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2014 Insurance

2014 Health Insurance

The Office of Group Benefits offers a number of health plan options to state employees and retirees including an HMO, PPO,  Consumer Drive Health Plan-HSA and Medical Home (Vantage). Only LSU System employees and retirees are eligible for the LSU First (WebTPA/AETNA) health insurance plan.

Important Notice:
The Office of Group Benefits announced that there will be a 5% premium increase for all OGB health insurance plans effective July 1, 2014. Click here for the health insurance premiums. 
OGB Health Plans with the 5% increase
- PPO Administered by Blue Cross / Blue Shield of LA
- HMO Administered by Blue Cross / Blue Shield of LA
- CDHP with HSA Administered by Blue Cross / Blue Shield of LA
- Medical Home HMO Administered by Vantage Health Plan
Note:  The LSU First health insurance plan did not experience a mid-year increase.

2014 Health Insurance Information
Click here to view the 2014 Health Insurance Summary for all Health Insurance Plans
Click here to view the 2014 Health Insurance Comparison (doesn't include LSU First)
Click here to view 2014 Health insurance Premiums 
Click here for Health Insurance Change form
Click here for Health Enrollment Form (GB-01)
Health Insurance plans are eligible to be deducted on a pre-tax basis via the "premiums only plan." Click here to enroll.

HEALTH INSURANCE PLANS

A. LSU First (WebTPA/AETNA): LSU System Health Plan
1.855.346.LSU1 (5781)
URL:  www.lsufirst.org 
Member Access:  lsufirst.webtpa.com


Important documents for the LSU First plan:
CLICK HERE for the LSU First Benefit Snapshot
CLICK HERE for the LSU First 2014 Benefit Plan Highlights
The LSU First Summary Plan Description will be posted soon.

Changes to the LSU First Plan Benefits effective 01/01/2014
Vendor Change: The LSU First plan issued a RFP and CIGNA was not selected as the administrator for the 2014 plan year.  The new claims administrator for the 2014 plan year is WebTPA Employer Services, LLC.  WebTPA uses the AETNA Signature Administrators national network. Plan members will need to search for in-network providers (doctors, hospitals, labs, physical therapists, radiologists, etc.). The LSU First plan has many opportunities for plan member to visit in-network providers. Verity Healthnet currently handles the First Choice Provider network for the LSU First health plan and will continue to do so. In addition, Verity administers a "wrap" network for the LSU First plan. A wrap network offers an additional listing of in-network providers for plan members. Express Scripts will continue to serve as the Pharmacy Benefits Manager for the plan.

Search for in-network providers:
A. First Choice Providers
http://www.verityhealth.com/lsufirstchoice.asp
When plan member visit providers who are in the First Choice network, claims are first paid from the HRA account and then are paid by the plan at 100%.

B. AETNA Signature Administrators (National Network) - Majority of the providers are in this network!

www.aetna.com/asa
When plan members visit providers who are in network with AETNA Signature Administrators, claims are first paid from the HRA account, then the employee is responsible for the remaining deductible. After the remaining deductible is satisfied, then the plan pays 90% of in-network charges and the plan member is responsible for 10% of in-network charges.

C. Verity Healthnet ("Wrap" Network)
http://www.verityhealth.com/ProviderSearch.asp
When plan members visit providers who are in network with Verity Healthnet Network, claims are first paid from the HRA account, then the employee is responsible for the remaining deductible. After the remaining deductible is satisfied, then the plan pays 90% of in-network charges and the plan member is responsible for 10% of in-network charges.

Increased out-of-pocket maximum
: The out-of-pocket maximum, applicable to medical expenses, will increase beginning January 1, 2014. 
The out-of-pocket maximums for in-network providers are as follows:
Employee only: Increasing by $500 to $2,000
Employee / Spouse:  Increasing by $750 to $3,000
Employee / Children:  Increasing by $750 to $3,000
Family:  Increasing by $1,000 to $4,000
Note:  These numbers represent the in-network out-of-pocket maxim. The out-of-network out-of-pocket maximum is also increaing. 
There is no cap on brand name medication co-pays. The co-pays are NOT applied to the out-of-pocket maximum.

The $25,000 Term Life Insurance Policy will be DISCONTINUED.
  There is not a portability option. 

IMPORTANT PHARMACY INFORMATION FOR LSU FIRST PLAN MEMBERS
Pharmacy management programs:
 
1) Express Scripts requires annual notification from plan members who have "Maintenance Medications" filled at a Retail Pharmacy. Express Scripts is the company who manages prescription drug benefits for the LSU First health insurance plan. This is a reminder to plan members who take "maintenance medications" (medications taking more than 2x a year) and have these scripts filled at a retail pharmacy. CLICK HERE for the Express Scripts Maintenance Medication List. Plan members need to notify Express Scripts Plan members should call 1-888-772-5188 or visit www.expressscripts.com.

Options:
- Mail Order (90-day fill)
- Continue with retail pharmacy (30-day fill)

Express Scripts will allow plan members to have prescriptions filled at a retail pharmacy during the month of January and February (without notification). If a plan member has not yet notified Express Scripts of their decision and they go to the pharmacy on March 1st or after, the insurance will not cover the prescription until they have been notified.
Note: This annual notification is not required for plan members who currently receive prescriptions drugs via mail order.

2) Drug Quantity Management: Aligns dispensed quantity of prescription with FDA approved dosage guidelines. Will eliminate wasteful spending - ensures most cost effective product strength is dispensed. For example: if a member receives two monthly prescriptions for a low dose of one medication, they could receive one monthly prescription at a higher dose for just as effective treatment. CLICK HERE for the Express Scripts Drug Quantity Management List

3) Step Therapy with Grandfathering: Requires members to try generic medications at $0 cost before pricey brand name drugs on NEW prescriptions. Grandfathering allows members currently receiving brand name medications to continue without having to try generics. CLICK HERE for the Express Scripts Step Therapy with Grandfathering List. 

4) Supplemental Prior Authorization: If a member's prescribed medication is on the Supplemental Prior Authorization list, the member's physician will be contacted to discuss alternate treatment options or provide authorization to dispense medication as written. Please note that very few members will be impacted by this. CLICK HERE for the Express Scripts Supplemental Prior Authorization List

Reminder: Payment of Brand Name Medications: After the HRA account is exhausted and the remaining deductible has been satisfied, plan members will have to pay a co-pay for brand name drugs. 1) LSU Pays (HRA Account), 2) You Pay (Deductible), 3) $40 co-pay for brand name drugs or $120 co-pay for specialty medications. There is no cap on brand name medication co-pays and the co-pays are NOT applied to the out-of-pocket maximum.

Example: If a plan member selects mail order brand name maintenance medications - they should consider this scenario! If a person has met their deductible and they take three brand-name maintenance medications, they will pay $40 co-pay x 3 = $120 in co-pays for one month, so they will have to pay $360 at one-time for the 90-day mail order supply! Plan members should talk to their physician about the possibility of generic drugs. This is a cheaper alternative and is paid by the plan at 100% after the HRA is exhausted.

How the LSU First Plan works 
LSU First (AETNA) Option 1 (Higher premium, lower deductible)
Option 1, Employee only level of coverage: First claims are paid from your $1,000 Health Reimbursement Account (HRA ). After the HRA is exhausted, generic drugs and first choice providers are paid at 100%. The plan member pays the "remaining reductible" of $500 for in-network medical claims and brand name drugs. After the $500 remaining deductible is satisfied, plan members pay 90/10 co-insurance for in-network medical claims, $40 co-pay for brand name prescription drugs (30-day fill) or $120 co-pay for specialty drugs (30-day fill).

Option 1, Employee / Spouse or Employee / Children level of coverage
: First claims are paid from your $1,500 Health Reimbursement Account (HRA). After the HRA is exhausted, generic drugs and first choice providers are paid at 100%. Plan members pay the "remaining reductible" of $750 for in-network medical claims and brand name drugs. After the $750 remaining deductible is satisfied, plan members pay 90/10 co-insurance for in-network medical claims, $40 co-pay for brand name prescription drugs (30-day fill) or $120 co-pay for specialty drugs (30-day fill).
Note: Employee / spouse or employee / children "share" the HRA account and "share" the remaining deductible.

Option 1, Family level of coverage
: First claims are paid from your $2,000 Health Reimbursement Account (HRA ). After the HRA is exhausted, generic drugs and first choice providers are paid at 100%. Plan members pay the "remaining reductible" of $1,000 for in-network medical claims and brand name drugs. After the $1,000 remaining deductible is satisfied, plan members pay 90/10 co-insurance for in-network medical claims, $40 co-pay for brand name prescription drugs (30-day fill) or $120 co-pay for specialty drugs (30-day fill). Note: Covered plan members "share" the HRA account and "share" the remaining deductible.

LSU First (AETNA) Option 2 (lower premium, higher deductible)
Plan members may consider this plan as an alternative for a lower premium. The HRA amounts are the same in Option 2. This option may be a good possibility for members who have HRA rollover dollars from the prior plan year as these dollars are used to cover the higher deductible. 

B. PPO (Preferred Provider Organization) administered by Blue Cross / Blue Shield of LA:
1-800-392-4089
http://www.bcbsla.com/ogb

This plan is available for active employees and retirees. Active employees have a $500 deductible per person, maximum of 3 per family. Retirees have a $300 deductible, maximum of 3 per family. After the deductible is satisfied, plan members pay 10% co-insurance for in-network charges. Pharmacy Benefits (in-network) are as follows: Plan member pays 50%, maximum $50 per 31-day fill, After $1200 per person per plan year, brand name drug co-pay is $15, generic co-pay is $0.

Changes to the PPO Plan
Pharmacy Benefit Manager Change: MedImpact will be the new Pharmacy Benefit Manager for the 2014 plan year. Plan members will receive a new card around January 1, 2014.
Health Management Program: Free health management for active plan members (including rehired retirees without Medicare) and covered dependents diagnosed with one or more of these 5 ongoing health conditions: 1) Diabetes, 2) Heart Disease, 3) Heart Failure, 4) Asthma, 5) Chronic Obstructive Pulmonary Disease (COPD). Reduced co-payments to eligible participants for prescription drugs used to treat these 5 chronic conditions. Active participation with a health coach is required to receive the reduced pay prescription drugs. Plan members should call 1.800.363.9159 for additional information.  Retirees and/or dependents who have Medicare Parts A&B are no longer eligible for the program.

CLICK HERE for the Office of Group Benefits Annual Enrollment Newsletter
CLICK HERE for the Blue Cross / Blue Shield Enrollment Guide
CLICK HERE for the OGB Comparison of Health Insurance Plans (doesn't include LSU First)
CLICK HERE to search for In-network providers

C. HMO (Health Maintenance Organization) currently Blue Cross/Blue Shield of Louisiana
1-800-392-4089
http://www.bcbsla.com/ogb

Visit http://www.bcbsla.com/ogb to access the Blue Cross/Blue Shield website for a list of in-network providers along with details of the (HMO) Blue Cross/Blue Shield plan. Plan member pay a $15 co-pay for a primary care physician and $25 for a specialist. No referral is required. Hospitalization co-pays are $100 per day, max $300 per admit, precertification is required. Plan members should view the BC/BS of LA website for additional applicable co-pays (MRI's, CT Scans, Emergency Room, etc.). There is no deductible for in-network claims. Out-of-network claims are subject to a $1000 deductible Pharmacy Benefits (in-network) are as follows: Plan member pays 50%, maximum $50 per 31-day fill, After $1200 per person per plan year, brand name drug co-pay is $15, generic co-pay is $0.

Changes to the HMO Plan:
Pharmacy Benefit Manager Change: MedImpact will be the new Pharmacy Benefits Manager for the 2014 plan year. Plan members will receive a new card by January 1, 2014.
Health Management Program: Free health management for active plan members (including rehired retirees without Medicare) and covered dependents diagnosed with one or more of these 5 ongoing health conditions: 1) Diabetes, 2) Heart Disease, 3) Heart Failure, 4) Asthma, 5) Chronic Obstructive Pulmonary Disease (COPD). Reduced co-payments to eligible participants for prescription drugs used to treat these 5 chronic conditions. Active participation with a health coach is required to receive the reduced pay prescription drugs. Plan members should call 1.800.363.9159 for additional information. Retirees and/or dependents who have Medicare Parts A&B are no longer eligible for the program.

CLICK HERE for the Office of Group Benefits Annual Enrollment Newsletter
CLICK HERE for the Blue Cross / Blue Shield Enrollment Guide
CLICK HERE for the OGB Comparison of Health Insurance Plans (doesn't include LSU First)
CLICK HERE to search for In-network providers

D. Consumer Driven Health Plan (CDHP) with an optional Health Savings Account administered by Blue Cross / Blue Shield of LA:
1-800-392-4089
http://www.bcbsla.com/ogb

Please note that this plan is not available for retirees. The Office of Group Benefits will continue to offer a CDHP plan with an optional HSA administered by BC/BS of LA. The premiums will be lower than the other state health insurance plans; however, this plan's deductible will be higher. Once the plan member has satisfied the deductible, the plan will pay 80% of in-network eligible expenses. The Health Savings Account (HSA) option allows employees to make pre-tax contributions to a savings account. A list of in-network providers and the details of the CDHP plan will soon be posted on the Office of Group Benefits website under "health plans." Enrollment forms will be posted upon receipt.

The deductibles are as follows:
Employee Only.........................$1,250
Two Person...............................$2,500
Family.....................................$3,000

Features of the Health Savings Account:
Money sheltered into the HSA can be used to offset the deductible as well as for other out pocket medical expenses. Upon enrollment into the plan, the state will contribute $100 per plan year to each member's HSA and match up to $400 in additional member contributions per plan year. The account will be managed by Bancorp Bank. The account will be portable. Employees may increase, decrease or cease contributions throughout the plan year. Unlike a health care flexible spending account with a use-it-or-lose-it provision, the HSA does not require the employee to spend all annual contributions. Instead, the money remains in the HSA and grows tax free from year to year. If the employee changes health plans or jobs, or retires, the employee still owns the entire balance of the HSA. From age 65 on, these HSA dollars can be used for any health care or non-healthcare expense with no penalty.

HSA Contribution limits for calendar year 2013
•Single: $3250
•Family: $6450

Employees who participate in the HSA option will not be able to participate in the Flexible Spending Account Program for the January 1, 2014 - December 31, 2014 plan year. Employees must have exhausted their Healthcare Spending Account as of December 31, 2013 to be eligible for the HSA account and enroll for January 1, 2014.

E. Medical Home Health Maintenance Organization (HMO)
Please visit http://employees.vhp-stategroup.com to access the Vantage Health Plan website or call 1-888-823-1910.
This plan is available for active employees and retirees. The plan requires participating plan members to designate a primary care physician in East Carroll, Franklin, Jackson, Lincoln, Madison, Morehouse, Ouachita, Richland, Union or West Carroll parishes only.

Retiree Medicare Advantage plans will be changing. Retirees should refer to the publications that will be mailed to their home address from the Office of Group Benefits.

ADDITIONAL HEALTH INSURANCE INFORMATION
1. Coverage for Dependent Children up to age 26
Effective July 1, 2011, all health and supplemental benefit plans are extending the age limit for dependent coverage to children up to age 26, regardless of student, marital, employment or tax status. Employees can enroll eligible children between October 1, 2013 -October 31, 2013 for coverage effective January 1, 2014. Employees will no longer be required to submit student verification for covered dependents over the age of 21, however dependent verification documentation will still be required to verify the relationship of eligible dependent. If the dependent verification documentation is not submitted within the enrollment period, the dependent will not be added to your plan effective January 1, 2014. If you have already submitted the dependent verification documentation to Human Resources for the newly eligible dependent, additional documentation is not needed. Click on the link below for a list of acceptable documentation.

Please note: A covered child who is or becomes incapable of self-sustaining employment prior to age 26 may be eligible to continue coverage as an overage dependent if OGB receives medical documents to verifying the dependent's incapacity before they reach age 26. In addition, OGB has broadened the definition to include mental and physical incapacity.

CLICK HERE for the list of acceptable documentation for dependent verification
CLICK HERE for the enrollment form to add dependents to the health plan

2. Enrolling Employees/Dependents not currently covered under a Health Plan:

Employees can enroll in health coverage or add dependents at any time during the year as a "late applicant." For coverage to be effective on the first of a month, a GB-01 form must be received in HRM no later than the 14th of the previous month. If you wish to have coverage for January 1st, you do not have to submit the enrollment forms until December 1st - December 14th; however, if you want your premiums deducted on a pre-tax basis you will have to submit the Premiums only Plan form no later than 4:30 pm on October 31, 2013. 

3. Changing Your Health Plan
Employees wishing to make a change to their health plans effective January 1, 2014 may do so by completing a change form.