magnacare direct plus plan

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. divisions covered include: a, m, mij, apprentice, m helpers, adm, expeditor, re & rw, teledata, j and outside linemen. Our physician network offers primary, specialty, and urgent care at more than 100 locations across northern New Jersey and Rockland County. Plan Administrator: Joint Industry Board of the Electrical Industry Preventive Health Services Dnde se puede encontrar un consulturio/centro diagnostico que son participantes? yrZI$7KSn, H8*$dd8:%C*f/8}CyX4Wl`#8v_]aS}O7iW!T;jI@ sjjVf9$As02'FL2-!4f,3^Pl:ax)! Below are the Medical Plan highlights. We have consistently demonstrated cost savings for our clients while maximizing health and wellness for their members. Start with our Member Resource Center to find resources to help you achieve your health goals. Ask your Fund if it participates in the Nurse Case Management program, and whether youd be a good fit. 2023 Laboratory Corporation of America Holdings. health plan management company. also provides vision benefits to you and your dependents. 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. If you have a health concern that is not life-threatening, you may consider calling our ER on Demand service at (516) 918-6005. . 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. If you would like assistance with identifying a current Tier 1 provider or are interested in nominating a provider to be evaluated for Tier 1 network participation, please call member services at (855) 340-7737. 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. Complete details are available in the Summary Plan Description. 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. 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) In a true emergency, you are covered. What do I do if I need to go to the Emergency Room? One Healthy Way Free medical services at JIB Medical, P.C. All applicable co-pays will apply to such admissions. Benefits are provided once every 12 months. Simply use your smartphone camera to scan the QR-Code below and choose the iPhone or Android link to download the EXPRESS SCRIPTS APP. Once you meet the eligibility requirements above, you become a participant. Most popular medical specialty of providers who accept MagnaCare: Internist. All therapies must be pre-approved by MagnaCare. Do I need to use the Express Scripts by Mail service? Receiving care from an out-of-network hospital could increase your out-of-pocket costs. We can improve team member experience by using Brighton for claims processing and customer service, and the Northwell Direct network for expanded access to a comprehensive network of high-quality providers to members living in areas not currently covered by our Tier 1 providers. Do you have any of the following chronic conditions? All Rights Reserved. Below is a list of the network and plans we currently participate in. A: For additional questions and support on the medical plan TPA and provider/facility networks, please call Brighton at (855) 340-7737, Monday through Friday, 8:00 am to 6:00 pm or email [emailprotected]. The Northwell Direct network and MagnaCare network already serve as the Tier 1 and 2 networks for the HDHP. Beacon Behavioral Health. For dates of service on or after August 1, 2011, you should call MagnaCare's dedicated Local Union No. Please call (877) 624-6210. At Mount Sinai South Nassau, we participate in Medicare, Medicaidand most HMOs and commercial insurance plans. The claim may then get denied as a not covered routine test. Member Login Take control of your health care. Mount Sinai South Nassau's participating plans: If you have Medicare, you must complete the Medicare Secondary Payor Questionnaire. Consulte siempre a su libro de descripcin Resumen del Plan (SPD) para obtener informacin detallada acerca de su plan. This information may impact your level of coverage. 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. or by calling them at (877) 624-6210. Affinity all lines of business, including the Health Exchange Plan. 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. 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. Some of this information may be available on your insurance card. If you need a Tier 2 provider or facility outside of New York and New Jersey, you would use the CIGNA network. 3 service line at (877) 624-6210. Medicaid is a state-run health care program for patients not covered by other health care insurance. Please note that hospital-employed physicians may accept many, but not all, of the plans that the hospital accepts. Your benefit coverage for care provided by NYC Health + Hospitals is determined solely by your insurance company and is based on the provisions of your specific medical benefit plan. The Tier 1 network offers you providers and facilities contracted by Northwell, allowing for the lowest out-of-pocket expense to you. N')].uJr Click here to view which zip codes are now in-area and OOA. This change does not impact any other benefit plan for Value, Buy-up and HDHP. RadNet has a network of 309 owned and/or operated outpatient imaging centers. Participants and their eligible dependents can get their adult annual well-care visit 100% covered by the PHBP at these conveniently locatedmulti-specialtygroup practices. Do I still have to pay the highest co-pay? If you believe you may be eligible for Medicaid, apply at your local office of the Department of Social Service (links to another website). 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. In cases of emergency, go to the nearest emergency room. HU]oF|_dQoo}\-") MagnaCare is a health plan management company with members on the east coast, primarily New York, New Jersey, and Connecticut. Get your members the most appropriate and highest quality medical care at the lowest cost. Website: https://idoc.davisvision.com/members/FindAProvider/Index, To locate a participating retail pharmacy, obtain a claim form, or find out more about your prescription drug benefit, please call Member Services at 1 866 713-8004 or log in to our website, www.express-scripts.com. If I am a retiree, who do I call if I have questions about the crossover or outstanding Medicare secondary claims? What type of Chiropractic care is covered by the Plan? MagnaCare is powered by Brighton Health Plan Solutions, LLC, the company accredited by URAC for Health Utilization Management. If it is an emergency visit, the facility may call within 24 hours after the admission. These tests will be totally and completely paid for by your Plan if you utilize a in-network, free-standing diagnostic center. View the insurance plans that participate with MSK below: Questions? 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. Todas las pruebas diagnsticas como rayos x, hueso densidad, ecocardiograma, mamografa, ecocardiograma, ultrasonido, y ecografas deben realizarse en los laboratorios participantes. Log onto MyCreateHealth.com to view all your claims for services received in 2017 and later. May be eligible regardless of immigration status. 0000002462 00000 n Learn More >, Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. Start with our Member Resource Center to find resources to help you achieve your health goals. Facility name - Select - Insurance information Primary insurance coverage Carrier name Street City State - Select - ZIP code Phone Identification number Effective date Disadvantages include the possibility of large expenses for catastrophic claims, especially for small companies. For additional free-standing laboratories, please call Magnacare at 1(866)-281-0364. Uninsured nQt}MA0alSx k&^>0|>_',G! Make sure you advise your doctor to send your specimen to a participating lab. 563 Southpark Boulevard, Colonial heights, VA 23834. When you do, there is a $100 co-pay. NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE Listen to the message prompts and press the selection for pre-certification. 0000081601 00000 n Englewood, NJ 07631 A: In the event of a medical life-threatening emergency, you should go to the closest emergency room. 0000004339 00000 n They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug. 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: 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. How long can I remain covered under the PHBP Medical Plan? *The $45,000 lifetime limit is retroactive and includes prior completed procedures. Visit Northwell.edu/myMeds for information about Vivo Health and in-network pharmacies. "F$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 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. Your new, enhanced service portal is now live! 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. My doctor requires that I take a drug that is NOT Plan-preferred and for which there are no equivalent preferred brands or generics. Plans provide hearing benefits through either the Aetna network or the direct member reimbursement (DMR) service. Quest Diagnostics www.questdiagnostics.com Phone # 1(866)-697-8378. They will bill separately. Autism affects 1 in 59 children in the United States, and the condition varies greatly from person to person. If you are unsure or would like assistance in locating a participating center call us at the Welfare Fund for help. 0000096306 00000 n Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. The Joint Industry Board of the Electrical Industry is a non-profit organization established under Section 501(c)(5) of the Internal Revenue Code. 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. 2023 Joint Industry Board of the Electrical Industry. 0000001528 00000 n Qu son los servicios de diagnstico y cmo puedo encontrar proveedores que son participantes? 0000001439 00000 n In MagnaCares Nurse Case Management Program, highly trained registered nurses establish one-on-one relationships with members, uncover their needs and challenges, and help them attain their personal health and wellness goals. 516-632-3000, or 0000085219 00000 n Find an Urgent Care Center. 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. (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. 26 verified reviews. . 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). Mike Smith Presidente del Local 810& Lorraine Buonacore Administrador de los Fondos. 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. We're committed to improving your health and wellness so you can live life to the fullest. The Affordable Care Act requires health insurance companies to provide this pricing information to their customers. at (718) 591-2000, Extension 2491. Services that are not part of discharge planning require pre-certification directly through the Plan. 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. 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. Failure to do so will result in your prescription being denied at your local pharmacy. Your insurer may require you to pay for any services provided that are not covered by your contract. Ask your physician to provide you the specific diagnosis descriptions or procedure descriptions. Yes. Asthma is treatable, but symptoms sometimes flare up.Learn More >, Heart disease is the leading cause of death worldwide. 0000004823 00000 n 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. You can find a doctor in the MagnaCare preferred provider network online. 0000084956 00000 n 3 service line at (877) 624-6210. You are eligible after 26 weeks of employer contributions. Learn more about our Medical Management services >. JIB Medical, P.C. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. This list is updated periodically and subject to change. or call 1-800-548-0138 . Access your account anytime, anywhere with the MyCreateHealth Mobile App. I am presently collecting Workers Compensation or disability. 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 We are glad to see you are making health and wellness a priority, great job! RadNets core markets include New York, New Jersey, Maryland, Delaware, Florida, California and Rhode Island. Heart disease is the leading cause of death worldwide. You can find out more about each PHBP Area Group Practice by visiting their website or by calling them. Learn More >, People living with diabetes can go almost anywhere and do almost anything. Medicare Plus Plan 2 (HMO) $21: $2,500 per ear: $7,500: 212-691- 4100 ext.313. Click here for more information on Magnacare or call (866)-281-0364 Option 1 Heartscan Services NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE 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. If the review is approved, you will receive a letter indicating the length of approved coverage. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. Traer la receta de su mdico y pagar slo el copago. These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. View All Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP) FAQs. Once you meet the eligibility requirements above, you become a participant. An independent Express Scripts committee of physicians and pharmacists determines which brand-name drugs are preferred. 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. Do the PHBP Medical Plan co-pays apply if I use an out-of-network (non-MagnaCare) provider? 0000106362 00000 n For quick and easy access, store this card in your digital wallet! It's important to know what you should do when you experience lower back pain. 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). Claims will not be paid unless prior approval from MagnaCare is obtained. Vivo Health has a large pharmacy network, which includes ten Vivo Health Pharmacy locations, mail order and more than 64,000 participating retail pharmacies. or by calling them at (877) 624-6210. 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. Any MRI, Endoscopy, Colonoscopy, PET or CAT Scans must be pre-approved. 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. Confirm with practice)MetroPlus - HIV Special Needs Plan (Pertains only to certain providers in Staten Island. 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. ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ Servicios diagnostico son una amplia gama de pruebas que son esenciales para la gestin bsica del cuidado del paciente, permitiendo a los mdicos a detectar la enfermedad antes, hacer diagnsticos, prescribir tratamientos y seguimiento de resultados de los pacientes. If so, your doctor must call a special toll-free number at Express Scripts to initiate a review. 0000115710 00000 n How do I submit my claims? It includes a range of conditions that affects your heart with different symptoms associated with it. Please check with the specific doctor you are seeking care and verify eligibility and coverage with your insurance company. 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. 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. The Tier 1 network will always be more cost-effective for you than the Tier 2 network. 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. 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

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