Eligibility
A spouse, an adoptive or biological children or stepchild.
Dependents
This is the day when a medical service is provided.
Day of Service
Tabulates information about eligibility for a member based on the contract and Job type.
Provisions
On January 1, 2022 this location will be OON.
Presbyterian Hospital
Pharmacy administrator for 1201 Retirees, for the Suburban Philadelphia School District.
Humana
Working in a job classification for which the employer is required to make contributions to the Fund.
Covered Employment
If involved in an automobile accident, Empire is always secondary to ____ ________.
No Fault
Member information you can update.
Member contact information
NYU Langone, Westchester or Northwell.
INN-NP (In network non-preferred facilities)
Optum portal allows you to search for a member using Alternate ID, also referred to as.
The members SSN
MRI, MRA, PET, CAT & Nuclear Imaging Studies.
High-tech radiology
After you login, from the Welcome page, scroll down to the bottom for 720902 – Building Services 32BJ Health Fund Metropolitan to view claims prior to DOS___________.
01/01/2021
This section displays information about the participant’s employment.
The Roster section
Fund participants will pay $0 for bariatric or joint replacement surgery only when the surgery is performed at a ____________________.
COE Hospital
Frequency at which the eligibility file feed is sent to our Medical Vendor / Empire.
Twice a week
5 Star Center locations that have one PCP who provides primary, preventive and urgent care services for New Jersey and Florida residents.
Everside Health
A three character prefix followed by an ID number that is provided to our members for identification purposes and billing.
ETR
Single, Family or Single Plus Children
Coverage Type
Health Care provider you are not to perform a search for, but transfer to the Vendor.
Behavioral/ Mental Health
All request are to be transferred.
A request for Plan benefits?
Claim
This is the method of limiting health insurance benefits so that insurance companies will not duplicate benefits or payments.
Coordination of Benefits
The type of Workflow you need to create to send a request to another department.
Escalation WF
$1,000 Copay
In-patient at an In-network non-preferred facility.
Prior to Optum, this vendor managed benefits until 12/31/2020.
CVS Caremark