The In-Area Plan: Health Center Program
If you live in Manhattan, the Bronx, Brooklyn or Queens, all of your medical care begins with the Health Center. The Health Centers provide a complete range of in-house medical, diagnostic and screening services.
There are no deductibles, no co-pays (except for prescriptions) and no claim forms when using the Health Centers.
Covered health services, not available through the Health Centers can be arranged by the Health Center, with a written referral.
If additional services are required after the first outside referral visit, additional referrals are necessary, so please return to the Health Center to have them prepared.
If a referral is not used for each outside healthcare visit, you will be responsible for all charges associated with medical care received outside of the Health Centers.
Members using an outside provider without following the above referral process, will be responsible for all charges for services, fees and outside pharmacies.
Making an Appointment
If you or your eligible dependents need medical care, call your Health Center to make an appointment. If you need to cancel your appointment, call the Health Center as soon as possible so that your reserved time can be given to someone else. If you need to see a specialist outside the Health Center, or need to be hospitalized, the Health Center will make the necessary arrangements for the outside service or hospital admission.
The Health Centers and Pharmacies are open Monday through Friday, 7:30 AM to 7:00 PM. They are closed on weekends and certain major holidays.
If you choose to use an outside doctor without first receiving a referral for these services, or use an outside pharmacy, you will be responsible for all charges.
You can reach a nurse at Nurse Line at 877-TALK-2-RN (825-5276), for advice. They're available 24 hours a day, 7 days a week.
If you need a prescription filled after hours or when the Funds Pharmacies are closed, ask your doctor to write two prescriptions for each medication:
Prescription #1: This 1st prescription is written for an initial or partial supply to last you for at least 2 days. You may choose to fill this prescription at a local pharmacy. Note: You are responsible for all retail pharmacy costs.
Prescription #2: This 2nd prescription is written for an additional supply of medication to complete the course of treatment. This can be filled at the Funds Pharmacies during normal business hours, under your prescription drug benefit plan with the Funds.
|Services Provided at the Health Centers|
|The Health Centers provide a complete range of in-house medical, diagnostic and screening services, including those listed below. When outside services are needed, a Health Center will refer you to a provider.|
What is a Referral?
A referral is a written authorization to obtain care or service outside of the Health Center. A referral is only issued after completion of a physical evaluation by a medical practitioner at the Health Center.
About Our Providers
The Health Benefits Fund recruits and credentials its Health Center providers and approved outside provider panel based on the health care service needs of its members. The Fund contracts with providers who meet uniform standards established to ensure the selection of appropriately trained and qualified MDs, DOs, DDSs and DPMs and other licensed independent health care professionals. During its credentialing and re-credentialing processes, the Fund conducts primary- and secondary-source verifications with state licensing entities, medical malpractice carriers and medical boards.
These processes are similar to those applied by many large commercial insurance companies and are designed to help ensure quality selection and retention of our providers.