HANDBOOK FOR NYCT, MTA Bus, MaBSTOA, SIRTOA, HQ and MTAPD Employees - Use of MagnaCare and Sedgwick PPO Networks

Sep 17, 2026

Upload by Đào

Handbook for NYCT, MTA Bus, MaBSTOA, SIRTOA, HQ and MTAPD employees explaining medical provider network requirements for Workers’ Compensation injuries and illnesses occurring on or after May 19, 2025. It specifies initial treatment in the MagnaCare New York Certified PPO network or the Sedgwick Preferred Provider Network covering NJ/CT/PA, describes the 24/7 WC Clinical Consultation program, and outlines how to find providers, obtain second opinions, request prior authorization, and file complaints.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages15

Reading Time5 min

AccessFree to download

Introduction

Health Care Provider Networks

Required Use and Opting Out

Finding a Provider

Occupational Health Clinics

Obtaining Second Opinions

Prior Authorization Requests

Filing Complaints

Patient Satisfaction

Rights and Responsibilities

HANDBOOK FOR NYCT, MTA Bus, MaBSTOA, SIRTOA, HQ and MTAPD EMPLOYEES Use of MagnaCare and Sedgwick PPO Networks healthcare providers for treatment for Workers’ Compensation covered injuries and illnesses In NY: MagnaCare NYS Certified Workers’ Compensation Preferred Provider Network In NJ /CT / PA: Sedgwick Workers’ Compensation Preferred Provider Network | Table of Contents | | | | --- | --- | --- | | 0 | Introduction | p. 2 | | 1 | Health Care Provider Networks | p. 4 | | 2 | Required Use and Opting Out | p. 4 | | 3 | Finding a Provider | p. 4 | | 4 | Occupational Health Clinics | p. 8 | | 5 | Obtaining Second Opinions | p. 8 | | 6 | Prior Authorization Requests | p. 9 | | 7 | Filing Complaints | p. 9 | | 8 | Patient Satisfaction | p. 12 | | 9 | Rights and Responsibilities | p. 13 | Introduction Employees of the agencies covered by this handbook who seek medical treatment for a workrelated injury or illness that occurs on or after May 19, 2025 must seek initial treatment with a medical provider in: • The MagnaCare New York Workers’ Compensation Certified PPO network for medical treatment in New York; or • The Sedgwick Workers’ Compensation PPO for medical treatment in New Jersey, Connecticut or Pennsylvania. These two networks are referred to in this handbook as the MagnaCare/Sedgwick Provider Networks.1 The details of an emergency exception to this requirement as well as instructions for finding and connecting to providers are explained in this handbook. Also, the MTA has arranged for a Workers’ Compensation 24/7 Clinical Consultation program to help ensure that you get quality medical care if you suffer an injury on the job. Through this program, injured members will receive assistance to find and connect to appropriate and available medical providers from these networks. The purpose of this program is to improve how the MTA supports injured members by providing assistance that is: ~~•~~ Available 24/7. The MTA’s transportation systems operate 24 hours a day, 7 days a week. So will the 24/7 WC Clinical Consultation program, so that injured employees can access quality care fast. • Convenient. The MagnaCare/Sedgwick Provider Networks include thousands of medical providers and many hospitals serving the locations where our employees work and live. • High-quality. High-Quality. Healthcare providers are subject to a credentialing process and monitoring by the MagnaCare/Sedgwick Provider Networks which maintains the quality of their networks. • Easy. Nurses and other staff that support the MagnaCare/Sedgwick Provider Networks will help you navigate the healthcare system – for instance, finding and getting appointments with specialists and coordinating care across multiple medical providers. 1 Sedgwick will also be handling Workers’ Compensation claims administration for the agencies covered by this handbook starting on May 19, 2025. Here is an overview of how the new MagnaCare/Sedgwick Provider network requirement and the 24/7 WC Clinical Consultation program will work: Who is this program for? All employees of the agencies covered by this handbook. | What’s the best way to find a provider? | If you are injured on duty, call the 24/7 WC Clinical Consultation program at 888-602-1116 to immediately speak to a nurse about your injury. | | --- | --- | | When does this program start? | The requirement will apply for all injuries that occur on or after May 19, 2025. The Clinical Consultant program also starts then. | | What if I want to use an out-ofnetwork provider? | Use of the MagnaCare/Sedgwick Provider Networks for initial, nonemergency treatment following a work-related injury is mandatory for the 30 days following that in-network treatment. After that, employees may opt out of the MagnaCare/Sedgwick Provider Networks. For opt-out instructions, see section 2 below.
If you obtain treatment with a provider outside of the
MagnaCare/Sedgwick Provider Networks prior to your r

FAQs

Who is covered by this handbook’s provider network requirement?

All employees of the agencies covered by this handbook must use the specified provider networks for initial, non-emergency treatment after an injury or illness on or after May 19, 2025.

Which provider network must employees use for initial treatment?

In New York, employees must seek initial treatment in the MagnaCare New York Workers’ Compensation Certified PPO network; in NJ/CT/PA, employees must use the Sedgwick Workers’ Compensation Preferred Provider Network.

What if an employee wants to use an out-of-network provider?

Use of the MagnaCare/Sedgwick networks is mandatory for the 30 days following in-network treatment for initial, non-emergency care. After that period, employees may opt out, and treatment outside the networks before the opt-out right may not be covered.

Sep 17, 2026

Upload by Đào