Frequently Asked Questions
LSU First is a self-funded health plan offered to full-time employees of the LSU System and the Louisiana Legislative Branches, comprised of the House of Representatives, the Senate, the Office of the Legislative Auditor, the Legislative Fiscal Office and the Legislative Budgetary Control Council. LSU is financially responsible for paying all claims. Being self-funded allows LSU First to customize and control the plan design, cost and utilization, and wellness programs and incentives.
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 the 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.
*$150 Emergency Room Copay, waived if admitted.
*$150 penalty for CT scan and/or MRI performed in a hospital setting. No penalty if performed at free-standing imaging center. Exclusions may apply.
*$300 penalty for outpatient surgery performed in a hospital setting. No penalty if performed at ambulatory surgery center. Exclusions may apply
Active Employees - your employer pays 75% of your health insurance premium. You are responsible for 25%. For a listing of the 2022 premiums, please see the 2022 Health Plan Premiums.
Retired Employees – premiums for retirees who began participation on or after January 1, 2002 are based on the number of years within an Office of Group Benefits (including LSU First) health plan. Employees with continuous coverage prior to 2002 through their retirement are grandfathered into the 75% premium category.
|Years of Participation||Percentage of Premium||2022 Premiums|
|Less than 10 years||19% of premium paid by State||2022- 19%|
|10 years or more, but less than 15 years||38% of premium paid by State||2022 - 38%|
|15 years or more, but less than 20 years||56% of premium paid by State||2022 - 56%|
|20 years or more||75% of premium paid by State||2022 - 75%|
Contact information is provided to LSU First by your HRM department. Please contact them to make any updates to your address or other contact information (phone, email, etc).
You can log into the WebTPA portal or mobile app to obtain a digital copy of your ID card. You can also request a new ID card be mailed to your home address. Please verify that your address is correct in the system before ordering. If you do not have a WebTPA portal account, you can create one at webtpa.com. You may also call Customer Service or email email@example.com for a digital or mailed copy.
The plan-wide policy information along with you unique Member ID number allows you to seek services if you do not have your ID card available.
- Policy Number: LSUFIRST
- RxBIN: 003585
- RxPCN: ASPROD1
- RxGRP: LSU01
Care Coordination, provided by HighCare Health, provides personalized assistance to help eliminate barriers to health and well-being. The team works directly with members and their Primary Care Providers (PCPs) to identify, understand, and take control of health risks and chronic diseases. For more information on this free service, please see the Care Coordination flyer or contact them directly at 844-218-8740.
Prior authorization is an evidence-based medical management tool that helps ensure patients receive optimal care. Providers must submit documentation to LSU First to provide evidence that certain services are medically necessary. This also helps to identify those who may benefit from care coordination. A list of services that require prior authorization can be found in the Summary Plan Document (SPD).
Those eligible for LSU First are:
- A full-time Employee of the Louisiana State University (“full-time Employee” means a person employed at 75% effort or greater per pay period (average 30 hours per week), with an appointment of more than 120 days or one academic semester).
- A full-time Employee, member, or officer of the Louisiana Legislative Branch, comprised of the House of Representatives, the Senate, the Office of the Legislative Auditor, the Legislative Fiscal Office and the Legislative Budgetary Control Council.
In all cases, eligibility determinations shall be made in accordance with the applicable statutory and regulatory provisions of the Office of Group Benefits.
To enroll in LSU First, you must contact your Human Resource Management (HRM) department. They will assist you in completing the enrollment process and send the information to LSU First on your behalf.
You can add or delete dependents or cancel coverage during Annual Enrollment or with a Qualified Life Event. You are required to bring original dependent verification documents (marriage license, birth certificate, etc) within the first 30 days of a qualifying event in order to add your dependents. Please contact your Human Resource Management department for further instruction.
A Qualifying Life Event (QLE) is a term that describes events that allow you to make changes to your coverage. This includes getting married, having or adopting a baby, or gaining/losing health coverage. You must have a QLE to make changes to your coverage outside of Annual Enrollment. You have 30 days from the date of the QLE to make the changes. If changes are not made within 30 days, you must wait until Annual Enrollment.
Retirees who are eligible for Medicare must enroll in Medicare Part A and Part B. Part D drug coverage is not required. You must provide your HRM department with a copy of your Medicare card. They will submit it to LSU First so claims will adjudicate appropriately.
Active employees over the age of 65 are encouraged to enroll in premium-free Part A but are not required to enroll in Part B while actively employed. LSU First will remain primary while you are an active employee over age 65.
LSU First funds 100% of your HRA at the beginning of each Plan Year (January 1). The HRA pays for 100% of covered medical expenses and prescription drugs until the HRA is exhausted. The amount of your HRA is based on your level of coverage and the effective date of your coverage. The below chart shows the HRA for a full plan year (January -December). Please see the proration grid for HRA and remaining deductible amounts if coverage is effective in the middle of the plan year.
|Employee + Spouse||$1,500|
|Employee + Child(ren)||$1,500|
Yes, any balance in your HRA at the end of the Plan Year will be rolled over to the next Plan Year up to a maximum combined total of current year and rollover amounts (see chart below). Rollover funds will be used to pay for all covered medical and pharmacy expenses, including First Choice Providers and non-specialty generic drugs. Your combined total HRA Rollover and new allocations of HRA may not exceed the following amounts in a Plan Year:
|Employee + Spouse||$3,000|
|Employee + Child(ren)||$3,000|
The deductible includes your HRA (employer-paid funds) and your remaining deductible (member responsibility portion). The amount of your deductible is based on your level of coverage and the effective date of your coverage. The below chart shows the HRA and remaining deductible for a full plan year (January -December). Please see the proration grid for HRA and deductible amounts if coverage is effective in the middle of the plan year.
|Coverage Plan||HRA||Remaining Deductible|
|Employee + Spouse||$1,500||$750|
|Employee + Child(ren)||$1,500||$750|
First Choice providers are a Louisiana network of providers that have met certain established standards and who have agreed to accept certain fixed fee payments from the plan for covered expenses that results in them being paid in full by LSU First. This means that First Choice providers are covered at 100% after your HRA is exhausted. You do not need to meet your remaining deductible, resulting in no out-of-pocket costs for you.
Note there are some exceptions, such as the Emergency Room copay and the Outpatient Surgery and Imaging (CT Scans/MRI) penalties.
Verity HealthNet and Aetna ASA providers are In-Network providers. The Verity network is mostly Louisiana-based while the Aetna network provides nationwide coverage. Unlike First Choice providers, you must meet your remaining deductible for the Verity or Aetna networks. Once your HRA is exhausted and your remaining deductible is met, LSU First will pay 80%, you are responsible for 20%.
Providers not participating in the First Choice, Verity HealthNet, or Aetna ASA networks will be considered Out-of-Network. This may include ancillary services received at in-network facilities, such as radiology, anesthesiology, etc. After your HRA is exhausted and you meet your deductible, the Plan pays 60% of eligible out-of-network charges; you pay the remaining 40% and anything over the Maximum Allowable Charge (MAC).
Generic medications are covered at 100% after the HRA is exhausted. You do not need to meet your remaining deductible, resulting in no out-of-pocket costs for you.
Brand name and specialty medications are covered at 80% after the HRA is exhausted and the remaining deductible is met. Members are responsible for 20% of the drug cost, up to a maximum of $150 for a 30-day supply.
|Prescription Coverage||Member Responsibility for 30-day supply|
|Tier 1 - Generic||Covered at 100%; $0 after HRA|
|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|
LSU First utilizes the MedImpact Preferred Formulary. The formulary is subject to change every quarter. You can review the formulary through the Formulary Look Up Tool.
Expenses for care or treatment received outside of the United States or its territories, except for unexpected emergency situations while traveling, are excluded. For emergent care in other countries, you will need to pay your bill and submit it to WebTPA for reimbursement pursuant to applicable Plan provisions. We recommend you pay with a credit card as it automatically adjusts the amount to U.S. dollars.
An EOB details how a specific claim was processed, any member responsibility due, and the reasons for denying payment, if applicable. You may access your EOBs by creating an account or logging into webtpa.com. Due to HIPAA laws, members will not be able to see information on their spouse or dependent children over age 18. A HIPAA authorization form can be submitted to WebTPA for access.
An out-of-network provider is a health care provider that has not entered into a contract with one of the three networks used by LSU First (First Choice, Verity HealthNet, or Aetna ASA). Providers cannot be required to join a network, and without a network contract, LSU First cannot limit how much an out-of-network provider charges a patient. You should be aware that even if a facility such as a hospital or surgical center is in one of the LSU First networks, these facilities may employ or contract with providers including radiology, anesthesiology, pathology or emergency room physicians that do not contract with the same network(s).
To receive maximum financial benefits from your LSU First Plan and avoid unexpected costs, you must ensure that all of your healthcare providers are in one of the LSU First networks. If you are planning to receive services in a facility such as a hospital or surgical center, you should contact the facility’s admissions or billing department to find out the names of the physicians or physician groups that work in their facility. Before you receive services, you should confirm each provider’s network status by clicking on Search for Providers or by calling 855-346-5781.