Frequently Asked Questions
You will need to turn in a completed enrollment change form, proof of your QLE and the appropriate documentation for any dependents you are adding.
You can obtain an enrollment change form from Human Resources or by reaching out to our Lacher benefits advocate. All paperwork should be turned in together to one of the parties mentioned above.
For most QLE's, you will need to submit your change, cancellation, or enrollment within 30 days of the event.
Preventive screenings can help you take better control of your health. They are an important foundation of early detection and prevention of disease.
Preventive care services are NOT subject to a copayment or deductible when using in-network providers and must be billed to insurance with proper preventive coding.
Take a look at this flyer to learn about the services and screenings that are covered as preventive care.
Please note: Coverage for these services is subject to certain conditions, age and time limits.
Take a look at this flyer to learn about your choices when it comes to where you should receive care.
High level overview:
Family Wellness Center Primary Care Center (for Hatfield) - This is your home base. Your doctor knows your history and is a good place to start. Cost to you:
Low Deductible Plan: $10 copay.
High Deductible Plan: $10 copay.
Primary Care Physician - If you are not using the Family Wellness Center Primary Care Center, you can access a Primary Care Physician elsewhere. Cost to you:
Low Deductible Plan: $20 copay.
High Deductible Plan: After you pay your deductible, insurance pays 100%.
Urgent Care - Consider an urgent care center for non-life threatening condition. You'll save time and money over the ER. Cost to you:
Low Deductible Plan: $80 copay.
High Deductible Plan: After you pay your deductible, insurance pays 100%.
Telemedicine through 98point6 (excludes Hatfield) - Consider using 98point6 for non-life threatening conditions, and when you need 24/7 care. Cost to you:
Low Deductible Plan: $0 copay.
High Deductible Plan: $0 copay.
For more information about the 98point6 app, click here.
Emergency Room - Go to an ER when you have a life-threatening issue. Cost to you:
Low Deductible Plan: $500 copay.
High Deductible Plan: After you pay your deductible, insurance pays 100%.
When you register on the Independence Administrators portal, you will have access to print an ID card, view your claims, or find an in-network doctor. Visit www.myibxtpabenefits.com to register. If you do not have your Member ID, you can use your social security number to register.
If have any questions, please feel free to contact your benefits advocate, Jen Witter, at 215-660-0339 or jen@lacherinsurance.com.
Watch this video to learn more:
The Affordable Care Act (ACA) requires that most citizens and legal residents have health insurance, however there is currently no penalty enforcing this requirement. Clemens does not require you to have their health insurance.
While regular medical care focuses on treating illness, preventive care aims to keep you from getting sick in the first place by focusing on helping you maintain good health. When you visit your doctor for a preventive care service - like a physical exam or a health screening - you should not be billed. However, if you ask your doctor about a specific health concern while you are at your preventive care visit, it may be billed as an office visit, and not a preventive care visit.
Here’s how to be sure your preventive care visit is free for you:
Mention prevention upfront – When scheduling your appointment, confirm that you are scheduling a preventive care visit.
Know what to discuss with your doctor during the visit – During your visit, keep the conversation focused on how you can maintain a healthy lifestyle.
Ask your doctor - If you do ask questions about a specific health concern while at your visit, ask your doctor if that will be treated as an office visit or as a preventive visit. Let your doctor know you are expecting this visit to be of no charge to you.
For more information about preventive care, contact your Lacher benefits advocate.
Eligible dependents include: (1) Your legal spouse; and (2) Your children up to age 26. Only those dependents who meet the eligibility requirements can enroll for coverage.
Marriage and birth certificates are required documents to meet eligibility requirements for spouses and/or dependent children.
You can make changes to your benefit elections during your healthcare and benefits open enrollment OR if you have a qualifying life event (QLE).
A QLE is a change in your situation, like a marriage, divorce, or having a baby, for example, which allows you to make changes to your health insurance. Take a look a this document for more information.
You have 30 days to submit your changes online through our benefits enrollment system.
Here's an overview of qualifying life events from Healthcare.gov.
If you have a QLE, contact your Lacher benefits advocate.
The benefit plan year extends from May to April each year. Team members can change their benefits for May 1st during Clemens’ Open Enrollment which typically occurs two months prior.