As long as the admission is precertified and determined to be medically necessary through MagnaCare, your in-patient or Emergency Room hospital bills will be covered. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug. Worrying about finances is the last thing anyone needs when it comes to health. As a courtesy to our members we will waive the co-payment if you use their facilities. Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. 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. 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. Get your members the most appropriate and highest quality medical care at the lowest cost. AlphaCare Nassau County only. Related, out-of-network claims should be submitted to the Plan for reimbursement. Offer your members high-quality healthcare where they live and work. 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. 0000084904 00000 n Were committed to improving your health and wellness so you can live life to the fullest. IN ADDITION, THE PHYSICIANS WHO PROVIDE CARE WITHIN OUR HOSPITAL MIGHT NOT PARTICIPATE IN THE SAME INSURANCE PLANS AS THE HOSPITAL. Quest Diagnostics www.questdiagnostics.com Phone # 1(866)-697-8378. What type of Chiropractic care is covered by the Plan? Mount Sinai South Nassau's participating plans: AgeWell Medicare. Most popular medical specialty of providers who accept MagnaCare: Internist. 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- They also include Latino/Hispanic heritage under ethnicity and consider it independent of . For additional free-standing laboratories, please call Magnacare at 1(866)-281-0364. 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. 0000002425 00000 n If you choose to use providers that are out-of-network you will pay significantly more. What drugs are not covered under the Prescription Drug Plan? 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. 2023 Brighton Health Plan Solutions. 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. 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. Labcorp of America www.labcorp.com. All covered visits, both in and out-of-network, are subject to the $35 co-payment. Contact us Getting direct about business solutions for a list of in-network doctors and other providers. 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. Confirm with practice)MetroPlus - Medicaid (Pertains only to certain providers in Staten Island. Englewood Hospital is committed to protecting our patients from surprise medical bills. 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. They will bill separately. If this occurs, you can call the Joint Industry Board Members Records Department at (718) 591-2000, Extension 2491 to obtain a form to initiate a review to determine if the preferred brand co-pay applies. V)gB0iW8#8w8_QQj@&A)/g>'K t;\ $FZUn(4T%)0C&Zi8bxEB;PAom?W= or by calling them at (877) 624-6210. Effective April 10, 2019, covered participants in the divisions listed below shall be entitled to be reimbursed for a days pay based on a straight time contractual rate from the Welfare Plan when he or she takes off a day from work to go for a physical exam and loses a days pay pursuant to the Plan rules. With this increased availability, there are more areas that were previously considered OOA now determined as in-area. Our physician network offers primary, specialty, and urgent care at more than 100 locations across northern New Jersey and Rockland County. Note that a physicians or hospitals participation with an insurance plan does not automatically mean that your plan will cover every expense; always check with your insurance company before undergoing any diagnostic procedure (such as a lab test or radiology) to ensure that the physician, lab or facility participates in your plan; that the test is a covered expense; and what portion of the diagnostic expense you will be responsible for. k}Z@fr&*Mae1d*C+}t:jQIB>bN,{]Q'$U1!V|KN]7?MPJI" N!io[c-IM b&;BZB Zc?Qn[;lx}BpN[:/uzQWM6\Sp?Wt VGBx9 *'p Together with affiliated radiologists, and inclusive of full-time and per diem employees and technicians, RadNet has a total of approximately 7,300 employees. DNDE SE PUEDE IR PARA HACERME MIS PRUEBAS DE DIAGNOSTICO? Phone # 1(800)-845-6167. This process typically takes one or two business days. 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. Beacon Behavioral Health. What happens if I am out of town and admitted to the hospital? Your co-pays are shown on the chart of covered services on theMedical Plan page. What services require pre-certification through MagnaCare? 516-632-3000, or 0000106362 00000 n If it is an emergency visit, the facility may call within 24 hours after the admission. 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. Out-of-network claims are paid according to the MagnaCare fee schedule and are subject to the same co-payments as in-network claims. It's important to know what you should do when you experience lower back pain. Call 1(888)-590-7370 for participating providers. Asegrese de que usted aconseja su medico que le envie su muestra a un laboratorio participante. How am I and my family covered if I am retired, living out-of-state and not yet eligible for Medicare? A: Northwell offers three medical plans, Value, Buy-up and the HDHP. 212-691- 4100 ext.313. Carriers Currently Filed by Labcorp. Yes, if it involves maintenance medication. Online websites and applications may vary how they list and identify the plan. _________________________________________________________. Eligible participants can receive medical and hospitalization benefits under this plan. Learn More >, People living with diabetes can go almost anywhere and do almost anything. Affinity all lines of business, including the Health Exchange 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. All remaining balances are the participant's responsibility. MagnaCare is a health plan management company with members on the east coast, primarily New York, New Jersey, and Connecticut. 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. A: 2022 benefit guides are available on the myBenefits site. What do I do if I need to go to the Emergency Room? 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. 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 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. 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. The claim may then get denied as a not covered routine test. One Healthy Way . 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. 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. NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE Ask your insurance company for an estimate of your total out-of-pocket costs. Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. A: In the event of a medical life-threatening emergency, you should go to the closest emergency room. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. 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. Stay in-network and reduce out-of-pocket expenses. 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). 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. You are eligible after 26 weeks of employer contributions. There is no need to submit claims when Medicare is your primary insurance for dates of service rendered on or after 8/1/2011. Please have ready the name of the physician you visited who prescribed the diagnostic tests and the date of the visit. 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. MagnaCare's extensive PPO network in New York, New Jersey, and Connecticut includes more than 200 hospitals and 220,000 healthcare provider locations. 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. *zm;2CI7A',l#8X'0jtRjP[H4-F@|P:y>&yQh\]6Tc z endstream endobj 633 0 obj <> endobj 634 0 obj <> endobj 635 0 obj <> endobj 636 0 obj <> endobj 637 0 obj <>stream 0000035095 00000 n Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations. Submit claims to MagnaCare at P.O. View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. 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. Paying for Your Care Accepted Insurances Find a Doctor Request an Appointment x Catholic Health Facility Insurance Plan Participation As of January 1, 2020, Catholic Health hospitals have contracts with the following managed care health plans. 26 verified reviews. 0000081601 00000 n 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. Patient Information and Medical History Form. ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ Learn more about your health plan and how we keep you well and healthy, Custom-fit your health plan to meet the unique needs of your members, Find out why TPAs and carriers choose MagnaCare, Join our network of leading providers in New York, New Jersey, and Connecticut. Documentation from the physician and paystub must be submitted with a completed application signed by the participant and the employer. At Mount Sinai South Nassau, we participate in Medicare, Medicaidand most HMOs and commercial insurance plans. All Rights Reserved. 0000003597 00000 n If you have a specific question about your Medicare benefits, call Empire Medicare, toll-free: (800) 442-8430 or go to empireblue.com. You can find a doctor in the MagnaCare preferred provider network online. Extend your presence in New York, New Jersey, and Connecticut with our large, high-quality, affordable network, trusted by local, regional, national, and international TPAs and carriers for more than 30 years. Scheduled procedures performed in a hospital should be pre-certified by the physician. Some of this information may be available on your insurance card. Box 1001, Garden City, NY 11530. Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? Traer la receta de su mdico y pagar slo el copago. All Rights Reserved. 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/. See information regardingphysicians who are employedby Englewood Hospital. Mike Smith Presidente del Local 810& Lorraine Buonacore Administrador de los Fondos. All therapies must be pre-approved by MagnaCare. 877-SOUTH-NASSAU Learn More >, Pregnancy care consists of prenatal (before birth) and postpartum (after birth) healthcare. If you have health insurance, there are important steps you should take to understand your coverage and protect yourself from unexpected bills. Thank you for using our secure online forms. I am a retiree on Medicare. We are glad to see you are making health and wellness a priority, great job! (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. 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. 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: wG xR^[ochg`>b$*~ :Eb~,m,-,Y*6X[F=3Y~d tizf6~`{v.Ng#{}}jc1X6fm;'_9 r:8q:O:8uJqnv=MmR 4 This plan uses a provider network. RadNet provides radiology information technology solutions, teleradiology professional services and other related products and services to customers in the diagnostic imaging industry. 0000002593 00000 n Start with our Member Resource Center to find resources to help you achieve your health goals. 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. 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. They are included on a drug list know as a formulary. Care provided by NYC Health + Hospitals may not be covered by your health plan at the highest available benefit level, nor may NYC Health + Hospitals participate . Benefits are provided once every 12 months. Consulte siempre a su libro de descripcin Resumen del Plan (SPD) para obtener informacin detallada acerca de su plan. Choose from a wide range of health plans customized to your needs. 0000001439 00000 n These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. Once you meet the eligibility requirements above, you become a participant. 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. 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 live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. Please note that this list DOES NOT represent an exclusive list of physicians who may provide professional services to you while at Englewood Hospital. 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). Beech Street PPO. If you need a Tier 2 provider or facility outside of New York and New Jersey, you would use the CIGNA network. Prospective applicants must call to apply for the Prenatal Care Medicaid Program before seeing a doctor. Please note that hospital-employed physicians may accept many, but not all, of the plans that the hospital accepts. 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. Always refer to your Summary Plan Description (SPD) for detailed information about your 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). This list is updated periodically and subject to change. A: No. Aetna - All Products Accepted except Better Health Fida. Si usted utilizan un centro de diagnstico que son participantes. Major participating labs are Quest, Lab Corp of America, Bio-Reference Lab, Sunrise Lab, etc. 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. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. 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. If the hospital or surgi-center fails to call and give MagnaCare the required information, the facility will not receive payment from the Plan. Disadvantages include the possibility of large expenses for catastrophic claims, especially for small companies. For more information, click here for Frequently Asked Questions about the program. What are the co-payments for physical therapy claims? Insulin is no longer on the list. The state analyzed 69,065 total adult cardiac surgeries, including isolated coronary artery bypass graft (CABG), valve, valve/CABG, and other cardiac surgeries performed statewide and discharged between December 2016-November 2019. 0000071187 00000 n A: Providers are continually being evaluated for participation within the Northwell Direct network. 0000002707 00000 n Phone (877) 432-7823 Get the care you needsafely Request an appointment 20-Minute Health Talk 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. RadNet, Inc. is the leading national provider of free-standing, fixed-site diagnostic imaging services in the United States. 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. 0000085219 00000 n **Network is held by Northwell Direct Administrative Services Organization, Inc. One Penn PlazaSuite 1410New York, NY 10119. How do I know what my co-pay will be for an expense covered by the PHBP Medical Plan?