Employment Packet - Folder #3 - Medical Insurance

Kristen Manes  |  3/30/2017 6:45:00 PM

ELIGIBILITY:

Appointments greater or equal to 121 days and 75% effort or greater

IMPORTANT INFORMATION:

  • You will need to present a Social Security Card for each individual enrolling in the health insurance plan. If no Social Security number has been issued, the Individual Tax Identification Number will need to be presented.
  • If you are choosing to add your spouse, children, or any other qualified dependents to the plan, you must also provide DEPENDENT VERIFICATION for each along with the enrollment form.
  • You have 30 days from your date of hire to make a health insurance election. If you do not sign up for health insurance during this time, you will not be eligible to sign up until you experience a family qualifying event (here’s a comprehensive list of Qualified Life Events) or you make an election to participate during Annual Enrollment (generally, each October - for a January 1 effective date). Additionally, no one may be added to or deleted from the plan unless you experience a family qualifying event and initiate the addition or deletion within 30 days of that event.
  • You have 30 days from your date of hire to elect to participate in the state life insurance. If you do not sign up for the life insurance during this time, you may apply at any time. However, you must be approved after submitting Evidence of Insurability before coverage can begin.

PLEASE COMPLETE THE ELECTION IN WORKDAY



For active employees, health plans are offered through the state of Louisiana and through LSU.

The state offers the following plans:
Magnolia Open Access
Magnolia Local Plus
Magnolia Local
Pelican HRA 1000
Pelican HSA 775
Vantage Home HMO

LSU offers the following plans:
LSU First, Option 1
LSU First, Option 2

Insurance-eligible LSU Agcenter employees may choose from all plans listed.

The LSU First Plan

The LSU First Health Plan is a fully-funded self-insured plan. Utilizing WebTPA as the Claims Administrator, Aetna ASA as the nationwide network of providers and the Medical Manager, Citizens Rx as the Pharmacy Benefit Manager, and Verity HealthNet for local and First Choice Provider network administration.

  • Plan members control which doctors they see.
  • In most cases, no co-payments or deductibles are due on site.
  • Plan members receive a Health Reimbursement Account (HRA) - these funds are used to cover allowable services. HRA balances roll over from one plan year to the next.
  • The First Choice Provider Network provides 100% coverage once HRA funds have been exhausted.
    • 100% coverage for generic medications once HRA funds are exhausted.
    • Plan members have their pick of three networks within LSU First: Aetna ASA (national network), the Verity Health Net (statewide network and surrounding areas), and the First Choice Provider Network (statewide).
  • A current listing of network providers for the LSU First plan is accessible at any time on the LSU First website.
  • If you are a Member and would like to speak with an experienced MEMBER ADVOCATE regarding your Plan, call 1-855-346-5781.

Two options available - Option 1 and Option 2. The difference between Option 1 and Option 2 is the member responsibility is higher under option 2. The monthly premium is lower as a result of the higher out-of-pocket responsibility of the member under Option 2. Option 2 may be a good choice if you have rollover HRA dollars from a previous Plan Year or if you know you will have minimal healthcare costs during the Plan Year.

Citizens Rx

Citizens Rx will continue managing the pharmacy portion of the plan. Home delivery and specialty medications will continue through Praxis Rx. There will be no changes to the prescription drug co-pays. Members will be responsible for paying a $40 co-pay for a 30-day supply of Brand Name drugs and a $150 co-pay a 30 day supply of Specialty drugs. These co-pay amounts do count towards the out of pocket maximum.
*Please note that generic drugs are covered at 100% throughout the plan.

If you do not have your LSU First member card with the Citizens Rx information, please provide the following information to the pharmacy to fill prescriptions until you receive a new card:

Rx Bin: 015284

Rx PCN: CRX

Rx Group: LSYA

LSU First Plan Benefits

  • Members will not incur any out-of-pocket expenses for covered services from First Choice Providers and/or generic prescription drugs.
  • Health Reimbursement Account (HRA) and deductible amounts will remain the same.
  • The co-payment for brand and specialty drugs will remain the same.
  • First Choice Providers and generic drugs will still be covered at 100%.
  • Your Aetna ASA nationwide network will remain the same.
  • Split Fill Program for specialty drugs.

Online Employee Assistance Program

LSU First Health Plan offers members the Employee Assistance Program (EAP) Resource via the www.mylifevalues.com website. Click here for more information and how to access the site.

Need a replacement ID card?

To print a temporary LSU First health insurance card go to www.lsu.edu/lsufirst, click on “My Accounts,” then click on “Access WebTPA for health plan information.” You’ll be directed to a new webpage where you will select “Register Now” on the lower right side of the page. Complete the required section with the member information to create an account. Then click on print/view temporary card. *It is also good to verify that the address shown on the online account is correct, including apartment/complex numbers. If the address or any other information is incorrect, please contact our office for assistance. You may also call LSU HRM at 225-578-8200 and we can request a card on your behalf.

Need to file a claim?

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the LSU First. LSU First/WebTPA will then reimburse you according to the plan's guidelines.

Authorization for Release of Protected Health Information: HIPAA Form - Authorizing the use and disclosure of protected health information to an individual other than member.

Anyone with questions is encouraged to call an HR Generalist for immediate assistance at 225-578-8200 or email lsufirst@lsu.edu. You may also contact WebTPA customer service at 1-855-346-5781.


Customer Service: 1.800.392.4089
Forms and Resources


Magnolia Local & Local Plus Plan (HMO)

Administered by Blue Cross Blue Shield

Upcoming Clinics for 2018 premium discount can be found here.

Magnolia Local

The Magnolia Local plan is a limited provider in-network only plan for members who live in specific coverage areas. Out-of-network coverage is provided in emergencies only and may be subject to balance billing.

  • Community BlueCommunity Blue is a select, local network designed for members who live in the parishes of East Baton Rouge, West Baton Rouge, Ascension, Caddo and Bossier.
  • BlueConnectBlueConnectis a select, local network designed for members who live in the parishes of Jefferson, Orleans and St. Tammany.

*You must stay in your network when receiving care. Your residence determines which Magnolia Local network you are in.

magnolia local

Magnolia Local Plus

The Magnolia Local Plus option offers the benefit of nationwide in-network providers. The Local Plus plan provides the predictability of co-payments rather than using employer funding to offset out-of-pocket costs.

This plan provides care in the Blue Cross and Blue Shield nationwide network. Out-of-network coverage is provided in emergencies only and may be subject to balance billing.

magnolia local plus

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the appropriate carrier. You may submit a claim form (see side bar) along with a copy of the invoice to your health insurance carrier. BCBS will then reimburse you according to the plan's guidelines.


Customer Service: 1.800.392.4089
Forms and Resources


Magnolia Open Access Plan (PPO)

Administered by Blue Cross Blue Shield

Upcoming Clinics for 2018 premium discount can be found here.

The Magnolia Open Access Plan offers coverage both inside and outside of Blue Cross’s nationwide network. It differs from the other Magnolia plans in that members enrolled in the open access plan will not pay co-payments at physician visits. Instead, once a member’s deductible for allowable charges is met, he or she will pay 10% of the allowable amount for in-network care and 30% of the allowable amount for out-of-network care. Out-of-network care may be balance billed.

Though the premiums for the open access plan are higher than OGB’s other plans, its moderate deductibles combined with a nationwide network make it an attractive plan for members who live out of state or travel regularly.

magnolia open access

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the appropriate carrier. You may submit a claim form (see side bar) along with a copy of the invoice to your health insurance carrier. BCBS will then reimburse you according to the plan's guidelines.


Customer Service: 1.800.392.4089
Forms and Resources


Pelican HRA 1000

Administered by Blue Cross Blue Shield

The Blue Cross Blue Shield Customer Service number is 1-800-392-4089.

The Pelican HRA1000 includes $1,000 in annual employer contributions for employee-only plans and $2,000 for family plans in a health reimbursement arrangement that can be used to offset deductibles and other out-of-pocket medical, not pharmacy, costs throughout the year.


The HRA funds are available as long as you remain employed by an OGB-participating employer. Any unused funds roll up to the in-network, out-of-pocket maximum (see following chart), allowing members to build up balances that cover eligible medical expenses.

pelican hsa 1000

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the appropriate carrier. You may submit a claim form (see below) along with a copy of the invoice to your health insurance carrier. BCBS will then reimburse you according to the plan's guidelines.

- See more at: http://www.lsu.edu/hrm/employees/benefits/health_i...

Customer Service: 1.800.392.4089
Forms and Resources


Pelican HSA 775

Administered by Blue Cross Blue Shield

The Pelican HSA775 offers our lowest premium in addition to a health savings account funded by both employers and employees. Employers contribute $200, then match any employee contributions up to $575. Employees can contribute additional funds on a pre-tax basis, up to $3,350 for an individual and $6,750 for a family, to cover out-of-pocket medical and pharmacy costs.

Unused funds are rolled over every year with no limit. Unlike the HRA option, the money in an HSA follows the member even if he or she changes jobs or retires.

pelican hsa 775

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the appropriate carrier. You may submit a claim form (see below) along with a copy of the invoice to your health insurance carrier. BCBS will then reimburse you according to the plan's guidelines.


Customer Service: 1.888.823.1910
Forms and Resources


Medical Home HMO

Administered by Vantage

Vantage Medical Home HMO is a patient-centered approach to providing cost-effective and comprehensive primary health care for children, youth and adults. This plan creates partnerships between the individual patient and his or her personal physician and, when appropriate, the patient’s family. This plan includes a preferred provider network, Affinity Health Network (AHN), which has lower co-payments for certain covered services as indicated by “AHN.” This plan also includes Out-of-Network coverage.

vantage

At times you may have to pay out of pocket for medical services or for prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to the appropriate carrier. You may submit a claim form (see below) along with a copy of the invoice to your health insurance carrier. Vantage will then reimburse you according to the plan's guidelines.

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