Forgot password? 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.) Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. If you have health insurance, there are important steps you should take to understand your coverage and protect yourself from unexpected bills. 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. 0000003597 00000 n Phone (877) 432-7823 Get the care you needsafely Request an appointment 20-Minute Health Talk 0000106362 00000 n divisions covered include: a, m, mij, apprentice, m helpers, adm, expeditor, re & rw, teledata, j and outside linemen. 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. A: No. 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. 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. (PHBP Medical Plan). 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. *The $45,000 lifetime limit is retroactive and includes prior completed procedures. We aim to make sure that you receive the treatment you deserve and need and can begin your road to recovery today. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. A: No. At Mount Sinai South Nassau, we participate in Medicare, Medicaidand most HMOs and commercial insurance plans. 0000084956 00000 n Please note:These lists contain Labcorps most commonly billed insurance carriers, which are subject to change, and not all-inclusive. Healthgrades conducts a rigorous evaluation of Medicare-patient records to assess patient mortality and complication rates for 31 of the most common conditions and procedures at nearly 4,500 short-term acute care facilities across the country. This list is updated periodically and subject to change. Once you meet the eligibility requirements above, you become a participant. Medicaid covers almost all aspects of health care, although some services are subject to patient copay amounts ranging from $0.50 to $25. All their providers participate with Magnacare. at the Electric Industry Center in Flushing, NY. Para las pruebas de rayos X/ecografa click Radiology Centers, Por sangre y/o exmenes de laboratorio click Laboratories. HU]oF|_dQoo}\-") If so, your doctor must call a special toll-free number at Express Scripts to initiate a review. 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. Participants who are on disability will remain covered for up to 26 weeks and may extend coverage up to two years if continuing proof of disability is provided. Mike Smith President of Local 810 & Lorraine Buonacore Administrator of Funds. 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. If you use an in-network provider, there is no out-of-pocket expense for covered services other than the co-pays indicated below. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. Estas pruebas se pagaran totalmente y completamente por su Plan. V)gB0iW8#8w8_QQj@&A)/g>'K t;\ $FZUn(4T%)0C&Zi8bxEB;PAom?W= Simply use your smartphone camera to scan the QR-Code below and choose the iPhone or Android link to download the EXPRESS SCRIPTS APP. For in-network claims, you will be responsible for only four (4) co-payments of $35 per incident or illness. Note that a physicians or hospitals participation with an insurance plan does not automatically mean that your plan will cover every expense; always check with your insurance company before undergoing any diagnostic procedure (such as a lab test or radiology) to ensure that the physician, lab or facility participates in your plan; that the test is a covered expense; and what portion of the diagnostic expense you will be responsible for. You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. If your doctor prescribes you a diagnostic test that requires radiology or blood work you must use an in-network free-standing facility. You must check with your physician before treatment to determine the insurance plans s/he accepts. If the review is denied, the letter will include the reason for denial and instructions on how to submit an appeal if you choose. What type of insurance is MagnaCare? The Tier 2 network is an extended network which has higher out-of-pocket expenses. 0000000896 00000 n Dnde se puede encontrar un consulturio/centro diagnostico que son participantes? If the hospital or surgi-center fails to call and give MagnaCare the required information, the facility will not receive payment from the Plan. For example, most patients are required to obtain their laboratory and radiology services at a dedicated facility. They also include Latino/Hispanic heritage under ethnicity and consider it independent of . Ir a pagina web Magnacare.com y leer a continuacin, o llame a (866)-281-0364 y siga las instrucciones. Please fill out as much information as you can. 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. Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. At MagnaCare, we take healthcare personally and we put people first. Box 1001, Garden City, NY 11530. What do I do if I need to go to the Emergency Room? 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? 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. Start with our Member Resource Center to find resources to help you achieve your health goals. for a list of in-network doctors and other providers. 0000115326 00000 n A: Providers are continually being evaluated for participation within the Northwell Direct network. Visit Northwell.edu/myMeds for information about Vivo Health and in-network pharmacies. Click here for the benefit changes effective July 1, 2022 for Medicare eligible retirees. The Tier 1 network offers you providers and facilities contracted by Northwell, allowing for the lowest out-of-pocket expense to you. Call 1(888)-590-7370 for participating providers. Ask your physician to provide you the specific diagnosis descriptions or procedure descriptions. Our nurses have helped members lose weight, quit smoking, improve mental health, and manage their diabetes and other conditions. 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. 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. Scheduled procedures performed in a hospital should be pre-certified by the physician. Prospective applicants must call to apply for the Prenatal Care Medicaid Program before seeing a doctor. Qu son los servicios de diagnstico y cmo puedo encontrar proveedores que son participantes? 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. 0000004088 00000 n At Rocky Point Physical Therapy, we accept numerous insurance plans along with Medicare and workers' compensation. N')].uJr It includes a range of conditions that affects your heart with different symptoms associated with it. at (718) 591-2000, Extension 2491. **Network is held by Northwell Direct Administrative Services Organization, Inc. One Penn PlazaSuite 1410New York, NY 10119. JIB Medical, P.C. www.magnacare.com. The claim may then get denied as a not covered routine test. If you prefer, call MagnaCare at (877) 624-6210 or contact the Health Advocate at (866) 799-2723. 3 service line at (877) 624-6210. Plus, we offer innovative narrow networks in conjunction with leading . Plan-preferred brand-name drugsare those that do not yet have a generic equivalent available and are preferred based on safety, effectiveness and cost. A: No. Plan Administrator: Joint Industry Board of the Electrical Industry Preventive Health Services In this case, you can make a request to override the rule that only allows the first fill and one refill for a maintenance drug at a local pharmacy. Please give us a call at 201-894-3099 to verify if we are a participating facility. We are glad to see you are making health and wellness a priority, great job! 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. Learn more about our Medical Management services >. 0000115710 00000 n Oceanside, NY 11572 All Rights Reserved. Ask your Fund if it participates in the Nurse Case Management program, and whether youd be a good fit. 877-SOUTH-NASSAU There is a $200 emergency room co-pay, which is waived if you are admitted within 24 hours. It includes a range of conditions that affects your heart with different symptoms associated with it. For example, GI drugs (such as Nexium, Protonix, omeprazole) have been added to this list. Eligibility is based on household size and income. A: Team member care has always been our top priority, and by partnering directly with Northwell Direct, we believe we can provide care directly to our team members without an intermediary through the Northwell Direct network. To guard against this possibility, please make sure the physician requesting the diagnostic tests is writing the appropriate diagnosis code on the request he sends you with and the drawing station records it. RadNets core markets include New York, New Jersey, Maryland, Delaware, Florida, California and Rhode Island. All you need to do is register yourself using your email, name, date of birth, zip code and the last 4 digits of your Social Security Number. ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ Always refer to your Summary Plan Description (SPD) for detailed information about your plan. Autism affects 1 in 59 children in the United States, and the condition varies greatly from person to person. Tests done in a hospital setting will not be covered. 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. 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. Access the in-network provider and facility search on Northwell.edu/myMedical. Heart disease is the leading cause of death worldwide. Cualquier resonancia magntica, endoscopia, colonoscopia, PET o computarizadas deben ser previamente aprobados. 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. Get your members the most appropriate and highest quality medical care at the lowest cost. Brighton Health Plan Solutions,LLC. All applicable co-pays will apply to such admissions. A: The Northwell Direct network has more providers and facilities available in New Jersey, the Bronx, Westchester and Connecticut than previously available for you and your family to utilize. We're committed to improving your health and wellness so you can live life to the fullest. Yes, paper claims need to be filed for the following services: Covered services rendered by the Veteran's Administration; the shingles (Zostavax) vaccination; hearing aid devices; diabetic needles and syringes; foreign travel claims; and coordination of benefit claims. Major participating labs are Quest, Lab Corp of America, Bio-Reference Lab, Sunrise Lab, etc. There is no need to submit claims when Medicare is your primary insurance for dates of service rendered on or after 8/1/2011. Servicios diagnostico son una amplia gama de pruebas que son esenciales para la gestin bsica del cuidado del paciente, permitiendo a los mdicos a detectar la enfermedad antes, hacer diagnsticos, prescribir tratamientos y seguimiento de resultados de los pacientes. 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. Heartscan Services identifies early risk factors of Heart Disease, Stroke, PAD (Peripheral arterial disease and diabetes), and Thyroid nodules. The following is a list of insurance carriers with which most of our doctors participate. Insulin is no longer on the list. 212-691-4100 ext.313. All therapies must be pre-approved by MagnaCare. Express Scripts will now advise you when your medication either goes on or comes off of the maintenance drug list. Does the list of maintenance medications ever change? Claims will not be paid unless prior approval from MagnaCare is obtained. These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. 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. Find an Urgent Care Center. MagnaCare health plans use a self-insured model, allowing companies the freedom to choose what to cover and how to cover it. Englewood Hospital (EH) strives to ensure that all patients have access to EH services. 0000115774 00000 n Once the review is complete, Express Scripts will notify you and your doctor of the decision. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. Click here for the benefit changes effective October 1, 2016 for Active Participants and non-Medicare retirees. Englewood, NJ 07631 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- If you visit a retail drugstore, your pharmacist will let you know if your medication requires pre-certification. Were committed to improving your health and wellness so you can live life to the fullest. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. Please note that this list DOES NOT represent an exclusive list of physicians who may provide professional services to you while at Englewood Hospital. Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? 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/. Learn more about our casualty solutions >. Vivo Health offers convenient services such as mail order, a specialty pharmacy and a mobile app for your on-the-go pharmacy needs. Who should I call? 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. The screening is non-invasive, takes approximately 30 minutes and no preparation is required. In addition to hospital and out-of-network coverage, non-Medicare eligible retirees and their families that live in all states will have access to. 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. Reimbursement will be at the network allowance and is subject to the same co-payments as in network claims. Englewood Hospital is committed to protecting our patients from surprise medical bills. Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. 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. Please click here to read important information about paying for your care at Mount Sinai South Nassau. All therapies must be pre-approved by MagnaCare. MagnaCare is a health plan management company with members on the east coast, primarily New York, New Jersey, and Connecticut. For additional free-standing laboratories, please call Magnacare at 1(866)-281-0364. 624 0 obj <> endobj xref 624 30 0000000016 00000 n Please check with the specific doctor you are seeking care and verify eligibility and coverage with your insurance company. In a true emergency, you are covered. 2023 Joint Industry Board of the Electrical Industry. 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. Welcome to MagnaCare Rx, which covers all your pharmacy needs. 3 service line at (877) 624-6210. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug. 4.77. FAQs, Vacation, Holiday and Unemployment Plan FAQs. Your information will never be sold to a third party, in accordance with our Privacy Policy. yrZI$7KSn, H8*$dd8:%C*f/8}CyX4Wl`#8v_]aS}O7iW!T;jI@ sjjVf9$As02'FL2-!4f,3^Pl:ax)! Affinity - All Products Accepted except Exchange. The Tier 2 network for the New York and New Jersey area is the MagnaCare network. Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations. Stay in-network and reduce out-of-pocket expenses. Our physician network offers primary, specialty, and urgent care at more than 100 locations across northern New Jersey and Rockland County. If you have a specific question about your Medicare benefits, call Empire Medicare, toll-free: (800) 442-8430 or go to empireblue.com. Average Overall User Rating for providers who take MagnaCare: 4 (out of 5) The Northwell Direct network and MagnaCare network already serve as the Tier 1 and 2 networks for the HDHP. 0000084904 00000 n We have consistently demonstrated cost savings for our clients while maximizing health and wellness for their members. also provides vision benefits to you and your dependents. Beacon Behavioral Health. MagnaCare was founded in 1992 with headquarters in Westbury, NY . A: In the event of a medical life-threatening emergency, you should go to the closest emergency room. Plan Number: 505 Plan Year: October 1 through September 30 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. The PHBP will cover up tofour annual diabetic education sessions. If I am a retiree, who do I call if I have questions about the crossover or outstanding Medicare secondary claims? 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 .

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