magnacare direct plus plan

All Rights Reserved. Carriers Currently Filed by Labcorp. 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. 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: Lenox Hill's cardiac program ranks among best in NYS, DOH reports Learn more about our comprehensive health plan management >. 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. 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 . Stay in-network and reduce out-of-pocket expenses. Para hacer una cita, pngase en contacto con el proveedor ms cercano a su hogar o trabajo. 516-632-3000, or MagnaCare health plans use a self-insured model, allowing companies the freedom to choose what to cover and how to cover it. The PHBP will cover up tofour annual diabetic education sessions. (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. For example, most patients are required to obtain their laboratory and radiology services at a dedicated facility. Members Learn more about your health plan and how we keep you well and healthy Plan Sponsors 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. Regardless of the physicians relationship with Englewood Hospital, these healthcare professionals costs are never included in the facilitys charges and you will still receive a separate bill for these services. In our continuing effort to track the latest innovative technology and provide truly comprehensive health screening programs to our participants The United Wire, Metal, and Machine Benefit Fund is proud to share with you news of our partnership with Heartscan Services: A non-invasive mobile cardio vascular screening and wellness program. 2y.-;!KZ ^i"L0- @8(r;q7Ly&Qq4j|9 We're committed to improving your health and wellness so you can live life to the fullest. Insurance List | Carriers Currently Filed by Labcorp These include: To receive pre-certification for the above services, contact the Plan at (718) 591-2000, Extension 1350 or send a fax request to the Managed Care Coordinator at (718) 591-1107. *The $45,000 lifetime limit is retroactive and includes prior completed procedures. Customer service: Receiving care from an out-of-network hospital could increase your out-of-pocket costs. Your information will never be sold to a third party, in accordance with our Privacy Policy. or by calling them at (877) 624-6210. All applicable co-pays will apply to such admissions. You may locate a MagnaCare participating physical therapist by visiting their website at www.magnacare.com. 0000002462 00000 n The Tier 2 network is an extended network which has higher out-of-pocket expenses. Dnde se puede encontrar un consulturio/centro diagnostico que son participantes? 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. Contact the provider closest to your home/work for an appointment. 2023 Joint Industry Board of the Electrical Industry. Certain exceptions may apply by geographic or specific member coverage or plan. Plan Administrator: Joint Industry Board of the Electrical Industry Preventive Health Services 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. My MagnaCare doctor visit was covered by the Plan, but MagnaCare denied the lab bill. A: Whether you are on the Value, Buy-up, HDHP or union-sponsored plan administered by Northwell, you can now search for in-network doctors, and other healthcare providers and facilities, all in one place. 350 Engle Street Plus, we offer innovative narrow networks in conjunction with leading . It is always important to verify and update insurance information and know which testing laboratories are in-networkor participating providers for your benefit plan. Listen to the message prompts and press the selection for pre-certification. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. Brighton Health Plan Solutions Expands Nationally with its Technology Learn More >, Find out more on what you can do to help prevent disease, injury, or illness to stay healthy. No, but if you have a Health Reimbursement Account, you may submit to that Fund. 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. They will bill separately. Why did that happen and what should I do? Thank you. MagnaCare was founded in 1992 with headquarters in Westbury, NY . In New York, RadNet provides approximately 2.3 million outpatient imaging procedures annually through a network of 78 outpatient imaging centers. Go to Magnacare.com and read below, or Call (866)-281-0364 and follow their instructions. Do I need to pre-certify in order to receive prescription drug benefits? Blood tests can only be performed in a doctors office during a medical emergency. Choose from a wide range of health plans customized to your needs. Please note that hospital-employed physicians may accept many, but not all, of the plans that the hospital accepts. 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. 0000115710 00000 n Autism affects 1 in 59 children in the United States, and the condition varies greatly from person to person. The Affordable Care Act requires health insurance companies to provide this pricing information to their customers. Offer your members high-quality healthcare where they live and work. 0000085219 00000 n A: Northwell offers three medical plans, Value, Buy-up and the HDHP. 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. When you do, there is a $100 co-pay. What do I do if I need to go to the Emergency Room? 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. also provides vision benefits to you and your dependents. Can I send co-pays or balances due from out-of-network claims that have been paid by MagnaCare to the Pension, Hospitalization and Benefit Plan for reimbursement? What type of Chiropractic care is covered by the Plan? You can cover your spouse and children. All Participants should call MagnaCare's dedicated Local Union No. RadNet, Inc. is the leading national provider of free-standing, fixed-site diagnostic imaging services in the United States. The Joint Industry Board of the Electrical Industry is a non-profit organization established under Section 501(c)(5) of the Internal Revenue Code. Find a doctor | Northwell Health Home healthcare and home infusion therapy: In-network provider and facility coverage, Out-of-Network (OON): $8,500 individual/$17,000 family, Growth hormones for height related treatment. Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. Make sure you advise your doctor to send your specimen to a participating lab. Ir a pagina web Magnacare.com y leer a continuacin, o llame a (866)-281-0364 y siga las instrucciones. Medicaid is a state-run health care program for patients not covered by other health care insurance. Teamhealth Anesthesia: 350 Engle Street, Englewood, NJ 07631; 888-983-4885, Englewood Pathologists, PA: 350 Engle Street, Englewood, NJ 07631, 201-894-3420, Englewood Radiologic Group: 350 Engle Street, Englewood, NJ 07631; 800-889-4447, Horizon Blue Cross Blue Shield (all plans), United Healthcare Community Plan (formerly Americhoice), Blue Cross and Blue Shield most out of state plans, Emblem Health: Group Health Incorporated (GHI) Comprehensive Benefit Plan (CBP/Outpatient only), MagnaCare (Direct Plus, PPO, Workers Comp and Create), 1199 National Benefit Fund (Health Care Payers Coalition), Preferred Health Strategies (Family Health Choice Alliance), Religious Order of Jehovahs Witnesses (Health Care Support/Watchtower). Cant find your Express-Scripts identification card? 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. It involves treatments and trainings to ensure a healthy pre-pregnancy, pregnancy, and labor and delivery for mom and baby. A: Yes. 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. Do you have any of the following chronic conditions? 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. Our nurses have helped members lose weight, quit smoking, improve mental health, and manage their diabetes and other conditions. 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. Sometimes in such cases, the physician does not put the diagnosis codes on the request you take to the drawing station, and the lab marks it as a routine diagnostic test. 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 Who can I call for help? Is MagnaCare a PPO? You must check with your physician before treatment to determine the insurance plans s/he accepts. RadNets core markets include New York, New Jersey, Maryland, Delaware, Florida, California and Rhode Island. Heartscan Services phone number: 1(866)-518-1112. 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. 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- Your insurer may require you to pay for any services provided that are not covered by your contract. You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. Home - MagnaCare Member Resources For additional information call 1-800-652-0063, For Davis Vision Please fill out as much information as you can. Beacon Behavioral Health. IN ADDITION, THE PHYSICIANS WHO PROVIDE CARE WITHIN OUR HOSPITAL MIGHT NOT PARTICIPATE IN THE SAME INSURANCE PLANS AS THE HOSPITAL. Englewood, NJ 07631 Dr. Kibot is a board-certified family nurse practitioner who has been practicing since 2016. 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. Click here for the benefit changes effective October 1, 2016 for Active Participants and non-Medicare retirees. You can find a doctor in the MagnaCare preferred provider network online. I am a retiree on Medicare. The Joint Industry Board of the Electrical Industry is a non-profit organization established under Section 501(c)(5) of the Internal Revenue Code. The company works to provide a variety of services and products to meet the unique needs of clients, with more than 225 in-network hospitals and 130,000 physicians in the states listed above. A: 2022 benefit guides are available on the myBenefits site. If you do not find your insurance plan on the list below, we may still be in network. Affinity all lines of business, including the Health Exchange Plan. 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. If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). Confirm with practice)MetroPlus - Essential Plan 2 (Pertains only to certain providers in Staten Island. 877-SOUTH-NASSAU You should always confirm with your provider/facility using your member and group ID found on your medical benefit ID card. A MagnaCare health plan is a type of health insurance plan overseen by MagnaCare in which a corporation chooses to pay most employee health claims themselves instead of signing up with an insurance company, according to MagnaCare. A: In the event of a medical life-threatening emergency, you should go to the closest emergency room. 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) It includes a range of conditions that affects your heart with different symptoms associated with it. Exmenes de sangre slo puede realizarse en el consultorio de un mdico durante una emergencia mdica. d,~1-AieF`;Nk0Uv K@:=``03u- For your convenience, we suggest that you print out the questionnaire, complete it and bring it with you to the hospital. Please give us a call at 201-894-3099 to verify if we are a participating facility. Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. Northwell Health selects Northwell Direct's provider network for All Rights Reserved. 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. *xt@ uBJ(ipNE` R@,^+8@6GA)C} NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE 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. Member Login - Brighton Health Plan Solutions Mike Smith President of Local 810 & Lorraine Buonacore Administrator of Funds. For in-network claims, you will be responsible for only four (4) co-payments of $35 per incident or illness. V)gB0iW8#8w8_QQj@&A)/g>'K t;\ $FZUn(4T%)0C&Zi8bxEB;PAom?W= 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. MSK must receive this authorization before any appointments are scheduled. Access your account anytime, anywhere with the MyCreateHealth Mobile App. Learn More >, People living with diabetes can go almost anywhere and do almost anything. I am a retiree on Medicare. or call 1-800-548-0138 . 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. MagnaCare | Health Plan & Human Resource Administrator All Rights Reserved. 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. Plan-preferred brand-name drugsare those that do not yet have a generic equivalent available and are preferred based on safety, effectiveness and cost. Charges rendered by a Psychiatrist, PhD, or Social Worker ("MSW") are covered for active and retired eligible Participants for individual therapy. 0000111900 00000 n 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. Phone # 1(800)-845-6167. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. 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. MagnaCare's extensive PPO network in New York, New Jersey, and Connecticut includes more than 200 hospitals and 220,000 healthcare provider locations. Below are the Medical Plan highlights. The plan at 1-718-591-2000 or the Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA (3272) or If you need a Tier 2 provider or facility outside of New York and New Jersey, you would use the CIGNA network. 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. Prescription coverage has not changed. 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. Just contact one of the conveniently located optical providers for an appointment. There are increased costs if you visit the Tier 2 networks, but if the provider does not participate in either the Northwell Direct, MagnaCare or CIGNA networks, they are considered a non-participating provider (also called an out-of-network provider). Free medical services at JIB Medical, P.C. 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. Qu son los servicios de diagnstico y cmo puedo encontrar proveedores que son participantes? Access the in-network provider and facility search on Northwell.edu/myMedical. 0000004339 00000 n 0000005080 00000 n 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 If I am a retiree, who do I call if I have questions about the crossover or outstanding Medicare secondary claims? Tests done in a hospital setting will not be covered. 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. the Enrollment Form for Eligible Dependents. Amidacare - All Products. Submit claims to MagnaCare at P.O. You've got the power. This process typically takes one or two business days. HU]oF|_dQoo}\-") AlphaCare Nassau County only. This program is for uninsured pregnant women and adolescents residing in New York state. 4.77. 26 verified reviews. for a list of in-network doctors and other providers. 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. Eligibility is determined by criteria such as earnings and family size. There is a $200 emergency room co-pay, which is waived if you are admitted within 24 hours. A: If your provider or facility is not included in the Tier 1 network, you can use the MagnaCare network, the Tier 2 network for New York and New Jersey. 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. You can call MagnaCare Advocacy Services for assistance at (866) 624-6260. And, youll have access to discounted medical liability insurance through our partner, MLMIC. All remaining balances are the participant's responsibility. 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. or by calling them at (877) 624-6210. Insurance - Rocky Point Physical Therapy All therapies must be pre-approved by MagnaCare. Accepted Insurances | Catholic Health - CHSLI 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. Please note that co-payments for all other services, other than the annual adult well-care visits, will apply. How long can I remain covered under the PHBP Medical Plan? Affinity - All Products Accepted except Exchange. 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. 0000106362 00000 n Eligible participants can receive medical and hospitalization benefits under this plan. Quest Diagnostics www.questdiagnostics.com Phone # 1(866)-697-8378. How much is my prescription drug co-pay under the PHBP Prescription Drug Plan? 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. Note that the available options for marital status, race and ethnicity are the options required by the US Government. Best MagnaCare Doctors Near Me | Zocdoc MagnaCare is a health plan management company with members on the east coast, primarily New York, New Jersey, and Connecticut. MagnaCare Rx 0000002593 00000 n View the insurance plans that participate with MSK below: Questions? 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. N')].uJr Upon registration, your Express-Scripts identification card will appear digitally on your smartphone and is ready to be used at your convenience. 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. Medical and Prescription Drug Plan (Pension, Hospitalization, and 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. Ask your physician to provide you the specific diagnosis descriptions or procedure descriptions. Before scheduling a procedure at the hospital, ask your insurance company whether you need pre-authorization or a referral. www.magnacare.com. Please check with the specific doctor you are seeking care and verify eligibility and coverage with your insurance company. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug.

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