Forms and Resources
Forms
- LSU First Enrollment Form: GB-01
- Medical Claim Form (WebTPA)
- Prescription Drug Claim Form (MedImpact)
- First Choice Provider Nomination Form
- Aetna ASA Provider Nomination Form
- Medical Necessity Form
- WebTPA HIPAA Form
- MedImpact Rx HIPAA Form
- Certification of Adult Dependent Form
Resources
- 2020 Summary Plan Document
- 2020 LSU First Benefit Snapshot
- 2020 Summary of Benefits
- 2020 Premiums for Active Employees
- 2020 Premiums for Retirees
- Employee Assistance Program
- Guide to WebTPA’s Explanation of Benefits
- Proration Guide
- EQ Health Care Coordination
- HIPAA Privacy Practice Effective 12/01/2020
- Marketplace Notice
- Medicare Part D Notice
- Preventative Care Guidelines