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.
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.
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.
Below are the Medical Plan highlights. Complete details are available in the Summary Plan Description.
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:
- 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.
Covered Services and Co-Pay Information
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.
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
- 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:
- Generic: $35*
- Plan-Preferred Brand-Name: $65
- Non-Preferred Brand-Name: $110
- 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.
Free medical services at JIB Medical, P.C.
You and your eligible dependents are entitled to free services provided by JIB Medical, P.C. 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.
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 (804) 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.
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.
The PHBP will cover up to four annual diabetic education sessions at the Winthrop University Diabetes Education Center. For more information call (516) 663-2350.
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
Forms and Documents
(718) 591-2000, Extension 1350
Pre-certification through MagnaCare
Managed Care Coordinator at the JIB
(718) 591-2000, Extension 1350
JIB Substance Abuse Services
(718) 591-2000, Extension 1396
Members' Records Department
(718) 591-2000, Extension 2491
Express Scripts Network (Prescription Drug Questions)
MSK Direct Program