Administered by WebTPA and MedImpact
o LSU First offers members access to 100% coverage with First Choice providers and generic prescriptions. This means that members will not incur any out-of-pocket expenses for covered services from First Choice Providers* and/or generic prescriptions. LSU First also includes an employer-paid health reimbursement account (HRA) that can be used to offset deductible and other out-of-pocket medical and pharmacy expenses throughout the year. Any unused HRA funds roll over, up to a maximum, allowing members to build up balances to cover eligible medical expenses.
* The fees below apply to all networks, including the First Choice network.
- $150 Emergency Room co-pay, waived if admitted
- $150 Penalty for MRIs and CT scans performed at a hospital facility (No penalty if performed at free-standing imaging center)
- $300 Penalty for outpatient surgery performed at a hospital facility (No penalty if performed at ambulatory surgery center)
|Medical Coverage||Employee Only||Employee + Spouse||Employee + Children||Family|
|Employer Contribution to HRA||$1,000||$1,500||$1,500||$2,000|
|Coinsurance (First Choice)||0%||0%||0%||0%|
|Out-of-pocket max (in-network)*||$4,500||$6,750||$6,750||$9,000|
|Out-of-pocket max (out-of-network)*||Unlimited||Unlimited||Unlimited||Unlimited|
*Out-of-Pocket Maximums include HRA, Deductible, and Coinsurance.
**Based on the Maximum Allowable Charge
|Prescription Coverage||Member Responsibility for 30-day supply|
|Tier 1 - Generic||$0 after HRA; covered at 100%|
|Tier 2 – Preferred Brand||20% up to $150; subject to HRA and Deductible|
|Tier 3 – Non-preferred Brand||20% up to $150; subject to HRA and Deductible|
|Tier 4 - Specialty||20% up to $150; subject to HRA and Deductible|
MedImpact administers the pharmacy portion of the plan. Home delivery and specialty medications are provided through MedImpact Direct.
- Generic medications are covered at 100% after the HRA is exhausted.
- Brand name and specialty medications are covered at 80% after the HRA is exhausted and the Deductible is met. Members are responsible for 20% of the drug cost, up to a maximum of $150 for a 30-day supply.
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