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FAQ's Health Insurance | FAQ's Life Insurance |
FAQ's Lay Retirement Plan
FAQ's Voluntary Benefits | Office of Benefits Resources and Forms
The Benefits Office provides administrative support regarding employee benefits to all eligible diocesan parish, school, institution, and agency employees. The Benefits Coordinator meets with all employees of the diocese periodically regarding benefits. The Benefits Coordinator provides information to all employees including a periodic Health Insurance Update Newsletter to inform employees of changes in benefits.
The Benefits Office process enrollments, terminations and status changes, and
assist employees with questions regarding claims, coverage and eligibility for the following:
Medical Insurance
Offered through a self-insured Preferred Provider Organization.
Life Insurance
Life Insurance offered through Symetra Life Insurance Company
Voluntary Dental Insurance
Offered through First Commonwealth Dental Insurance with Network and PPO options available. |
Karen Walsh
Coordinator of Benefits, email
Terri Crockett
Benefits Secretary, email |
Auto Insurance
Offered through a self-insured plan, and available to priest in the diocese.
Lay Retirement Plan
A defined benefit plan administered by a board appointed by the Bishop.
Vision Insurance Plan
Offered through Spectera
Employee Assistance Program
Offered through Perceptives
This information is only a summary of typical questions, and does not replace the binding plan documents.
Please call the Benefits Office at (219) 769-9292, extension 277, for information regarding premiums and/or co-payments.
What is the name of the health insurance plan?
The name of the plan is Anthem Blue Cross Blue Shield.
What type of health insurance plan is the Diocese of Gary Health Care Plan?
It is a self-insured PPO (Preferred Provider Organization) plan.
What is a self-insured health insurance plan?
Self-insured means that the Diocese of Gary assumes the financial risk for eligible member’s claims. We also purchase stop-loss coverage from an insurer, who agrees to bear the risk for those expenses exceeding a predetermined amount.
What does PPO health insurance plan mean?
It means that participants of this plan may seek care from any provider. However, the participants will be responsible for a far greater part of the cost of their services when they see providers that are not network of preferred providers.
What is the network of preferred providers for the health insurance plan?
The Diocese of Gary Health Care Plan uses the Anthem network.
How do I find out what providers are part of the Anthem network?
You may check the Internet at:
www.anthem.com
(click on Blue Access PPO)
Or call: 1-800-810-2583
It is your responsibility to be certain of the network status of any provider prior to scheduling an appointment for services.
Who is eligible for employee benefits, including health insurance, life insurance, vision insurance, dental insurance and the lay retirement plan?
You must be an active full-time employee, regularly scheduled to work 30 hours or more per week, and forty weeks a year.
May I waive my health insurance coverage?
The Diocese of Gary Health Care Plan is a contributory plan, and therefore you may waive your health insurance coverage. However, it is very important to note that eligibility for retiree medical coverage is based on the years of continuous coverage, not on years of service. Therefore, if you waive coverage you may be forfeiting your eligibility for retiree medical coverage.
Can I cover dependent children and/or my spouse on the health insurance plan?
Yes, you may cover dependents. However, you are responsible for the monthly premium for the dependents by payroll deduction. The term dependent usually means your spouse and/or children. Please see the plan document for a detailed explanation regarding dependent eligibility. Call the Benefits Office at (219) 769-9292, extension 277 for information on the premiums for dependent coverage.
What is a premium?
A premium is the monthly amount paid by a participant in the plan and/or the employer for coverage.
What is a deductible?
This is the amount that you are personally responsible to pay each calendar year before the plan begins to pay any benefits. There are different deductible amounts depending upon your choice of an in-network or out-of-network provider. Please check the current plan document for the most current deductibles, or call the Benefits Office at (219) 769-9292, extension 277. You should submit all claims, so that they may be applied to your deductible.
What is the total amount of deductibles I pay each calendar year, if I see both in-network and out-of-network providers?
Your maximum deductible for a calendar year is the amount of the out-of-network deductible. It is not a combination of both the in-network and out-of-network deductible.
What is the out-of-pocket limit?
The out-of- pocket limit is the maximum amount of co-payments you are responsible for in a calendar year. It does not include co-payments for prescriptions.
What is an Explanation of Benefits (EOB)?
This is a form the third party administrator (Anthem) sends to you explaining the payment of your claim. If you require help understanding the form, you should call the member services number on your I. D. card. An EOB is not a bill, or request for payment.
What is a Third Party Administrator?
A third party administrator is a company hired by a self-insured health plan to handle claims processing, paying providers, and other functions of the health insurance plan.
What is a co-payment?
This is the amount that you are responsible to pay for each claim, after you meet your deductible for the calendar year. For example, if you met your deductible, and you have an in-network claim for $100.00, the plan pays 90% of the claim minus any discounts, and you are responsible for the balance as your co-payment.
Until what age are my dependents eligible to remain on the health insurance plan?
Eligible dependents may remain on the Diocese of Gary Health Care Plan until the end of the year that they are 19 years old, or to the end of the calendar year during which the child attains age 24 if they qualify as a Federal tax exemption.
Can I add a dependent to the health insurance plan?
Yes, you may add an eligible dependent to the plan during open enrollment by completing a Change of Status Form and a Payroll Deduction Authorization Form. You are responsible for the premium for your dependent through a payroll deduction. Open enrollment material will be mailed to your home for changes effective April 1st each year.
Can I delete a dependent from the health insurance plan?
Yes, you may delete a dependent at any time by calling the Benefits Office for the proper form. Remember, you may only re-enroll the dependent during a subsequent open enrollment period.
What is open enrollment?
Effective April 1, 2004, there will be an annual Open Enrollment period every spring.
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For employees currently participating in the plan, Open Enrollment will be the only time when dependents not previously enrolled in the plan can be added (unless there is a documented status change such as marriage, birth, adoption, legal guardianship or loss of other coverage).
When should I add a newborn to the health insurance plan?
You must enroll newborns in the plan within 30 days from the date of birth. The Diocese of Gary plan will not cover services provided for the newborn unless there is a timely enrollment. If you wish to enroll the newborn, you should complete a Change of Status Form and a Payroll Deduction Authorization, which are available from your work location. You may add the newborn later, however coverage will start on the date you sign the enrollment form at midnight.
When does my health insurance coverage begin as a new enrollee?
Your coverage starts on the first date of your employment, as long as you properly complete your enrollment forms within 30 days from your start date. If you wait and complete the forms beyond the 30-day period, your coverage will not start until the date the forms are completed at midnight.
When does my health insurance coverage end?
Coverage ends on the last day of the month in which your employment terminates. For contracted teachers, your last day of coverage is August 31st.
Is COBRA coverage available to continue my health insurance benefits?
No, because church plans are not required to provide COBRA coverage. There is a conversion insurance plan available which guarantees you coverage regardless of health. This is not the same coverage as the Diocese of Gary Health Care Plan. If you are interested in the conversion insurance, please call the Benefits Coordinator at (219) 769-9292, extension 277.
May I continue my health insurance when I terminate my employment?
See the answer above.
How do I get a new I.D. card to replace my lost card?
Call the Benefits Office at (219) 769-9292, extension 277.
Is the procedure my doctor ordered covered by the health insurance plan?
If you are not sure if a particular procedure is covered, you or your doctor’s office should call Anthem Member Services at 1 800 324-6086 prior to scheduling the procedure.
Has my health insurance claim been paid, or was it paid correctly?
Call Anthem Member Services at 1 800 324-6086.
When do I need to call to pre-certify For a health insurance benefit?
You must pre-certify for all admissions by calling Anthem at 1 877 814-4803. You cannot call the Benefits Office at the Pastoral Center to pre-certify.
What address do I send a health insurance claim to?
Anthem Blue Cross Blue Shield
P.O. Box 37010
Louisville, KY 40233-7010
Am I eligible for health insurance when I am retired?
You must have a minimum of fifteen years of continuous health insurance coverage to continue on the health care plan at retirement. Please note that eligibility is not based on years of service, but rather on years of continuous health insurance coverage.
Are medical supplies including diabetic test strips covered by the health insurance plan?
Yes, through the Medco prescription plan by mail order or at retail.
Does my health insurance cover me while traveling out of the country?
Yes, however you may need to pay the bill and be reimbursed because many foreign providers do not accept a health insurance card. Please understand that translating bills and converting currencies takes a good deal of additional time as opposed to processing a domestic claim.
What is the co-payment for my prescriptions?
Please call the Benefits Office at (219) 769-9292, extension 277, for this information or consult the most current plan document.
How do I order maintenance prescriptions through the mail?
Complete the mail-order form that is available from the Benefits Office at (219) 769-9292, extension 277.
- Policy Number is 610014
- Group Number is DOFGARY
Members must use the mail order plan for maintenance medications.
Both the Diocese of Gary Health Care plan and my spouse’s plan cover my dependent. How do I know which plan pays first, and which plan pays second?
The Diocese of Gary follows the birthday rule. With a few exceptions for separated parents and joint custody decrees, the primary plan (pays first) is the plan with the parent whose birthday is earlier in the year.
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What is the amount of my lay employee life insurance coverage?
A term policy in the amount of $10,000, which reduces to $6,000 at age 70 for eligible lay employees.
Can I purchase coverage for family members?
No, life insurance coverage is available on the employee only.
How do I change a beneficiary on my life insurance policy?
Complete a new designation of beneficiary form, which should be available at your work location.
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What is the vesting schedule for the lay pension plan?
You become completely vested with 15 years of continuous service. You are partially vested after 10 years of continuous service.
What if I had a break in service?
If you had a break in service, you must work at least as long after the break as the length of the break, to bridge your service credit. For example, if you work for five years and then had a two year break in service, you would need to work at least two years to get service credit for the first five year period of employment.
How can I find the amount of my monthly pension benefit at retirement?
Your benefit amount is based on your lifetime wages. An estimate of your benefit amount is available by calling the Benefits Coordinator at (219) 769-9292, extension 277.
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When can I enroll in voluntary dental or vision insurance benefits?
The open enrollment period is in late spring for coverage changes effective July 1st. The Benefits Office mails open enrollment materials to all eligible employees for which they have been notified.
Can I drop my voluntary dental or vision coverage at any time?
No, you must continue on the plan for one full year from July 1st until June 30th.
What is the monthly cost of voluntary vision and dental benefits?
Please call the Benefits Office at (219) 769-9292, extension 277 for premium amounts because they are subject to annual increases.
If you have other questions, please contract the Benefits Coordinator
at (219) 769-9292, extension 277.
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