set percentage of the allowed amount you are required to pay for health care services. For example, Gold Level pays 10% and Silver Level would pay 30%

Is there an "Out-of-Pocket Maximum," and what does that mean?

Out-of-Pocket Max means the total amount of money you can spend of your pocket in a Plan Year (April 1st through March 31st). The out-of-pocket maximum for In-Network Services through Independence Administrators (IA) and MHC is as follows:

Gold Level: $1,000.00 for an individual and $2,000.00 for a family.
Silver Level: $2,000.00 for an individual and $4,000.00 for a family.

Please note, there is a separate out-of-pocket maximum for Out of Network Services through IA and MHC:

Gold Level $15,000.00 for an individual and $30,000.00 for a family after the Out of Network Deductible is met.
Silver Level $30,000 for an individual and $60,000.00 for a family after the Out of Network Deductible is met.

What is the Out-of-Network Out-of-Pocket?

If you utilize Out-of-Network Facilities, the deductible is:

Gold Level ($10,000.00 individual/$20,000.00 family)
Silver Level ($20,000.00 individual/$40,000.00 family)

After the deductible is met, your Out-of-Pocket Maximum is a combination of your copays and coinsurances (50/50 coinsurance) with a limit of:

Gold Level $15,000.00 for individuals and $30,000.00 for family.
Silver Level $30,000.00 for individuals and $60,000.00 for family.

Can I use an Urgent Care Facility, or a Minute Clinic at a pharmacy?

Is there a Deductible?

For In-Network claims processed through Independence Administrators (IA) and Mental Health Consultants (MHC) there is currently NO DEDUCTIBLE.

For Out-of-Network claims processed through Independence Administrators (IA) and Mental Health Consultants (MHC) the deductible is as follows:

Gold Level - $10,000.00 deductible for an individual and a $20,000.00 deductible for a family.
Silver Level - $20,000.00 deductible for an individual and a $40,000.00 deductible for a family.

If you are seeking services and the provider is Out-of-Network, contact IA or MHC and ask for alternative physicians.

Where can I find a list of Participating Independence Administrator's Providers?

What is considered Preventative Care?

Where do I send my Independence Administrators Claims to?

Where can I find the Consolidated Appropriations Act Machine Readable File?