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.
Your Eligibility
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.
Dependent Eligibility
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.
Plan Overview
Below are the Medical Plan highlights. Complete details are available in the Summary Plan Description.
Find a Doctor
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 applicable co-pays and/or deductibles. 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 (877) 624-6210 or refer to the Summary Plan Description 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, 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.
Grandfathered Plan Status
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
Covered Services and Co-Pay Information
Medical, Surgical and Maternity Services
Effective 10/1/2023, Laboratory & Pathology Services co-payments: $35 or $65*
Specialist Office Visit: $50 or $80*
Urgent Care: $75
*The higher co-payment applies to participants and spouse who have not received an annual physical; the lower co-payment always applies to dependent children.
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 $200 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 $250 co-pay. Related, out-of-network claims should be submitted to the Plan for reimbursement.
Prescription Drug Benefits Effective 01/01/2024
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: $30
- Non-Preferred Brand-Name: $60
Active Participants:
- Generic: $20*
- Plan-Preferred Brand-Name: $40
- Non-Preferred Brand-Name: $80
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: $70
- Non-Preferred Brand-Name: $165
Active Participants:
- Generic: $40*
- Plan-Preferred Brand-Name: $90
- Non-Preferred Brand-Name: $160
*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, P.C.
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. This $25 co-payment does not apply to immunizations, laboratory work, routine eye exams.
* This co-payment applies to both active and non-Medicare retired Participants and as well as all eligible dependents, at the time of the appointment.
Vision Benefits at JIB Medical, P.C.
JIB Medical, P.C. also provides vision benefits to you and your dependents through Jena Optical. Benefits are provided once every 12 months.
Vision Benefits
All active and Retired Participants and their Eligible Dependents are entitled to an eye examination for new glasses or contact lenses every 12 months at Jena Optical, a state-of-the-art eye care center. Jena Optical is located in the Electchester Shopping Center (JIB Medical Annex) across the street from the Joint Industry Board.
The Plan provides a benefit for an eye exam, contacts and/or a pair of glasses (frames and/or lenses) for a total value of up to $125 at Jena Optical as described below.
Glasses and Contacts Benefits
The following benefits are offered to Participants and their Eligible Dependents at no cost (except as specified below):
- Examinations performed by a licensed optometrist for glasses and/or contact lenses.
- Lenses for glasses for reading, distance or line-bifocals prescribed by a licensed optometrist.
- Frames selected in conjunction with lenses newly prescribed by a licensed optometrist. Frames may be chosen from a selection that includes both plastic and metal frames. Jena Optical has over 500 fashion forward benefit frames to choose from with a one-year warranty.
- A replacement pair of glasses for children 12 and under who break or lose their glasses within 12 months of their last visit. Prior to obtaining a replacement pair of glasses, the child must have had an examination at Jena Optical. Jena Optical has a wide selection of children’s benefit frames in all styles and colors.
The following items require an out-of-pocket expense above the $125 benefit described above:
- Lenses other than those described above (i.e., progressive, transition and high-index anti-glare lenses).
- Frames other than those described above (i.e., designer frames). Jena Optical has over 500 Designer frames to choose from including such names as Gucci, Tom Ford, Cazal, Fendi, Silhouette, Prada, Ray-Ban and many more.
- Contact lenses. Jena Optical has a wide range of lenses from Acuvue, Bauch and Lomb and CooperVision.
Prescription Safety Glasses Benefit
An annual stand-alone prescription safety glasses benefit (occupational or recreational) for a total value of up to $200 is also covered at Jena Optical. The stand-alone prescription safety glasses benefit is available only to the active Participants and dependent children (not spouses). Jena Optical has over 25 styles of Z-87 rated Wiley Safety Glasses and a wide variety of children’s Rec Spec Sport Safety Glasses.
The prescription safety glasses benefit is in addition to the Plan’s annual optical benefits for glasses and/or contact lenses described above.
To schedule an optical appointment at Jena Optical, call 1-718-591-2014 from Monday through Friday, 8:00 A.M. to 6:00 P.M. and Saturday from 8:00 A.M. to 2:30 P.M. Appointments should be made in advance.
Out-of-Area Optical Benefits
Active and Retired Participants and Eligible Dependents who do not live within the 5 boroughs of New York City may also choose a participating optical outlet within the General Vision Services or Vision Screening Networks that will enable them to receive covered optical benefits as described above.
- General Vision Services (“GVS”): You can contact the GVS Concierge hotline at 1-646-453-2910 or go to the GVS website at www.generalvision.com to confirm eligibility, make an appointment or to find a location.
- Vision Screening (“VS”): You can schedule your appointment online by going to www.vscreening.com, where you will also find the most convenient location. If you have any questions, please feel free to call the Vision Screening hotline at 1-800-652-0063.
Retired Participants who live outside the 5 boroughs of New York City may choose a provider outside of Jena Optical Center or the GVS or Vision Screening Networks. The Plan will pay up to $56 for covered services applicable to covered optical charges described above.
You can contact the Members Records Department at 1-718-591-2000 extension 2491 to confirm your eligibility and request an application for direct reimbursement. The application must be returned along with an itemized receipt to the Member Records Department at the Joint Industry Board.
MSK Direct Program
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.
Addiction & Mental Health Referral and Guidance Services
The JIB Addiction and Mental Health Referral Service Department now offers a disease management program that provides outreach and support to Participants and Eligible Dependents affected by mental health and substance use disorders. Staff assist in connecting individuals with appropriate inpatient or outpatient treatment programs and provide information on mental health and substance use disorders, addiction, and the recovery process. The department also helps identify aftercare resources, including confidential Local 3 support groups.
Participants and eligible dependents are encouraged to use this service to access high-quality, cost-effective care. To be referred to a preferred provider, please contact the department at 718‑591‑2000 ext. 1396 or 1397.
Wellness Benefit
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.
Diabetic
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.
Applied Behavioral Analysis Therapy
The Plan provides coverage for Applied Behavioral Analysis (“ABA”) Therapy for Participants and Eligible Dependents with autism. ABA Therapy is a behavioral health treatment and includes many techniques for understanding and managing the behavior of those who are diagnosed with autism. ABA Therapy can be adapted to meet the unique needs of each person and to support that person and their family in a personalized way. Participants and Eligible Dependents also have access to MagnaCare’s Autism Support Program described above. Participants and Eligible Dependents may also contact MagnaCare at 877-624-6210 to get assistance with finding a provider.
Pre-certification is required for ABA Therapy. The initial office visit will be treated as an office visit and does not require pre-certification. Pre-certification is required if the provider determines that a treatment plan is warranted. Your provider (whether Network or Non-Network) must request pre-certification by calling MagnaCare’s Pre-certification Department at 877-624-6210. The co-payments described above apply to the initial visit and approved ABA Therapy visits, which is $35 for Participants and Eligible Dependents. Note that the increased co-payment of $50 will apply to Participants and spouses that have not obtained an annual physical as described above.
Autism Support Program
An autism support program is available to provide advice and information to parents of a child with autism spectrum disorder (“autism”).
MagnaCare’s Member Advocacy Services is a care management program that provides services that can help improve quality of life. This program will be expanded to support families seeking information related to autism. A personal care coordinator will be available to guide Participants and Eligible Dependents to available resources and community programs. Information regarding the MagnaCare’s Members Advocacy Services can be found on MagnaCare’s website by visiting www.magnacare.com/member-resources, clicking on the “autism” tab and scroll to the bottom of the page, or, enter “JIB Autism Support Program” in the site’s search bar.
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.