The Lake County Indiana, NECA – I.B.E.W. Health and Benefit Plan is a self-insured insurance plan designed to reduce the out-of-pocket expenses incurred whenever its participants need catastrophic or day-to-day medical care.
The Plan is administered by a Board of Trustees made up of Union and Employer representatives whose powers and duties are defined in the Agreement and Declaration of Trust. These members serve without any compensation and act on behalf of you and your fellow employees in managing the Fund’s operations. The current list of Trustees is:
Alec J. Davis
Felipe H. Hernandez
Richard C. Anderson Jr.
Thomas R. Corsiglia
Edward J. Shikany
William J. Walton
Participating Physicians / In-Network Physicians. As a participant of the Plan, you are free to seek medical care from the provider of your choice. Meaning: you have the option to utilize a participating provider or a non-participating provider at any time you need care. However, if you choose to access the services of a in-network provider or participating physicians, the Fund will pay ninety percent (90%) of the negotiated fee for covered services that exceed your annual deductible.
Additionally, through the Plan’s affiliation with Grand Rounds, active participants can receive free assistance:
- Finding trusted and experienced doctors within the Plan’s network.
- Obtaining a remote second opinion from a leading- expert specializing in your area of need. Perfect for whenever you are unsure about a diagnosis, or you’ve been recommended surgery as a form of treatment. And,
- Quick answers to medical questions. Grand Rounds can provide you with over-the-phone guidance and support from their team of physicians.
Further, active participants have access to Teladoc. Teladoc can provide you and any eligible dependent with free 24/7 telephone, video and web access consultation to a board-certified physician for common and minor ailments.
Designated Hospitals and Facilities.The Plan maintains a narrow network of participating hospitals and facilities. Meaning, the number of participating hospitals and facilities that have agreed to accept the Plans reasonable and allowable payment schedule is very limited. As such, designated hospitals and facilities will not balance-bill you for amounts in excess of the Plan’s reference-based price for any covered service.
There are two levels of participating hospitals and facilities.
In-network Level A Designated Hospital Facilities
Franciscan St. Anthony Health - Crown Point, IN
Franciscan St. Anthony Health - Michigan City, IN
Franciscan Healthcare - Munster, IN
Franciscan St. Margaret Health - Dyer, IN
Franciscan St. Margaret Health - Hammond, IN
Level A designated facilities accept the Plan’s payment as payment in full for any covered facility related expense that you may incur. Additionally, the Plan will not apply the participants annual deductible obligation toward covered facility related expenses. What does this mean? You save money by utilizing level A designated hospital facilities.
The level A payment methodology only applies to covered expenses charged by the group of hospitals listed above. Claims from physicians, surgeons and other medical professionals rendered within level A facilities will still be subject to the Plans deductible and in and out-of-network payment provisions. Meaning: Providers bill separately and hospitals bill separately. Further, most physicians, surgeons and other medical professionals, such as, but not limited to, radiologists, anesthesiologist, pathologists and emergency room physicians work in a hospital, but not for the hospital. Therefore, even if you pay $0 for the hospital charges, you may still be responsible for any co-insurance and/or deductible charges associated with services rendered to you by independent physicians, surgeons, groups or medical entities working within or used by the Level A hospital. Charges from those entities will be paid in accordance to their network affiliation with this Plan, or lack thereof.
In-network Level B Designated Hospital Facilities
Upon meeting your annual deductible, a Level B designated facility will accept 90% of the Plan’s payment as payment in full for any covered facility related expense that you or an eligible dependent may incur. Participating Level B facilities are as follows:
Community Hospital - Munster, IN
Community Stroke and Rehabilitation Center – Crown Point IN
Methodist Hospital - Gary, IN
Methodist Hospital - Merrillville, IN
Pinnacle Hospital - Crown Point, IN
Portage Hospital - Portage, IN
Porter Regional Hospital - Valparaiso, IN
St. Mary Medical Center - Hobart, IN
St. Catherine’s Hospital - East Chicago, IN
University of Chicago - Chicago, IN
The Plan’s level B payment methodology only applies toward covered services incurred within one of the facilities listed directly above. Further, and for the reason that most physicians, surgeons and other medical professionals, such as, but not limited to, radiologists, anesthesiologists, pathologists, and emergency room physicians, work in a hospital, but not for the hospital, you may still be responsible for any co-insurance and/or deductible charges associated with services rendered by these independent medical professionals or entities. The Plan will pay claims from these entities in accordance to their network affiliation with this Plan, or lack thereof. Accordingly, annual deductibles, co-insurance and maximum out-of-pocket limits will apply to these types of claims.