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Benefits

Health Insurance

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

ANNOUNCEMENT
Effective August 1, 2013, state employees and retirees on the PPO, HMO and Consumer Driven HSA plans will pay 1.77% less in monthly health insurance premiums through the Office of Group Benefits. In some cases, LSU First (CIGNA) plan members will pay 1.77% less.
The LSU First (CIGNA) health plan is requreied to have health insurance premiums be the same or below the premiums for the PPO plan. In instances where the LSU First (CIGNA) premiums were already lower than the revised PPO premiums, the LSU First rates remain unchanged. In cases where the LSU First premiums were the same as the PPO plan, they were lowered by 1.77%. Click here to access the health insurance premiums effective August 1, 2013.

2013 Health Insurance Information
Click here to view the 2013 Health Insurance Comparison
Click here to view health insurance premiums for the 2013 plan year.
Click here to view health insurance premiums for the 2012 plan year effective 08/01/2012.
Click here for Health Insurance Change form
Click here for Health Enrollment Form (GB-01) 
Click here for Portability Form (this form is not required for dependents younger than age 19)
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 (CIGNA): LSU System Health Plan 
    1-866-929-5781
    www.lsufirst.org or www.mycigna.com

LSU First will continue to have CIGNA administer the health plan.  Express Scripts will also continue to serve as the Pharmacy Benefit Manager for the plan.  Visit www.lsufirst.org to access the list of in-network providers and First Choice Providers along with details of the plan design for the LSU First Health Plan.  

How the LSU First Plan works beginning 01/01/2013
LSU First (CIGNA) 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 (CIGNA) 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.    

Changes to the LSU First Plan Benefits effective 01/01/2013
Increased out-of-pocket maximum: The out-of-pocket maximum is the amount of money a plan member is responsible for after satisfying the dedutible. After plan members satisfy their deductible, they pay 10% co-insurance (in-network charges) until the following underlined dollar amounts have been met.
Out-of-Pocket maximum will be increasing by:
- $500 for Employee only to $1500
- $750 for Employee / Spouse to $2250
- $750 for Employee / Children to $2250
- $1000 for Family to $3000
These numbers represent the in-network out-of-pocket maxim.  The out-of-network OOP is also increaing. 
Plan members who take maintenance medication ARE REQUIRED TO NOTIFY EXPRESS SCRIPTS if they plan to use a retail pharmacy (30-day fill) rather than mail order (90-day fill)Plan members should call 1-866-929-5781 or visit www.expressscripts.com. After a short grace period, these medications will not be paid by the plan at the pharmacy and the member will be responsible for 100% of the cost until Express Scripts has been notifed of their selection.
Click here to see a list of maintenance medications.
Payment of Brand Name Medications: There is no more 90/10 co-insurance after the deductible is met. 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. 
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. 
Pharmacy management programs: 1) supplemental prior authorization, 2) drug quantity management, 3) step therapy with grandfathering and 4) specialty step therapy.
Walgreens: has re-joined the Express Scripts network effective 09/15/2012.

Other important documents for the LSU First plan:
CLICK HERE for the List of Changes to the LSU First Plan for the 2013 year
CLICK HERE for the Express Scripts Maintenance Medication List (requires mandatory mail order)
CLICK HERE for the Express Scripts Drug Quantity Management List
CLICK HERE for the Express Scripts Step Therapy List
CLICK HERE for the Express Scripts Supplemental Prior Authorization List
CLICK HERE for the LSU First (CIGNA) Summary Plan Description for the 2013 plan year 
CLICK HERE  for the LSU First (CIGNA) $25,000 term life insurance beneficiary designation form.
CLICK HERE to view the 2013 Annual Enrollment Presentation.

B. PPO (Preferred Provider Organization) administered by Blue Cross / Blue Shield of LA effective 01/01/2013
:
    1-800-392-4089
    http://www.bcbsla.com/ogb

This plan is available for active employees and retirees.  The website will be updated with a link to the list of in-network providers (upon receipt) along with details of the PPO plan. 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. Brand-name drug with FDA-approved generic available: Plan member pays cost difference between brand-name drug & generic, plus 50% of brand-name drug cost. Cost does not apply to $1200. Mail order (93-day fill) is available.

Changes to the PPO Plan
Nationwide Network: BC/BS of LA has a nationwide network, unlike the Office of Group Benefits (statewide network).
Provider network change: Plan members should call doctors offices and facilities to see if their provider is in-network with Blue Cross / Blue Shield of LA.
Pharmacy Benefit Manager Name Change:  Catalyst Rx, now called Catamaran, will administer the Pharmacy Benefits.
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.  Retirees and/or dependents who have Medicare Parts A&B are no longer eligible for the program.

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 Name Change: Catalyst Rx, now called Catamaran, will administer the Pharmacy Benefits.
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. Retirees and/or dependents who have Medicare Parts A&B are no longer eligible for the program.

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 now administered by BC/BS of LA effective January 1, 2013.  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, 2013 - December 31, 2013 plan year. Employees must have exhausted their Healthcare Spending Account as of December 31, 2012 to be eligible for the HSA account and enroll for January 1, 2013.  Additional details regarding the CDHP plan and the coordination of the HSA option will be discussed at the annual enrollment meetings.

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.
edical Home HMO Plan Document

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.

Click here for the 2012 LSU Sysetm Benefits booklet.The 2013 version will be released soon!

ADDITIONAL HEALTH INSURANCE INFORMATION
1. Additional Changes to All Health Plans Mandated by the "Federal Accordable Care Act" (Health Care Reform) Effective July 1, 2011
There will be no pre-existing condition (PEC) exclusion for individuals up to age 19. If you add a child to your health plan under age 19, you will no longer have to provide proof of prior coverage.  There is an elimination of individual lifetime maximum ($5 million).  Preventive care (Wellness) paid at 100% if provided by a network provider; current wellness dollar limits no longer apply.  Mental health and substance abuse treatment benefits enhanced and limits are removed to comply with federal Mental Health Parity Act.

2. 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, 2012 -October 31, 2012 for coverage effective January 1, 2013.  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, 2013.  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

3. 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 and IPL 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 Wednesday, October 31, 2012.

Applicants will have 12-month pre-existing condition exclusion unless proof of prior coverage is provided which can reduce or eliminate the exclusion period. Please remember there will be no pre-existing condition (PEC) exclusion for individuals up to age 19 effective July 1, 2011.  

4. Changing Your Health Plan
Employees wishing to make a change to their health plans effective January 1, 2013 may do so by completing a change form.