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I don’t understand the difference between generic, Plan-preferred brand-name and non-preferred brand-name drugs.
Generic drugs are manufactured after the original manufacturer’s patent expires. These drugs are safe, effective and FDA-approved to meet the same rigorous standards for quality, strength and purity as their brand-name counterparts. They are less expensive because the generic manufacturer does not have the investment costs of the developer of a new drug.
Plan-preferred brand-name drugs are those that do not yet have a generic equivalent available and are preferred based on safety, effectiveness and cost. An independent Medco committee of physicians and pharmacists determines which brand-name drugs are preferred. They are included on a drug list know as a formulary.
Non-preferred brand-name drugs are those that do not yet have a generic equivalent, but for reasons of effectiveness or cost, are not on your Plan’s formulary drug list.
How much is my prescription drug co-pay under the PHBP Prescription Drug Plan?
Your co-pay is based on the status of your drug (generic, plan-preferred or non-preferred) and the quantity (number of days supply) you receive. Your co-pays are shown on the chart of covered services on the Medical Plan Page. You can also refer to the “Savings Advisor” at Medco.com to see if alternate medications are available that would save you money.
Keep in mind that you can minimize your out-of-pocket expense by speaking with your physician about prescribing a generic or Plan-preferred drug for you whenever possible. You can find information about generic drugs and pricing details online at www.medco.com or by calling Medco Member Services at 1-800-818-0883.
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. Participants who work for an employer who contributes 8.5% are covered under a separate benefit schedule and should refer to that Summary Plan Description.
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, 87K) for the Enrollment Form for Eligible Dependents. |
Below are the Medical Plan highlights. Complete details are available in the Summary Plan Description (PDF, 563K).
Deductible for Non-Network Services |
$300 per calendar year per family member with an annual $500 maximum family deductible through 2007. This deductible is eliminated for all services rendered on or after January 1, 2008. |
Maximum Lifetime Limit |
$2,000,000 lifetime limit applies to all hospital, medical and prescription drug benefits for you and each of your eligible dependent(s). |
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 Members’ Records Department at the JIB to request a hard copy of the provider directory. 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, as well as all applicable deductibles (through 2007). 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, 563K) 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:
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. |
Medical, Surgical and Maternity Services |
Doctor visits and diagnostic services: $25 co-pay/$50 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. To ensure coverage, participant must notify MagnaCare within 24 hours of service. |
Prescription Drug Benefits |
Save at the counter or save even more through the mail. Retail Pharmacy. The Medco Network covers the cost of prescriptions, except for the applicable co-pay:
Medco 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:
*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. |
The Medical Center |
Free medical services at the JIB. You and your eligible dependents are entitled to free services provided by the Medical Center (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. |
| Vision Benefits at the Medical Center | The Medical Center (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. |
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 |
