Frequently Asked Questions

Healthcare

Specifically, the name of your insurance provider is the Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan.

Regardless of any medical network affiliation, the Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan directly provides you and any eligible dependent the benefits contained within the Plan’s Summary Plan Description book. It is the Lake County Indiana, NECA – I.B.E.W, Health and Benefit Plan that assumes the responsibility for paying claims in accordance to the terms, conditions and provisions set forth within that document.

In order to enroll, please complete and sign an enrollment form. The enrollment form for your plan can be found under the "Forms” tab under the Health & Benefit Plan web page. Return the completed enrollment form along with a copy of your birth certificate and a copy of your Social Security card to the Benefit Fund Office.

Generally, for new employees who have a letter of credible coverage on file at the Plan office, coverage will begin on the first day of the month following the month in which 160 hours of employer contributions are received on your behalf within a six-month period.

If a new employee does not have a letter of credible coverage, then coverage will begin on the first day of the month following the month in which 420 hours of employer contributions are received on your behalf within a six-month period.

Refer to the section of the Health and Benefit Plan Summary Plan Description Book or contact the Health and Benefit Office for exact details.

Journeypersons or employees are required to have 420 hours contributed on their behalf during a calendar quarter or make a self-payment equivalent to the monthly cost of the hourly employer contribution requirement.

Apprentices and Indiana Plan participants need 326 hours contributed on their behalf during a calendar quarter or make a self-payment equivalent to the monthly cost of the hourly employer contribution requirement.

If you’re a journey person and your coverage has terminated, it will again be reinstated on the first day of the first month following the month in which 420 hours of employer contributions are received on your behalf within a six-consecutive month period.

Reinstatement coverage will be for the remainder of the calendar quarter in which you became eligible and the successive calendar quarter.

The same parameters will apply for Apprentices and Indiana Plan participant’s, non-bargaining employees and Owners and Owners in Fact, except the number of required hours needed to be contributed by a signatory employer is 324, 324, 160 and 500 respectively

Congratulations! Yes, you can add your spouse to this Plan.

Recently married participants will need to complete a new enrollment form and return it to the Benefit Fund Office along with a copy of your marriage certificate and your spouse’s birth certificate and Social Security Card. Provided the enrollment of your spouse occurs within thirty (30) days from the date of your marriage, your spouse will be automatically eligible for coverage effective as of the date of your marriage.

If you fail to timely submit a properly completed enrollment form and the proper supporting documentation as determined by the Plan, your spouse will be enrolled in the Plan on the first day after the Health and Benefit Plan receives and deems complete the enrollment form and all proper supporting documentation. Any bills incurred prior to the Plans enrollment of your spouse prior to that date will remain the sole responsibility of the participant.

It is recommended that when a participant enrolls a spouse, they also take a moment to review their beneficiary elections on file with the various Benefit Plans as well as the Local 697 Union office and if needed, update accordingly.

Yes, however, you will need to complete a new enrollment form and return it to the Benefit Office along with a copy of the child’s birth certificate and Social Security card within ninety (90) days of your child’s birth.

Parents of new-born children will be provided a ninety-day (90) grace period from the date of the child’s birth to both enroll their child into the Plan and submit the proper and required documentation. If you fail to properly enroll your newborn within that time period, any claims incurred prior and after that time will remain the responsibility of the participant.

It is recommended that with each new addition to your family, you take a moment to review their beneficiary elections on file with the various Benefit Plans and Local 697 Union office and if needed, update accordingly.

Children are covered until the last day of the month in which they turn age 26. Children do not have to be students, unmarried, financially dependent or living with their parents in order to be covered.

Coverage will either terminate on the last day of the month of the calendar quarter in which you have earned coverage or on the last day of the month of the month in which you have made a monthly self-payment. After your coverage terminates, the Plan will send you a COBRA election package.

Generally, the cause of the shortage is either one or two things.

  1. The employer does not adhere to the common practice of closing out the calendar quarter on the last Sunday of the month. Instead, work performed for part of the last week of the calendar quarter and the first part of the first week of the subsequent quarter, are contributed by the employer at the end of the new quarter. Or,
  2. You worked outside the jurisdiction of the I.B.E.W. Local 697. If you did, then the employer’s contributions for the hours you worked were sent to the Local in the jurisdiction you worked and pursuant to your ERTS instructions, they have yet to be forwarded back to the Lake County Indiana NECA – I.B.E.W. Health and Benefit Plan. .

Unfortunately, and for the reasons that it neither has any control over the Fringe Benefit payment practices of an employer, nor any control over the reciprocity issuance practices of another Local, there is nothing the Health and Benefit Plan Office can do.

Simply put, the Fund Office cannot credit monies it has not received nor back date contributions because the employer does not adhere to the common methodology of closing the calendar quarter on the last Sunday of the month.

Additionally, Local 697 is signatory to the National Reciprocity Agreement. It is this document that dictates when a I.B.E.W. Local’s Benefit Office is required to remit hours back to the Local pursuant to that participant’s ERTS election. While the Local 697 Benefit Office exceeds those reciprocity remittance requirements, other Locals are more “relaxed” in their adherence to those regulations.

Further, please be advised that unless you informed the Fund Office that you are working in another Local’s jurisdiction, the Fund Office does not know if it is to expect reciprocated contributions.

In both cases you will need to check in with the employer to see when they made their Fringe Benefit contributions. If you worked in another I.B.E.W Local’s jurisdiction you will also have to call that Local’s Benefit Fund Office and instruct them to forward those contributions to the Local 697 Benefit Office.

If you do not make the required self or COBRA payment, or make that payment by the mandated due date, coverage for you and any eligible dependent will terminate. If terminated, the following will occur:

  1. Eligibility for dental, health, HRA, life-insurance, pharmaceutical and vision benefits cease for you and any eligible dependents.
  2. Your HRA (Create) debit card is frozen and you will have sixty days to manually submit claims for reimbursement that were incurred within the twelve months prior to the termination from the Plan.
  3. Regardless of subsequent reinstatement, after sixty-days any balance within your HRA account will be forfeited.

Grand Rounds is a tremendous resource. Specifically, Grand Rounds provides medical guidance. They direct you to a higher level of care, provide second opinions, research and/or supply you with additional information to help you make the right health decision for you and your family.

  • Want to find the highest qualified provider and as such, the “best of the best” within any specialty within the Plans network, or available to you under the terms of this Plan? Of course, you do. Contact Grand Rounds.
  • Do you have concerns about a proposed procedure and want to make sure that the suggested course of action is correct or even necessary? Call Grand Rounds.
  • Are you confused about your treatment options? Call Grand Rounds to discuss diagnoses, symptoms, and treatment plan options.

Grand Rounds is available to only the active and non-Medicare participants of the Plan.

There is NO CHARGE to you for this service. The Health and Benefit Plan will pay the full cost for eligible Health and Benefit Plan participants.

There are three ways in which you can sign up or register with Grand Rounds, they are:

Mobile

  • Search “Grand Rounds: in the Apple App Store or Google Play Store.
  • Download the Grand Rounds app.
  • Enter your e-mail and password, then input your personal information to create your account.

Desktop

  • Log on at grandrounds.com/ibew697
  • Enter your e-mail and password, then input your personal information to create your account.

Phone

  • Call Grand Rounds at 1-800-929-0926 to speak with a care coordinator and set up your account.

Participants who misplaced their medical identification card, can order another one at www.mycreate.com or can either call the Fund Office (219-940-6181) or MagnaCare (855-295-1160) directly and they will order one for you.

On October 1, 2018, balances within a journeypersons or employee’s hour bank were combined with whatever balance existed within their MRP account to create the HRA.

Please reference the section of the Summary Plan Description book titled “Health Reimbursement Arrangement (HRA) for information concerning how you can utilize HRA monies to pay for any shortage of hours you may have incurred.

The following medical services require prior-authorization or pre-certification.

  • Alcohol dependency
  • Bariatric/gastric bypass
  • Cardiac rehabilitation
  • Cat Scans
  • Chemical dependency
  • Chemotherapy
  • Corrective surgery
  • Dental work performed in a hospital setting
  • Durable medical equipment in amounts greater than $1,000.00.
  • Epidural injections/nerve blockers
  • Genetic testing
  • Home health care
  • Hospice
  • Inpatient care
  • Inpatient rehabilitation
  • Inpatient surgery
  • Mental Health benefits
  • MRI’s
  • Neuropsychological testing
  • Occupational therapy
  • Orthotics greater than $1,000.00.
  • Orthotripsy
  • Outpatient surgery
  • PET Scans
  • Pharmacogenetics
  • Physical therapy treatments greater than 17
  • Private Duty Nursing
  • Prosthetics
  • Pulmonary Rehabilitation
  • Physical therapy
  • Radiation therapy
  • Reconstructive surgery
  • Sclerotherapy
  • Skilled nursing benefits
  • Specialty Drugs (Must be pre-certified by the Plan’s PBM which is SavRx)
  • Speech therapy
  • Substance abuse
  • Surgeries of any type
  • Synagis Injections
  • Transplants
  • Trigger point injections
  • Vein therapy

With the exception of specialty drugs, the Plan will not make payment toward services that require pre-certification but did not receive authorization.

Regarding specialty drugs, should either the treating physician, treating facility or covered participant refuse to allow the pharmaceutical to be secured through the Plan’s PBM or the Plan’s specialty drug PBM, then the Plan will pay for that drug or drugs that were administered only up to the amounts that it would have paid if it purchased the drug itself and only to the limits as outlined within the Health and Benefit Plan’s Summary Plan Description book.

Self-payments are always due no later than the close of business on the first business day of the month.

Eligible journeypersons, apprentices, employees and Indiana Plan employees can receive a gross weekly income of up to fifty percent (50%) of their weekly salary (excluding any overtime) up to a maximum of $550.00 per week.

Teladoc is the name of the Health and Benefit Plans telemedicine provider. Teladoc provides you and any eligible dependent with 24/7 telephone, video and web access consultation to a board-certified physician for common and minor ailments such as allergies, sinus infections, ear infections, flu, colds etc.

Covered active and retiree participants are permitted to receive Teladoc benefits.

There are three ways to access Teladoc:

Phone

Call 1-800-Teladoc [1-800-835-2362] to talk to a doctor at any time.

Mobile

Visit Teladoc.com/mobile or visit your app store to download their app. Then follow the instructions directly below:

  1. Create an account. After downloading the app, you’ll provide medical history to give doctors the information they need to provide you with quality medical care. You can also add family members to give them around the clock care.
  2. Speak with the first available Teladoc doctor or schedule an appointment. Within minutes, a doctor will call ready to listen, diagnose and prescribe, if medically necessary, medication. After you consult, you can choose to share the results with your primary care physician.
  3. Pick up your prescription. If medically necessary a prescription can be sent to your local pharmacy. Search for nearby pharmacies or use one of your favorites. Teladoc is the convenient and affordable way to get the care you need now.

Online

Simply visit Teladoc.com, click “Set up account” and then follow the instructions directly below:

  1. Step 1 – “The Basics”: Provide a little information about yourself to confirm your eligibility.
  2. Step 2 – “Do you have a username?”: Select “yes” or “no”. Not everyone has a username to activate their Teladoc account, so don’t worry about selecting “No.”
  3. Step 3 – “How do you have Teladoc?”: Teladoc is an exclusive service that is not available to everyone. Because you are covered under the Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan you will select the option titled “My employer or insurance provider offers me access to Teladoc.
  4. Step 4 – “Who is your insurance provider?”: Really? You’re not seriously asking for this information, are you? That’s truly heartbreaking!

If only there was some easy way that you could find that out? Perhaps, someone could build some sort of electronic portal in which such information could be contained and easily accessed? Or, maybe someone could write a document, nay…., a summary document in which the name of said insurance provider is listed no less than thirty times. And, maybe that document could be placed within that electronic portal? Wait a second……what if a phone number existed or better yet…. wait for it……. What if a toll-free-phone number existed in which someone could call for assistance with this question? And wouldn’t it be terrific if someone anticipated such a question and took the extra time to include said information within this very FAQ section?

“If only” statements can be kind of sad, don’t you think?

On the other hand, doesn’t the very nature of an “if only” statement demand them to be “truth-functional”? If so, then this suggests that such statements can be factual. Which also means that they don’t have to be so sad after all.

But we digress. Go read your SPD.

There is NO CHARGE to you for this service. The Health and Benefit Plan will pay the full cost for eligible Health and Benefit Plan participants.