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 information provided below provides the highlights of the ESF Health and Welfare Plan applicable to both 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.
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.
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.
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.
To find a MagnaCare network provider, use the MagnaCare Provider Locator tool. You can also obtain a list of participating providers by contacting MagnaCare at (800) 548-0138.
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 (800) 548-0138 or www.magnacare.com.
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.
Plan A and C Benefits
Plan A: In-patient and out-patient hospital charges, as well as, surgical and other benefits are covered.
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.
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
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); and
- a $50 annual deductible on serves that are not preventative or basic.
To find a dentist who participates in the DDS panel, call (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.
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, P.C.
- Diagnostic medical services available at an approved facility located in New Jersey or Long Island
Free exams and eyeglasses. If you use JIB Medical 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 (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.
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
Forms and Documents
Prenotification through MagnaCare:
Substance Abuse Services:
(718) 591-2000, Extension 1396
Members' Records Department:
ESI (Prescription Drug Questions):
Dental Benefits through DDS, Inc.:
www.ddsinc.net (password: 3)
JIB Medical Department:
Professional Evaluation Medical Group ("PEMG"):
Electrical Workers Death Benefit Society:
MagnaCare Advocacy Services