Transcript 14.78MB 10/17/2016 5:05:45 PM

2017
ANNUAL
ENROLLMENT
ANNUAL ENROLLMENT
Important Dates
LSU First and Voluntary Benefits
 October 1 st – October 31 st
Office of Group Benefits
 October 1 st – November 15 th
 LSU First will not be open after October 31 st
Effective date of coverage
 January 1 st, 2017
 All LSU First materials are posted to the
www.lsuagcenter.com/annualenrollment and www.LSUFirst.org
websites.
LSU FIRST MEDICARE RETIREE PLAN
Group Medicare Advantage Plan
 No Deductible
 Better access to care
 Any provider who accepts Medicare will be paid at 100%
 Additional Benefits
 Care Coordination, SilverSneakers, NurseLine
Medicare-Primary Retirees and
Spouses/Dependents Only
 All participants must have Parts A and B
 Premium - $89.26/per individual (fully vested)
LSU FIRST MEDICARE RETIREE PLAN
Anyone currently in LSU First that is eligible, will
automatically move over. No action is required.
If Retirees do not wish to be enrolled, they can select an
OGB plan during Annual Enrollment.
Timeline
 September 19 th – Announcement Letter from LSU
 September 26 th – Pre-Enrollment Plan Guide from UHC
 October – Annual Enrollment
 Mid-December – Welcome Kit and ID Cards mailed
2017 LSU First Medicare
Retiree Benefit Plan
H2001_160928_114810
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Welcome
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1
Highlights
2
Medicare Basics
3
Plan Benefits
4
How to Enroll
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Highlights
LSU First has chosen to work with UnitedHealthcare® to provide Medicareeligible retirees with the LSU First Medicare Retiree Plan for your health
and prescription drug coverage.
• This plan is designed to better meet the needs of retirees and to
coordinate more effectively with Medicare coverage.
• Retirees and their Medicare-eligible dependents will be automatically
enrolled into the new LSU First Medicare Retiree plan administered by
UnitedHealthcare effective January 1, 2017. No action is required for
current LSU First Medicare-eligible retirees.
• Any retirees who do not wish to participate in the LSU First Medicare
Retire Plan can switch to an OGB plan during Annual Enrollment.
• Retirees and all their covered dependents must have both Medicare A
and B, in order to be enrolled in this new plan. They will remain enrolled
in LSU First unless they elect to move to an OGB plan during Annual
Enrollment.
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Original Medicare Basics
When Are You Eligible for Medicare?
 You’re eligible for Original Medicare (Parts A and B) if:
You’re 65 years old, or you’re under 65 and qualify on the
basis of disability or other special situation.
 AND
You’re a U.S. citizen or a legal resident who has lived in the
United States for at least five consecutive years.
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Plan Benefits
LSU First Medicare Retiree
Group Medicare Advantage (PPO) Plan
Your Medicare Advantage Plan
The advantages of a single plan.
Medicare Advantage (Part C) plans are provided through private insurers, like
UnitedHealthcare. They include Part A and Part B coverage and often Part D — all
in one plan. Medicare Advantage plans also generally offer additional benefits
beyond doctor and hospital visits.
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All the benefits of Part A
• Hospital stays
• Skilled nursing
• Home health
All the benefits of Part B
• Doctor’s visits
• Outpatient care
• Screenings and shots
• Lab tests
Prescription drug coverage
• Included in many Medicare
Advantage plans
Additional benefits, programs
and features
• May be bundled with the plan
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Your Plan Overview (National PPO)
Getting the health care coverage you may need.
Coverage for visiting doctors, clinics and hospitals in one plan
Prescription drug coverage
Vision, hearing and chiropractic coverage
No referral needed to see a specialist
You can see doctors outside the network for the same cost share as innetwork providers as long as the provider accepts Medicare and the plan
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Your Doctors (National PPO)
Large network of doctors, specialists and hospitals.
There’s a chance your doctor is already part of our network. To find out,
consult our online Provider Directory at www.uhcretiree.com/lsufirst
If your doctor is in the network, he or she must accept this plan if you are a
current patient. If your doctor is not in our network, he or she may choose
not to treat you unless it is an emergency.
If you need help finding a doctor, we're here to help. Just call us.
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UnitedHealthcare® Group Medicare
Advantage (PPO) Plan
You Pay
Monthly plan premium
$357.05
LSU pays
$267.79*
Retiree Pays (individual)
$89.26*
Annual Deductible
$0
*Assumes full vesting
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UnitedHealthcare® Group Medicare
Advantage (PPO) Plan
Network Plan
UHC Advantage
Non-Network
Medicare Providers
Primary care provider
(PCP) office visit
$0
$0
Specialist office visit
$0
$0
Urgently needed care
$0
$0
Inpatient hospitalization
$0
$0
Outpatient surgery
$0
$0
Benefit Coverage
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UnitedHealthcare® Group Medicare
Advantage (PPO) Plan
Preventive Services
Benefit Coverage
Network Plan
UHC Advantage
Non-Network
Medicare Providers
Annual physical
$0
$0
Annual Wellness Visit
$0
$0
Immunizations
$0
$0
Breast Cancer screening
$0
$0
Colon Cancer screening
$0
$0
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UnitedHealthcare® Group Medicare
Advantage (PPO) Plan
Benefit Coverage
Medicare-covered
podiatry (Plus 6
Network Plan
UHC Advantage
Non-Network
Medicare Providers
$0
$0
$0
$0
$0
$0
$0
$0
$0
$0
Routine podiatry visits)
Medicare-covered
chiropractic care
Medicare-covered
vision services (plus 1
routine vision exam every
12 mo)
Medicare-covered
hearing services
(plus $4,800 hearing
aid allowance every
36 mo.)
Emergency room
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“True Emergency”
coverage
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Annual Wellness Visit
 Take charge of your health
Schedule your annual physical, annual wellness visit and other
preventive care. Both your annual physical and wellness visit are
covered by your health plan for a $0 co -pay. 1,2
Make the most of your annual care:
Save time by combining your wellness visit and physical into a
single office visit
Schedule your appointment as soon as you can to get any
preventive care you may need
Make sure you follow through with your provider’s
recommendations for screenings, exams and other care
You can get your annual wellness visit any time during the calendar
year no matter when you had your last visit.
1A
co-pay or co-insurance may apply if you receive additional services that are not part
of the annual physical.
2Covered at a $0 co-pay when you see a network doctor (if your plan has a network).
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Fitness Program
Get active and have fun with SilverSneakers ® Fitness 1
 Designed for all fitness levels and abilities, SilverSneakers ®
includes access to exercise equipment, classes and more than
13,000 participating locations. SilverSneakers ® signature classes,
offered at select locations, are led by certified instructors trained
specifically in adult fitness and include a range of options from using
light hand weights to more intense circuit training.
 At-home kits are offered for members who want to start working out
at home or for those who can’t get to a fitness location due to injury,
illness or being homebound.
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UnitedHealthcare’s Virtual Doctor Visits
 See a doctor using your computer, tablet or mobile
phone
UnitedHealthcare’s Virtual Doctor Visits lets you choose to see and
speak to specific doctors using your computer or a mobile device,
like a tablet or smartphone. These doctors are special providers
that have the ability to offer virtual medical visits.
During a virtual visit, you can ask questions, get a diagnosis and
the doctor can even prescribe medication 1 that, if appropriate, can
be sent to your pharmacy.
You can find a list of participating virtual medical doctors online
at www.uhcretiree.com/lsufirst .
Residents of Louisiana should use AmWell for virtual visits. They
are approved to prescribe medicines in Louisiana.
1Doctors
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can’t prescribe medications in all states.
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NurseLineSM
 You’re never alone.
Whether you have questions about a medication or have a health
concern in the middle of the night, with NurseLine SM a nurse answers
your call 24 hours a day.
Services include:
 Help choosing a doctor
 Tips on how to help control diabetes, blood pressure or high cholesterol
 Reviewing your medications and exploring how to save money on
prescriptions
 Connecting you with community resources
 Choosing appropriate medical care
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Solutions for Caregivers
 Extra support for those who take care of others
Get helpful advice and decision -making support from a
professional care manager.
Have a registered nurse perform an in-person health overview of
the person you are caring for.
Work together to create a custom plan that may address both
your needs and the needs of the person you are caring for.
Get help to find and arrange community -based programs and
services for your specific needs.
Access educational resources, discounted products and services
online.
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Your Prescription Drug Plan (PDP) Coverage
More than 67,000 network pharmacies nationwide — many national drugstore chains
and independent pharmacies are included.
Thousands of covered brand name and generic drugs.
Bonus drug coverage in addition to Medicare Part D drug coverage.
Check your plan's drug list or call Customer Service to see if your prescription drugs
are covered.
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Drug Payment Stages
Your plan does not include an annual deductible. Your coverage begins in the initial coverage stage.
(No Donut Hole)
In this drug payment stage:
Your plan sponsor is providing additional
coverage through the gap:
After your total out-of-pocket costs
reach $4,950:
You pay a co-pay
You continue to pay the same co-pay
as you did in the initial coverage stage
You pay a small co-pay amount
$8.25 for Brand
$3.30 for Generics
You stay in this stage until your
total drug costs reach $3,700
You stay in this stage until your total
out-of-pocket costs reach $4,950
You stay in this stage for the rest
of the plan year
Total drug costs: The amount you pay (or others pay on your behalf) and the plan pays for prescription drugs
starting January 2017. This does not include premiums.
Out-of-Pocket costs: The amount you pay (or others pay on your behalf) for prescription drugs starting January
2017. This does not include premiums, or the amount the group health plan, former employer, or plan sponsor pays
for prescription drugs.
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Your Prescription Drug (Part D) Benefits
Tier
Prescription
Drug Type
Your Costs
Retail (30-day supply)
Preferred Mail Order
(90-day supply)*
Tier 1
Generic and some
Brands
$0 co-pay
Tier 2
Preferred Brands
$40 co-pay
$120 co-pay
Tier 3
Non-Preferred
Brands
$40 co-pay
$120 co-pay
Tier 4
Specialty Drugs
$100 co-pay
$300 co-pay
$0 co-pay
*90-day supply may also be filled at many neighborhood pharmacies.
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Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
Diabetic Testing & Monitoring Supplies
Your plan will provide coverage for the following brands of
blood glucose testing strips and meters:
OneTouch® Ultra® 2
ACCU_CHEK Aviva
OneTouch® Verio™
ACCU_CHEK SmartView
OneTouch® UltraMini™
OneTouch® Verio® FlexTM
System Kit with OneTouch®
Verio® test strips
When you use one of these brands, your cost-share for diabetes testing and
monitoring supplies is $0 co-pay.
These supplies include the above brands of test strips and meters, and any brand
of lancets, lancing device, glucose control solution (to test the accuracy of your
meter), and replacement batteries for your meter.
You may be required to get a new prescription from your doctor. If you are using a
different brand than identified above, a temporary supply of your current brand
can be requested.
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More Ways You Can Save
1
2
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Review your medications. Review your prescription drugs with your doctor
at least once a year. Ask, “Do I still need them all? Can I stop taking the
ones I don’t need?”
Use your member ID card. Show your member ID card at the pharmacy to
get the plan’s discounted rates.
3
Use participating network pharmacies. You may get great benefit if you
use
in-network pharmacies.
4
Consider using OptumRx ® Home Delivery Pharmacy. You could save time
and trips to the pharmacy.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
LSU FIRST PREMIUMS
ACTIVE
LSU First Option 1
LSU First Option 2
EE Only
$167.62
$149.66
EE+Spouse
$484.64
$422.04
EE+Children
$241.26
$229.86
EE+Family
$580.18
$508.84
RETIRED ON MEDICARE: LSU First Option 3
EE Only
$89.26*
EE + Spouse
$178.52*
Complete list of premiums can be found at www.lsufirst.org
*Assumes full vesting
Enrollment
Enrolling for LSU First Medicare Retiree Plan
You will be automatically enrolled
LSU First Medicare Retiree and their Medicare eligible dependents will be
automatically enrolled in the plan and no action is needed
You can opt out
You will have the opportunity to opt out of this plan if you don’t want to be
enrolled.
You can opt-out by contacting AgCenter Human Resources Department during
the Annual Enrollment period (October 1, 2016 – October 31, 2016).
If you wish to continue to receive Medical and Prescription drug coverage
through LSU First Medicare Retiree Medicare Advantage Plan, you do not need to
take any action.
Prescriptions: current mail orders that have remaining refills will be
transferred to UHC OptumRX. It is recommended that you fill prescriptions
mid to late December if possible and then request a new prescription from
your physician as a backup.
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What to Expect after Enrollment
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1
You will receive your new member ID card and you can start using it as
soon as your plan is effective.
2
You will receive a welcome guide that gives you more information on how
your benefits work and how to get the most out of your plan.
3
After your effective date, register online at www.uhcretiree.com/lsufirst
4
Soon after you’re a member, we will contact you to help us understand
your unique health needs.
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
How to Use Your New Plan after December 31,
2016
 It’s easy!
Beginning January 1, 2017, Simply use your UnitedHealthcare ® member
ID card each time you go to the doctor or hospital or get a prescription
filled at the pharmacy
Don’t discard your red, white and blue Medicare card; keep it in a safe
place!
Store this card in a safe place in 2017
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Use this card beginning January 1, 2017
Proprietary information of UnitedHealth Group. Do not distribute or reproduce without express permission of UnitedHealth Group.
uhcretiree.com/lsufirst
After your coverage begins, register online at
uhcretiree.com/lsufirst to access plan information,
materials and programs.
Medical and Drug Claim Search
Health Needs Assessment
Plan Materials
Temporary or replacement member ID cards
Provider Search
Medical and Drug detail/history
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Understanding Original Medicare’s Rules
You must be entitled to Medicare Part A and enrolled in Medicare
Part B and continue to pay your Medicare Part B premium.
You can only be in one Medicare Advantage plan at a time. Enrolling
in another plan will automatically disenroll you from any other
Medicare Advantage or prescription drug plan.
If you do not enroll in a Medicare Part D prescription drug plan or a
Medicare Advantage plan that includes prescription drug coverage,
or you do not have other creditable prescription drug coverage, you
may have to pay Medicare’s Late Enrollment Penalty.
When you are a member, you must read the plan’s Evidence of
Coverage (EOC), including appeals and grievance rights which can
be found in the plan Annual Notice of Change.
• The EOC also covers specific plan benefits, co-pays, exclusions, limitations and
other terms.
Please review the full text of the Statement of Understanding in your 2017 enrollment kit.
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Thank You
We look forward to welcoming
you to our LSU First Medicare
Retiree family.
Additional Information
This document is available in alternative formats. If you receive full or partial subsidy for your premium from a plan
sponsor (former employer, union group or trust), the amount you owe may be different than what is listed in this
document. For information about the actual premium you will pay, please contact your plan sponsor’s benefit
administrator directly.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premium and/or co-payments/co-insurance may change on January 1
of each year.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when
necessary.
You must continue to pay your Medicare Part B premium, if not otherwise paid for under Medicaid or by another third
party.
Out-of-network/non-contracted providers are under no obligation to treat <Plan/Part D Sponsor> members, except in
emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your
provider to ask us for a pre-service organization determination before you receive the service. Please call our customer
service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to outof-network services.
Plans are insured through UnitedHealthcare Insurance Company or one of its affiliated companies. For Medicare
Advantage and Prescription Drug Plans: A Medicare Advantage organization with a Medicare contract and a Medicareapproved Part D sponsor. Enrollment in these plans depends on the plan’s contract renewal with Medicare.
SPRJ26560
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Additional Information
SilverSneakers 1Connsult a health care professional before beginning any exercise program. Availability of the
SilverSneakers program varies by plan/market. Refer to your Evidence of Coverage for more details. Healthways and
SilverSneakers are registered trademarks of Healthways, Inc. and/or its subsidiaries. © 2016 Healthways, Inc. All rights
reserved.
NurseLine This service should not be used for emergency or urgent care needs. In an emergency, call 911 or go to the
nearest emergency room. The information provided through this service is for informational purposes only. The nurses
cannot diagnose problems or recommend treatment and are not a substitute for your doctor's care. Your health
information is kept confidential in accordance with the law. The service is not an insurance program and may be
discontinued at any time.
Solutions for Caregivers 2Solutions for Caregivers assists in coordinating community and in-home resources. The
final decision about your care arrangements must be made by you. In addition, the quality of a particular provider must
be solely determined and monitored by you. Information provided to you about a particular provider does not imply and
is in no way an endorsement of that particular provider by Solutions for Caregivers. The information on and the
selection of a particular provider has been supplied by the provider and is subject to change without written consent of
Solutions for Caregivers.
Mail Order Pharmacy 3You are not required to use OptumRx home delivery for a [90- or 100- day] supply of your
maintenance medication. If you have not used OptumRx home delivery, you must approve the first prescription order
sent directly from your doctor to OptumRx before it can be filled. New prescriptions from OptumRx should arrive within
ten business days from the date the completed order is received, and refill orders should arrive in about seven
business days. Contact OptumRx anytime at 1-888-279-1828, TTY 711. OptumRx is an affiliate of UnitedHealthcare
Insurance Company.] [$<0> co-pay is applicable for tier 1 and tier 2 medications during the initial coverage phase and
may not apply during the coverage gap; it does not apply during the catastrophic stage.
SPRJ26560
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OFFICE OF GROUP BENEFITS
 Members are encouraged to attend OGB Regional Meetings
 For OGB information:
 Website: www.groupbenefits.org
 Phone: 225-925-6625
 For BCBS information:
 Website: www.bcbsla.com/ogb
 Phone: 1-800-392-4089
 For Vantage information:
 Website: employees.vhp-stategroup.com
 Phone: 1-888-823-1910
 OGB Reminders:
 Passive enrollment for 2017 – No action required
 Premium Increase
 Pelican Plans and Magnolia Local Plan – 3%; Magnolia Local Plus and Open Access Plans – 7.5%;
Vantage – 7%
OFFICE OF GROUP BENEFITS
HEALTH PLAN OPTIONS FOR RETIREES:
PELICAN HRA1000
MAGNOLIA LOCAL
MAGNOLIA LOCAL PLUS
MAGNOLIA OPEN ACCESS
VANTAGE MEDICAL HOME HMO
PEOPLES HEALTH HMO
VANTAGE PREMIUM HMO, REGULAR HMO, AND
ZERO-PREMIUM HMO
TOWERS WATSON’S ONE EXCHANGE
PELICAN PLANS
OGB’S PELICAN BENEFIT OPTIONS OFFER LOW
PREMIUMS, IN COMBINATION WITH EMPLOYER
CONTRIBUTIONS, TO CREATE THE MOST AFFORDABLE
OPTIONS FOR ENROLLEES IN 2017.
PELICAN PLANS OFFER COVERAGE WITHIN THE BLUE
CROSS AND BLUE SHIELD NATIONWIDE NETWORK, AS
WELL AS OUT-OF-NETWORK COVERAGE.
Proprietary information of UnitedHealth Group. Do not distribute or
reproduce without express permission of UnitedHealthGroup.
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PELICAN HRA1000
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.
Proprietary information of UnitedHealth Group. Do not distribute or
reproduce without express permission of UnitedHealthGroup.
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PELICAN HRA1000MEDICAL COVERAGE
Proprietary information of UnitedHealth Group. Do not distribute or
reproduce without express permission of UnitedHealthGroup.
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Magnolia Local Plus
(Nationwide In-Network Providers)
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
Active Employees and non-Medicare retirees – retirement date on or AFTER 3-12015
Medical Coverage
EmployeeOnly
Employee +
1 (Spouse
or Child)
Prescription Coverage
Employee +
Children
Family
Employer Contribution to
HRA/HSA
$0
$0
$0
$0
Deductible (in-network)
$400
$800
$1,200
$1,200
Deductible (out-of-network)
No coverage
No coverage No coverage No coverage
Out-of-pocket max (in-network)
$2,500
$5,000
Out-of-pocket max (out-ofnetwork)
No coverage
No coverage No coverage No coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
Co-Payment (out-of-network)
No coverage
No coverage No coverage No coverage
$7,500
$25/$50
$7,500
$25/$50
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Magnolia Local Plus
non-Medicare retirees – retirement date BEFORE 3-12015
Medical Coverage
EmployeeOnly
Employee +
1 (Spouse
or Child)
Prescription Coverage
Employee +
Children
Family
Employer Contribution to
HRA/HSA
$0
Deductible (in-network)
$0
$0
Deductible (out-of-network)
No coverage
No coverage No coverage No coverage
$0
$0
$0
$3,000
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
$0
$0
Out-of-pocket max (in-network)
$1,000
$2,000
Out-of-pocket max (out-ofnetwork)
No coverage
No coverage No coverage No coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
Co-Payment (out-of-network)
No coverage
No coverage No coverage No coverage
$25/$50
Tier
$3,000
$25/$50
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Magnolia Open Access
(Nationwide Providers)
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 copayments 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
Active Employees and non-Medicare retirees – retirement date on or AFTER 3-12015
Medical Coverage
EmployeeOnly
Employer Contribution to
HRA/HSA
Prescription Coverage
Employee
Employee +
+1
Children
(Spouse or
Child)
Family
$0
$0
$0
$0
Deductible (in-network)
$900
$1,800
$2,700
$2,700
Deductible (out-of-network)
$900
$1,800
$2,700
$2,700
Out-of-pocket max (in-network)
$2,500
$5,000
$7,500
$7,500
Out-of-pocket max (out-ofnetwork)
$3,700
$7,500
$11,250
$11,250
Coinsurance(in-network)
10%
10%
10%
Coinsurance (out-of-network)
30%*
30%*
30%*
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
10%
Non-Preferred
$40 co-pay
30%*
Specialty
$40 co-pay
*Once a member’s deductible for allowable charges is met, he or she will pay 30% of the
allowable
charge, plus 100% of the difference between the allowable charge and billed amount for outof- network care.
Magnolia Open Access
– retirement date BEFORE 3-12015
Non-Medicare
retirees
Medical Coverage
EmployeeOnly
Employer Contribution to
HRA/HSA
Deductible (in & out-of-network)
Prescription Coverage
Employee
Employee +
+1
Children
(Spouse or
Child)
Family
$0
$0
$0
$0
$300
$600
$900
$900
Out-of-pocket max (in-network)
$1,300 individual; plus $1,300 per additional person up
to 2; plus $1,00 per additional person up to 10 people;
$12,700 for a family of 12+
Out-of-pocket max (out-ofnetwork)
$3,300 individual; plus $3,000 per additional person up
to 2;$12,700 for a family of 4+
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Coinsurance(in-network)
10%
10%
10%
10%
Non-Preferred
$40 co-pay
Coinsurance (out-of-network)
30%*
30%*
30%*
30%*
Specialty
$40 co-pay
*Once a member’s deductible for allowable charges is met, he or she will pay 30% of the
allowable
charge, plus 100% of the difference between the allowable charge and billed amount for outof- network care.
Magnolia Local
(Limited In-Network Provider Only Plan)
The Magnolia Local plan is a limited provider in-network only
plan for members who live in specific coverage areas. Out-ofnetwork coverage is provided in emergencies only and may be
subject to balance billing.
o Community Blue
Community 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.
o BlueConnect
BlueConnect is 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
Active Employees and non-Medicare retirees – retirement date on or AFTER 3-12015
Medical Coverage
Prescription Coverage
EmployeeOnly
Employee
+1
(Spouse or
Child)
Employee
+ Children
Employer Contribution to
HRA/HSA
$0
$0
$0
$0
Deductible (in-network)
$400
$800
$1,200
$1,200
Deductible (out-of-network)
No
coverage
No
coverage
No
coverage
No
coverage
Out-of-pocket max (in-network)
$2,500
$5,000
$7,500
$7,500
Out-of-pocket max (out-ofnetwork)
No
coverage
No
coverage
No
coverage
No
coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
$25/$50
$25/$50
Co-Payment (out-of-network)
No
coverage
No
coverage
No
coverage
Family
No
coverage
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Magnolia Local
non-Medicare
retirees
– retirement date BEFORE 3-12015
Medical Coverage
Prescription Coverage
EmployeeOnly
Employee
+1
(Spouse or
Child)
Employee
+ Children
Employer Contribution to
HRA/HSA
$0
$0
$0
$0
Deductible (in-network)
$0
$0
$0
$0
Deductible (out-of-network)
No
coverage
No
coverage
No
coverage
No
coverage
Out-of-pocket max (in-network)
$1,000
$2,000
$3,000
$3,000
Out-of-pocket max (out-ofnetwork)
No
coverage
No
coverage
No
coverage
No
coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
$25/$50
$25/$50
Co-Payment (out-of-network)
No
coverage
No
coverage
No
coverage
Family
No
coverage
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Vantage Medical Home HMO
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 Medical Home HMO
Medical Coverage
Employee +1
(Spouse or
child)
$800
$3,000
$5,000
$1,200
$4,500
$5,000
$1,200
$4,500
$7,500
Unlimited
Unlimited
Unlimited
$10 AHN/$20
$10 AHN/$20
$10 AHN/$20
$10 AHN/$20
$35 AHN/$45
$35 AHN/$45
$35 AHN/$45
$35 AHN/$45
EmployeeOnly
Deductible (Tier I)
Deductible (Tier II & Out-of-Network)
Out-of-pocket max (Tier I)
$400
$1,500
$2,500
Out-of-pocket max (Tier II & Out-of-Network) Unlimited
Co-Payment PCP (Tier I)
Co-Payment Specialist (Tier I)
Employee +
Children
Family
Coinsurance – PCP (Out-of-Network)
50% coverage; subject to out-of-network deductible
Coinsurance – Specialist (Out-of-Network)
50% coverage; subject to out-of-network deductible
Prescription Coverage
Tier
Tier 1 Preferred Generics
Tier 2 Non-Preferred
Generics
Tier 3 Preferred Brand
Tier 4 Non-Preferred
Brand
Tier 5 Specialty
Member
Responsibility
$5
$20
$50
$80
$150
Tier I Providers
Members seeing Tier I providers pay the Tier I co-pays, co-insurance and
deductibles as listed in the Certificate of Coverage and Cost Share Schedule.
Tier I consists of two networks:
•
A preferred provider network, Affinity Health Network (AHN), which has
lower co-payments for certain covered services; and
A standard provider network
•
Tier II Providers
Members who chose to see these providers will have to pay an additional
20% coinsurance in addition to their Tier I cost share, after the applicable
deductible is met.
Individual Medicare Plans through
OneExchange
Sampling of plans available through
OneExchange: Customize your insurance
Towers Watson's OneExchange is an Individual Medicare Market Exchange
offered to OGB retirees and spouses who have Medicare Parts A and B.
OneExchange offers a variety medical, prescription drug, and dental plans
based on an individual's provider preferences, prescription drug needs,
geographic location and medical conditions. These plans may include Medicare
Advantage, Medicare Supplement (or Medigap) and Medicare Part D
Prescription Drug coverage.
Plan Advice and Enrollment Assistance
OneExchange gives you access to licensed benefit advisors and online tools
combined with comprehensive knowledge of the Medicare market. Licensed
benefit advisors are available to assist you before, during and after enrollment.
You can contact benefit advisors at (855) 663-4228, Monday through Friday
from 8:00 a.m. until 8:00 p.m. central standard time.
OneExchange Health Reimbursement Arrangement (HRA)
Retirees enrolled in a medical plan through OneExchange receive a Health
Reimbursement Arrangement. The OneExchange HRA allows for tax-free
reimbursement of qualifying medical expenses to the extent that funds are
available in the HRA account. A single retiree will receive HRA credits of $200
per month and a retiree plus spouse will receive HRA credits of $300 per month
from the agency you retired.
Compare Plans
OneExchange offers a variety of tools to help you compare insurance plans and
premiums. They also offer a Prescription Profiler™ that uses your current and
projected medication expenses to determine which plans will have the lowest
estimated annual out-of-pocket cost.
For a complete list of plans and providers visit:
medicare.oneexchange.com/ogb or call OneExchange at
1-855-663-4228.
OneExchange
Peoples Health
Medicare Advantage
The Peoples Health Medicare Advantage plan offers much more than
Medicare, with extra benefits like vision and dental coverage, free health
club membership and prescription drug coverage. As a Peoples Health
Group Medicare member, retirees pay a premium in addition to paying their
Medicare Part B premium; retirees receive 100 percent coverage for many
services with NO Medicare deductibles.
COVERED BENEFIT
PEOPLES HEALTH HMO-POS
PLAN YEAR DEDUCTIBLE
MAXIMUM OUT-OF-POCKET EXPENSE (IN-NETWORK)
MAXIMUM OUT-OF-POCKET EXPENSE (OUT-OF-NETWORK)
OFFICE VISIT - PRIMARY CARE / SPECIALIST
EMERGENCY ROOM
INPATIENT HOSPITAL
PRESCRIPTION DRUGS (PART D)
Preferred Generics
Non-Preferred Generics
Preferred Brand
Non-Preferred Brand
Specialty
$0
$2,500
20%
$5 / $10 co-pay per visit
$50 ER co-pay per visit
$50 per day (days 1-10)





$0 co-pay
$0 co-pay
$20 co-pay (30-day supply)
$40 co-pay (30-day supply)
20%
Vantage Health Plan
Medicare Advantage
For retirees who are 65 and over, Vantage offers several great Medicare
Advantage plans as an alternative to Medicare. One benefit to Vantage’s
Medicare Advantage plans is that a network of providers is already contracted
with the plan throughout Louisiana. These physicians, hospitals and specialty
medical facilities have already agreed to provide health care services to treat
AdvantageVantage
members.
COVEREDMedicare
BENEFIT
Premium HMO-POS
VANTAGE POS PLAN
VANTAGE ZERO-PREMIUM HMO-POS
PLAN YEAR DEDUCTIBLE
MAXIMUM OUT-OF-POCKET EXPENSE
OFFICE VISIT
PRIMARY CARE / SPECIALIST
EMERGENCY ROOM
INPATIENT HOSPITAL
N/A
$2,000
N/A
$3,000
N/A
$6,700
$5/$20 co-pay per visit or
$0/$10 AHN co-pay per visit
$10/$40 co-pay per visit or
$0/$30 AHN co-pay per visit
$50 co-pay per visit;
worldwide coverage
$50/per day (days 1-10)
$75 ER co-pay per visit worldwide coverage
$300/day (days 1-5)
$15/$50 co-pay per visit or
$5/$40 AHN co-pay per
visit
$75 ER co-pay per visit - worldwide
coverage
$345/day (days 1-5)
PRESCRIPTION DRUGS (PART D)
Tier 1 – Preferred Generics
Tier 2 – Non-Preferred Generics
Tier 3 – Preferred Brand
Tier 4 – Non-Preferred Brand
Tier 5 – Specialty
$5 co-pay
$10 co-pay
$25 co-pay
$50 co-pay
20% coinsurance
$4 co-pay
$10 co-pay
$47 co-pay
$100 co-pay
33% coinsurance
$4 co-pay
$10 co-pay
$47 co-pay
$100 co-pay (after $125 deductible)
25% coinsurance (after $125
deductible)
Retirees
• OGB coverage must be in effect immediately prior to a member’s
retirement to be eligible for retiree coverage. If the member started
participation or rejoined state service on or after January 1, 2002, the
state contribution of their premium is based on the number of
participation years in an OGB health plan. This also applies to
surviving spouse who started coverage after July 1, 2002.
• The participation schedule below shows the number of years a
member must participate in an OGB health plan to receive a specified
state contribution.
Retiree Participation Schedule
Years of OGB Plan Participation
State’s Share of Total Monthly Premium
20 years or more
75 percent
15 years but less than 20 years
56 percent
10 years but less than 15 years
38 percent
less than 10 years
19 percent
Retirees – Medicare Eligibility
If a retiree or the covered spouse of a retiree is eligible for premiumfree
Medicare Part A (hospitalization insurance), he or she MUST ALSO
enroll in Medicare Part B (medical insurance) to receive OGB benefits
on Medicare Part B claims
If the above applies to the member or covered spouse, he or she should
visit the Social Security office to enroll in Medicare Part B at least 3 months
prior to their 65th birthday.
This does not apply to anyone who reached age 65 before July 1, 2005
If the plan member is retired but has not yet reached age 65, this will apply to
the member when he or she reaches age 65.
If the member reached age 65 on or after July 1, 2005, but has not
retired, this will apply to the member when he or she retires.
Retirees – Medicare Eligibility
If a retiree or the covered spouse of a retiree is eligible for premiumfree
Medicare Part A (hospitalization insurance), he or she MUST ALSO
enroll in Medicare Part B (medical insurance) to receive OGB benefits
on Medicare Part B claims
This applies to the member and covered spouse regardless of whether
each has individual Medicare eligibility (under his/her own Social Security
number) or one person is eligible as the dependent of another person.
Retirees should bring the name(s) and social security number(s) of
previous spouses (divorced or deceased spouse) so that Social Security
can determine which spouse they may qualify under.
Sponsored by Blue Cross
and Blue Shield of Louisiana
• Provides resources to help monitor health, understand risk
factors, make educated choices that can prevent illness &
manage health conditions
• Complete two steps to qualify for annual premium discount:
1.
2.
Schedule a wellness checkup through Catapult Health or
see your MD for wellness visit and submit completed
Primary Care Provider form
Fill out Personal Health Assessment online survey at
www.bcbsla.com/OGB
• Participation information on the 2017 plan year will be
forthcoming
THANK YOU
LSU First & WebTPA: Working Together
2017 LSU First Health Plan Changes
(For Retirees WITHOUT Medicare)
2017 LSU First Health Plan Changes
 No Medical Plan Design Changes
 No Pharmacy Co-Pay Changes
 Reminder: EAP is now on line. Members
can visit www.mylifevalues.com for
more information.
2017
Plan Changes
What You Need to Know
64
2017 LSU First Health Plan– Precertification
Precertification











65
Genetic Testing
Home Healthcare
Skilled Nursing
Physical Therapy
Occupational Therapy
Speech Therapy
ABA Therapy
Inpatient Hospital Admissions
Durable Medical Equipment (over $1,000)
PET Scans
Chemotherapy
Precertification














Cardiac Rehabilitation
CT Scans
MRI / MRA
Outpatient Pain Rehabilitation / Pain Control
Programs
Residential Treatment Centers
Mental Health – Inpatient and Outpatient
Substance Abuse – Inpatient and Outpatient
Selected Outpatient Surgeries
Orthotic Devices (over $1,000)
Prosthetics (over $1,000)
Injectables (over $1,000)
Hyperbaric Oxygen Therapy
Blood Clotting Factors
Transplant
User-Friendly Member Portal
66
View, Download & Print ID Cards
67
View Deductible Balances
Screen mock-up: member homepage with HRA balance added
68
Integration with
 Calorie Counter
 Meal Plans
 Personalized Fitness Plan
& Exercise Demos
 Active Support
Message Boards
 Advice From Experts
 Member-Created Goal
Teams / Employer-Based
Fitness Competitions
 Integration with FitBit™
 Recipes, Articles, Tips
and More!
69
Mobile App
Now available for Android, iPhone, iPad
WebTPA
On-the-go functionality to view ID cards,
check eligibility, review claims, and more!
70
We’re here to help.
Phone: 855.346.LSU1(5781)
Email: [email protected]
Fax: 469.417.1974
Contact Us
Home office:
WebTPA, Inc.
8500 Freeport Pkwy South
Suite 400
Irving, TX 75063
Care Coordination with eQHealth
eQHealth’s Care Coordination program is a
high-touch approach that ensures each
member receives the care, services and
community support leading to improved
health.
We engage the member’s primary physician
and care team as part of overall patient
plan of care.
Under the direction of the primary physician,
our Care Coordinator manages and
monitors the needs of the members.
Confidential – Proprietary to eQHealth Solutions
Who are Care Coordinators
• Care Coordinators are Nurses who can assist with
questions or concerns related to the member’s health.
• Services they provide:
– Disease Education
– Medication Education
– Self Care Education
– Provide Community Resources
– Coordination with their Doctors
– Assistance in Navigating the HealthCare System
•
Care Coordinators establish a relationship and an
understanding of the member’s needs.
Care Coordination Programs Available
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Catastrophic Case Management
Care Transitions
Asthma
Chronic Kidney Disease
COPD
Depression
Diabetes
Heart Failure
HIV/AIDS
Hypertension
Maternity (High Risk Pregnancy/Post Partum)
Oncology
Smoking Cessation
Special Needs Children
Transplants
Citizens Rx
• Citizens Rx will continue managing the pharmacy
portion of the benefit program during 2017.
• There are no changes to the prescription drug co-pays
for 2017.
• You will continue to receive prescription drug services
for retail, home delivery, and specialty pharmacy services
from Citizens Rx. Home delivery and specialty
medications will continue through Praxis Rx.
• If you have questions about your prescription drug
benefit, you may contact Citizens Rx at any time using
the number on the back of your card (855) 346-LSU1.
Citizens Rx Retail Pharmacy Networks
Members have access to one
of the nation’s largest retail
pharmacy networks -
67,000 pharmacies
• Independent Pharmacies
• Regional Chains
• National Chains
77
Home Delivery
• PraxisRx Pharmacy Home Delivery is your mail order pharmacy
delivery service.
• For NEW home delivery:
• PraxisRx Pharmacy can contact your physician for you for your
new home delivery prescriptions; OR
• You can obtain a prescription from your physician and send it to
PraxisRx Pharmacy by mail; OR
• Your Physician can send a prescription to PraxisRx Pharmacy by
fax or through electronic prescribing
• Be sure to ask your physician to write the prescription for a 90-day supply
with three refills and authorize a one-year supply (when appropriate)
78
Specialty Pharmacy
•
•
•
•
•
•
•
•
•
79
19 different conditions served
High touch therapy management
Patient Care Coordinator – First call resolution
Free delivery of medications and supplies
Verified refill reminders (adherence counseling,
side effect management)
Injection training
Therapy specific and disease specific education
Side effect management and support
24/7 Access clinical pharmacist
Prior Authorization
• Prior authorization ensures that your medications are safe
and helpful for your condition.
• Drugs may need prior authorization if they
•
•
•
•
•
Have strong or unsafe side effects
Can be harmful if taken with other drugs
Should only be used for certain health conditions
Are often abused or misused
Have lower-cost options that may work better
• What can you do?
• Ask your doctor to send a prior authorization request to Citizens
Rx by fax to 888-557-0896, or call 888-556-7482 to speak to a
Prior Authorization Specialist.
• Authorization requests are reviewed as quickly as possible.
Step Therapy
• Step therapy means that you must start with safe, lower
cost drugs (Step One drugs) before use of a higher cost
brand medication.
• If Step One drugs doesn’t help, you can try another drug
that may cost more (Step Two drug).
• This helps ensure you get medications that are safe and
cost effective.
• What if your doctor wants you to take a Step Two
drug?
• If your doctor thinks Step One drugs will not help you, your
benefit plan will sometimes cover a Step Two drug.
• Your doctor may send a prior authorization form by fax to 888557-0896, or call 888-556-7482 to speak to a Prior Authorization
Specialist.
Preferred Drug Formulary
New drugs excluded include:
Product Name
Use
Preferred Alternatives
Alogliptin, alogliptin/
metformin
Diabetes
Januvia, Tradjenta, Janumet/XR and Jentadueto/XR
Colchicine
Gout
Colcrys and Mitigare
Daklinza
Hepatitis C
Harvoni and Zepatier
Evzio
Opioid
overdose
Naloxone syringes and Narcan nasal spray
Genvisc 850, Hymovis,
Supartz/ Supartz FX
Osteoarthritis
Euflexxa, Monovisc and Orthovisc
Kineret, Orencia
Arthritis
Actemra, Cosentyx, Enbrel, Humira, Otezla, Remicade,
Simponi 100mg, Stelara and Xeljanz/ Xeljanz XR
Taltz
Psoriasis
Actemra, Cosentyx, Enbrel, Humira, Otezla, Remicade,
Simponi 100mg, Stelara and Xeljanz/ Xeljanz XR
Zyclara
Actinic
keratosis
Fluorouracil 5% cream, fluorouracil 2% solution,
imiquimod 5% cream, Carac and Picato
VOLUNTARY
BENEFITS
VOLUNTARY BENEFITS RATES
UnitedHealthcare Voluntary Benefits
Dental – 5% rate increase for Basic and Enhanced Plans
Vision/Financial Protection Products – No rate increase
UNUM
No premium increase
Retirees that did not take these insurances
into retirement may not add these during
annual enrollment.
Voluntary Dental Plan
•5% premium increase for Basic
and Enhanced plans
•80% Out of Network
Reimbursement
•Active members can enroll,
cancel, make changes and
switch from one plan to the other
•Retirees can switch plans,
make changes (add/delete
dependents), or cancel
Dental Rates
Coverage Available
Basic Plan
Enhanced Plan
EE Only
$18.78
$34.50
EE+SP
$35.28
$67.52
EE+CH
$48.76
$82.08
EE+FAM
$65.26
$115.06
Basic Plan Benefits
Refer to your Benefit Summary for full details
•
Dental Services
In-Network
Out-of-Network
100%
100%
Minor Restorative
Scheduled Benefits
Scheduled Benefits
Simple Extractions
Scheduled Benefits
Scheduled Benefits
Endodontics
Scheduled Benefits
Scheduled Benefits
Periodontics
Scheduled Benefits
Scheduled Benefits
Oral Surgery
Scheduled Benefits
Scheduled Benefits
Crown & Bridge
Scheduled Benefits
Scheduled Benefits
Dentures
Scheduled Benefits
Scheduled Benefits
$50/$150
$50/$150
Annual Maximum
$1,500
$1,500
Waiting Period
None
None
Preventive and Diagnostic
Basic Services
Major Services
Deductible
Fee Schedule has not changed.
Enhanced Plan Benefits
Dental Services
In-Network
Out-of-Network
100%
100%
Minor Restorative
80%
80%
Simple Extractions
80%
80%
Periodontics - maintenance
80%
80%
Periodontics – surgical
50%
50%
Endodontics
50%
50%
Oral Surgery
50%
50%
Crown & Bridge
50%
50%
Dentures
50%
50%
Orthodontia – Adult & Child
50%
50%
Lifetime Ortho Maximum
$1,500
$1,500
None
None
Annual Maximum
$1,500
$1,500
Waiting Period
None
None
Preventive and Diagnostic
•
Basic Services
Major Services
Deductible
Providers
In-Network vs Out-of-Network
‒ Currently 60% of members are going Out of Network
How to help?
‒ UHC is reaching out to Top 25 providers
‒ Please have your employees check their providers
and submit Provider Nomination Forms for them
Please note that Margaret Dillon is a fictitious character used to illustrate UnitedHealthcare tools and programs.
Tools & Information
www.myuhc.com
Dentist Locator
• Find general dentists and specialists
• Treatment Cost Calculator
• Provider Nomination Forms Available
Plan Information
• View benefit summary
• Order an ID card
• Print an ID card online
• Answers to common
questions about dental plans
Claims Information
• Review claim status and history
• Download a claim form for Out-of-Network Visits
Voluntary Vision Plan
•No Changes to plan design or
premiums
•Active members can enroll,
cancel, and/or make changes
•Retirees can cancel or make
changes (add/delete
dependents)
Vision Rates
Coverage Available
Monthly Premium
EE Only
$7.39
EE+SP
$12.45
EE+CH
$12.72
EE+FAM
$20.50
In-Network Benefits at a Glance
Frequency
Benefits
Comprehensive Eye Exam
Every 12 months
No copay
Pair of eyeglass lenses
Every 12 months
No copay
Frames
Every 12 months
$130 allowance
Lens Options
See benefit summary for details
Covered selection of Contact Lenses
(lens fitting included)
Every 12 months
No copay
Up to 4 boxes
Elective Contact Lenses
‒ Contact lenses that fall outside the
covered selection.
(Copay does not apply)
Every 12 months
$130 allowance
Additional Materials
20% off
Resources
www.myuhcvision.com
‒
‒
‒
24-hour benefit access
Provider locator & Frequently Asked Questions
Eye care & eye health information
Provider Location
1-800-839-3242
Toll-free, 24-hours a day, 7 days a week
Customer Service Center
1-800-638-3120
8:00 a.m. to 11:00 p.m. ET Monday-Friday
9:00 a.m. to 6:30 p.m. ET Saturday
ID Cards
Dental
•
•
•
Only employees electing coverage for annual enrollment will receive dental ID
cards mailed to their home address.
Existing members will not receive new ID cards.
Members can now print Dental ID cards online
Vision
•
With UHC’s paperless vision benefit and claims, members do not need a vision
ID card to use their benefits. However, if members would like one, an ID card
can be printed from the vision member website: www.myuhcvision.com.
Unum Long Term Care
• www.unuminfo.com/LSUS - LSU’s personalized UNUM LTC website
– Rates are based on the age when purchased
– Rates have never increased since plan inception
– UNUM website has LTC calculator that will help you choose which
plan may best fit your needs
• Age
• Duration (3 years or 6 years)
• Amount ($1,000, $2,000, $3,000, $4,000)
• Plan Options
– Plan 1 – LTC Facility and Professional Home Care
– Plan 2 – LTC Facility and Professional Home Care, Total Home Care
– Plan 3 – LTC Facility and Professional Home Care, Simple Inflation
– Plan 4 – LTC Facility and Professional Home Care, Total Home Care, Simple
Inflation
• LTC is not open during Annual Enrollment
• Anyone wishing to apply must go through Evidence of Insurability
96
THINGS TO REMEMBER
ENROLLMENT ENDS 10/31/16
UPDATE ADDRESS AND PHONE NUMBERS WITH HRM
MUST BE IN WRITING BUT CAN BE FAXED OR EMAILED.
ADDING/DELETING DEPENDENTS – USE PAPER FORM AND
SUBMIT MARRIAGE/BIRTH CERTIFICATE
FOREIGN DOCUMENTS MUST BE TRANSLATED PRIOR TO SUBMISSION
GRANDCHILDREN – ONLY COVERED WITH A COURT ORDERED
CUSTODY OR GURADIANSHIP. CURRENT COVERED GRANDCHILDREN
ARE GRANDFATHERED INTO THE PLAN.
LSU FIRST MEMBERS – MAY NEED A NEW 90 DAY PRESCRIPTION IF
YOU USE MAILORDER
THANK YOU