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. All remaining balances are the participant's responsibility. A: Please sign up on Northwell.edu/myMedical where you can search for providers and facilities, view and share your digital ID card, review claims and your Explanation of Benefits (EOBs) and check coverage and benefits. Youll get the peace of mind of knowing you can manage your health condition. Call the Joint Industry Board Members Records Department at (718) 591-2000, Extension 2491 to obtain a form to initiate a review. Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. As a courtesy to our members we will waive the co-payment if you use their facilities. HyTSwoc [5laQIBHADED2mtFOE.c}088GNg9w '0 Jb 212-691- 4100 ext.313. Your doctor may prescribe certain tests to be done that need prior approval from your Fund. MSK must receive this authorization before any appointments are scheduled. 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. The Joint Industry Board of the Electrical Industry is a non-profit organization established under Section 501(c)(5) of the Internal Revenue Code. RadNets core markets include New York, New Jersey, Maryland, Delaware, Florida, California and Rhode Island. Principales laboratorios participantes son Quest, Lab Corp de Amrica, laboratorio de Bio-Reference, Sunrise Lab, etc. You can cover your spouse and children. Learn More >, Find out more on what you can do to help prevent disease, injury, or illness to stay healthy. or by calling them at (877) 624-6210. RadNet is honored to expand their relationship with Local 810, United Wire Metal and Machine. 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. 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. If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). Customer service: You can call MagnaCare Advocacy Services for assistance at (866) 624-6260. for a list of in-network doctors and other providers. THE SCREENING PROGRAM 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/. There is no need to submit claims when Medicare is your primary insurance for dates of service rendered on or after 8/1/2011. at (718) 591-2000, Extension 2491. (877-768-8462), Mount Sinai South Nassau Participating Insurance Plans, The Empire Plan New York State Employees and Participating Agencies (NOTE: United Health Care Insurance Company of New York provides Medical coverage), The City of New York Plan (NOTE: GHI provides Medical coverage), BlueCross/BlueShield Federal Employee Program, All Commercial HMO, PPO and Self-Insured Plans, HMO, PPO, Self-Insured Plans and Medicare HMO, Commercial, NON PAR WITH UnitedHealthcare Community Plan, Medicaid HMO, Child Health Plus Plans, United Dual Complete, Compass, UNITED HEALTHCARE EXCHANGE, UNITED HEALTH CORE/CHARTER, Mount Sinai South Nassaus Cardiologists and Interventional Specialists, Prostate Cancer Symptoms, Tests & Diagnosis, Center for Sleep Wellness Contact / Inquiry Form, Division of Trauma & Surgical Critical Care, Freestanding Emergency Department at Long Beach, Mount Sinai South Nassau Oceanside, Family Medicine, Mount Sinai Doctors - Bellmore, Interventional GI, Joint Replacement Class at Mount Sinai South Nassau, Neonatal Intensive Care Services, Level II NICU, Watch the Mount Sinai South Nassau Maternity Tour, Pediatrics and Maternity Visiting Policies, Mount Sinai Doctors - Oceanside, Radiology, Mount Sinai Doctors - Rockville Centre, PET/CT Radiology, Weight Loss Surgery Frequently Asked Questions, Mount Sinai South Nassau Hospital Non-Participating Insurance Plans, Mount Sinai South Nassau Employed Physician Participating Insurance Plans, Mount Sinai South Nassau Employed Physician Non-Participating Insurance Plans, Plan Participation for Oceanside and Long Beach Emergency Rooms, Outpatient Laboratory Participating Plans, Updates from the Mount Sinai Health System, COVID-19 Vaccination Information and Resources, Truth About Prescription Weight Loss Drugs, Truth About the Tridemic: Don't Delay Vaccines, Truth About Government & COVID-19 Testing, Long Beach Medical Arts Pavilion (Mount Sinai Doctors - Long Beach), Oceanside Campus Central Utility Plant & Emergency Electrical Infrastructure, FEMA Environmental Assessment(s) Finding of No Significant Impact, Womens Health at Mount Sinai South Nassau, Federal No Surprises Act Balance Bill Protections, Protecciones De La Ley De Proteccin Contra Facturacin Del Saldo Inesperada, Plan Participation for Employed Physicians Except Neonatology & Oceanside ER, Mount Sinai South Nassau Non-Participating Insurance Plans, Patient Guide to Patient Satisfaction Surveys and Ratings, can check the listing of our labs participating insurance companies here. Reimbursement will be at the network allowance, less the co-pay. 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. The hospital must do a medical screening evaluation prior to determining your medical coverage (as mandated by federal law). This plan uses a provider network. For quick and easy access, store this card in your digital wallet! xb```BQ ea0`0X"h j1l`^cHc-,Z~"J Express Scripts will now advise you when your medication either goes on or comes off of the maintenance drug list. Asegrese de que usted aconseja su medico que le envie su muestra a un laboratorio participante. The Northwell Direct network and MagnaCare network already serve as the Tier 1 and 2 networks for the HDHP. 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. 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. A: No. Mount Sinai South Nassau's participating plans: If you have Medicare, you must complete the Medicare Secondary Payor Questionnaire. Some of this information may be available on your insurance card. 0000106362 00000 n Please note that co-payments for all other services, other than the annual adult well-care visits, will apply. N')].uJr 0000115774 00000 n Do I still have to pay the highest co-pay? 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. It includes a range of conditions that affects your heart with different symptoms associated with it. Initial eligibility is attainedby having worked on a full-time basis for a Contributing Employer to this Planduring which time contributions were madefor atleast 26 consecutive weeks immediately prior to incurring a reimbursableexpense. NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE Under the PHBP Medical Plan, what happens if the hospital does not pre-certify my admission? 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 plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. 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. Once you have filled two prescriptions of the same drug at your pharmacy, you must then use the Express Scripts by Mail service for your prescriptions. View the insurance plans that participate with MSK below: Questions? If you file your prescription through Express Scripts, their pharmacist will initiate the pre-certification review with your doctor. MagnaCare health plans use a self-insured model, allowing companies the freedom to choose what to cover and how to cover it. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. Please give us a call at 201-894-3099 to verify if we are a participating facility. Plan-preferred brand-name drugsare those that do not yet have a generic equivalent available and are preferred based on safety, effectiveness and cost. Free medical services at JIB Medical, P.C. If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. 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. Certain exceptions may apply by geographic or specific member coverage or plan. Autism affects 1 in 59 children in the United States, and the condition varies greatly from person to person. All Rights Reserved. If you are seeking assistance for inpatient services, Mount Sinai South Nassaus Financial Assistance professionals may be able to help you complete your application. Insulin is no longer on the list. You may locate a MagnaCare participating physical therapist by visiting their website at www.magnacare.com. There is a $200 emergency room co-pay, which is waived if you are admitted within 24 hours. For your convenience, we suggest that you print out the questionnaire, complete it and bring it with you to the hospital. 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. Reimbursement for hospital and surgical expenses are subject to the applicable co-pays (see the Summary Plan Descriptionfor details). Who can I call for help? Why did that happen and what should I do? You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. 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. 0000002593 00000 n This program is for uninsured pregnant women and adolescents residing in New York state. 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 will be having laboratory tests performed at Mount Sinai South Nassau, you can check the listing of our labs participating insurance companies here. If you are using the Tier 2 network, you should identify your plan as MagnaCare in New York or New Jersey and CIGNA outside of New York and New Jersey. 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. Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations. 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. 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. Please note that hospital-employed physicians may accept many, but not all, of the plans that the hospital accepts. 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. Choose from a wide range of health plans customized to your needs. 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 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 the Enrollment Form for Eligible Dependents. . ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ 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. Downloadthe Enrollment Form for Eligible Dependents. 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. Ask your Fund if it participates in the Nurse Case Management program, and whether youd be a good fit. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. What drugs are not covered under the Prescription Drug Plan? Plan Administrator: Joint Industry Board of the Electrical Industry Preventive Health Services If your doctor prescribes you a diagnostic test that requires radiology or blood work you must use an in-network free-standing facility. Phone # 1(800)-845-6167. Please check with the specific doctor you are seeking care and verify eligibility and coverage with your insurance company. at (718) 591-2000, Extension 2491. All applicable co-pays will apply to such admissions. 877-SOUTH-NASSAU MagnaCare is powered by Brighton Health Plan Solutions, LLC, the company accredited by URAC for Health Utilization Management. Disadvantages include the possibility of large expenses for catastrophic claims, especially for small companies. Learn more about our Medical Management services >. My MagnaCare doctor visit was covered by the Plan, but MagnaCare denied the lab bill. All remaining balances are the participant's responsibility. Learn more about our comprehensive health plan management >. A: Providers are continually being evaluated for participation within the Northwell Direct network. 0j0zgFX&Z|`a0ma=a:fzCaLB endstream endobj 625 0 obj <> endobj 626 0 obj <>/ColorSpace<>/Font<>/ProcSet[/PDF/Text/ImageC/ImageI]/ExtGState<>>>/Type/Page>> endobj 627 0 obj <> endobj 628 0 obj [/ICCBased 637 0 R] endobj 629 0 obj [/Indexed 628 0 R 0 643 0 R] endobj 630 0 obj <> endobj 631 0 obj <> endobj 632 0 obj <>stream If you do not find your insurance plan on the list below, we may still be in network. Traer la receta de su mdico y pagar slo el copago. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug. A maximum of 30 office visits to a chiropractor will be covered in a calendar year for each family member. Phone (877) 432-7823 Get the care you needsafely Request an appointment 20-Minute Health Talk This list is updated periodically and subject to change. It is always important to verify and update insurance information and know which testing laboratories are in-networkor participating providers for your benefit plan. How My Regus Can Boost Your Business Productivity, How to Find the Best GE Appliances Dishwasher for Your Needs, How to Shop for Rooms to Go Bedroom Furniture, Tips to Maximize Your Corel Draw Productivity, How to Plan the Perfect Viator Tour for Every Occasion. View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. The advantage of self-insured health plans is a reduced cost for the employer, according to Beckers Hospital Review.