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Employees Security Fund Medical, Prescription Drug and Dental Plan (for members of the Fixture, Manufacturing, or Supply Divisions)

The Employees’ Security Fund (ESF) Health and Welfare Medical Plan offers two levels of coverage: Plan “A", and Plan “C.” The level of coverage that applies to you is determined by the collective bargaining agreement held with your employer. The chart below provides the highlights of the ESF Health and Welfare Plan applicable to all three levels of the Plan, unless otherwise noted. For a detailed schedule of covered expenses under each plan, please refer to the appropriate section of the Summary Plan Description (PDF, 395K).

Plan Overview

 

Your Eligibility

You are eligible after 26 consecutive weeks of full-time work. Thereafter, at least 26 weeks of contributions out of the past 52 must be received in order for you to remain eligible. If you are unemployed during all or any portion of this time, you must be registered as available for employment. To be eligible, you must complete an enrollment form and submit applicable documentation.

If you are a retired participant, you and your eligible dependents are only eligible for dental, optical, prescription drug and annual diagnostic medical benefits.

Eligibility for Your Dependents

You can cover your spouse and children. Once you meet the eligibility requirements and enroll, you are able to cover your spouse and dependent children according to the rules of the Plan.

Plan Highlights

Plan A: In-patient and out-patient hospital charges, as well as, surgical and other benefits are covered. Click here for more details (PDF, 21K).

Plan C: Most services are covered within the MagnaCare network. Physician's office visits (for non-preventive care) are covered in and out of network and are subject to a $50 co-payment. Click here for more details (PDF, 22K)

Find a Doctor for Plan C

If you are covered under Plan C, you will have lower out-of-pocket expenses when you use a provider who participates in the MagnaCare Preferred Provider Organization.

Pre-notification

Plan C requires pre-notification of certain services including hospital admissions and any surgical procedure performed at a hospital or surgi-center (both in-patient and out-patient).

Plan A does not require pre-notifications.

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Plan A and C Benefits
 

Find a Surgeon

You will have lower out-of-pocket expenses if you use a provider who participates in the MagnaCare Preferred Provider Organization. You can obtain a listing of these participating providers by contacting MagnaCare at 1-877-548-0138 or www.magnacare.com.

Prescription Drug

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

  • Generic: $15
  • Plan-Preferred Brand Name: $25
  • Non-Preferred Brand Name: $40

 

Express Scripts Mail service. If you are using a maintenance medication to treat illnesses such as high blood pressure or arthritis, you can have your prescription filled for a 90-day supply through the mail-order program. The cost to you is only the applicable co-pay:

  • Generic: $45
  • Plan-Preferred Brand Name: $75
  • Non-Preferred Brand Name: $120

Dental

Use a network provider. If you and your eligible dependents use a dentist who participates in the DDS, Inc. panel, your out-of-pocket expenses will be limited and you will not have to submit a claim form.

The dental benefit includes:

  • a $1,500 annual maximum on all dental work performed in a single calendar year(excluding pediatric)
  • a $50 annual deductible on serves that are not preventative or basic

To find a dentist who participates in the DDS panel, call 1-800-255-5681 or log on to http://www.ddsinc.net/ (password: 3)

If you use a non-DDS provider, out-of-pocket expenses are your responsibility.

Diagnostic Medical Services through JIB Medical or Other Facility

Get a free check-up. You and your eligible dependents can receive an annual physical exam for diagnostic purposes only. This exam is available through any of the following:

  • JIB Medical
  • Diagnostic medical services available at an approved facility located in New Jersey or Long Island

Vision Benefits at JIB Medical or Other Facilities

Free exams and eyeglasses. If you use JIB Medical (PDF, 22K) at JIB, you and your eligible dependents can receive an annual eye exam and, if prescribed, one pair of eyeglasses at no cost. You do not need to file a claim for this benefit.

If you use an optical provider who belongs to either the Vision Screening Panel or the approved New Jersey panel, covered benefits will be paid in full. To obtain benefits from a panel provider please contact the Fund Office at 1-718-591-1100 to request an optical voucher.

If you receive vision benefits outside the Medical Department, you will be responsible to pay any applicable expenses.

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Plan Information
 

Plan Name

Employees Security Fund of the Electrical Products Industries

Plan Identification Number

13-6100908

Plan Number

501

Plan Year

January 1 through December 31

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.

Plan Administrator

Joint Industry Board of the Electrical Industry

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