NEW CO-PAYMENTS, NEW ID CARDS

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1 August 2013 NEW CO-PAYMENTS, NEW ID CARDS Effective October 1, 2013, new co-payments will apply to some medical and prescription drug benefits as provided under the PHBP. MEDICAL CO-PAYMENTS All current $25 co-payments (MD visits, diagnostic radiology, physical, occupational and other therapies) are increased from $25 to $30 - effective for services rendered on or after October 1, For services rendered on or after October 1, 2013, co-payments for physician visits, diagnostic services and therapy visits rendered outside the JIB Medical Department will be raised from $25 to $30. Such visits will continue to be covered through the JIB Medical Department with no co-payment. Annual wellness visits at participating Area Group Practices will continue to be provided with no co-payment. This new co-payment amount applies to all active and non-medicare retired Participants. GET YOUR ANNUAL CHECK-UP! All Participants and spouses who have a physical in a two-year period shall receive a $5 reimbursement for all $30 medical copayments (such as MD visits, diagnostic radiology and physical, occupational and other therapies) for services rendered on or after October 1, As part of the Pension, Hospitalization and Benefit Plan s Wellness Program, participants and spouses who get a physical in a 24-month period from the date of service will receive a reimbursement of $5 for all $30 medical co-payments as described above. The reason the $30 co-payment must be made at the time of service is because the service providers will not know which participants are enrolled in our Wellness Program and have taken a physical. This benefit applies to all active participants and spouses and non-medicare retired participants and spouses. This benefit does not apply to dependent children or Medicare-eligible retirees. Examples: 1 Joe had a physical on September 1, He goes to his MagnaCare-participating doctor on October 30, 2013 because he does not feel well. He will make a $30 copayment at the time of his visit. When MagnaCare processes this claim, their records will indicate that he had a physical in September Since the date of that physical is within 2 years of his October 30th visit, MagnaCare will issue a $5 reimbursement check to Joe. 2 Frank never had an annual physical. He has a sore throat and sees his MagnaCare-participating doctor on October 2, He will make a $30 co-payment at the time of his visit. Because Frank has not had an annual physical within 2 years, he is not eligible for a $5 reimbursement on his $30 co-payment. 3 Bill and his spouse Joan both had annual physicals in January They make appointments to see their non-magnacare-participating doctor on November 1, Because both Bill and Joan had an annual physical within 2 years of the visit, a $25 co-payment rather than a $30 copayment will be applied to their out of network claim.

2 PRESCRIPTION DRUG CO-PAYMENTS Prescription Drug Co-payments for active participants and their dependents only shall be increased effective October 1, Effective October 1, 2013, prescription drug co-payments will be increased to the following amounts: Retail (up to a 34-day supply): Generic: $15 Preferred Brand: $25 Non-Preferred Brand: $40 Mail Order (90-day supply): Generic: $36 Preferred Brand: $73 Non-Preferred Brand: $120 The Plan s mandatory generic and mandatory mail order provision remain unchanged. Co-payments for retired participants and their dependents remain unchanged. NEW CARDS Prior to October 1, 2013, you will be receiving, via separate mailings, a new MagnaCare ID card and a new Express Scripts prescription drug ID card. MAGNACARE CARD You should show this new card to your MagnaCare provider for any visits on or after October 1, The new co-payment information will be on the back of the card. You will notice that your new MagnaCare card has a new ID Number. This new ID Number will be used in future communications as your new JIB reference number. EXPRESS SCRIPTS CARD You will be receiving a new prescription benefit member ID card with your new group number. Please begin using this card when you purchase covered prescriptions at participating retail pharmacies on or after October 1, To avoid confusion, please destroy your old member ID card since it contains your old group number and is no longer valid for purchasing prescriptions. Please note that only your group number has changed. Your prescription benefit and all other information on the card, including your member ID number, are the same. Remember! Never use your Express Scripts card when filling a prescription related to a Workers Compensation claim! This will prevent you from having to make a co-payment. EVALUAIDE PROGRAM: The PHBP has added a wonderful new benefit to its health plan to ensure that selected participants are receiving the appropriate level of health care. MagnaCare s Evaluaide SM Program is a care management service offered at no extra cost to eligible plan participants. Enrollees receive a personal Care Coordinator who can help improve quality of life. Services include but are not limited to: telephone support, home visits if requested and are necessary, help in locating a provider or specialist, help with arranging transportation to medical services if needed, providing education materials about your disease, creating a diet or exercise plan that is appropriate to your needs and medication review. If you have received a letter and have not yet been contacted, please take a moment to call your Care Coordinator at the number provided in the letter. Remember all services, as well as your health data, are completely confidential and are in no way shared with the Plan, the JIB or the Union. MagnaCare s Evaluaide SM Department looks forward to helping you make sense of the (often) overwhelming healthcare system. In order to make sure participants receive the maximum benefit of this program, as well as all other communications from the PHBP, it is important that we have your most up to date information on file. That is why we are re-enrolling all PHBP participants at this time. WHAT PARTICIPANTS ARE SAYING: The Care Coordination calls have help me stay on track of my medical goals from the multitude of daily diversions - 2 -

3 TIME TO RE-ENROLL! Enclosed with this newsletter you will find an Enrollment Form and a self-addressed envelope. We urge every participant to complete the Enrollment Form and return it to the Joint Industry Board as soon as possible. Knowing how to reach all of our participants will help us serve you better! OPTICAL BENEFITS Effective October 1, 2013, the Plan will pay up to $125 for glasses, contacts or prescription safety glasses (occupational or recreational) as part of the annual vision benefit. This means more choice and less out of pocket expense for participants. Prescription safety glasses are available only to the participant and dependent child. DIABETES EDUCATION Effective October 1, 2013, the PHBP will cover up to 4 annual diabetes education sessions at the Winthrop University Diabetes Education Center. The Winthrop University Diabetes Center can provide you with the knowledge, skills and tools needed to manage diabetes successfully. The Center s staff of Registered Nurses and Dietitians who are also Certified Diabetes Educators provide personalized guidance to meet your needs. Individual sessions as well as group classes are available. Participants will be allowed a total of 4 individual or group classes per calendar year at this facility only. There are no co-payments associated with this benefit. To learn more, call the Winthrop University Diabetes Education Center at (516) or contact Judy Blades at the JIB Medical Department at , ext ed. The Care Coordinator s help on finding local resources to help with my husband s ALS has saved me a lot of time that is dedicated back to other responsibilities

4 THE PENSION, HOSPITALIZATOIN AND BENEFIT PLAN OF THE ELECTRICAL INDUSTRY MENTAL HEALTH AND SUBSTANCE ABUSE BENEFITS Effective October, 1, 2013, the PHBP must comply with the Mental Health Parity and Addiction Equity Act of 2008 ( MHPAEA ). Accordingly, the following changes will be effective as of October 1, 2013: Mental Health The 30-day annual limit for mental health-related hospital admissions will be eliminated. The 4-visit calendar year deductible for out-patient visits will be eliminated. Annual out-patient limit of 30 visits per family is eliminated. Substance Abuse The once in a lifetime limit for this benefit will be eliminated. Out-patient and Emergency Room services will be covered in the same manner as other admissions and visits as allowed under the PHBP. The Pre-certification rule will apply in the same manner as all other PHBP facility admission and services. An expanded network of both out-patient and in-patient facilities will be available to participants and their dependents. THE AFFORDABLE CARE ACT ( ACA ) Effective January 1, 2014, the new health care exchanges will be operational. As a participant in the PHBP, you should know that: a. Your coverage under the PHBP is considered to provide at least minimal value and to be affordable under the terms as defined under the ACA. b. You will not be eligible for a premium tax credit to purchase a qualified health plan through the Marketplace unless the coverage your employer offers you does not meet certain standards. Since your coverage under the PHBP not only meets, but exceeds those standards, participants of the PHBP do not qualify for a tax credit. c. While the Employer contributions made to provide your health coverage is excluded from your income for Federal and State income tax purposes, you would have to pay for coverage in the Marketplace using after-tax dollars. You will be receiving a notice from your Employer that confirms the PHBP s status under the ACA no later than October 1, THE RENEWAL OF YOUR OSHA 10-HOUR CARD IN NYC Your OSHA-10 Card expires 5 years from the date it was issued. Please check your card to determine if your card has expired or is due to expire soon. If you need to renew your OSHA Card please contact the Help Desk at Ext.1499 for registration and access information for the online course. NYC Local Law 41 requires all workers working on construction sites to have successfully completed the OSHA 10-Hour Course for Construction every five years. As the Members Assistance Program ( MAP ) at the Joint Industry Board grows to accommodate these new and expanded benefits, more information regarding the substance abuse network and pre-certification procedures will be provided via mail and the JIB website. CONNECT TO HEALTH For Your Well-Being - 4 -

5 ENROLLMENT FORM PENSION, HOSPITALIZATION AND BENEFIT PLAN OF THE ELECTRICAL INDUSTRY SECTION 1: PARTICIPANT INFORMATION: Last Name First Name Social Security Number Date of Birth Phone Number Cell Phone Number SECTION 2: DEPENDENT INFORMATION: 1. Relation to Participant (check one): spouse: date of birth: child: date of birth 2. Relation to Participant (check one): spouse: date of birth: child: date of birth 3. Relation to Participant (check one): spouse: date of birth: child: date of birth The Pension, Hospitalization and Benefit Plan of the Electrical Industry Harry Van Arsdale Jr. Avenue Flushing, NY Phone: (718) Fax: (718) Please Turn Over

6 4. Relation to Participant (check one): spouse: date of birth: child: date of birth 5. Relation to Participant (check one): spouse: date of birth: child: date of birth 6. Relation to Participant (check one): spouse: date of birth: child: date of birth 7. Relation to Participant (check one): spouse: date of birth: child: date of birth SECTION 3: COORDINATION OF BENEFIT INFORMATION If you or a dependent are a participant in another group health plan, please provide information about your coverage below: Name of other health plan: Type of Plan (check one): Individual Family Name of Person(s) Covered: Policy Holder is (check one): Actively Working Retired Other (i.e. disabled) Effective date of coverage: SECTION 4: PARTICIPANT S SIGNATURE Please print, sign your name, and date this form. Print Name Date Sign Name