Forms


LSU First Enrollment Form: GB-01
Medical Claim Form (WebTPA)
Citizens Rx Prescription Drug Claim Form
Citizens Rx Mail Order Prescription Delivery Registration Form
First Choice Provider Nomination Form
Aetna ASA Nomination Form
Medical Necessity Form
WebTPA HIPAA Form

Resources


2019 LSU First Benefit Snapshot
2019 Premiums for Active Employees
2019 Premiums for Retirees
2019 LSU First Preferred Drug List
2019 LSU First Specialty Drug List
2019 LSU First Prior Authorization Drug List
2019 LSU First Drug Exclusion List
2018 Benefit Snapshot
2018 Medical Premiums for Active Employees
2018 Medical Premiums for Retirees
2018 Drug Exclusions
2018 Preferred Formulary
Employee Assistance Program
Summary of Benefits Option 1
Summary of Benefits Option 2
Citizens Rx Diabetic Meter
Guide to WebTPA’s Explanation of Benefits
Proration Guide
EQ Health Care Coordination
Diabetes Monitoring
HIPAA Privacy Practice Effective 1/1/2017
Marketplace Notice
Medicare Part D Notice
Preventative Care Guidelines

LSU FIRST

Claim Support:

1-855-346-LSU1 (5781)

Escalated claim or pharmacy issues? Contact a Member Advocate:

225-906-1280 or 866-607-5325

Member Support:

225-578-8200

LSUFIRST@LSU.EDU

LSUFIRST.WEBTPA.COM

SEARCH FOR PROVIDERS

2018 LSU FIRST PLAN HIGHLIGHTS

Praxis Rx (home delivery pharmacy provider) phone ordering service can be reached at 813-374-6550. For questions about orders, please call 888-903-7453.