
Please note the following:
- Independent Health does not utilize CVS Pharmacies 
- BBOE Independent Health enrollees are not impacted by the Roswell Park situation. All BBOE enrollees can continue and or seek services at Roswell Park. 
This health insurance plan is available to all Medicare-eligible retirees & their eligible dependents (who are enrolled in Medicare Part A and Part B). Retirees who are eligible for district health insurance are encouraged to review the chart below to determine their eligibility for enrollment in this health insurance plan.
| Union | Retirement Date | Passport PPO | Forever Blue | 
| BCSA | Before 9/20/2017 | Voluntary | Ineligible | 
| BCSA | On or after 9/20/2017 | Ineligible | Mandatory | 
| 
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 | 
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| BEST | Before 7/1/2021 | Voluntary | Ineligible | 
| BEST | On or after 7/1/2021 | Mandatory | Ineligible | 
| 
 | 
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 | 
 | 
| BTF | Regardless of retirement date | Voluntary | Ineligible | 
| 
 | 
 | 
 | 
 | 
| Local 264 Cook Managers | Before 7/1/2014 | Voluntary | Ineligible | 
| Local 264 Cook Managers | On or after 7/1/2014 | Ineligible | Mandatory | 
| 
 | 
 | 
 | 
 | 
| Local 264 Service Center | Before 7/11/2012 | Voluntary | Ineligible | 
| Local 264 Service Center | On or after 7/11/2012 | Ineligible | Mandatory | 
| 
 | 
 | 
 | 
 | 
| Local 409 | Before 12/21/22 | Voluntary | Ineligible | 
| Local 409 | On or after 12/21/22 | Mandatory | Ineligible | 
| 
 | 
 | 
 | 
 | 
| PCTEA | Before 7/1/2012 | Voluntary | Ineligible | 
| PCTEA | On or after 7/1/2012 | Ineligible | Mandatory | 
The Passport PPO In Area program includes several benefits, the chart below provides some highlights. For detailed benefits click on the 2026 Independent Health Benefit Summary - In Area. Benefits of the Passport PPO Out of Area program can be viewed by clicking on the 2026 Independent Health Benefits Summary - Out of Area.
| 
 | Passport PPO | 
| Annual Physical | $0 copay | 
| Primary Doctor Visit | $5 copay | 
| Specialist Doctor Visit | $15 copay | 
| Hospital Inpatient | $0 copay | 
| Diabetic Supplies | $0 copay | 
| Dental | |
| Eyewear | |
| Free Silver Sneakers Membership | 
Passport PPO includes additional benefits that you will find valuable, including:
- Lab Services – Participation with all local labs, not just Quest Diagnostics. 
- Prescription Coverage – Tier enhancements to many commonly-used prescriptions, including vaccines, along with less requirements for prior authorization or step therapy. 
- Senior Savings Program – Get a $30 incentive reward just for doing your free Enhanced Annual Wellness Visit with your doctor. 
- Receive a $10 reward for completing a Health Risk Assessment 
- 3 Local Member Service Centers – Conveniently located and staffed with experienced RedShirts 5 days a week, year-round, to answer your questions and help you get the most from your health plan and your health care dollar. 
Please call Member Services with medical or pharmacy benefit questions, or if you are in need of care management services or help in locating a provider, etc.
Independent Health Member Services
Phone: 716-250-4401
Toll-Free: 1-800-665-1502
(TTY: 711)
Enrollment
Retirees can choose to enroll in the Independent Health Passport PPO by completing the Medicare Advantage Form. Applications will be accepted any month during the year once a retiree has reached Medicare eligibility and is enrolled in Part A & Part B.
Should a retiree, or their eligible spouse/dependent, choose to return to a commercial benefit plan, they must take action during annual Open Enrollment, which is held in the month of November, and identify a plan that was available to them at the time of the retirement.
2026 Forms
