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Calls outside of those hours will be returned the next business day. All remaining balances are the participant's responsibility. I dont understand the difference between generic, Plan-preferred brand-name and non-preferred brand-name drugs. OVERVIEW | MEDICAL PLANS | SUPPORT. 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. 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. Thank you. Related, out-of-network claims should be submitted to the Plan for reimbursement. Each of these plans consist of a Tier 1 network and Tier 2 network. Who should I call? What type of Chiropractic care is covered by the Plan? How much is my prescription drug co-pay under the PHBP Prescription Drug Plan? Please note that co-payments for all other services, other than the annual adult well-care visits, will apply. Choose from a wide range of health plans customized to your needs. 0000004339 00000 n Are there any exceptions when a paper claim needs to be filed? Generic drugsare manufactured after the original manufacturers patent expires. Reimbursement will be at the network allowance, less the co-pay. 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. A: The Northwell Direct network** became effective on Jan. 1, 2022, and is the Tier 1 network for our team member Value and Buy-Up medical plans replacing the Northwell Clinical Integration IPA (CIIPA) network. 877-SOUTH-NASSAU 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. All Participants should call MagnaCare's dedicated Local Union No. Click here for more information on Magnacare. 0000002462 00000 n 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. (PHBP Medical Plan). Scheduled procedures performed in a hospital should be pre-certified by the physician. It is the hospitals responsibility to pre-certify all admissions by calling (877) 624-6210 once you have given them the information by presenting your ID card. by having worked on a full-time basis for a Contributing Employer to this Plan, during which time contributions were made, least 26 consecutive weeks immediately prior to incurring a reimbursable. 0000060018 00000 n Box 1001, Garden City, NY 11530. 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. Heart disease is the leading cause of death worldwide. Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. Principales laboratorios participantes son Quest, Lab Corp de Amrica, laboratorio de Bio-Reference, Sunrise Lab, etc. Oceanside, NY 11572 2023 Brighton Health Plan Solutions. 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. at the Electric Industry Center in Flushing, NY. 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. Yes. Para las pruebas de rayos X/ecografa click Radiology Centers, Por sangre y/o exmenes de laboratorio click Laboratories. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. MagnaCare health plans use a self-insured model, allowing companies the freedom to choose what to cover and how to cover it. The hospital must do a medical screening evaluation prior to determining your medical coverage (as mandated by federal law). A: Northwell offers three medical plans, Value, Buy-up and the HDHP. AlphaCare Nassau County only. At Rocky Point Physical Therapy, we accept numerous insurance plans along with Medicare and workers' compensation. What are the co-payments for physical therapy claims? For example, GI drugs (such as Nexium, Protonix, omeprazole) have been added to this list. Ask your insurance company if Englewood Hospital is in network with your insurance plan. 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. Before scheduling a procedure at the hospital, ask your insurance company whether you need pre-authorization or a referral. Some of this information may be available on your insurance card. Qu son los servicios de diagnstico y cmo puedo encontrar proveedores que son participantes? What do I do if I need to go to the Emergency Room? Si no est seguro o necesita ayuda para localizar un centro diagnostico que son participantes por favor llame el fondo de bienestar para ayuda. If you visit a retail drugstore, your pharmacist will let you know if your medication requires pre-certification. 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. Plan-management tools: Our powerful, user-friendly dashboards and dynamic online reporting system provide access to reports and program information, and our account management staff can help interpret results and offer recommendations. Who can I call for help? All covered visits, both in and out-of-network, are subject to the $35 co-payment. Under the PHBP Medical Plan, all hospital admissions and surgical procedures performed in a hospital facility or surgi-center require pre-certification through MagnaCare. Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. Confirm with practice)MetroPlus - Essential Plan 2 (Pertains only to certain providers in Staten Island. If your question is about insurance only, please call us at 646-497-9176, Monday through Friday, 8:00 a.m. to 5:00 p.m. (Eastern time) Learn More >, Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare. If you use an in-network provider, there is no out-of-pocket expense for covered services other than the co-pays indicated below. Patient Information and Medical History Form. 0000002508 00000 n I am a retiree on Medicare. 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. You may qualify for Medicare benefits if you: Your Medicare card will indicate if you have Part A benefits, Part B benefits or both, and their effective dates. CIGNA is the network outside of New York and New Jersey should you or a dependent need access to a provider outside of the area. Do I still have to pay the highest co-pay? Make sure you advise your doctor to send your specimen to a participating lab. In order to qualify for coverage, certain medications require pre-certification in order to determine the appropriateness of the drug in treating your condition. 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. JIB Medical, P.C. 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. View the full version of www.magnacare.com.. To report errors related to this website, please email your results at webmaster@magnacare . Dr. Kibot is a board-certified family nurse practitioner who has been practicing since 2016. 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 (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/. All their providers participate with Magnacare. 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. 212-691-4100 ext.313. Please note that this list DOES NOT represent an exclusive list of physicians who may provide professional services to you while at Englewood Hospital. Below is a list of the network and plans we currently participate in. These practices are participating providers in the MagnaCare network. Member Login Take control of your health care. 0000084956 00000 n 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. 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. MagnaCare providers listed on Doctor.com have been practicing for an average of: 28.6 year (s) Average ProfilePoints score for Providers who take MagnaCare: 44/80. Asegrese de que usted aconseja su medico que le envie su muestra a un laboratorio participante. If you are not sure if we participate with your insurer, please call your insurer for confirmation and for any special considerations. If I am a retiree, who do I call if I have questions about the crossover or outstanding Medicare secondary claims? Your co-pay is based on the status of your drug (generic, plan-preferred or non-preferred) and the quantity (number of days supply) you receive as well as your status as an active or retired Participant. for a list of in-network doctors and other providers. If you have a specific question about your Medicare benefits, call Empire Medicare, toll-free: (800) 442-8430 or go to empireblue.com. 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. 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. Englewood Hospital is committed to protecting our patients from surprise medical bills. Submit claims to MagnaCare at P.O. What services require pre-certification through MagnaCare? 0000115326 00000 n If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. Most self-insured plans also include a fee for stop-loss insurance coverage, which pays large claims over a certain amount. Does the list of maintenance medications ever change? Yes. Simply use your smartphone camera to scan the QR-Code below and choose the iPhone or Android link to download the EXPRESS SCRIPTS APP. Disadvantages include the possibility of large expenses for catastrophic claims, especially for small companies. 563 Southpark Boulevard, Colonial heights, VA 23834. Secondary claims are paid by MagnaCare on an automatic crossover. When you do, there is a $100 co-pay. Then ask your insurer if the services ordered by your physician are covered services.. 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. For in-network claims, you will be responsible for only four (4) co-payments of $35 per incident or illness. Members Learn more about your health plan and how we keep you well and healthy Plan Sponsors If you choose to use providers that are out-of-network you will pay significantly more. I am a retiree on Medicare. 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. Always refer to your Summary Plan Description (SPD) for detailed information about your plan. 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. Do I need to pre-certify in order to receive prescription drug benefits? All Rights Reserved. Beacon Behavioral Health. Your insurance card also includes a customer service number where you can get answers to your specific coverage questions. Where do I find an in-network, private free-standing facility? Please refer to the chart of covered services on the Medical Plan page for co-pay amounts. Ask your Fund if it participates in the Nurse Case Management program, and whether youd be a good fit. Listen to the message prompts and press the selection for pre-certification. Most popular medical specialty of providers who accept MagnaCare: Internist. If you file your prescription through Express Scripts, their pharmacist will initiate the pre-certification review with your doctor. Learn more about our casualty solutions >. Learn more about our comprehensive health plan management >. Prospective applicants must call to apply for the Prenatal Care Medicaid Program before seeing a doctor. Other services requiring pre-certification include: The toll-free phone number for any pre-certification through MagnaCare is (877) 624-6210. 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. 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. The hospital/surgi-center can appeal to MagnaCare to receive payment but it must provide all of the documentation pertinent to your hospital admission. 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. Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). Affinity all lines of business, including the Health Exchange Plan. Heartscan Services identifies early risk factors of Heart Disease, Stroke, PAD (Peripheral arterial disease and diabetes), and Thyroid nodules. Yes, if it involves maintenance medication. You must check with your physician before treatment to determine the insurance plans s/he accepts. 0000007729 00000 n If it is an emergency visit, the facility may call within 24 hours after the admission. Please call (877) 624-6210. 0000115774 00000 n A: Providers are continually being evaluated for participation within the Northwell Direct network. 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. 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. Blood tests can only be performed in a doctors office during a medical emergency. 2023 Joint Industry Board of the Electrical Industry. Have you done any of the following in the time frame mentioned? at (718) 591-2000, Extension 2491. Prescription coverage has not changed. Downloadthe Enrollment Form for Eligible Dependents. You can find out more about each PHBP Area Group Practice by visiting their website or by calling them. Username / Email Address Password as a New User Forgot username?

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