Your retirement. Your healthcare. A little less paperwork.
You've worked hard to reach retirement. Understanding your healthcare benefits shouldn't feel like another full-time job.
The Lake County Indiana NECA–IBEW Health and Benefit Plan is committed to helping eligible retirees and their dependents navigate Medicare coverage with confidence, clarity, and the support they deserve.
And while Medicare has developed a remarkable talent for making relatively simple ideas sound complicated, we're going to do our best to make things easier.
First Things First: Eligibility Matters
If you meet the Fund's retiree eligibility requirements and become eligible for Medicare, you may qualify for coverage through the Fund's group Medicare Advantage program.
The important words here are "eligibility requirements."
Turning 65 does not, by itself, establish eligibility for the Fund's retiree healthcare benefits. You must also satisfy the applicable requirements of the Health and Benefit Plan.
Before making decisions about your coverage, please review the retiree eligibility provisions in your Summary Plan Description (SPD).
A few minutes of reading today can prevent a great deal of confusion tomorrow. And that's a pretty good return on your investment.
What Exactly Is Medicare Advantage?
If you're already familiar with Medicare Advantage, wonderful. Feel free to move ahead.
If not, here's the simple explanation.
Original Medicare generally provides two principal types of coverage:
- Part A:Hospital insurance.
- Part B:Medical insurance, including physician services and other covered medical care.
Medicare Advantage, sometimes called Part C, is another way to receive your Medicare benefits.
These plans are approved by Medicare but administered by private insurance companies. They provide your Medicare Part A and Part B benefits and may also include prescription drug coverage and additional services not ordinarily available through Original Medicare.
Think of it as bringing several important pieces of your healthcare coverage together under one coordinated program.
The Fund's group Medicare Advantage program is provided through Anthem, with retiree assistance coordinated by RetireeFirst.
Can I Continue Seeing My Own Doctors?
That's an excellent question. And one worth asking before you need an appointment.
The Fund's group Medicare Advantage program is structured as a Preferred Provider Organization (PPO), giving you flexibility in choosing healthcare professionals.
You may receive covered services from participating providers and, subject to the program's requirements, eligible nonparticipating providers.
However, not every provider who accepts Original Medicare necessarily agrees to treat patients under every Medicare Advantage arrangement. We encourage you to confirm your provider's participation or willingness to accept the program before receiving services.
The goal is simple: preserve access to quality care while helping you avoid unpleasant surprises.
Because surprises are wonderful for birthdays. Medical bills? Not so much.
And What About Filing Claims?
Here's some welcome news.
In most circumstances, your healthcare provider submits claims directly to the Medicare Advantage insurer.
That means less paperwork for you, fewer forms to navigate, and more time for the things you actually retired to enjoy.
The insurer processes covered claims according to the terms of the Medicare Advantage program, including any applicable member cost-sharing provisions.
Of course, if a claim or billing question arises, assistance is available.
Your Medicare Advantage Benefits
The Fund's group Medicare Advantage program includes medical and prescription drug coverage, along with additional benefits described in the current Medicare Advantage Plan Guide.
Depending on the specific service and applicable program provisions, benefits may include:
- Hospital and physician services.
- Prescription drug coverage.
- Preventive healthcare services.
- Routine vision and hearing benefits.
- Hearing aid allowances.
- Fitness and wellness programs.
For exact coverage provisions, limitations, exclusions, and other important details, please consult your current Medicare Advantage Plan Guide and related materials.
The guide explains the benefits. Our goal is to help you understand how to use them.
A Real Person. A Real Answer. Real Help.
Meet RetireeFirst
Even the best healthcare program can occasionally leave you with questions.
Perhaps a prescription isn't being filled as expected. A physician's office is uncertain about your coverage. Or a bill arrives that looks as though it was calculated by someone with a particularly imaginative approach to arithmetic.
That's where RetireeFirst comes in.
RetireeFirst helps retirees navigate their Medicare Advantage benefits and resolve questions that might otherwise require several telephone calls, a considerable amount of patience, and possibly a second cup of coffee.
Their assistance may include:
- Questions about physicians and healthcare providers.
- Prescription drug coverage and pharmacy concerns.
- Prior authorization questions.
- Replacement identification cards.
- Mail-order prescription assistance.
- Billing and claims questions.
- Coverage questions while traveling.
- Updating personal information.
- Help understanding available benefits.
You don't have to figure everything out on your own.
When questions arise, we encourage you to contact RetireeFirst using the telephone number provided in your current enrollment materials.
Sometimes the most valuable benefit isn't another page in the handbook. It's having someone who can help you find the answer.
Additional Benefits Provided by the Fund
Your Medicare Advantage coverage is only part of the picture.
The Health and Benefit Plan also provides certain additional benefits to eligible retirees and dependents, subject to the Fund's governing documents.
Dental Benefits
Eligible retirees and their dependents have access to dental benefits under the Fund's retiree dental provisions.
The current retiree dental program provides a $1,500 annual family allowance, subject to applicable coverage provisions. Preventive and diagnostic services are covered at 100%, while other covered dental services are generally subject to 20% member coinsurance.
The dental program is being administered exactly as it was prior to you becoming a Medicare eligible participant of the Plan, so no need to explain how that all works here. But if you have any doubts, please review the current Summary Plan Description and applicable amendments for complete details or call the Fund office.
Vision Benefits
Eligible retirees and dependents also have access to vision exams under the current Medicare Advantage Plan. However, and similar to the aforementioned dental benefit, Medicare eligible participants still maintain a vision benefit. And it works like it always has with one exception, retired participants may elect eligible safety glasses in place of regular frames once every 24 months, subject to the Plan's requirements.
For complete coverage details, please consult the current Summary Plan Description.
Benefits That Do Not Continue Under Medicare-Eligible Retiree Coverage
Some benefits available to active participants are not included in the Fund's Medicare-eligible retiree coverage.
These include:
- Short-term disability benefits.
- The Fund's fitness membership stipend for active participants.
- The Funds telemedicine benefit through Included Health.
This does not necessarily mean that comparable services are unavailable through your Medicare Advantage program. For example, your Medicare Advantage coverage may include its own fitness, wellness, or telehealth benefits.
The distinction matters: a benefit offered through the Medicare Advantage program is not necessarily the same benefit previously offered through the Fund's active participant program.
Your current Medicare Advantage Plan Guide explains which services are included.
Three Important Responsibilities. Please Don't Skip These.
We recognize that no one visits a retirement benefits website hoping to discover more rules.
Nevertheless, these three deserve your attention because they may affect your continued eligibility for healthcare coverage.
1. Maintain Your Eligibility
Retiree healthcare coverage depends upon satisfying the Fund's eligibility requirements.
If your eligibility ends, you may not have the right to re-enroll later.
Before making any decision that could affect your coverage, please contact the Fund Office and review the applicable Plan provisions.
2. Enroll in Medicare Parts A and B When Required
Eligible retirees and dependents must have and maintain the Medicare enrollment required by the Fund.
Failure to enroll in Medicare Parts A and B when required may result in the loss of Fund-provided retiree healthcare coverage.
Please don't assume enrollment happens automatically in every circumstance.
Confirm your Medicare enrollment and effective dates before your coverage is scheduled to begin.
3. Tell Us When Other Insurance Coverage Changes
If you or an eligible dependent gains or loses other healthcare coverage, please notify the Fund Office promptly.
That includes coverage through another employer, a spouse's plan, or another insurance arrangement.
Why does this matter?
Because coordinating benefits correctly helps ensure that claims are processed by the appropriate plan, in the appropriate order, and for the appropriate amount.
Failure to provide required information may have serious consequences for your eligibility and benefits under the Plan.
A simple notification today can prevent a complicated problem tomorrow.
We're Here to Help You Enjoy Retirement, Not Study for It.
Healthcare coverage matters. So does understanding it.
But your retirement should be about much more than insurance cards, benefit schedules, and the occasional mysterious explanation of benefits.
Our commitment is to make information accessible, expectations clear, and assistance available when you need it.
Take a moment to familiarize yourself with your benefits. Keep your important documents somewhere convenient. And when something doesn't make sense, ask.
You earned your retirement. We're here to help you make the most of it.
All benefits are subject to the terms, conditions, eligibility requirements, limitations, and exclusions of the applicable governing Plan documents and insurance contracts. This website is intended to provide general information and does not amend, replace, or supersede those documents. In the event of any inconsistency, the applicable governing documents control.
