2022 Plan Year
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 2022 Plan Year runs on a calendar year, from January 1- December 31. All Health Reimbursement Accounts (HRAs), remaining 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.
LSU First will offer a $25 a month wellness credit for employees who meet certain requirements. Please see the Wellness Credit webpage for more information.
All members will receive a new ID card for the 2022 Plan Year. To ensure LSU First has correct contact information on all members, please review your contact information, including mailing address and phone number, on file with your Human Resource Management (HRM) office.
HighCare will replace eQ Health. They will provide care coordination services and help educate members on various health conditions.
LSU First will implement a penalty for certain services performed in a hospital setting. There will be no penalty associated with these services if they are received outside of a hospital setting, such as a free-standing surgery or imaging center or at a doctor’s office. The penalty is similar to a copay but does not accrue to a member’s out-of-pocket maximum.
- $150 penalty for CT scan and/or MRI performed in a hospital setting
- No penalty if performed at free-standing imaging center
- To find a free-standing imaging center, search network by specialty
- First Choice and Verity - “Imaging Center” or “Laboratory”
- Aetna ASA – “Labs and Testing”
- $300 penalty for outpatient surgery performed in a hospital setting
- No penalty if performed at ambulatory surgery center
- To find an ambulatory surgery center, search network by specialty
- First Choice and Verity - “Surgery Center”
- Aetna ASA – “Outpatient Treatment and Facilities”
LSU First members will have the option of receiving a 90-day (3-month) supply of maintenance medications not only by mail order, but also at multiple retail pharmacies nationwide, including CVS, Walgreens, and Wal-Mart, through Choice90 program. Members will still have the option to have maintenance medication delivered through mail order with MedImpact Direct.
LSU First will have a tiered premium increase with an average increase of 3.8%. Please see the 2022 Premiums for Active Employees for a list of LSU First premiums.
* The below fees 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)
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 - 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.
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.
2022 HEALTH PLAN PREMIUMS
Retirees may continue medical coverage upon retirement if eligibility requirements for age and years of service under TRSL or LASERS are met. Learn more about determining the state's subsidy of a retiree's premium here.