MagnaCare and Create Flex

Questions on open enrollment? Call the Concierge at 866.624.6222

8:30 am–6:00 pm Monday–Friday
[email protected]

Carisk Partners offers exciting health plan options for New York, New Jersey & Connecticut employees.

All other states

The network includes:

200+
LEADING HOSPITALS
220,000+
PROVIDER LOCATIONS IN
NEW YORK, NEW JERSEY &
CONNECTICUT

Three MagnaCare plan designs to choose from.

FIND A PROVIDER

The network includes:

35
LEADING HOSPITALS
50,000+
PROVIDER LOCATIONS IN
NEW YORK & NEW JERSEY
  • Three Create® Flex plan designs to choose from.
  • LOWEST COST OPTION!

FIND A PROVIDER

This year, enrollment is online May 14–20, 2020.

START ENROLLMENT

Watch the recorded webinar to learn more about your health plan choices

You will also benefit from Concierge customer service and an advanced technology platform, including a mobile app.

 
View the resources and below FAQs to learn more.

Concierge Customer Service

MyCreateHealth Mobile App

How to Find a Provider

Accordion FAQ

What is Create Flex?

Create Flex is a network of six leading health systems that includes high quality healthcare providers, hospitals and facilities throughout the NY and NJ area.

As a Create health plan member, you also receive an advanced technology platform, including our award-winning mobile app, and expert guidance from our concierge team.

What is MagnaCare?

MagnaCare is a leading network of 200+ hospitals and 200,000+ high quality healthcare providers in NY, NJ and CT.

As a MagnaCare health plan member, you also receive an advanced technology platform, including our award-winning mobile app, and expert guidance from our concierge team.

Can I choose a different health plan for another family member?

Create Flex and MagnaCare health plans are family plans. Our benefits and network coverage are designed to cover the needs of every member of your family. Enrolling in our health plans means choosing one health plan for you and the family members you choose to enroll.

What if my current healthcare provider is not part of the Create Flex or MagnaCare network?

We understand how important your relationship with your healthcare provider is. Our network is designed to provide you with a broad range of choices of high quality healthcare providers.

Can I continue to see my current healthcare provider as a Create Flex or MagnaCare member?

If your healthcare provider is not part of your chosen network, you may choose to see them as an out-of-network (or non-network) provider.

  • If you select a Create Flex or MagnaCare PPO plan, it will cover 80% of the out-of-network allowances after your deductible. To learn whether the service you are seeking is covered under your plan, please review your plan’s Benefits.
  • If you select a Create Flex or MagnaCare EPO plan, non-network providers are not covered by your plan.
Am I covered outside the coverage area?

The Create Flex network includes participating providers in the NY/NJ metro area, and the MagnaCare network includes participating providers in NY, NJ and CT. If you travel out of the area, your health plan offers the First Health nationwide network for emergency and urgent care services only. Please remember to take your member ID card with you.

What if I have a college student who’s out of the coverage area or out of state?

College students living outside the coverage area are covered by the First Health nationwide network for emergency and urgent care services only. (College students should make routine appointments with their providers when they are home, in the coverage area.)

What if I need to see a healthcare provider who is not part of my plan?

Our health plans provide you with access to a wide range of primary care and specialty care providers. In the unlikely event that the services you need are not available within your network and you seek care from an out-of-network provider, you may request that the non-participating provider is covered at an in-network benefit level. To do so, you/your provider, or the non-participating provider should contact our medical management team to provide information that necessary services are not available in the network you chose.

Please keep in mind that you can expect to pay more out-of-pocket when you receive care from providers who are not part of the network (also known as out- of-network providers or non-network providers).

How do I find out if the Create Flex and MagnaCare networks have providers or facilities near my home or work?

To learn which network has healthcare providers and facilities near you, you can use the ‘Find a Provider’ tool on mycreatehealth.com. Pick the network name, and search by address, distance, name, specialty, and many other criteria. Our search tool is also integrated with Google maps and directions

Where can I find information on continuing my health insurance after I leave my job?

If you leave your job, you and your covered dependents will receive information on continuing coverage requirements, known as COBRA, by mail. For additional information on COBRA benefits, you can visit the United States Department of Labor website at https://www.dol.gov/general/topic/health-plans/cobra.

After I enroll, how do I add family members to (or remove family members from) my health plan?

We understand that your family may change over time.You can send a request to add or remove a dependent after you have enrolled by visiting our Member Service Portal at mycreatehealth.com

We will generally accept changes to enrollment due to qualifying life events such as:

  • Marriage
  • Divorce or Legal separation
  • Birth or Adoption
  • Loss of coverage

You can find a complete list of Qualifying Life events and time limit to submit your request after enrollment in the Summary of Plan document found on the Member Service portal.

Are emergency room services covered?

Emergency services obtained for treatment of an emergency medical condition are covered anywhere in the country. No prior authorization is required. Your share of the cost of services is determined by your plan and your payment(s) will count toward your deductible.

For emergency services received from non- participating providers (which may include radiology, anesthesiology, pathology and non- participating emergency providers), we will calculate the allowed amount (the maximum amount your plan will pay for a covered service) as the greatest of the following:

  1. Our average contracted rate for such services, or
  2. 125% or higher of the Medicare rate for such services.

It’s always best to stay in-network, but in a life- threatening emergency you should go to the closest emergency room. If your symptoms aren’t so serious that you have to go to an ER, urgent care centers are a less expensive and often less time-consuming option for quick medical attention.

Are Urgent Care services covered?

Yes, urgent care services are covered and do not require prior authorization.

Whether you are in the service area, or out of the service area, it matters whether you choose a participating or non-participating provider. Like with all services, when you seek care from a non-participating provider your plan determines how much the plan covers and how much you are responsible for.

For emergency services received from non- participating providers (which may include radiology, anesthesiology, pathology and non- participating emergency providers), we will calculate the allowed amount (the maximum amount your plan will pay for a covered service) as the greatest of the following:

  • In-network (i.e., participating) providers – You must access urgent care providers participating in your health plan network in or- der for those services to be covered at the highest coverage level under your plan. You will only be liable for the urgent care cost share under your plan.
  • Out-of-network (i.e., non-participating) providers – When you have out-of-network benefits and you receive services from a non-participating urgent care provider, you will have a larger out-of-pocket cost. When you do not have out-of-network benefits, non-participating providers are not covered.

To find participating providers:

  • Within the service area of your plan – Go to mycreatehealth.com and select your network (Create Flex or MagnaCare).
  • Outside the service area of your plan – Go to mycreatehealth.com and select “First Health Network,” your plan’s out-of-network coverage. You will only be responsible for the urgent care cost share required under your plan.
When does my coverage begin and end?

Your benefit year is the same as your plan year. This corresponds to the calendar year. Coverage begins July 1, 2020 and ends June 30, 2021.

What is my deductible, copay, coinsurance?

know how important it is to understand the cost of your healthcare. Let’s define a few important terms.

Deductible: Your deductible is the amount you pay annually out of pocket for the covered medical services or prescriptions you use before your health plan begins to pay.

For example, if your plan’s deductible is $1,500, that means for most healthcare expenses you’ll pay 100 percent of your medical and pharmacy bills until the amount you pay reaches $1,500. After that, your plan will begin covering the services your plan offers as benefits minus coinsurance and copays.

Coinsurance: Your coinsurance is the portion of your healthcare costs that you are responsible for covering. This is usually a percentage of the cost of your healthcare services.

Here’s how it works: Let’s say you have allergies and see a doctor regularly. Once you meet your $1,500 deductible, your plan will cover 70 percent of the cost of your allergy shots. You will pay the remaining 30 percent—that’s your coinsurance. If your treatment costs $150, your plan will pay $105 and you will pay $45. If you use an out-of-network provider, your plan will still share the cost of services, but the percentage you are responsible for (your coinsurance) will be higher. And, if the medical service you receive from an out-of-network provider is more expensive than what your plan would pay an in-network provider, you’ll be responsible for the difference.

Copay: Copay is the flat fee you pay when you visit your healthcare provider or fill a prescription. Copays vary by service, including prescription drugs, and provider and facility visits.

For example, a doctor’s office visit might have a copay of $30. The copay for an emergency room visit will usually be more expensive. Note: For some services, you may have both a copay and coinsurance.

Out-of-Pocket Maximum (OOP): Your out-of- pocket maximum is the most you’ll pay, each year, for covered services.

When will I receive my ID Card after I enroll?

You will receive your ID cards along with a Welcome Kit by mail in 2 to 3 weeks after your Open Enrollment period ends.

In the meantime, if you need to use your ID card, you can download or print your ID card by going to mycreathealth.com and navigating to “Cards” on the Member Portal menu. You can also call Concierge customer service.

How can I contact my health plan?

We’re here to help! As a Create Flex or MagnaCare member, you’ll receive concierge service and expert guidance from a customer service team that is committed to providing reliable, quality and consistent customer care when you need it most.

Online self-service is available anytime, anywhere through the member portal at mycreatehealth.com. Or you can call to speak with a Concierge at 844.769.2738, Monday through Friday, 8:30am to 5:30pm ET.

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