Benefits

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-CBP’s 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 $25 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.