magnacare direct plus plan

Visit Northwell.edu/myMeds for information about Vivo Health and in-network pharmacies. Benefits are provided once every 12 months. Your information will never be sold to a third party, in accordance with our Privacy Policy. 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. 0000003597 00000 n For additional information call 1-800-652-0063, For Davis Vision If you are unsure or would like assistance in locating a participating center call us at the Welfare Fund for help. . Our nurses have helped members lose weight, quit smoking, improve mental health, and manage their diabetes and other conditions. Home - MagnaCare Member Resources Go to Magnacare.com and read below, or Call (866)-281-0364 and follow their instructions. Anyone can experience lower back pain at any time even if you don't have a prior injury or any risk factors. Heartscan Services phone number: 1(866)-518-1112. Reimbursement will be at the network allowance, less the co-pay. If you need a Tier 2 provider or facility outside of New York and New Jersey, you would use the CIGNA network. 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. Confirm with practice)MetroPlus - Essential Plan 2 (Pertains only to certain providers in Staten Island. Prospective applicants must call to apply for the Prenatal Care Medicaid Program before seeing a doctor. also provides vision benefits to you and your dependents. Please call (877) 624-6210. You can find a doctor in the MagnaCare preferred provider network online. For your convenience, we suggest that you print out the questionnaire, complete it and bring it with you to the hospital. Estas pruebas se pagaran totalmente y completamente por su Plan. 0000081601 00000 n If you live out-of-state and have not received this card, you may call the Joint Industry Board, Members Records Dept. Your insurer may require you to pay for any services provided that are not covered by your contract. Affinity - All Products Accepted except Exchange. Then ask your insurer if the services ordered by your physician are covered services.. . RadNet, Inc. is the leading national provider of free-standing, fixed-site diagnostic imaging services in the United States. Please give us a call at 201-894-3099 to verify if we are a participating facility. This change does not impact any other benefit plan for Value, Buy-up and HDHP. The Northwell Direct network and MagnaCare network already serve as the Tier 1 and 2 networks for the HDHP. What drugs are not covered under the Prescription Drug Plan? 0000111900 00000 n All therapies must be pre-approved by MagnaCare. 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? Non-preferred brand-name drugsare those that do not yet have a generic equivalent, but for reasons of effectiveness or cost, are not on your Plans formulary drug list. Access your account anytime, anywhere with the MyCreateHealth Mobile App. trailer <]>> startxref 0 %%EOF 653 0 obj <>stream Who should I call? In accordance with New Jerseys new Out-of-Network Consumer Protection, Transparency, Cost Containment and Accountability Act, we have provided the information below regarding potential healthcare costs. 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. Start with our Member Resource Center to find resources to help you achieve your health goals. Confirm with practice)MetroPlus - Medicaid (Pertains only to certain providers in Staten Island. Mike Smith Presidente del Local 810& Lorraine Buonacore Administrador de los Fondos. Eligibility is determined by criteria such as earnings and family size. The Northwell Direct network and MagnaCare network already serve as the Tier 1 and 2 networks for the HDHP. Each of these plans consist of a Tier 1 network and Tier 2 network. yrZI$7KSn, H8*$dd8:%C*f/8}CyX4Wl`#8v_]aS}O7iW!T;jI@ sjjVf9$As02'FL2-!4f,3^Pl:ax)! The Tier 1 network will always be more cost-effective for you than the Tier 2 network. If your doctor prescribes you a diagnostic test that requires radiology or blood work you must use an in-network free-standing facility. My MagnaCare doctor visit was covered by the Plan, but MagnaCare denied the lab bill. Health insurance enrollment | Northwell Health For help submitting insurance information, call the Financial Services team at (888) 214-4066. indicates a required field Patient information Patient name Hospital account no. 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. Insurance List | Carriers Currently Filed by Labcorp For quick and easy access, store this card in your digital wallet! Tests done in a hospital setting will not be covered. 0000002508 00000 n The Affordable Care Act requires health insurance companies to provide this pricing information to their customers. They will bill separately. 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. 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. MagnaCare | Health Plan & Human Resource Administrator 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. Once you meet the eligibility requirements above, you become a participant. I am presently collecting Workers Compensation or disability. If you have a health concern that is not life-threatening, you may consider calling our ER on Demand service at (516) 918-6005. You will pay less if you use a provider . 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. Youll get the peace of mind of knowing you can manage your health condition. If the hospital or surgi-center fails to call and give MagnaCare the required information, the facility will not receive payment from the Plan. 130193. Principales laboratorios participantes son Quest, Lab Corp de Amrica, laboratorio de Bio-Reference, Sunrise Lab, etc. Simply use your smartphone camera to scan the QR-Code below and choose the iPhone or Android link to download the EXPRESS SCRIPTS APP. In a true emergency, you are covered. If I am a retiree, who do I call if I have questions about the crossover or outstanding Medicare secondary claims? Call 1-866-250-8679 or fill out the form below. 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 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. *xt@ uBJ(ipNE` R@,^+8@6GA)C} You should always confirm with your provider/facility using your member and group ID found on your medical benefit ID card. **Network is held by Northwell Direct Administrative Services Organization, Inc. One Penn PlazaSuite 1410New York, NY 10119. Please refer to the chart of covered services on the Medical Plan page for co-pay amounts. Contact MagnaCares Pre-certification Department at (877) 624-6210or refer to the Summary Plan Descriptionfor complete details. 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. Most self-insured plans also include a fee for stop-loss insurance coverage, which pays large claims over a certain amount. What are the co-payments for physical therapy claims? Contact the provider closest to your home/work for an appointment. As a courtesy to our members we will waive the co-payment if you use their facilities. Before scheduling a procedure at the hospital, ask your insurance company whether you need pre-authorization or a referral. This list is updated periodically and subject to change. 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. Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations. 2023 Joint Industry Board of the Electrical Industry. Ir a pagina web Magnacare.com y leer a continuacin, o llame a (866)-281-0364 y siga las instrucciones. 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. Box 1001, Garden City, NY 11530. Scheduled procedures performed in a hospital should be pre-certified by the physician. Claims will not be paid unless prior approval from MagnaCare is obtained. Aetna/US Health Care all HMO, PPO, Self-Insured Plans, Aetna Signature Administrators, Indemnity, Medicare HMO and PPO. 0000096306 00000 n Northwell Health selects Northwell Direct's provider network for Certain exceptions may apply by geographic or specific member coverage or plan. 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. (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. They also include Latino/Hispanic heritage under ethnicity and consider it independent of . Other services requiring pre-certification include: The toll-free phone number for any pre-certification through MagnaCare is (877) 624-6210. For example, most patients are required to obtain their laboratory and radiology services at a dedicated facility. 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. Mount Sinai South Nassau's participating plans: If you have Medicare, you must complete the Medicare Secondary Payor Questionnaire. Lenox Hill's cardiac program ranks among best in NYS, DOH reports Just contact one of the conveniently located optical providers for an appointment. 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. Vivo Health offers convenient services such as mail order, a specialty pharmacy and a mobile app for your on-the-go pharmacy needs. I am an active Participant who has questions about benefits or claims. AlphaCare Nassau County only. All Rights Reserved. This program is for uninsured pregnant women and adolescents residing in New York state. Yes. Accepted Insurance Plans | NewYork-Presbyterian Medical Group Hudson Valley Northwell Direct Member FAQ - Brighton Health Plan Solutions The hospital must do a medical screening evaluation prior to determining your medical coverage (as mandated by federal law). If you are using the Tier 2 network, you should identify your plan as MagnaCare in New York or New Jersey . Exmenes de sangre slo puede realizarse en el consultorio de un mdico durante una emergencia mdica. Disadvantages include the possibility of large expenses for catastrophic claims, especially for small companies. Insulin is no longer on the list. 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. 26 verified reviews. How do I know what my co-pay will be for an expense covered by the PHBP Medical Plan? What happens if I am out of town and admitted to the hospital? MAGNACARE - 1600 Stewart Ave, Westbury, New York - Yelp Mike Smith President of Local 810 & Lorraine Buonacore Administrator of Funds. 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. A: No. You can cover your spouse and children. Related, out-of-network claims should be submitted to the Plan for reimbursement. Confirm with practice)MetroPlus - Harp and Essential Plans 3-4 (Pertains only to certain providers in Staten Island. Phone number: 1-800-999-5431 2023 Laboratory Corporation of America Holdings. Affinity all lines of business, including the Health Exchange Plan. or by calling them at (877) 624-6210. 3 service line at (877) 624-6210. What is MagnaCare Direct Plus? 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). There is a $200 emergency room co-pay, which is waived if you are admitted within 24 hours. ZRm"XiHngwfVWeOF]`i+IA'9)]b>{)4X!+>$;G7+z.h.(C3ko35wB{QEKx~ Services that are not part of discharge planning require pre-certification directly through the Plan. These tests will be totally and completely paid for by your Plan if you utilize a in-network, free-standing diagnostic center. If you prefer, call MagnaCare at (877) 624-6210 or contact the Health Advocate at (866) 799-2723. The PHBP will cover up tofour annual diabetic education sessions. Its that east! Member Login - Brighton Health Plan Solutions Online Patient Information and History Form- cary Optometric 0000106362 00000 n How much is my prescription drug co-pay under the PHBP Prescription Drug Plan? 0000085219 00000 n They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug. 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. Insurance: MagnaCare - NYC Health + Hospitals NEW YORK, Dec. 2, 2020 /PRNewswire/ -- New York-based healthcare enablement company Brighton Health Plan Solutions today announced its expanded suite of technology, direct provider contracting and . The Tier 1 network offers you providers and facilities contracted by Northwell, allowing for the lowest out-of-pocket expense to you. The screening is non-invasive, takes approximately 30 minutes and no preparation is required. 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. Click here for the benefit changes effective July 1, 2022 for Medicare eligible retirees. Where do I find an in-network, private free-standing facility? Please note that this list DOES NOT represent an exclusive list of physicians who may provide professional services to you while at Englewood Hospital. Although Englewood Hospital participates in most insurance plans, there may be some plans with whom we do not have a contract. You must check with your physician before treatment to determine the insurance plans s/he accepts. (PHBP Medical Plan). Submit claims to MagnaCare at P.O. You should only go to an emergency room when absolutely necessary. You and your eligible dependents are entitled to free services provided by JIB Medical, P.C. DNDE SE PUEDE IR PARA HACERME MIS PRUEBAS DE DIAGNOSTICO? This process typically takes one or two business days. You can find information about generic drugs and pricing details online atwww.expres-scripts.comor by calling Express Scripts Patient Customer Service at (800) 818-0883. A: 2022 benefit guides are available on the myBenefits site. Online websites and applications may vary how they list and identify the plan. A: Yes. 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. 0000071187 00000 n And, youll have access to discounted medical liability insurance through our partner, MLMIC. 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) Once a drug comes off the list, you may purchase it at your retail pharmacy. 9EN|~U^=.lQT_"PvS.+:a;6qG rY53fcT:[]_WEo.:r?&4+hp$XX#J: `0 Pre-certification is required for all inpatient and outpatient hospital services, surgical procedures in hospital or surgicenter, home health care services and durable medical equipment that are related to a hospital discharge, dialysis, all therapies and hospital based MRI, MRA, CAT, SPECT and PET Scans. The Plan does not cover weight-loss medications (such as Xenical and Meridia), erectile dysfunction medications (such as Cialis, Levitra, and Viagra), fertility medications (such as Clomid and Repronex), non-sedating antihistamines (such as Allegra, Clarinex, and Zyrtec), and vitamins. We're committed to improving your health and wellness so you can live life to the fullest. 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. Medical and Prescription Drug Plan (Pension, Hospitalization, and All Participants should call MagnaCare's dedicated Local Union No. Carriers Currently Filed by Labcorp. An independent Express Scripts committee of physicians and pharmacists determines which brand-name drugs are preferred. Complete details are available in the Summary Plan Description. You may locate a MagnaCare participating mental health care provider by visiting their website atwww.magnacare.com. Get MagnaCare Confidential Health Information Consent Reimbursement for hospital and surgical expenses are subject to the applicable co-pays (see the Summary Plan Descriptionfor details). Do I still have to pay the highest co-pay? Click here for more information on Magnacare. 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. Why did that happen and what should I do? Log onto MyCreateHealth.com to view all your claims for services received in 2017 and later. Labcorp will file claims for insured patients directly to Medicare, Medicaid, and many insurance companies and managed care plans. 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. If you do not find your insurance plan on the list below, we may still be in network. 877-SOUTH-NASSAU 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. Below outlines the plan design changes to our Value, Buy-up and HDHP for 2022. 0000111603 00000 n nQt}MA0alSx k&^>0|>_',G! 2023 Joint Industry Board of the Electrical Industry. You can call MagnaCare Advocacy Services for assistance at (866) 624-6260. 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. Brighton Health Plan Solutions Expands Nationally with its Technology 212-691-4100 ext.313. Lenox Hill among America's 50 Best Hospitals for second consecutive Phone (877) 432-7823 Get the care you needsafely Request an appointment 20-Minute Health Talk Do I need to use the Express Scripts by Mail service? Participants and their eligible dependents can get their adult annual well-care visit 100% covered by the PHBP at these conveniently locatedmulti-specialtygroup practices. Learn more about leasing our PPO network >. 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. 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. Access the in-network provider and facility search on Northwell.edu/myMedical. MagnaCare plans are available in New York and New Jersey and usually include a wellness component to reduce health care costs. At MagnaCare, we take healthcare personally and we put people first. Reimbursement will be at the network allowance and is subject to the same co-payments as in network claims. For additional free-standing laboratories, please call Magnacare at 1(866)-281-0364. Heart disease is the leading cause of death worldwide. 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. What do I do if I need to go to the Emergency Room? Plans provide hearing benefits through either the Aetna network or the direct member reimbursement (DMR) service. If you are seeking assistance for inpatient services, Mount Sinai South Nassaus Financial Assistance professionals may be able to help you complete your application. What services require pre-certification through MagnaCare? MagnaCare health plans use a self-insured model, allowing companies the freedom to choose what to cover and how to cover it. NEW BENEFIT WITH 100% COVERAGE FOR MEMBER AND SPOUSE It is always important to verify and update insurance information and know which testing laboratories are in-networkor participating providers for your benefit plan. Please fill out as much information as you can. 2y.-;!KZ ^i"L0- @8(r;q7Ly&Qq4j|9 Aetna - All Products Accepted except Better Health Fida. We are glad to see you are making health and wellness a priority, great job! You should also know that these healthcare professional(s) costs are not included in the facilitys charges. 212-691- 4100 ext.313. MSK Direct can be reached at the dedicated toll-free member line for PHBP members (844) 506-0587, Monday through Friday from 8:30 am to 5:30 pm ET. health plan management company. Para las pruebas de rayos X/ecografa click Radiology Centers, Por sangre y/o exmenes de laboratorio click Laboratories. 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. MagnaCare is powered by Brighton Health Plan Solutions, LLC, the company accredited by URAC for Health Utilization Management.
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