Nova / Independent Health Option B
Summary of Benefits and Coverage (SBC)
Effective January 1, 2017, includes benefit change to out-of-pocket out-of-networkPlease 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.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
FORMS - NY44 Living Healthy Wellness ProgramWe 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.
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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 PlanA 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.
The prescription plan from Pharmacy Benefit Dimensions includes:
Dental Pay Plus Plan
$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 (J‐Codes): 7% co‐payment with a maximum co‐payment of $120 per 30‐day supply $0 co‐payment for insulin and other oral agents
Not every district participates in the dental plan. This is a negotiated item.
See the Dental tab for information about the plan.Nova/IH Customer Service
Please refer to the information on the back of your health card.