trailer <]>> startxref 0 %%EOF 653 0 obj <>stream Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? Home health care or hospice in conjunction with a hospital discharge, Durable medical equipment in conjunction with a hospital discharge, Out-patient therapies, including physical, occupational, speech, cardiac, and respiratory therapies, Home health care and hospice unrelated to a hospital discharge, Durable medical equipment including but not limited to canes, crutches, wheelchairs and oxygen supplementation. A: Yes. 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. 0000096306 00000 n El mdico puede prescribir ciertas pruebas a realizar que necesitan aprobacin previa de su fondo. 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. 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. When you do, there is a $100 co-pay. Where do I find an in-network, private free-standing facility? For in-network claims, you will be responsible for only four (4) co-payments of $35 per incident or illness. Member Login - Brighton Health Plan Solutions Who should I call? at (718) 591-2000, Extension 2491. Documentation from the physician and paystub must be submitted with a completed application signed by the participant and the employer. Box 1001, Garden City, NY 11530. 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.) Beech Street PPO. 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. You may locate a MagnaCare participating physical therapist by visiting their website at www.magnacare.com. 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. 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. You can find a doctor in the MagnaCare preferred provider network online. If it is an emergency visit, the facility may call within 24 hours after the admission. 212-691-4100 ext.313. If you have a specific question about your Medicare benefits, call Empire Medicare, toll-free: (800) 442-8430 or go to empireblue.com. Northwell Direct Member FAQ - Brighton Health Plan Solutions MagnaCare | Health Plan & Human Resource Administrator Insurance List | Carriers Currently Filed by Labcorp If you prefer, call MagnaCare at (877) 624-6210 or contact the Health Advocate at (866) 799-2723. RadNet has a network of 309 owned and/or operated outpatient imaging centers. 9EN|~U^=.lQT_"PvS.+:a;6qG rY53fcT:[]_WEo.:r?&4+hp$XX#J: `0 All Rights Reserved. Covered Participant members may apply for one medical exam day benefit using this form. All Participants should call MagnaCare's dedicated Local Union No. Patient Information and Medical History Form. 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. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. What type of mental health benefits does the Plan cover? One Healthy Way 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. 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. Stop-loss insurance policies and multi-company self-insurance programs help minimize these risks. health plan management company. ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. Free medical services at JIB Medical, P.C. You can call MagnaCare Advocacy Services for assistance at (866) 624-6260. Please fill out as much information as you can. If you are seeking assistance for inpatient services, Mount Sinai South Nassaus Financial Assistance professionals may be able to help you complete your application. Member Login Take control of your health care. Consulte siempre a su libro de descripcin Resumen del Plan (SPD) para obtener informacin detallada acerca de su plan. Listen to the message prompts and press the selection for pre-certification. Plan Administrator: Joint Industry Board of the Electrical Industry Preventive Health Services Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations. 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. Pregnant while Black: A conversation with Dr. Monique Rainford Complete details are available in the Summary Plan Description. 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. Username / Email Address Password as a New User Forgot username? 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. 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. RadNet is honored to expand their relationship with Local 810, United Wire Metal and Machine. What do I do if I need to go to the Emergency Room? Insurance - Rocky Point Physical Therapy 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. And, youll have access to discounted medical liability insurance through our partner, MLMIC. If you are not sure if we participate with your insurer, please call your insurer for confirmation and for any special considerations. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. MagnaCare Rx I am an active Participant who has questions about benefits or claims. "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 The claim may then get denied as a not covered routine test. Labcorp will file claims for insured patients directly to Medicare, Medicaid, and many insurance companies and managed care plans. All their providers participate with Magnacare. How am I and my family covered if I am retired, living out-of-state and not yet eligible for Medicare? 0000084956 00000 n 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. Call 1-866-250-8679 or fill out the form below. 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. Find a doctor | Northwell Health 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. Note that the available options for marital status, race and ethnicity are the options required by the US Government. HyTSwoc [5laQIBHADED2mtFOE.c}088GNg9w '0 Jb MagnaCare works with employers to custom design plans that bring together self-insurance components, multi-company self-insurance options, traditional insurance for catastrophic situations, workers compensation and health management tools, maintains MagnaCare. Si no est seguro o necesita ayuda para localizar un centro diagnostico que son participantes por favor llame el fondo de bienestar para ayuda. 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. MSK is the worlds oldest and largest private cancer center and US News & World Report ranks MSK as the top hospital in the Northeast for cancer care. Call 1(888)-590-7370 for participating providers. I am a retiree on Medicare. If you choose to use providers that are out-of-network you will pay significantly more. Dnde se puede encontrar un consulturio/centro diagnostico que son participantes? Please have ready the name of the physician you visited who prescribed the diagnostic tests and the date of the visit. Asegrese de que usted aconseja su medico que le envie su muestra a un laboratorio participante. Access the in-network provider and facility search on Northwell.edu/myMedical. Copyright 2015 UNITED WIRE METAL & MACHINE, x-rays, bone density, echocardiogram, mammography, echocardiogram, ultrasound, and sonograms, https://idoc.davisvision.com/members/FindAProvider/Index. 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. 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. 0000002707 00000 n 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. 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- Contact us Getting direct about business solutions Prescriptions for maintenance medications must be mailed to Express Scripts after the first fill and one refill. Click here to view which zip codes are now in-area and OOA. This plan uses a provider network. 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. The Tier 1 network will always be more cost-effective for you than the Tier 2 network. Mount Sinai South Nassau's participating plans: If you have Medicare, you must complete the Medicare Secondary Payor Questionnaire. ECHOCARDIOGRAM Looks at size, shape, and movement of the heart, CAROTID ARTERY ULTRASOUD Can identify plaque in the carotid arteries, which can lead to stroke, ABI INDEX Looks for peripheral arterial diseases and early diabetes, ABDOMINAL ULTRASOUND To detect Abdominal Aortic Aneurysm (AAA). 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.
