The name of the plan is Anthem Blue Cross Blue Shield.

It is a self-insured PPO (Preferred Provider Organization) 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.

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.

The Diocese of Gary Health Care Plan uses the Anthem Access Blue PPO network.

You may check online 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.

Your coverage starts on the first date of your employment as long as you properly complete your ADP online enrollment within 31 days from your start date.

Yes, you may cover dependents. The term dependent typically means your spouse and/or children. Please see the plan document for a detailed explanation regarding dependent eligibility. You are responsible for the monthly premium for the dependents by payroll deduction.

Eligible dependent children may remain on the Diocese of Gary Health Care Plan until they reach twenty six years old.

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.

Yes, you may add an eligible dependent to the plan during open enrollment by making enrollment changes online through ADP.  If there is a status change (i.e. loss of other coverage, marriage, birth/adoption), you may add coverage for you and your dependents within 31 days of the status change.   You are responsible for the premium for your dependent through a payroll deduction.

You may delete you and/or a dependent during the annual open enrollment period or a qualifying life event. Remember, you may only re-enroll during a subsequent open enrollment period or qualifying life event.

The Diocese of Gary Health Care Plan is a contributory plan, and therefore you may waive your health insurance coverage. You must still complete the online ADP enrollment, but can select "Waive" for any of the plan options. 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.

A premium is the monthly amount paid for coverage by a participant in the plan and the employer.

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. You should submit all claims, so that they may be applied to your deductible.

Your maximum deductible for a calendar year is the same amount as the out-of-network deductible. It is not a combination of both the in-network and out-of-network deductible.

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.

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.

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. You may also access your EOB’s through Anthem’s web site at www.anthem.com.   An EOB is not a bill, or request for payment.

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.

Call Anthem Member Services at 1-800-324-6086 or access Anthem’s website at www.anthem.com.

You may request a replacement card as well as print a temporary card online at www.anthem.com or contact Anthem Member Services at 1-800-324-6086.

You must pre-certify for all admissions by calling Anthem at 1-877-814-4803.   The Benefits Office cannot pre-certify any procedure or hospital admission.

You must pre-certify for all admissions by calling Anthem at 1-877-814-4803.   The Benefits Office cannot pre-certify any procedure or hospital admission.

• Open Enrollment permits those who previously declined coverage under the Plan to elect coverage - effective July 1.
• For employees currently participating in the plan, Open Enrollment is also a time when dependents not previously enrolled in the plan can be added.

Anthem Blue Cross Blue Shield
P.O. Box 105187
Atlanta, GA 30348

Yes, you or the out of country medical provider can call Anthem’s Travel Coverage department at 1-800-810-2583.   As many foreign providers do not accept a health insurance card, you may need to pay the bill and submit a claim for reimbursement. Please understand that translating bills and converting currencies takes additional time as opposed to processing a domestic claim. 

Coverage ends on the last day of the month in which your employment terminates. For contracted teachers, your last day of coverage is detailed in your contract.

No, because not-for-profit religious organizations (such as church plans) are not required to provide COBRA coverage.

Below are the various situations in which you may or may not continue with the Diocese of Gary health insurance benefit.
Please note that eligibility is not based on years of service but rather on years of continuous health insurance coverage.

• If you are age 65 or older and have 25 years or more of continuous coverage prior to January 1, 2006, retiree medical coverage is available and the premium is paid by your employer.
• If you are age 65 or older and have at least 15 years of continuous coverage, retiree medical coverage is available and the premium is paid by you.
• If you are younger than 65 years old and have 25 years or more of continuous coverage prior to January 1, 2006, retiree medical coverage is available with the premium paid by you – the employee – at the active employee premium rate until you reach age 65 and are covered by Medicare.   At that time, your employer will pay the premium.
• If you are younger than age 65 years old and have at least 15 years of continuous coverage, medical coverage is available, and the premium is paid by you.
• At any age with less than 15 years of continuous health insurance coverage, there is no coverage available.

See the above answer.