Administered by WebTPA and Citizens Rx
2018 Plan Changes
The following plan changes are effective January 1, 2018:
- In-Network providers will be covered at 80%/20% coinsurance
- Brand Name and Specialty medications will be covered at 80%/20% coinsurance, following the satisfaction of the deductible, up to a maximum of a $150 co-pay for a 30-day supply
- Rollover HRA will apply to First Choice providers and generic medications
- Rollover HRA maximum will be capped at 1 time Current Year HRA
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
- 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.
- Option 1: Summary of Benefits & Coverage
- Option 2: Summary of Benefits & Coverage
- New Hire Proration Guide
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
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 firstname.lastname@example.org. You may also contact WebTPA customer service at 1-855-346-5781.