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

You are eligible after 26 weeks of employer contributions.

Initial eligibility is attained by having worked on a full-time basis for a Contributing Employer to this Plan during which time contributions were made for at least 26 consecutive weeks immediately prior to incurring a reimbursable expense.

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. Download the Enrollment Form for Eligible Dependents.

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.

Wage Replacement Day:

Effective April 10, 2019, covered participants in the divisions listed below shall be entitled to be reimbursed for a day’s pay based on a straight time contractual rate from the Welfare Plan when he or she takes off a day from work to go for a physical exam and loses a day’s pay pursuant to the Plan rules. divisions covered include: ‘a’, ‘m’, ‘mij’, apprentice, ‘m’ helpers, adm, expeditor, re & rw, teledata, ‘j’ and outside linemen.

Covered Participant members may apply for one medical exam day benefit using this form. Documentation from the physician and paystub must be submitted with a completed application signed by the participant and the employer.

Click here for the benefit changes effective July 1, 2022 for Medicare eligible retirees.

Click here for the benefit changes effective October 1, 2016 for Active Participants and non-Medicare retirees.

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

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).

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.

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.

EFFECTIVE JUNE 1, 2022, JIB MEDICAL CO-PAYMENTS WILL BE INCREASED FROM $15 TO $25 FOR ALL VISITS, EXCEPT THE ANNUAL PHYSICAL AND OTHER PREVENTATIVE CARE SERVICES AT THE JIB MEDICAL CENTER.

This $25 co-payment at JIB Medical applies to all non-preventative services for which co-payments apply outside JIB Medical which includes but is not limited to office visits, diagnostic radiology and ultrasound. This $25 co-payment does not apply to immunizations, laboratory work, routine eye exams or services provided by the JIB Optical Department.

* This co-payment applies to both active and non-Medicare retired Participants and all eligible dependents. This copayment does not apply to visits and services provided by the JIB Optical Department.

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. Benefits are provided once every 12 months.

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.

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.

JIB Medical values the physical and emotional health and well-being of the members and is making progress in promoting ways to enjoy a healthy way of life in our work and home environments. The programs are designed to encourage all participants to live healthier lifestyles and create a culture of health and wellness throughout our individual communities. Click here to learn more about JIB wellness initiatives.

The PHBP will cover up to four annual diabetic education sessions. For information on how to find a provider please call MagnaCare at (877) 624-6210