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Health Benefits
EPO, POS, and PPOs > DC 37 Med-Team Program



DC 37 Med-Team Program

Available only to DC 37 members, retirees, and their families, the DC 37 Med-Team Program offers a full range of coverage and more choices. Depending on the health care services you need, you are free to get covered services from medical providers participating in the GHI network or choose non-participating providers and receive out-of-network benefits.

The DC 37 Med-Team Program provides network benefits in GHI participating hospitals located in New York and New Jersey that are designated by GHI as being part of the network available to the DC 37 Med-Team Program (please note, emergency care is covered as a network benefit in any hospital located throughout the United States). When you choose the DC 37 Med-Team Program, you get these advantages:

  • You can choose to use participating or non-participating providers and still receive benefits.
  • You do not need a referral to see a specialist, so you are free to use any provider.
  • In-network hospital and medical benefits are paid in full after copayments.
  • There are no claim forms to file when you use in-network physicians and specialists.

In-Network Benefits
In-network benefits provided through this plan include:

office, specialist, and chiropractic visits allergy testing
diabetic supplies diabetes education and management
physical therapy physical rehabilitation
occupational, speech, and vision therapy one annual physical examination
well-woman care skilled nursing facility care
hospice care home health care visits including home infusion
durable medical equipment diagnostic procedures such as x-rays
MRI lab tests
chemotherapy radiation therapy
diagnostic screening tests Pap smears
mammography well-child care including immunization visits

In-network hospital admissions are subject to a $250 copay per admission.   Home and Office visits and Lab & X-ray services are subject to a $10 copayment.

Note: Non-emergency hospital admissions, Diagnostic X-ray and certain other medical services require pre-certification and failure to comply with the pre-certification requirements may result in a reduction in benefits.

Out-of-Network Benefits – Out-of-network services are covered health care services provided by a hospital or other provider that does not participate in the GHI network, or hospitals other than GHI participating hospitals located within New York and New Jersey that are designated by GHI as being considered non-participating under the DC 37 Med-Team Program. When you use an out-of-network provider, benefits are subject to the following:

You pay an annual deductible of $1,250 per individual/$3,000 per family, 30% coinsurance with a maximum out-of-pocket coinsurance of $3,750 per individual/$9,375 per family per calendar year plus any amount above the GHI Allowed Charge. 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.

Note: Durable Medical Equipment, Mental Health Care, and Routine Podiatric Care are not covered out-of-network.

Special Programs
GHI Centers of Excellence
– A program that gives members access to hospitals and medical professionals with demonstrated expertise and success in performing cardiac care and organ transplants.

Disease Management Program – Educational programs for eligible members to learn to manage chronic illnesses such as asthma, diabetes, etc.

Good Health Incentives Program: Offers special discounts on a wide variety of health-related products and services including:

  • General Nutrition Centers
  • Wellquest Fitness Network
  • Weight Watchers
  • Davis Vision Laser Vision Correction
  • Davis Vision Affinity Discount program
  • Acupuncture Therapy Discount Program
  • Massage Therapy Discount Program
  • Registered Dietician Discount Program
  • HEARx Hearing Aid and Product Discount
  • CARExpress Discount Health Programs
  • My Medical CD

Prescription Drugs
The DC 37 Health & Security Plan provides prescription drug benefits.

Cost
There is no cost for this program.

For More Information
If you have questions or would like additional information, please call (212) 501-4444 and identify yourself as a DC 37 Med-Team member. You may contact the plan at:

DC 37
125 Barclay Street, 3rd Floor
New York, NY 10007
Visit the DC 37 Web site
Visit the Plan Web site

 

Spotlight

Employee Assistance Programs (EAPs)
EAPs are staffed by professional counselors who can help employees and their eligible dependents handle problems in areas such as stress, alcoholism, drug abuse, mental health, and family difficulties.

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