Mike Smith President of Local 810 & Lorraine Buonacore Administrator of Funds. For more information, click here for Frequently Asked Questions about the program. 0000004088 00000 n You should only go to an emergency room when absolutely necessary. For in-network claims, you will be responsible for only four (4) co-payments of $35 per incident or illness. Effective 10/1/2016, all non-Medicare Participants and spouses who have a physical in a 2-year period shall receive a $5 reimbursement for all subsequent $35 co-payments. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. Mike Smith Presidente del Local 810& Lorraine Buonacore Administrador de los Fondos. The Express Scripts Network covers the cost of prescriptions, except for the applicable co-pay: If you use a maintenance medication to treat an illness such as high blood pressure, you can have your prescription filled for a 90-day supply through this program with the following co-pays: *This Plan has a mandatory generic policy. The screening is non-invasive, takes approximately 30 minutes and no preparation is required. Other services requiring pre-certification include: The toll-free phone number for any pre-certification through MagnaCare is (877) 624-6210. What type of Chiropractic care is covered by the Plan? Please refer to the chart of covered services on the Medical Plan page for co-pay amounts. Express Scripts will now advise you when your medication either goes on or comes off of the maintenance drug list. Eligibility is based on household size and income. If you believe you have a serious medical or surgical problem, such as new onset of chest pain or severe pain in your abdomen that has been getting worse over the past several hours and you cannot reach your doctor, it is reasonable to go to the Emergency Room for assistance. We are glad to see you are making health and wellness a priority, great job! 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. Below is a list of the network and plans we currently participate in. 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. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. Heartscan Services is mobile and can perform screening at locations close by your work places or home, making it convenient for all participants to take advantage of this program. To all eligible participants of United Wire Metal, & Machine & Welfare Fund. All Participants should call MagnaCare's dedicated Local Union No. Have you done any of the following in the time frame mentioned? . Prescription coverage has not changed. Note that the available options for marital status, race and ethnicity are the options required by the US Government. It includes a range of conditions that affects your heart with different symptoms associated with it. 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. Regardless of the physicians relationship with Englewood Hospital, these healthcare professionals costs are never included in the facilitys charges and you will still receive a separate bill for these services. If you choose to use providers that are out-of-network you will pay significantly more. If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). Labcorp will file claims for insured patients directly to Medicare, Medicaid, and many insurance companies and managed care plans. 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. 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. x- [ 0}y)7ta>jT7@t`q2&6ZL?_yxg)zLU*uSkSeO4?c. R -25 S>Vd`rn~Y&+`;A4 A9 =-tl`;~p Gp| [`L` "AYA+Cb(R, *T2B- This plan uses a provider network. Please call (877) 624-6210. Access the in-network provider and facility search on Northwell.edu/myMedical. 0000035095 00000 n Offer your members high-quality healthcare where they live and work. Thank you. Exmenes de sangre slo puede realizarse en el consultorio de un mdico durante una emergencia mdica. If you go to a physician for a non routine visit and diagnostic tests are prescribed by the physician, the tests are covered if the physician's visit is covered. AlphaCare Nassau County only. 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. It is always important to verify and update insurance information and know which testing laboratories are in-networkor participating providers for your benefit plan. 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. A: The TPA for union-sponsored plans administered by Northwell changed from UnitedHealthcare to Brighton as a plan administrator on Jan. 1, 2022. It is always important to verify and update insurance information and know which testing laboratories are in-network or participating providers for your benefit plan. For additional information call 1-800-652-0063, For Davis Vision Contact the provider closest to your home/work for an appointment. Learn More >. 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. "F$H:R!zFQd?r9\A&GrQhE]a4zBgE#H *B=0HIpp0MxJ$D1D, VKYdE"EI2EBGt4MzNr!YK ?%_&#(0J:EAiQ(()WT6U@P+!~mDe!hh/']B/?a0nhF!X8kc&5S6lIa2cKMA!E#dV(kel }}Cq9 Search for providers and facilities here or call (855) 340-7737, Monday through Friday, 8:00 am to 6:00 pm, to assist with your provider search. Member Resource Center At MagnaCare, we take healthcare personally and we put people first. Submit claims to MagnaCare at P.O. You are not required to use an in-network provider; however, if you use an out-of-network provider the out-of-pocket expense will be greater. Team members on the Value, Buy-up, HDHP or union-sponsored medical plans administered by Northwell do not require referrals when utilizing the Tier 1 and/or Tier 2 provider or facility networks. One Healthy Way How much is my prescription drug co-pay under the PHBP Prescription Drug Plan? 3 service line at (877) 624-6210. All Rights Reserved. The list of maintenance drugs is monitored by Express Scripts and changed periodically. It includes a range of conditions that affects your heart with different symptoms associated with it. That may include a copayment if required by your insurance plan or a deductible amount that you must pay yourself before insurance coverage kicks in. Why did that happen and what should I do? Under the PHBP Medical Plan, what happens if the hospital does not pre-certify my admission? Si su mdico le prescribe una prueba de diagnstico que requiere trabajo de radiologa o sangre se debe utilizar consultorios diagnosticos que son participantes con su Plan y NO ESTEN EN EL HOSPITAL. To guard against this possibility, please make sure the physician requesting the diagnostic tests is writing the appropriate diagnosis code on the request he sends you with and the drawing station records it. also provides vision benefits to you and your dependents. Facility name - Select - Insurance information Primary insurance coverage Carrier name Street City State - Select - ZIP code Phone Identification number Effective date wG xR^[ochg`>b$*~ :Eb~,m,-,Y*6X[F=3Y~d tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:O:8uJqnv=MmR 4 MagnaCare health plans use a self-insured model, allowing companies the freedom to choose what to cover and how to cover it. THE SCREENING PROGRAM No, but if you have a Health Reimbursement Account, you may submit to that Fund. You should directly contact your insurance company or the physician who is arranging your healthcare services to see which insurance plans the physician participates in. Learn more about our Medical Management services >. Then ask your insurer if the services ordered by your physician are covered services.. Just contact one of the conveniently located optical providers for an appointment. . If it is an emergency visit, the facility may call within 24 hours after the admission. 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. The hospital must do a medical screening evaluation prior to determining your medical coverage (as mandated by federal law). Extend your presence in New York, New Jersey, and Connecticut with our large, high-quality, affordable network, trusted by local, regional, national, and international TPAs and carriers for more than 30 years. If one of these medications is medically necessary, you may call the Joint Industry Board Members Records Department at (718) 969-4030 to obtain a form for you and your doctor to complete and submit to the PHBP Medical Plan for medical review. Major participating labs are Quest, Lab Corp of America, Bio-Reference Lab, Sunrise Lab, etc. My doctor requires that I take a drug that is NOT Plan-preferred and for which there are no equivalent preferred brands or generics. Complete details are available in the Summary Plan Description. Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. Estas pruebas se pagaran totalmente y completamente por su Plan. Eligibility will be verified at the time of your visit. The following is a list of insurance carriers with which most of our doctors participate. CIGNA is the Tier 2 network outside of New York and New Jersey. The plan at 1-718-591-2000 or the Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or Learn More >, Find out more on what you can do to help prevent disease, injury, or illness to stay healthy. Receiving care from an out-of-network hospital could increase your out-of-pocket costs. Uninsured View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. For quick and easy access, store this card in your digital wallet! Your co-pays are shown on the chart of covered services on theMedical Plan page. A: Yes. HU]oF|_dQoo}\-") A: Please visit the Whats new in 2022 page on the myBenefits site to view important updates, including plan design changes and a link to the new myMedical site outlining the changes to provider networks for all three team member plans and the third-party administrator for the Value and Buy-up plans. Call the Joint Industry Board Members Records Department at (718) 591-2000, Extension 2491 to obtain a form to initiate a review. 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. Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. Patient Information and Medical History Form. Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. Please note that co-payments for all other services, other than the annual adult well-care visits, will apply. Aetna/US Health Care all HMO, PPO, Self-Insured Plans, Aetna Signature Administrators, Indemnity, Medicare HMO and PPO. Englewood Hospital is committed to protecting our patients from surprise medical bills. 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. IN ADDITION, THE PHYSICIANS WHO PROVIDE CARE WITHIN OUR HOSPITAL MIGHT NOT PARTICIPATE IN THE SAME INSURANCE PLANS AS THE HOSPITAL. trailer <]>> startxref 0 %%EOF 653 0 obj <>stream You can find a doctor in the MagnaCare preferred provider network online. Emergency room visits for non-emergency conditions will not be approved as medically necessary and will not be covered by the Pension, Hospitalization and Benefit Plan. 201-894-3000, Derechos y responsabilidades de los pacientes, Data on Race, Ethnicity, Sexual Orientation, Nondiscrimination Notice - English Espaol Ting Vit Kreyl Franais Italiano Polski Portugus Tagalog . For example, most patients are required to obtain their laboratory and radiology services at a dedicated facility. Confirm with practice)MetroPlus - Exchange (Pertains only to certain providers in Staten Island. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. A: In the event of a medical life-threatening emergency, you should go to the closest emergency room. See information regardingphysicians who are employedby Englewood Hospital. 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 HealthCare.gov website, Effective 10/1/2016, Doctor visits and diagnostic services: $35 co-pay/$70 cap, Surgical procedures whose allowable Plan reimbursement equals or exceeds $1,000: $250 co-pay. Each of these plans consist of a Tier 1 network and Tier 2 network. 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. JIB Medical, P.C. Get your members the most appropriate and highest quality medical care at the lowest cost. A: Please sign up for the member portal at Northwell.edu/myMedical to access your digital ID card, review claims and Explanation of Benefits (EOBs), check coverage and benefits, and continue searching for providers and facilities.In-network provider and facility coverage. 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. at (718) 591-2000, Extension 2491. Autism affects 1 in 59 children in the United States, and the condition varies greatly from person to person. 0000002707 00000 n Gracias. With this increased availability, there are more areas that were previously considered OOA now determined as in-area. Who should I call? Yes. MagnaCare's extensive PPO network in New York, New Jersey, and Connecticut includes more than 200 hospitals and 220,000 healthcare provider locations. 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 Documentation from the physician and paystub must be submitted with a completed application signed by the participant and the employer. Eligible participants can receive medical and hospitalization benefits under this plan. Learn more about your health plan and how we keep you well and healthy, Custom-fit your health plan to meet the unique needs of your members, Find out why TPAs and carriers choose MagnaCare, Join our network of leading providers in New York, New Jersey, and Connecticut. MagnaCare is a health plan management company with members on the east coast, primarily New York, New Jersey, and Connecticut. I dont understand the difference between generic, Plan-preferred brand-name and non-preferred brand-name drugs. Our expansive and advanced technology New York footprint supported by the top radiologists in New York will continue to provide care to our members and offer an expansive radiology network outside of New York. You may locate a MagnaCare participating physical therapist by visiting their website at www.magnacare.com. For dates of service on or after August 1, 2011, you should call MagnaCare's dedicated Local Union No. Emergency room visits for non-emergency conditions will not be approved as medically necessary and will not be covered by the Pension, Hospitalization and Benefit Plan. 624 0 obj <> endobj xref 624 30 0000000016 00000 n Click here to view which zip codes are now in-area and OOA. Visit Northwell.edu/myMeds for information about Vivo Health and in-network pharmacies. The company works to provide a variety of services and products to meet the unique needs of clients, with more than 225 in-network hospitals and 130,000 physicians in the states listed above. Confirm with practice)MetroPlus - Essential Plan 2 (Pertains only to certain providers in Staten Island. Please note:These lists contain Labcorps most commonly billed insurance carriers, which are subject to change, and not all-inclusive. In accordance with New Jerseys new Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, we have provided the information below regarding potential healthcare costs. You will pay less if you use a provider . There is no need to submit claims when Medicare is your primary insurance for dates of service rendered on or after 8/1/2011. These practices are participating providers in the MagnaCare network. In a true emergency, you are covered. This benefit is in addition to Workers Compensation and provides income replacement, up to 15 weeks, if you are taken directly to the hospital and admitted because of an on-the-job injury. 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. 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. Traer la receta de su mdico y pagar slo el copago. Disadvantages include the possibility of large expenses for catastrophic claims, especially for small companies. k}Z@fr&*Mae1d*C+}t:jQIB>bN,{]Q'$U1!V|KN]7?MPJI" N!io[c-IM b&;BZB Zc?Qn[;lx}BpN[:/uzQWM6\Sp?Wt VGBx9 *'p You can cover your spouse and children. Through early intervention and treatment, symptoms can be greatly improved. At Mount Sinai South Nassau, we participate in Medicare, Medicaidand most HMOs and commercial insurance plans. Claims will not be paid unless prior approval from MagnaCare is obtained. Consulte siempre a su libro de descripcin Resumen del Plan (SPD) para obtener informacin detallada acerca de su plan. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. If this occurs, you can call the Joint Industry Board Members Records Department at (718) 591-2000, Extension 2491 to obtain a form to initiate a review to determine if the preferred brand co-pay applies. Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? As long as the admission is precertified and determined to be medically necessary through MagnaCare, your in-patient or Emergency Room hospital bills will be covered. Do I still have to pay the highest co-pay? Thank you for using our secure online forms. Customer service: Effective April 10, 2019, covered participants in the divisions listed below shall be entitled to be reimbursed for a days pay based on a straight time contractual rate from the Welfare Plan when he or she takes off a day from work to go for a physical exam and loses a days pay pursuant to the Plan rules. For help submitting insurance information, call the Financial Services team at (888) 214-4066. indicates a required field Patient information Patient name Hospital account no. What services require pre-certification directly through the PHBP Medical Plan? How do I submit my claims? Englewood, NJ 07631 As a participant, you are able to cover your lawful spouse, children (biological or legally adopted) and/or stepchildren according to the rules of the Plan. Diagnostic facilities can often have separate co-payment requirements, and some insurance companies may require you to have outpatient laboratory services performed at their designated facilities. The Joint Industry Board of the Electrical Industry is a non-profit organization established under Section 501(c)(5) of the Internal Revenue Code. Click here for the benefit changes effective October 1, 2016 for Active Participants and non-Medicare retirees. My MagnaCare doctor visit was covered by the Plan, but MagnaCare denied the lab bill. 516-632-3000, or Our nurses have helped members lose weight, quit smoking, improve mental health, and manage their diabetes and other conditions. Qu son los servicios de diagnstico y cmo puedo encontrar proveedores que son participantes? We're committed to improving your health and wellness so you can live life to the fullest. What drugs are not covered under the Prescription Drug Plan? You may locate a MagnaCare participating physical therapist by visiting their website atwww.magnacare.com. A: Team member care has always been our top priority, and by partnering directly with Northwell Direct, we believe we can provide care directly to our team members without an intermediary through the Northwell Direct network. Forgot password? Ask your insurance company if Englewood Hospital is in network with your insurance plan. Mount Sinai South Nassau's participating plans: AgeWell Medicare. Make sure you advise your doctor to send your specimen to a participating lab. A: Northwell offers three medical plans, Value, Buy-up and the HDHP. Reimbursement will be at the network allowance, less the co-pay. Some of this information may be available on your insurance card. Call 1-866-250-8679 or fill out the form below. Once you meet the eligibility requirements above, you become a participant. Oceanside, NY 11572 The Tier 2 network is an extended network which has higher out-of-pocket expenses. Keep in mind that you can minimize your out-of-pocket expense by speaking with your physician about prescribing a generic or Plan-preferred drug for you whenever possible. Once a drug comes off the list, you may purchase it at your retail pharmacy. 0000004823 00000 n 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. Affinity all lines of business, including the Health Exchange Plan. If you are not sure if we participate with your insurer, please call your insurer for confirmation and for any special considerations. In our continuing effort to track the latest innovative technology and provide truly comprehensive health screening programs to our participants The United Wire, Metal, and Machine Benefit Fund is proud to share with you news of our partnership with Heartscan Services: A non-invasive mobile cardio vascular screening and wellness program. Stop-loss insurance policies and multi-company self-insurance programs help minimize these risks. Find an Urgent Care Center. Phone number: 1-800-999-5431 If you prefer, call MagnaCare at (877) 624-6210 or contact the Health Advocate at (866) 799-2723. For a center near you, Visit the Vision Screening website at https://www.vscreening.com, Optical benefits for all eligible participants and their eligible dependents include Exams, Tinting, Frames, & Contact Lenses. RadNet, Inc. is the leading national provider of free-standing, fixed-site diagnostic imaging services in the United States. 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. Beech Street PPO. Your new, enhanced service portal is now live! If my doctor is monitoring the effectiveness of my medication, can I continue to get up to a 34-day supply from my local pharmacy until it is determined that a 90-day supply is necessary? The Tier 1 network will always be more cost-effective for you than the Tier 2 network. Dr. Kibot is a board-certified family nurse practitioner who has been practicing since 2016. Asthma is treatable, but symptoms sometimes flare up.Learn More >, Heart disease is the leading cause of death worldwide. I am having trouble finding an in-network provider on the MagnaCare website. A: If your provider or facility is not included in the Tier 1 network, you can use the MagnaCare network, the Tier 2 network for New York and New Jersey. Simply use your smartphone camera to scan the QR-Code below and choose the iPhone or Android link to download the EXPRESS SCRIPTS APP. Mount Sinai South Nassau's participating plans: If you have Medicare, you must complete the Medicare Secondary Payor Questionnaire. Examples of true emergencies include premature labor, significant bleeding from any site, broken bones, losing consciousness, new onset of seizures or seizures that are not being controlled, and difficulty breathing. Beacon Behavioral Health. Call (800) 352-6465 or click on the link: https://www.magnacare.com/local-union-no-3-ibew-autism-support-program/, Express Scripts Network (Prescription Drug Questions), MagnaCare Advocacy Services(866) 624-6260, https://www.healthcare.gov/coverage/preventive-care-benefits/.
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