Get your members the most appropriate and highest quality medical care at the lowest cost. All therapies must be pre-approved by MagnaCare. 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. How am I and my family covered if I am retired, living out-of-state and not yet eligible for Medicare? Non-preferred brand-name drugsare those that do not yet have a generic equivalent, but for reasons of effectiveness or cost, are not on your Plans formulary drug list. We have consistently demonstrated cost savings for our clients while maximizing health and wellness for their members. Access your account anytime, anywhere with the MyCreateHealth Mobile App. Simply use your smartphone camera to scan the QR-Code below and choose the iPhone or Android link to download the EXPRESS SCRIPTS APP. 0000001528 00000 n 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. 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. This plan uses a provider network. Englewood, NJ 07631 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. 0000000896 00000 n At Rocky Point Physical Therapy, we accept numerous insurance plans along with Medicare and workers' compensation. 0000106362 00000 n I am a retiree on Medicare. AlphaCare Nassau County only. Patient Information and Medical History Form. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. Beacon Behavioral Health. A: For team members and dependents currently undergoing specific medical services (e.g., a scheduled surgery, continuation of maternity and delivery care, chemotherapy) utilizing a provider that is not in-network, Brighton will work directly with you to be considered for continued care with that dedicated provider until April 1, 2022, and for maternity care until July 1, 2022. Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations. Choose from a wide range of health plans customized to your needs. The PHBP will cover up tofour annual diabetic education sessions. 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. Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. They will bill separately. A: No. 2023 Joint Industry Board of the Electrical Industry. ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ What are the co-payments for physical therapy claims? Contact MagnaCares Pre-certification Department at (877) 624-6210or refer to the Summary Plan Descriptionfor complete details. The Affordable Care Act requires health insurance companies to provide this pricing information to their customers. 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. 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. 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. Learn more about our Medical Management services >. 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 Ask your Fund if it participates in the Nurse Case Management program, and whether youd be a good fit. Available now Prospective applicants must call to apply for the Prenatal Care Medicaid Program before seeing a doctor. This program is for uninsured pregnant women and adolescents residing in New York state. You are eligible after 26 weeks of employer contributions. Member Resource Center At MagnaCare, we take healthcare personally and we put people first. Our nurses have helped members lose weight, quit smoking, improve mental health, and manage their diabetes and other conditions. 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. View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. Quest Diagnostics www.questdiagnostics.com Phone # 1(866)-697-8378. Benefits are provided once every 12 months. 2023 Laboratory Corporation of America Holdings. A: Yes. If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). Mount Sinai South Nassau's participating plans: If you have Medicare, you must complete the Medicare Secondary Payor Questionnaire. What happens if I am out of town and admitted to the hospital? 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. Heartscan Services identifies early risk factors of Heart Disease, Stroke, PAD (Peripheral arterial disease and diabetes), and Thyroid nodules. 130193. 0000096306 00000 n Eligibility will be verified at the time of your visit. Ir a pagina web Magnacare.com y leer a continuacin, o llame a (866)-281-0364 y siga las instrucciones. Plus, we offer innovative narrow networks in conjunction with leading . Visit Northwell.edu/myMeds for information about Vivo Health and in-network pharmacies. If so, your doctor must call a special toll-free number at Express Scripts to initiate a review. Phone # 1(800)-845-6167. Our physician network offers primary, specialty, and urgent care at more than 100 locations across northern New Jersey and Rockland County. 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 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 $35 co-payments. JIB Medical, P.C. For 2022, the Tier 2 network for all states outside of New York and New Jersey for HDHP is changing from First Health to CIGNA. Asthma is one of the most common chronic diseases. Your co-pay is based on the status of your drug (generic, plan-preferred or non-preferred) and the quantity (number of days supply) you receive as well as your status as an active or retired Participant. The Pension, Hospitalization and Benefit Plan of the Electrical Industry (PHBP) has partnered with Memorial Sloan Kettering Cancer Center (MSK) through MSK Direct- a program that offers guides access to expert cancer treatment for PHBP members and their eligible family members. It's important to know what you should do when you experience lower back pain. DNDE SE PUEDE IR PARA HACERME MIS PRUEBAS DE DIAGNOSTICO? wG xR^[ochg`>b$*~ :Eb~,m,-,Y*6X[F=3Y~d tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:O:8uJqnv=MmR 4 If you are using the Tier 2 network, you should identify your plan as MagnaCare in New York or New Jersey . Carriers Currently Filed by Labcorp. 3 service line at (877) 624-6210. (Press Enter or Space to Go to Landing Page or Press Down to expand Menu), Federally Qualified Health Centers (FQHCs), Combatting Modern Slavery and Human Trafficking Statement. Under the PHBP Medical Plan, what happens if the hospital does not pre-certify my admission? 2023 Brighton Health Plan Solutions. Oceanside, NY 11572 Ask your insurance company for an estimate of your total out-of-pocket costs. Mount Sinai South Nassau's participating plans: AgeWell Medicare. I dont understand the difference between generic, Plan-preferred brand-name and non-preferred brand-name drugs. at the Electric Industry Center in Flushing, NY. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. Remind your provider to call for pre-certification when you know that you will be admitted. 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. Our vision centers will provide a comprehensive eye exam and Rx lenses with No Out-Of-Pocket cost to you if you stay within the plan coverage. Affinity - All Products Accepted except Exchange. 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. At Mount Sinai South Nassau, we participate in Medicare, Medicaidand most HMOs and commercial insurance plans. Upon registration, your Express-Scripts identification card will appear digitally on your smartphone and is ready to be used at your convenience. Call the Joint Industry Board Members Records Department at (718) 591-2000, Extension 2491 to obtain a form to initiate a review. Medicare Plus Plan 2 (HMO) $21: $2,500 per ear: $7,500: Listen to the message prompts and press the selection for pre-certification. 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) A: In the event of a medical life-threatening emergency, you should go to the closest emergency room. Its that east! 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. Most popular medical specialty of providers who accept MagnaCare: Internist. 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. Cualquier resonancia magntica, endoscopia, colonoscopia, PET o computarizadas deben ser previamente aprobados. Youll get the peace of mind of knowing you can manage your health condition. Vivo Health has a large pharmacy network, which includes ten Vivo Health Pharmacy locations, mail order and more than 64,000 participating retail pharmacies. MagnaCare's extensive PPO network in New York, New Jersey, and Connecticut includes more than 200 hospitals and 220,000 healthcare provider locations. Contact the provider closest to your home/work for an appointment. 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. Were committed to improving your health and wellness so you can live life to the fullest. 0000007729 00000 n When you do, there is a $100 co-pay. For dates of service on or after August 1, 2011, you should call MagnaCare's dedicated Local Union No. 0000085219 00000 n (PHBP Medical Plan). Go to Magnacare.com and read below, or Call (866)-281-0364 and follow their instructions. 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. 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 0000111603 00000 n 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. Who should I call? Confirm with practice)MetroPlus - Medicaid (Pertains only to certain providers in Staten Island. How long can I remain covered under the PHBP Medical Plan? These practices are participating providers in the MagnaCare network. They are included on a drug list know as a formulary. Start with our Member Resource Center to find resources to help you achieve your health goals. You and your eligible dependents are entitled to free services provided by JIB Medical, P.C. Once you meet the eligibility requirements above, you become a participant. Aetna/US Health Care all HMO, PPO, Self-Insured Plans, Aetna Signature Administrators, Indemnity, Medicare HMO and PPO. 0000004088 00000 n Its a condition in which a persons airways can narrow and swell, making it difficult to breathe. Prescriptions for maintenance medications must be mailed to Express Scripts after the first fill and one refill. A: Northwell offers three medical plans, Value, Buy-up and the HDHP. OVERVIEW | MEDICAL PLANS | SUPPORT. No, but if you have a Health Reimbursement Account, you may submit to that Fund. Copyright 2015 UNITED WIRE METAL & MACHINE, x-rays, bone density, echocardiogram, mammography, echocardiogram, ultrasound, and sonograms, https://idoc.davisvision.com/members/FindAProvider/Index. Phone (877) 432-7823 Get the care you needsafely Request an appointment 20-Minute Health Talk If your doctor prescribes you a diagnostic test that requires radiology or blood work you must use an in-network free-standing facility. Brighton Health Plan Solutions,LLC. See information regardingphysicians who are employedby Englewood Hospital. Insulin is no longer on the list. With the MagnaCare Rx Prescription plan you have two ways to ll your prescriptions, depending on your medication needs: Short-term prescription needs: to be lled through a network retail pharmacy Long-term prescription needs: Mail Order to be lled through our mail order pharmacy partner Short-term prescription needs: 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. 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. 0000001439 00000 n What services require pre-certification through MagnaCare? Most self-insured plans also include a fee for stop-loss insurance coverage, which pays large claims over a certain amount. Contact us Getting direct about business solutions *xt@ uBJ(ipNE` R@,^+8@6GA)C} 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. You can find information about generic drugs and pricing details online atwww.expres-scripts.comor by calling Express Scripts Patient Customer Service at (800) 818-0883. The following is a list of insurance carriers with which most of our doctors participate. 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. It involves treatments and trainings to ensure a healthy pre-pregnancy, pregnancy, and labor and delivery for mom and baby. 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. 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. health plan management company. A: 2022 benefit guides are available on the myBenefits site. The Plan does not cover weight-loss medications (such as Xenical and Meridia), erectile dysfunction medications (such as Cialis, Levitra, and Viagra), fertility medications (such as Clomid and Repronex), non-sedating antihistamines (such as Allegra, Clarinex, and Zyrtec), and vitamins. Learn More >, Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. If you have a health concern that is not life-threatening, you may consider calling our ER on Demand service at (516) 918-6005. If you are not sure if we participate with your insurer, please call your insurer for confirmation and for any special considerations. A: No. Asthma is treatable, but symptoms sometimes flare up.Learn More >, Heart disease is the leading cause of death worldwide. trailer <]>> startxref 0 %%EOF 653 0 obj <>stream Dr. Kibot is a board-certified family nurse practitioner who has been practicing since 2016. 2023 Joint Industry Board of the Electrical Industry. A maximum of 30 office visits to a chiropractor will be covered in a calendar year for each family member. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. 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. or by calling them at (877) 624-6210. I am having trouble finding an in-network provider on the MagnaCare website. Average Overall User Rating for providers who take MagnaCare: 4 (out of 5) Prescription coverage has not changed. 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. V)gB0iW8#8w8_QQj@&A)/g>'K t;\ $FZUn(4T%)0C&Zi8bxEB;PAom?W= 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. 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. Medicaid is a state-run health care program for patients not covered by other health care insurance. Amidacare - All Products. Secondary claims are paid by MagnaCare on an automatic crossover. Have you done any of the following in the time frame mentioned? Reimbursement for hospital and surgical expenses are subject to the applicable co-pays (see the Summary Plan Descriptionfor details). Services that are not part of discharge planning require pre-certification directly through the Plan. 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. Free medical services at JIB Medical, P.C. Affinity all lines of business, including the Health Exchange Plan. For more information, click here for Frequently Asked Questions about the program. 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. www.magnacare.com. With our direct-to-employer network contracting model, we're proud to give businesses the opportunity to increase ease and efficiency while engaging a provider network that's unrivaled for quality." Phone (844) 694-3728 Northwell Direct offers a range of solutions, tailored to your needs. If you are seeking assistance for inpatient services, Mount Sinai South Nassaus Financial Assistance professionals may be able to help you complete your application. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. 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. 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. 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. What type of Chiropractic care is covered by the Plan? If you file your prescription through Express Scripts, their pharmacist will initiate the pre-certification review with your doctor. 0000002462 00000 n Yes. or by calling them at (877) 624-6210. A: No. If the review is approved, you will receive a letter indicating the length of approved coverage. 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. You can cover your spouse and children. With this increased availability, there are more areas that were previously considered OOA now determined as in-area. 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. 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. If the review is denied, the letter will include the reason for denial and instructions on how to submit an appeal if you choose. MagnaCare was founded in 1992 with headquarters in Westbury, NY .
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