Health

You can cover your spouse and children. Once you meet the eligibility requirements above, you become a participant. 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.

Stay in-network and reduce out-of-pocket expenses.

You can  find a doctor in the MagnaCare preferred provider network online. If you prefer, call MagnaCare at (877) 624-6210 or contact the Health Advocate at (866) 799-2723.

If you use an in-network provider, there is no out-of-pocket expense for covered services other than the co-pays indicated below. 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. Reimbursement will be at the network allowance and is subject to the same co-payments as in network claims. All remaining balances are the participant's responsibility.

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. Contact MagnaCare’s Pre-certification Department at (877) 624-6210 or refer to the Summary Plan Description for complete details.

Services that require pre-certification through the JIB’s Hospitalization Department include, but are not limited to:

• Orthotics
• 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)
• Supplies and Durable Medical Equipment
• Office-based Extracorporeal Shock Wave Therapy (Orthotripsy)

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.

Effective 10/1/2023, Laboratory & Pathology Services co-payments: $35 or $50*

Specialist Office Visit: $50 or $65*

Urgent Care: $75

*The higher co-payment applies to participants and spouse who have not received an annual physical; the lower co-payment always applies to dependent children.

Reimbursement for hospital and surgical expenses are subject to the applicable co-pays (see the Summary Plan Description for details). There is a $200 per day co-pay for in-patient admissions (up to $500).

In a true emergency, you are covered. You should only go to an emergency room when absolutely necessary. When you do, there is a $250 co-pay. Related, out-of-network claims should be submitted to the Plan for reimbursement.

Retail Pharmacy

The Express Scripts Network covers the cost of prescriptions, except for the applicable co-pay:

Retired Participants:

• Generic: $15*
• Plan-Preferred Brand-Name: $30
• Non-Preferred Brand-Name: $60

Active Participants:

• Generic: $20*
• Plan-Preferred Brand-Name: $40
• Non-Preferred Brand-Name: $80

Express Scripts by Mail

If you use a maintenance medication to treat an illness such as high blood pressure, you can have your prescription filled for a 90-day supply through this program with the following co-pays:

Retired Participants:

• Generic: $35*
• Plan-Preferred Brand-Name: $70
• Non-Preferred Brand-Name: $165

Active Participants:

• Generic: $40*
• Plan-Preferred Brand-Name: $90
• Non-Preferred Brand-Name: $160

*This Plan has a mandatory generic policy. 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.

Medical services at JIB Medical, P.C.

You and your eligible dependents are entitled to services provided by JIB Medical, P.C. at the Electric Industry Center in Flushing, NY.

Services include but are not limited to: annual physicals, mammograms, lab tests, X-rays, EKGs, pap smears, PSA tests and inoculations.

Participants and their eligible dependents can get their adult annual well-care visit 100% covered by the PHBP at these conveniently located multi-specialty group practices. These practices are participating providers in the MagnaCare network.

Please note that co-payments for all other services, other than the annual adult well-care visits, will apply.

You can find out more about each PHBP Area Group Practice by visiting their website or by calling them.

JIB Medical, P.C. also provides vision benefits to you and your dependents through Jena Optical. Benefits are provided once every 12 months.

MSK Direct: Exceptional Cancer Care, Simplified.

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. MSK is the world’s oldest and largest private cancer center and US News & World Report ranks MSK as the top hospital in the Northeast for cancer care.

THE MSK DIRECT TEAM WILL:

• 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

Contact MSK Direct if you are told you have cancer or if you want a second opinion about your cancer diagnosis.  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. Calls outside of those hours will be returned the next business day.

For more information, click here for Frequently Asked Questions about the program.

The PHBP will cover up to four annual diabetic education sessions at the Winthrop University Diabetes Education Center. For more information call (516) 663-2350.

You can cover your spouse and children. As a participant, you are able to cover your lawful spouse and children (adopted or biological). Stepchildren may be covered by purchasing COBRA.

Smile, we’ve got you covered. The Plan programs cover a wide range of services, including but not limited to basic and preventative care, prosthetics and orthodontic services. Refer to the Summary Plan Description for a schedule of maximum allowances under the Empire BlueCross BlueShield Fee-For-Service Program.

No pre-certification is needed for Empire Managed Network or DDS options.

Under the Empire Fee-For-Service Program, pre-certification of benefits is required for all prosthetic and orthodontic procedures before treatment begins, but not for basic preventative services.