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Benefits
DC 37 Med Team Phone:
GHI-CBP at 212-501-4444, DC 37s Med-Team office at 212-815-1313 Website:
GHI-CBP.com
As a member of DC 37 Med-Team, you have the freedom
to choose any provider. You can select a GHI-CBP participating provider and not
pay any deductibles or coinsurance, or go to an out-of-network provider and still
receive coverage, subject to deductibles and coinsurance. GHI-CBPs provider
network includes all medical specialties. When you need specialty care, you select
the specialist and make an appointment. You will not have to file a claim form
when you use a GHI-CBP participating provider; payment for services will be made
directly to the provider.
The DC 37 Med-Team Program provides in-network
benefits at GHI participating hospitals located in the states of New York and
New Jersey that are designated by GHI as being part of the network available to
the DC 37 Med-Team Program.
In-Network: In-network services include
but are not limited to primary care and specialist office visits; chiropractic
care; allergy testing; diabetes medication and supplies; physical, occupational,
and speech therapy; one annual physical examination; well-child care; well-woman
care; home healthcare visits; skilled nursing facility care; hospice care; durable
medical equipment; diagnostic screening tests and procedures such as X-rays, MRI's
and lab tests; chemotherapy and radiation therapy. Many services are subject to
a $10 copay; some services are subject to deductibles and maximum benefits. Each
in-network inpatient hospital admission is subject to a $250 deductible.
Dependents:
No copayments are required for in-network office visits and diagnostic tests like
x-rays or lab work for unmarried dependent children through the end of the year
in which they reach age 19.
Out-of-Network: An out-of-network service
is a covered health care service rendered by a hospital or other provider that
does not participate in the GHI-CBP network, or a hospital located in New York
or New Jersey that is designated by GHI as non-participating under the DC 37 Med-Team
Program. You will usually have to pay the provider when you receive care. You
will need to file a claim and payment will be sent to you. When you use out-of-network
providers, benefits are subject to an annual deductible of $1,000 per individual/$3,000
per family, 30% coinsurance with a maximum annual coinsurance of $2,700 per individual/$6,750
per family plus any amount above the GHI allowed charge. The subscriber is responsible
for any difference between the fee charged and the reimbursement made by GHI.
There is a lifetime maximum for covered expenses rendered by out-of-network providers.
Pre-certification:
Certain services require pre-certification. Failure to comply with the pre-certification
requirements may result in a reduction in benefits.
Special Programs:
GHI offers special programs including centers of excellence that give members
access to hospitals and medical professionals with demonstrated expertise and
success in performing cardiac care and organ transplants, a disease management
program to learn how to better manage chronic illnesses such as asthma or diabetes,
and the Good Health Incentives Program which offers discounts on a variety of
health-related products and services.
DC 37 Med-Team
Senior Care
Phone GHI-CBP at 212-501-4444, DC 37s Med-Team
office at 212-815-1313, Medicare at 1-800-633-4227 Websites: GHI-CBP
at GHI-CBP.com,
Medicare at Medicare.gov
DC
37 Med-Team Senior Care is a plan offered by GHI-CBP that supplements Medicare.
The programs hospital coverage supplements Medicare Part A to provide benefits
for such services as semi-private room and board and general nursing care. The
programs medical coverage supplements Medicare Part B to provide benefits
for such services as physician visits and supplies.
With DC 37 Med-Team
Senior Care, you can go to any provider. If you go to providers who accept Medicare
and the services are covered, the plan will cover all but a $50 deductible per
person per calendar year. If you go to providers who do not accept Medicare, you
may have more out-of-pocket expenses. Each Medicare Part A inpatient hospital
admission is subject to a $100 deductible.
Some other services are subject
to deductibles, copays, and maximum benefits.
Pre-certification:
Certain services require pre-certification. Failure to comply with the pre-certification
requirements may result in a reduction of benefits.
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