LSU First

First Choice Providers + Generic Drugs = Covered 100% First Choice Providers covered at 100% (after HRA is exhausted)

Tier 1 Generic prescriptions covered at 100%

Preventative Care covered at 100% with First Choice and In-Network providers

Ability to earn $25/month ($300 annual) premium wellness credit

News

2023 PLAN AMENDMENT AND SUMMARY OF MATERIAL MODIFICATION

Wellness Credit

Telemedicine Offered Through LSU First

LSU First Monthly Newsletter

2024 Plan Year

LSU First offers members access to 100% coverage with First Choice providers and Tier 1 generic prescriptions. This means that members will not incur any out-of-pocket expenses for covered services from First Choice Providers* and/or Tier 1 generic prescriptions. LSU First also includes an employer-paid health reimbursement account (HRA) that is used for covered medical 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 2024 Plan Year runs on a calendar year, from January 1- December 31. All Health Reimbursement Accounts (HRAs), deductibles, and out-of-pocket maximums reset to the full amount on January 1. Any remaining HRA dollars, up to and the maximum, will be rolled over.

*Emergency Room copay and imaging penalties may apply.

What's New for the 2024 Plan Year

LSU First expanded the wellness credit for the 2024 Plan Year to include covered spouses! Employees with Employee + Spouse or Family coverage will be eligible for an additional $10/month premium credit. Please see the Wellness Credit webpage for more information.

LSU First will have a 6% premium increase. Please see the 2024 Premiums for Active Employees for a list of LSU First premiums. Retiree premiums based on vesting level can be found on the sidebar.

First Choice providers will remain covered at 100% after your HRA is exhausted. In-Network providers within the Verity and Aetna networks will remain covered at 80% and Out-of-Network providers will continue to be covered at 60% of the Maximum Allowable Charge (MAC) after your HRA and deductible are met.

Tier 1 Generic medications will continue to be covered at 100% and do not deduct from your HRA. Tiers 2 – 4 Brand and Specialty medications will be covered at 80% by the plan and you will be responsible for the remaining 20% with a maximum of $150 for a 30-day supply. Brand and Specialty medications no longer deduct from your HRA nor do you have to meet your deductible for these medications.

LSU First will host virtual presentations during Annual Enrollment. For additional information regarding LSU First, we recommend a brief video that provides an overview of the program.

Date	Time	Link
Thursday, October, 5	2 - 3pm	Zoom Registration
Tuesday, October, 17	10-11am	Zoom Registration
Wednesday, November, 1	2-3pm	Zoom Registration

2023 Plan Year

The 2023 Plan Year runs on a calendar year, from January 1- December 31. All Health Reimbursement Accounts (HRAs), deductibles, and out-of-pocket maximums reset to the full amount on January 1. Any remaining HRA dollars, up to and the maximum, will be rolled over.

What's New for the 2023 Plan Year

LSU First will continue to offer a $25 a month wellness credit for employees who meet certain requirements. Please see the Wellness Credit webpage for more information.

LSU First will have a 1.5% premium increase. Please see the 2023 Premiums for Active Employees for a list of LSU First premiums. Retiree premiums based on vesting level can be found on the sidebar.

Beginning January 1, 2023, the Health Reimbursement Account (HRA) and Deductible will no longer apply to prescription drug coverage. The HRA and Deductible will only apply to medical services. Because prescription drug coverage will no longer apply to the HRA, the HRA amounts have been adjusted by half for the 2023 plan year. The deductible amount will remain the same. Members will still be allowed to rollover any unused 2022 HRA into 2023.

Tier 1 Generic medications will continue to be covered at 100% but will not deduct from your HRA. BTiers 2-4 Brand and Specialty medications will be covered at 80% by the plan and you will be responsible for the remaining 20% with a maximum of $150 for a 30-day supply. Tiers 2-4 Brand and Specialty medications will no longer deduct from your HRA nor will you have to meet your deductible for these medications. This allows for better predictability of cost throughout the year. There will be an additional Pharmacy Maximum Out-of-Pocket that will limit your coinsurance exposure.

The LSU First Team

The LSU First team is comprised of the following partners working together for your health care benefits:

LSU - LSU is financially responsible for paying your claims
WebTPA - Medical Claims Administrator and Medical Management. They have a dedicated team of employees for LSU to answer your calls and process your claims. They also certify precertification and provide case management.
HighCare Health - Care Coordination - They provide education and resources about various health conditions.
MedImpact - Pharmacy Benefits Manager. They provide customer service and administer prescription programs such as Step Therapy, Prior Authorization and Drug Quantity Management. They also provide mail order services for home delivery of maintenance and specialty medications.
Verity HealthNet - Local Network Administrator for the First Choice and Verity networks
Aetna ASA - National Network Administrator and web-based Employee Assistance Program (EAP) provider

The LSU First Networks

The LSU First Health Plan utilizes the following Networks:

First Choice (FC) - The First Choice network is a network of local providers within Louisiana. Services are covered at 100% after your HRA is exhausted. This means you pay no out of pocket for covered services with these providers.
Verity HealthNet - The Verity Network is a network of local providers within Louisiana. After your HRA is exhausted and you meet your deductible, the Plan will pay 80% and you are responsible for 20%.
Aetna ASA - The Aetna ASA Network is a nationwide network for providers outside of Louisiana and/or providers within Louisiana that are not in the First Choice or Verity networks. After your HRA is exhausted and you meet your deductible, the Plan will pay 80% and you are responsible for 20%.
Out-of-Network - Any providers not participating in the above networks will be considered Out-of-Network. This may include ancillary services, such as emergency room providers, radiology, anesthesiology, etc. After your HRA is exhausted and you meet your deductible, the Plan will pay 60% of the Maximum Allowable Charge (MAC). Members can be balance billed by Out-of-Network providers for billed services outside of the MAC.

Tiered Formulary

The LSU First Health Plan utilizes a 4-tier formulary, managed by MedImpact, that helps members select the most appropriate, lowest-cost medication options. The formulary is reviewed quarterly to reassess drug tiers based on the current prescription drug market. The amount you pay towards prescriptions depends on the tier the drug falls within and the cost of the medication. Beginning January 1, 2023, the HRA and Deductible do not apply to prescriptions.

Tier 1 Generic —Tier 1 Generic medications are covered at 100%. You owe $0 for these medications.
Tier 2 Preferred Brand — Tier 2 Preferred Brand medications are often less expensive than Non-Preferred Brands, which can save you money. They are covered at 80%. You are responsible for 20%, up to a maximum of $150 for a 30-day supply.
Tier 3 Non-Preferred Brand — Tier 3 Non-Preferred Brand medications are covered at 80% . You are responsible for 20%, up to a maximum of $150 for a 30-day supply.
Tier 4 Specialty — Tier 4 Specialty medications are covered at 80% with no HRA or Deductible. You are responsible for 20%, up to a maximum of $150 for a 30-day supply.

LSU First members have the option of receiving a 90-day supply of maintenance medications by mail order through MedImpact Direct or through multiple retail pharmacies nationwide, including CVS, Walgreens, and Wal-Mart, through MedImpact’s Choice90 program.

Online Resources

LSU First puts access at your fingertips. WebTPA, medical claims administrator, and MedImpact, pharmacy benefit manager, both have secure online portals and mobile apps that allow you to manage your healthcare. Due to HIPAA (Health Insurance Portability and Accountability Act) that protects health information, both portals require that any spouse and/or dependent over age 18 will need to create their own account to view claims information.

lsufirst.webtpa.com – Members can create an online account with WebTPA. Once registered, the WebTPA portal allows members to track their HRA, deductible, and out-of-pocket balances, view claims, and print ID cards. Note that any spouse and/or dependents over the age of 18 will need to have their own account to view claims information.

medimpact.com – Members can create an online account with MedImpact. Once registered, members can look on prescription drug coverage, drug costs, compare prices for medications, view medication history, and find an in-network pharmacy.