Learn About:

Medical and Prescription Drug Plan (Pension, Hospitalization, and Benefit Plan of the Electrical Industry) (PHBP)

Eligible participants can receive medical and hospitalization benefits under this plan. The description of benefits contained in the following pages applies only to participants who work for a contributing employer who is covered under an applicable Collective Bargaining Agreement. Summary Plan Description (PDF, 518K).

Your Eligibility

You are eligible after 26 weeks of employer contributions. Once under full employment, you must be working full-time for a contributing employer for 26 consecutive weeks immediately prior to incurring a reimbursable expense. If you were unemployed during any or all of this period, you must be registered for employment in order to be eligible for Plan benefits. If you are unemployed and registered for employment, you remain eligible for coverage for up to 39 weeks.

If you retire on an Early Standard, Standard, or Disability Pension from the Pension Plan (PHBP Trust Fund), you remain eligible for benefits under this Plan. The Medical Plan will remain your primary plan until you become Medicare eligible, at which time the Medical Plan becomes the secondary payer. This benefit applies to your eligible dependents as well.

Eligibility for Your Dependents

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. Click here (PDF,181K)for the Enrollment Form for Eligible Dependents.

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Plan Highlights

Below are the Medical Plan highlights. Complete details are available in the Summary Plan Description (PDF, 480K).
 

Find a Doctor

Stay in-network and reduce out-of-pocket expenses. Click here to find a doctor in the MagnaCare preferred provider network. If you prefer, call MagnaCare at 1-877-624-6210 or contact the Health Advocate at 1-866-799-2723.

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.

MagnaCare Pre-certification Requirements

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 1-877-624-6210 or refer to the Summary Plan Description (PDF, 480K) for complete details.

JIB Hospitalization Department Pre-certification Requirements

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, ext. 1350 Monday through Friday between 8:30 A.M. and 4:30 P.M.

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Covered Services and Co-Pay Information
 

Medical, Surgical and Maternity Services

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

Inpatient and Out-Patient Hospital Services

Reimbursement for hospital and surgical expenses are subject to the applicable co-pays (see the Summary Plan Description for details). There is a $100 per day co-pay for in-patient admissions (up to $500).

Emergency Room Visits

In a true emergency, you are covered. You should only go to an emergency room when absolutely necessary. When you do, there is a $100 co-pay. Related, out-of-network claims should be submitted to the Plan for reimbursement.

Prescription Drug Benefits

Effective 10/1/2016

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: $25
  • Non-Preferred Brand-Name: $40

Active Participants:

  • Generic: $20*
  • Plan-Preferred Brand-Name: $30
  • Non-Preferred Brand-Name: $45

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: $65
  • Non-Preferred Brand-Name: $110

Active Participants:

  • Generic: $41*
  • Plan-Preferred Brand-Name: $78
  • Non-Preferred Brand-Name: $125

*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.

JIB Medical

Free medical services at the JIB. You and your eligible dependents are entitled to free services provided by JIB Medical (PDF, 30K) 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.

PHBP Area Group Practices Participants and their eligible dependents can get their adult annual well-care visit 100% covered by the PHBP at these conveniently located multispecialty 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.
Vision Benefits at the JIB Medical JIB Medical (PDF, 30K) also provides vision benefits to you and your dependents. Benefits are provided once every 12 months.
Serious Injury Benefit 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.
Wellness Benefit Effective 10/1/2016, all non-Medicare Participants and spouses who have a physical in a 2-year period shall receive a $5 reimbursement for all subsequent $35 co-payments.
Diabetic Education Benefit The PHBP will cover up to 4 annual diabetic education sessions at the Winthrop University Diabetes Education Center. For more information call 516-663-2350

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Plan Information
 

Plan Name

Pension, Hospitalization and Benefit Plan of the Electrical Industry Plan

Plan Identification Number

13-0891045

Plan Number

505

Plan Year

October 1 through September 30

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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