All covered visits, both in and out-of-network, are subject to the $35 co-payment. Your insurance card also includes a customer service number where you can get answers to your specific coverage questions. Charges rendered by a Psychiatrist, PhD, or Social Worker ("MSW") are covered for active and retired eligible Participants for individual therapy. Amidacare - All Products. You may locate a MagnaCare participating physical therapist by visiting their website atwww.magnacare.com. With experience in the behavioral health, substance abuse (drug, alcohol programs) for over 20 years, JRN Consulting has put together a group of participating providers/facilities that accept our fee schedules with limited or no out-of-pocket cost to the patient. For a complete list of preventive items or services that will be covered without any co-payment, as well as any limitations that apply, visit the, Employees Security Fund Medical, Prescription Drug and Dental Plan, Dental Benefit Plan of the Electrical Industry, Accessing and Taking Courses on www.jiblearning.org, Electrical Employers Self Insurance Safety Plan, Home Health Care and Hospice (when not rendered directly after the release from a hospital and/or when not included as part of discharge planning related to a hospital admission), Office-based Extracorporeal Shock Wave Therapy (Orthotripsy), Make an appointment for you at MSK, usually within two business days, Help you gather your medical records for your first appointment, Meet you at your first appointment to introduce you to the facility and your care team, Make a referral to a local facility if you live at a distance from MSK and prefer to be closer to home. In a true emergency, you are covered. 0000002593 00000 n 0000115774 00000 n Bring prescription from your doctor and just pay co-pay. Contact MagnaCares Pre-certification Department at (877) 624-6210or refer to the Summary Plan Descriptionfor complete details. For 2022, the Tier 2 network for all states outside of New York and New Jersey for HDHP is changing from First Health to CIGNA. Your benefit coverage for care provided by NYC Health + Hospitals is determined solely by your insurance company and is based on the provisions of your specific medical benefit plan. Contact the provider closest to your home/work for an appointment. What happens if I am out of town and admitted to the hospital? A healthy life means taking care of your body and your mind, Neglecting your mental health can have a huge impact on your overall well-being. at (718) 591-2000, Extension 2491. A: For team members part of the Value, Buy-up and HDHP, you should identify that you are a Northwell team member that accesses the Northwell Direct network administered by Brighton Health Plan Solutions when speaking with your in-network provider or facility. Together with affiliated radiologists, and inclusive of full-time and per diem employees and technicians, RadNet has a total of approximately 7,300 employees. Participants covered under the PHBP Medical Plan who are on Workers Compensation can remain covered for up to two years from the date of their first Workers Compensation check, providing they are still collecting Workers Compensation. You can find a doctor in the MagnaCare preferred provider network online. How My Regus Can Boost Your Business Productivity, How to Find the Best GE Appliances Dishwasher for Your Needs, How to Shop for Rooms to Go Bedroom Furniture, Tips to Maximize Your Corel Draw Productivity, How to Plan the Perfect Viator Tour for Every Occasion. Its that east! The description of benefits contained in the following pages applies only to participants who work for a contributing employer who is covered under an applicable Collective Bargaining Agreement. xb```BQ ea0`0X"h j1l`^cHc-,Z~"J 0000071187 00000 n Type of Plan: This Plan is a self-insured, self-administered employee welfare benefit plan under which participants are covered for certain services related to their health. Average Overall User Rating for providers who take MagnaCare: 4 (out of 5) If a brand-name drug is prescribed when a generic equivalent is available, you will pay the difference between the cost of the brand-name and generic drugs, plus the generic co-pay. Forgot password? Benefits are provided once every 12 months. Confirm with practice)MetroPlus - HIV Special Needs Plan (Pertains only to certain providers in Staten Island. View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. With traditional fully insured health plans, an employer pays insurance premiums to an insurance company that pays health care claims as outlined in the health plan, states Zane Benefits. A trusted partner to plan sponsors, TPAs, and carriers for more than 30 years, MagnaCare achieves exceptional value for clients and their members through highly customized, innovative healthcare solutions. . MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. Care provided by NYC Health + Hospitals may not be covered by your health plan at the highest available benefit level, nor may NYC Health + Hospitals participate . 0000111900 00000 n Affinity - All Products Accepted except Exchange. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug. Online websites and applications may vary how they list and identify the plan. Asthma is treatable, but symptoms sometimes flare up.Learn More >, Heart disease is the leading cause of death worldwide. Prescription coverage has not changed. If the hospital or surgi-center fails to call and give MagnaCare the required information, the facility will not receive payment from the Plan. If you prefer, call MagnaCare at (877) 624-6210 or contact the Health Advocate at (866) 799-2723. Heartscan Services identifies early risk factors of Heart Disease, Stroke, PAD (Peripheral arterial disease and diabetes), and Thyroid nodules. Website: https://idoc.davisvision.com/members/FindAProvider/Index, To locate a participating retail pharmacy, obtain a claim form, or find out more about your prescription drug benefit, please call Member Services at 1 866 713-8004 or log in to our website, www.express-scripts.com. For example, GI drugs (such as Nexium, Protonix, omeprazole) have been added to this list. Para hacer una cita, pngase en contacto con el proveedor ms cercano a su hogar o trabajo. RadNet is honored to expand their relationship with Local 810, United Wire Metal and Machine. Brighton Health Plan Solutions,LLC. Find an Urgent Care Center. To initiate a discussion on transition of care for out-of-network providers, team members and their families should contact Brighton at (855) 340-7737. Youll enjoy the experience on MyCreateHealth.com where you can: To view older claims (from 2016 and earlier), log onto the service portal at magnacare.com. Failure to do so will result in your prescription being denied at your local pharmacy. *zm;2CI7A',l#8X'0jtRjP[H4-F@|P:y>&yQh\]6Tc z endstream endobj 633 0 obj <> endobj 634 0 obj <> endobj 635 0 obj <> endobj 636 0 obj <> endobj 637 0 obj <>stream The plan at 1-718-591-2000 or the Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or EFFECTIVE AUGUST 1, 2016 you will be able to access to free-standing facilities for all your radiological needs by calling 1-844-868-7068 or visit www.radnet.com/imaging-centers. 0000002462 00000 n How am I and my family covered if I am retired, living out-of-state and not yet eligible for Medicare? How do I know what my co-pay will be for an expense covered by the PHBP Medical Plan? A: No. Once you have filled two prescriptions of the same drug at your pharmacy, you must then use the Express Scripts by Mail service for your prescriptions. Learn more about our Medical Management services >. Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? A: Whether you are on the Value, Buy-up, HDHP or union-sponsored plan administered by Northwell, you can now search for in-network doctors, and other healthcare providers and facilities, all in one place. RadNets core markets include New York, New Jersey, Maryland, Delaware, Florida, California and Rhode Island. You must check with your physician before treatment to determine the insurance plans s/he accepts. 0000007729 00000 n Please have ready the name of the physician you visited who prescribed the diagnostic tests and the date of the visit. As a courtesy to our members we will waive the co-payment if you use their facilities. HU]oF|_dQoo}\-") For information on how to find a provider please call MagnaCare at (877) 624-6210, Plan Name: Pension, Hospitalization and Benefit Plan of the Electrical Industry Plan, Plan Year: October 1 through September 30. Thank you. 0000106362 00000 n Please note that this list DOES NOT represent an exclusive list of physicians who may provide professional services to you while at Englewood Hospital. For in-network claims, you will be responsible for only four (4) co-payments of $35 per incident or illness. Aetna - All Products Accepted except Better Health Fida. All Rights Reserved. A: No. divisions covered include: a, m, mij, apprentice, m helpers, adm, expeditor, re & rw, teledata, j and outside linemen. Below is a list of the physicians or physician groups that have a contract with the hospital to provide certain healthcare services that prevents us from using any other physicians for these services. I am an active Participant who has questions about benefits or claims. Do I need to pre-certify in order to receive prescription drug benefits? If you file your prescription through Express Scripts, their pharmacist will initiate the pre-certification review with your doctor. If you do not have insurance, or are unable to pay for the hospital services provided, our Financial Assistance Program may be able to help. Log onto MyCreateHealth.com to view all your claims for services received in 2017 and later. Labs & Appointments Toggle Labs & Appointments, Billing & Insurance Toggle Billing & Insurance, Diseases & Conditions Toggle Diseases & Conditions, OnDemand Testing Toggle OnDemand Testing, Testing by Disease & Condition Toggle Testing by Disease & Condition, Testing & Services For Toggle Testing & Services For, Hospitals & Physician Systems Toggle Hospitals & Physician Systems, Managed Care Health Plans Toggle Managed Care Health Plans, Lab Data Integrations & Tools Toggle Lab Data Integrations & Tools, Employee Wellness & Testing Toggle Employee Wellness & Testing, Government & Education Toggle Government & Education, Therapeutic Indications Toggle Therapeutic Indications, Development Phase Toggle Development Phase, Compounds & Molecules Toggle Compounds & Molecules. This plan uses a provider network. Medicaid is a state-run health care program for patients not covered by other health care insurance. It involves treatments and trainings to ensure a healthy pre-pregnancy, pregnancy, and labor and delivery for mom and baby. This change does not impact any other benefit plan for Value, Buy-up and HDHP. Available now Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? If your doctor prescribes you a diagnostic test that requires radiology or blood work you must use an in-network free-standing facility. We can improve team member experience by using Brighton for claims processing and customer service, and the Northwell Direct network for expanded access to a comprehensive network of high-quality providers to members living in areas not currently covered by our Tier 1 providers. Always refer to your Summary Plan Description (SPD) for detailed information about your plan. You should only go to an emergency room when absolutely necessary. MagnaCare (Direct Plus, PPO, Worker's Comp and Create) MultiPlan (including PHCS) Oxford QualCare United Healthcare Other plans 1199 National Benefit Fund (Health Care Payers Coalition) Bergen Risk Managers Consumer Health Network Plus CorVel Devon Health Plan Evolutions Healthcare Systems First MCO FOCUS Healthcare Management Galaxy Health Network In cases of emergency, go to the nearest emergency room. At Englewood Hospital, we are constantly working to ensure we meet the requirements of the new law and will update the below information as is necessary. In New Jersey, patients receiving emergency care will not be responsible for the added costs associated with care in an emergency department that is out-of-network. or by calling them at (877) 624-6210. Brighton is used for claims processing and customer service while the new provider and facility network in the New York and New Jersey area is the MagnaCare network. Vivo Health has a large pharmacy network, which includes ten Vivo Health Pharmacy locations, mail order and more than 64,000 participating retail pharmacies. Traer la receta de su mdico y pagar slo el copago. At Mount Sinai South Nassau, we participate in Medicare, Medicaidand most HMOs and commercial insurance plans. Englewood, NJ 07631 yrZI$7KSn, H8*$dd8:%C*f/8}CyX4Wl`#8v_]aS}O7iW!T;jI@ sjjVf9$As02'FL2-!4f,3^Pl:ax)! Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. There is a $200 emergency room co-pay, which is waived if you are admitted within 24 hours. Go to Magnacare.com and read below, or Call (866)-281-0364 and follow their instructions. You are not required to use an in-network provider; however, if you use an out-of-network provider the out-of-pocket expense will be greater. 0000060018 00000 n For 2022, the Tier 2 network for all states outside of New York and New Jersey for HDHP is changing from First Health to CIGNA. Affinity all lines of business, including the Health Exchange Plan. 212-691- 4100 ext.313. You can cover your spouse and children. Plan Administrator: Joint Industry Board of the Electrical Industry, PHBP - Welfare Plan - 2023 Plan Design Change Notice, PHBP Actives & Non-Medicare Retirees SBC 2022-2023, PHBP Medicare-Eligible Retirees SBC 2022-2023, PHBP Retiree - Non-Grandfather Notice on Plan Changes & Clarification, COBRA Continuation Coverage for Dependents - Age 26, COVID-19 Deadline Extensions - COBRA and Claims Appeals, COVID-19 Extended Deadline of Copay Increase w/o Physical Exam, Pension, Hospitalization and Benefit SPD.pdf, PHBP Plan - Certificate of Creditable Coverage, Important Information Regarding Alcohol and Substance Abuse Benefits, Important Information Regarding Coverage of Compound Prescriptions, Express Scripts Opioid Management Services, MagnaCares Evaluaide Autism support program. Si usted utilizan un centro de diagnstico que son participantes. Note that the available options for marital status, race and ethnicity are the options required by the US Government. Dramatically improve Workers Compensation outcomes at lower cost in New York and New Jersey, and lease the broadest network with the steepest discounts for auto injuries. If so, your doctor must call a special toll-free number at Express Scripts to initiate a review. What type of Chiropractic care is covered by the Plan? Who can I call for help? And, youll have access to discounted medical liability insurance through our partner, MLMIC. FAQs, Vacation, Holiday and Unemployment Plan FAQs. 130193. If you have a health concern that is not life-threatening, you may consider calling our ER on Demand service at (516) 918-6005. Access the in-network provider and facility search on Northwell.edu/myMedical. If you have health insurance, there are important steps you should take to understand your coverage and protect yourself from unexpected bills. Employees Security Fund Medical, Prescription Drug and Dental Plan, Dental Benefit Plan of the Electrical Industry, Accessing and Taking Courses on www.jiblearning.org, Electrical Employers Self Insurance Safety Plan, Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs, Employees Security Fund Medical, Prescription Drug and Dental Plan (for members of the Fixture, Manufacturing, or Supply Divisions) FAQs, Health Reimbursement Account (HRA) Plan FAQs, Dental Benefit Plan of the Electrical Industry FAQs, Pension Plan (the Pension Trust Fund for the Electrical Industry) FAQs, Employees' Security Fund Pension Plan (for members of the Fixture, Manufacturing, or Supply Divisions) FAQs, Electrical Employers Self Insurance Safety Plan (E.E.S.I.S.P.) May be eligible regardless of immigration status. Username / Email Address Password as a New User Forgot username? 0000002508 00000 n Certain exceptions may apply by geographic or specific member coverage or plan. Before scheduling a procedure at the hospital, ask your insurance company whether you need pre-authorization or a referral. A: Northwell offers three medical plans, Value, Buy-up and the HDHP. Help is always just around the corner with MagnaCare Access, our network of over 70,000 industry leading healthcare provider locations in the New York and New Jersey area. You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. Services that require pre-certification through the JIBs Hospitalization Department include, but are not limited to: For more information, contact the Managed Care Coordinator at the JIB at: (718) 591-2000, Extension 1350 Monday through Friday between 8:30 A.M. and 4:30 P.M. Click here for more information on Magnacare or call (866)-281-0364 Option 1 Heartscan Services NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE The Pension, Hospitalization and Benefit Plan of the Electrical Industry (PHBP) has partnered with Memorial Sloan Kettering Cancer Center (MSK) through MSK Direct- a program that offers guides access to expert cancer treatment for PHBP members and their eligible family members. Initial eligibility is attainedby having worked on a full-time basis for a Contributing Employer to this Planduring which time contributions were madefor atleast 26 consecutive weeks immediately prior to incurring a reimbursableexpense. Most self-insured plans also include a fee for stop-loss insurance coverage, which pays large claims over a certain amount. wG xR^[ochg`>b$*~ :Eb~,m,-,Y*6X[F=3Y~d tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:O:8uJqnv=MmR 4 Below is a list of the network and plans we currently participate in. Vivo Health offers convenient services such as mail order, a specialty pharmacy and a mobile app for your on-the-go pharmacy needs. (PHBP Medical Plan). For nearly 20 years weve kept New York and New Jersey healthy with our unrivaled MagnaCare Network, giving you access to the best healthcare pros around. With a self-insured plan, such as MagnaCare, the employer instead pays an administrative fee to the overseeing organization and then the actual health claims covered by the plan. If the review is approved, you will receive a letter indicating the length of approved coverage. For your convenience, we suggest that you print out the questionnaire, complete it and bring it with you to the hospital. 0000002707 00000 n Please call (877) 624-6210. Eligibility is determined by criteria such as earnings and family size. Related, out-of-network claims should be submitted to the Plan for reimbursement. Carriers Currently Filed by Labcorp. Your new, enhanced service portal is now live! In spite of all precautions, if you are in a situation where the physician's claim is paid but the diagnostic claim has been denied, please call the MagnaCare customer service line at 1-877-624-6210 and mention that you have a "diagnostic denial" claim issue. Call the Joint Industry Board Members Records Department at (718) 591-2000, Extension 2491 to obtain a form to initiate a review. Reimbursement will be at the network allowance and is subject to the same co-payments as in network claims. In addition, where specified in our plan summaries, Tier 1 providers/facilities must be used in NY/NJ for the below services: A: If you or your dependent need to use a provider outside of the New York and New Jersey area, you will use the Tier 2 CIGNA network to find in-network providers and facilities. We transitioned from UnitedHealthcare to Brighton Health Plan Solutions (Brighton) as a plan administrator to administer and manage medical plan aspects such as claims processing and more.The Northwell Direct network and MagnaCare network already serve as the Tier 1 and 2 networks for the HDHP. If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). Beech Street PPO. Have you done any of the following in the time frame mentioned? Learn more about our comprehensive health plan management >. for a list of in-network doctors and other providers. Estas pruebas se pagaran totalmente y completamente por su Plan. 2023 Joint Industry Board of the Electrical Industry. All Rights Reserved. Get your members the most appropriate and highest quality medical care at the lowest cost. Home healthcare and home infusion therapy: In-network provider and facility coverage, Out-of-Network (OON): $8,500 individual/$17,000 family, Growth hormones for height related treatment. MSK Direct can be reached at the dedicated toll-free member line for PHBP members (844) 506-0587, Monday through Friday from 8:30 am to 5:30 pm ET. Customer service: If you are seeking assistance for inpatient services, Mount Sinai South Nassaus Financial Assistance professionals may be able to help you complete your application. Click here for the benefit changes effective July 1, 2022 for Medicare eligible retirees. If you are unsure or would like assistance in locating a participating center call us at the Welfare Fund for help. MagnaCare Direct Plus; Commercial PPO Your insurance is accepted at the following hospitals: NYC Health + Hospitals/Bellevue NYC Health + Hospitals/Elmhurst NYC Health + Hospitals/Harlem NYC Health + Hospitals/Jacobi NYC Health + Hospitals/Kings County NYC Health + Hospitals/Lincoln NYC Health + Hospitals/Metropolitan Upon registration, your Express-Scripts identification card will appear digitally on your smartphone and is ready to be used at your convenience. You will pay less if you use a provider . **Network is held by Northwell Direct Administrative Services Organization, Inc. One Penn PlazaSuite 1410New York, NY 10119. These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. Call 888.799.6465 or fill out the form below. All remaining balances are the participant's responsibility. RadNet, Inc. is the leading national provider of free-standing, fixed-site diagnostic imaging services in the United States. n3kGz=[==B0FX'+tG,}/Hh8mW2p[AiAN#8$X?AKHI{!7. All retirees who have not become eligible for Medicare or who have non-Medicare eligible dependents should receive a card pertaining to the Preferred Provider Organization ("PPO") in their state. Las pruebas hecha en un hospital no se cubrirn. nQt}MA0alSx k&^>0|>_',G! IN ADDITION, THE PHYSICIANS WHO PROVIDE CARE WITHIN OUR HOSPITAL MIGHT NOT PARTICIPATE IN THE SAME INSURANCE PLANS AS THE HOSPITAL. Member Login Take control of your health care. Why did that happen and what should I do? What type of mental health benefits does the Plan cover? When you do, there is a $100 co-pay. . A: For additional questions and support on the medical plan TPA and provider/facility networks, please call Brighton at (855) 340-7737, Monday through Friday, 8:00 am to 6:00 pm or email [emailprotected]. Specialties: MagnaCare provides high-quality, innovative, affordable health plans and workers' compensation to employers and Labor Funds in NY, NJ, and CT. Nationwide, MagnaCare provides health plan administrative services, network access, and medical management services to employers, Labor Funds, brokers, TPAs and carriers. trailer <]>> startxref 0 %%EOF 653 0 obj <>stream Diagnostic services are a broad range of tests that are essential to the basic management of patient care, allowing physicians to detect disease earlier, make diagnoses, prescribe therapies, and monitor patient results. Insulin is no longer on the list. 0000003597 00000 n Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. Covered Participant members may apply for one medical exam day benefit using this form. Does the list of maintenance medications ever change? 0000084904 00000 n Copyright 2015 UNITED WIRE METAL & MACHINE, x-rays, bone density, echocardiogram, mammography, echocardiogram, ultrasound, and sonograms, https://idoc.davisvision.com/members/FindAProvider/Index. You will speak with a triage expert who will evaluate your symptoms and when appropriate connect you with one of our Emergency Medicine physicians to help decide next steps of care. Medicare Plus Plan 2 (HMO) $21: $2,500 per ear: $7,500: Ask your insurance company if Englewood Hospital is in network with your insurance plan. Do I need to use the Express Scripts by Mail service? If you are not sure if we participate with your insurer, please call your insurer for confirmation and for any special considerations. The advantage of self-insured health plans is a reduced cost for the employer, according to Beckers Hospital Review. This program is for uninsured pregnant women and adolescents residing in New York state. Search for providers and facilities here or call (855) 340-7737, Monday through Friday, 8:00 am to 6:00 pm, to assist with your provider search. 0000081601 00000 n Paying for Your Care Accepted Insurances Find a Doctor Request an Appointment x Catholic Health Facility Insurance Plan Participation As of January 1, 2020, Catholic Health hospitals have contracts with the following managed care health plans. There is no need to submit claims when Medicare is your primary insurance for dates of service rendered on or after 8/1/2011. If you do not have insurance, please call our Financial Assistance professionals at (516) 632-3979 to see if you qualify for Medicaid, Child Health Plus or the hospital Financial Assistance Program. We transitioned from UnitedHealthcare to Brighton Health Plan Solutions (Brighton) as a plan administrator to administer and manage medical plan aspects such as claims processing and more. N')].uJr How do I submit my claims? Cualquier resonancia magntica, endoscopia, colonoscopia, PET o computarizadas deben ser previamente aprobados. Medicare Part A provides benefits for: Medicare Part B beneficiaries who receive hospital outpatient care will be responsible for a predetermined co-payment for each covered procedure or test. In addition to hospital and out-of-network coverage, non-Medicare eligible retirees and their families that live in all states will have access toin-network medical, physician and surgical benefits. Pre-certification is required for all inpatient and outpatient hospital services, surgical procedures in hospital or surgicenter, home health care services and durable medical equipment that are related to a hospital discharge, dialysis, all therapies and hospital based MRI, MRA, CAT, SPECT and PET Scans. 2023 Laboratory Corporation of America Holdings. All applicable co-pays will apply to such admissions. Call 1-866-250-8679 or fill out the form below.