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Presentation Transcript

This presentation is a summary of information and does not purport to present complete details of all plan options offered by the Office of Group Benefits. For complete information on each plan option, individuals should read plan documents carefully and also consult other OGB and plan administrators’ publications.


This presentation will cover:

  • Ways to Save & Plan Changes
  • Eligibility
  • Overview of Health Plans
  • Flexible Benefits
  • Life Insurance
office of group benefits
Office of Group Benefits

Serving State Agencies, Universities & School Boards

Prescription Drugs




Mental Health Benefits


Medical Benefits


Life Insurance


Administrative costs are only 3.2% of total costs

(June 30, 2010)

annual enrollment timeline
Annual Enrollment Timeline

Annual Enrollment


Deadline for active employees

to submit Flexible Benefits

forms to HR

Last day of Special Enrollment for children under age 26

Deadline to submit

health plan enrollment forms

to HR if changing plans

New plan year begins

short plan year
Short Plan Year

To transition to a calendar year, the upcoming 2011 plan year will only be 6 months:

July 1, 2011 – December 31, 2011

  • Deductibles and out-of-pocket maximums in the PPO, HMO and Regional HMO will NOT reset on July 1, 2011
  • Deductible for CDHP-HSA will reset; however, the state will make a one-time contribution to HSA (in addition to usual contributions)in the amount of half of the deductible
  • Visit limitations will reset to the full amount on July 1, 2011

OGB will hold another Annual Enrollment in Fall 2011 for the 2012 plan year.

your health our priority 8 ways to save
Your Health: Our Priority8 Ways to Save
  • Choose Right Plan for You
  • Out-of-state coverage differs by plan
  • Out-of-state dependent, job transfer, travel
  • Are your providers in the plan?
  • All plans accessed through OGB website



  • Stay in Network
  • Avoid balanced billing


  • Pre-Procedure Checklist
  • Essential before surgery


  • Request Generic Drugs
  • Same chemical formulas and big savings
  • Preferred drug list at
your health our priority 8 ways to save9
Your Health: Our Priority8 Ways to Save
  • Get Preventive (Wellness) Exams
  • Prevention
  • Early diagnosis



  • Use Flexible Benefits
  • Pre-tax deduction saves money
  • Increases take-home pay
  • Sign Up for Diabetic Sense Program (PPO & HMO Blue Cross)
  • Get test supplies for free
  • 1.888.341.8582
  • Free glucometer
  • Provided by Catalyst Rx through Liberty


  • Sign Up for Living Well Louisiana Program
  • (PPO & HMO Blue Cross)
  • Access to health coaches, 24 hours a day, 7 days a week
  • 1.800.383.0115
  • Prescription drug incentive for active participants
  • Administered by Health Dialog


living well louisiana
Living Well Louisiana

Health Management Program

For PPO and HMO (Blue Cross) Health Plans

Administered by Health Dialog

Free health management program for active plan members (including rehired retirees without Medicare) diagnosed with 1 or more of these 5 ongoing health conditions:

  • Diabetes
  • Heart disease
  • Heart failure
  • Asthma
  • Chronic obstructive pulmonary disease (COPD)
living well louisiana13
Living Well Louisiana

Health Management Program

For PPO and HMO (Blue Cross) Health Plans

  • Once enrolled, you have access to...
    • Health coaches – 24 hours a day, 7 days a week
    • Online health information & resources
  • Reduced co-payments to eligible LWL participants for prescription drugs used to treat these 5 chronic conditions
  • When Medicare Part A and/or B become primary, you are no longer eligible for LWL program
living well louisiana14
Living Well Louisiana

Health Management Program

For PPO and HMO (Blue Cross) Health Plans

  • Active participation requires
    • Initial assessment by phone, and follow-up contacts by phone, mail or email
    • Ongoing relationship with LWL health coach (contact at least once every 3 months)
  • If plan member fails to maintain contact with health coaches, or if Medicare becomes plan member’s primary health coverage, participant is no longer eligible to participate in LWL program or receive reduced co-pay on applicable prescription drugs
premium cost saving strategies
Premium Cost-Saving Strategies

Married Couples

If both are state or schoolemployees...

  • Both eligible?
  • May save if split coverage
plan changes for july 1 2011
Plan Changes for July 1, 2011
  • Premium increase
  • Coverage expanded to include children up to age 26
  • No pre-existing condition (PEC) exclusion for individuals up to age 19
  • Preventive care (Wellness) paid at 100% (no cost sharing) if provided by a network provider; current wellness dollar limits no longer apply
  • Elimination of lifetime maximum ($5 million)
  • Mental health and substance abuse treatment benefits enhanced to comply with federal Mental Health Parity Act
  • Benefit added to PPO and HMO (Blue Cross) health plans for over-the-counter proton pump inhibitor (PPI) medications with a prescription
  • New administrator for mental health and substance abuse treatment is ValueOptions
children up to age 26 eligibility
Children Up to Age 26 Eligibility

Effective July 1, 2011, OGB is extending the age limit for dependent health coverage to children up to age 26, regardless of student, marital or tax status.

Special Enrollment

April 1 – July 31

Employees and retirees can enroll or re-enroll eligible children who had reached the previous maximum age during a Special Enrollment period from April 1 through July 31 for coverage effective July 1 with no pre-existing condition exclusion. Any such child enrolled after July 31 is considered a late applicant, and a pre-existing condition exclusion applies if the child is age 19 or older unless portability applies. Dependent verification required if not previously submitted.

children up to age 26 eligibility18
Children Up to Age 26 Eligibility

A child up to age 26 is eligible for re-enrollment if he or she:

  • Was a covered dependent by virtue of legal custody until coverage ended upon reaching age 18;
  • Was a covered dependent until coverage ended when he or she reached age 21;
  • Was a covered dependent until coverage ended when he or she reached age 24 or was no longer a full-time student;
  • Was a covered dependent until coverage ended when he or she married.

A covered child under age 26 who is or becomes incapable of self-sustaining employment is eligible to continue coverage as an overage dependent if OGB receives required medical documents verifying his or her incapacity before he or she reaches age 26.

The definition of incapacity has been broadened to include mental and physical incapacity.

no pec exclusions under age 19
No PEC Exclusions Under Age 19

Effective July 1, 2011, all individuals under age 19 are exempt from the pre-existing condition (PEC) exclusion.

This includes:

  • Employees
  • Verified dependents

*Any current PEC exclusions for those under age 19 expire June 30, 2011

preventive care benefits
Preventive Care Benefits

Effective July 1, 2011, preventive care (wellness) is covered at 100% (with no cost sharing) if provided by a network doctor or health care facility.

  • Preventive care benefit limits no longer apply.
  • Preventive care age and time restrictions remain the same.
  • Expanded list of preventive care benefits will be available on OGB’s website.
benefit for proton pump inhibitors ppi
Benefit for Proton Pump Inhibitors(PPI)

For PPO and HMO (Blue Cross) Health Plans Only

Effective July 1, 2011, the prescription drug benefit will be changed to allow benefits for over-the-counter PPIs (e.g. Prilosec OTC, Prevacid) as follows:

  • A physician prescription is required;
  • Member pays 50% of drug costs at point of purchase up to a maximum of $50 per 30-day supply.
eligibility same for all plans
Eligibility – Same for All Plans

Full-Time Employees and Dependents

  • Legal spouse
    • Louisiana does not recognize same-sex marriages regardless of other states’ laws
  • Children up to age 26 – employees can re-enroll children between the ages of 21 and 26 regardless of student status:
      • A child under 19 who was terminated due to loss of eligibility will not have a PEC exclusion;
      • A child for whom legal custody was obtained and who was terminated at age 18;
      • A dependent child of a covered dependent;
      • A dependent child who terminated due to marriage.
  • No one can be enrolled simultaneously as an employee and as a dependent under OGB health plans or life insurance, nor can a dependent be covered by more than one employee

Dependent verification required

eligibility change newborns
Eligibility Change - Newborns
  • Beginning July 1, 2011, the birth certificate MUST be received within 6 months from the date of birth.
  • The birth letter will suffice for the first 6 months only if received within 30 days of DOB.
  • A reminder letter will be sent 90 days after DOB.
eligibility children
Eligibility – Children
  • Natural child of you or your legal spouse
  • Legally adopted child
  • Child placed in home for adoption
  • Child in home under legal guardianship or custody
  • Grandchild dependent on you whose parent is your covered dependent

Dependent verification required

over age dependents
Over-Age Dependents
  • Incapable of self-sustaining employment (medical records required)
  • Covered dependent prior to age 26
  • OGB must receive medical records prior to dependent’s 26th birthday
dependent verification
Dependent Verification
  • Plan member must provide proof of the legal relationship of each dependent within 30 days of date of application for coverage
  • Proof: Official documents
      • Marriage certificate
      • Birth certificate
      • Other court records or legal documents
pre existing conditions new hires and late applicants
Pre-Existing ConditionsNew Hires and Late Applicants
  • Must complete enrollment form within 30 days for new dependent (otherwise, pre-existing condition exclusion applies) Does not apply to individuals under age 19
  • May be exempt from pre-existing condition limitation if continuously covered without 63-day break in coverage prior to enrollment date
  • If diagnosed or treated within 6 months prior to enrollment date, condition is pre-existing... no benefits payable for that condition in first 12 months of coverage
  • Coverage must be in effect prior to retirement date
  • Participation schedule applies to...
    • Employees who joined program on or after January 1, 2002
    • Dependents who joined program on or after July 1, 2002
retiree participation schedule
Retiree Participation Schedule

Schedule not affected when members change OGB plans

medicare and ogb coverage
Medicare and OGB Coverage

If you are retired and you reached age 65 on or after July 1, 2005, AND are eligible for free Medicare Part A, then…

  • You MUST enroll in Medicare Part B to receive OGB

health plan benefits for expenses covered under Part B

  • You must submit Social Security verification to OGB:
    • If eligible – submit copy of Medicare card
    • If not eligible – submit letter from Social Security

Also applies to active employee (and spouse) over age 65 at retirement

ogb health plans for 2011
OGB Health Plans for 2011

Medicare Advantage Plans availableduring

OGB’s Fall Enrollment

key points
Key Points
  • Can change health plans during Annual Enrollment
  • Compare costs, benefits and restrictions when choosing plan
  • Active employees and retirees who choose to keep same plan do not have to fill out a form
  • Active employees who want to change plans must notify HR department
key points36
Key Points
  • Retirees who want to change plans should…
    • Fill out GB-01 form…or
  • Write a letter and include
    • Your plan choice
    • Your name and address
    • Your date of birth
    • Your daytime phone number
  • Sign form or letter and mail to...

OGB Eligibility Department

P.O. Box 66678

Baton Rouge, LA 70896

    • ...or visit any OGB Agency Services office
plan member out of pocket expenses39
Plan Member Out-of-Pocket Expenses
  • * Plan member owes deductible, co-pay, co-insurance & balance of billed charges
    • ** No out-of-pocket maximum for non-network providers
prescription drug benefit ppo and hmo blue cross administered by catalyst rx
Prescription Drug BenefitPPO and HMO (Blue Cross), Administered by Catalyst RX

* OGB’s open formulary means EVERY prescription drug approved by the FDA is covered under the PPO and HMO (Blue Cross) health plans.

prescription drug benefit regional hmo administered by vhp s catalyst rx
Prescription Drug BenefitRegional HMO, Administered by VHP’s Catalyst RX

* Vantage Health Plan’s open formulary means prescription drugs not on their formulary list may be available at a higher cost-sharing

prescription drug benefit medical home hmo administered by vhp s catalyst rx
Prescription Drug BenefitMedical Home HMO, Administered by VHP’s Catalyst Rx

* Vantage Health Plan’s open formulary means prescription drugs not on their formulary list may be available at a higher cost-sharing

mental health substance abuse
Mental Health & Substance Abuse

1 Subject to plan year deductible and/or co-insurance

2 Pre-authorization required

ogb health savings account hsa
OGB Health Savings Account (HSA)
  • You cannot participate in the OGB HSA option if you have:
      • General-Purpose (Health Care) FSA or spouse has

General-Purpose (Health Care) FSA

      • Medical coverage under a non-CDHP
      • TRICARE or TRICARE for Life
      • Used any VA benefits within previous 3 months
      • Medicare Part A and/or Part B
    • You must participate in the OGB Consumer Driven Health Plan (CDHP) to participate in the Health Savings Account (HSA) option
health savings account hsa
Health Savings Account (HSA)

You can use your HSA to pay these eligible expenses:

  • Office visits (including deductibles and co-insurance)
  • Chiropractic services
  • Prescription drugs
  • Over-the-counter medications with a prescription
  • Dental expenses
  • Eye glasses, contact lenses and solutions
  • Eye surgery (including Lasik)
  • Lab fees
  • COBRA, Medicare and qualified long-term care premiums
health savings account hsa48
Health Savings Account (HSA)
  • State will make initial $100 deposit in your HSA
  • State will match your additional HSA contributions, dollar-for-dollar, up to $400 – if made through an IRS Section 125 cafeteria plan via payroll deduction
  • Reimbursement limited to current account balance
  • Total contribution limits for the calendar year:
    • $3,050 (individual coverage)
    • $6,150 (family coverage)
    • Can add $1,000 more if you are over age 55
health savings account hsa49
Health Savings Account (HSA)
  • For the six month period from July 2011 through December 2011, the employer contributes one-half of the deductible amount into the employee’s HSA.  Accordingly, here are the contribution amounts:
    • Single $625
    • Employee plus 1 $1,250
    • Employee plus 2 or more $1,500
  • These increased employer contributions should be billed to the employee’s agency in the first billing cycle of the new fiscal year or after the plan member opens the HSA through OptumHealth.
health savings account hsa50
Health Savings Account (HSA)
  • IRS “use-or-lose” rule does not apply
  • Funds can roll over from one plan year to the next
  • Money in your HSA grows tax-free
  • If you change health plans or jobs, or you retire, HSA is

yours to keep

  • From age 65 on, you can use your HSA dollars for any

health care or non-health care expense with no penalty

  • Decrease your taxable income
  • Use tax deferred dollars to pay for family household members NOT on your plan
unitedhealthcare consumer driven health plan cdhp hsa
UnitedHealthcare Consumer Driven Health Plan (CDHP) & HSA
  • UnitedHealthcare Consumer Driven Health Plan (CDHP) with Health Savings Account (HSA) option
    • The CDHP premium must be through an IRS Code Section 125 Cafeteria Plan (i.e. OGB’s Premium Conversion option).
  • Health Savings Account (HSA) eligibility
    • Current participants in a General-Purpose (Health Care) FSA must have a $0 balance on or before June 30 to be HSA-eligible on July 1; or
    • must have $0 balance on or before September 15 to be HSA-eligible on October 1.
premium conversion eligible ogb payroll deductions
Premium Conversion – Eligible OGB Payroll Deductions
  • PPO Plan (Office of Group Benefits)
  • HMO Plan (Blue Cross)
  • CDHP-HSA Plan (UnitedHealthcare)
  • Medical Home HMO (Vantage)
  • Regional HMO (Vantage)
  • Prudential Basic and/or Basic Plus Supplemental Term Life (employee only)
premium conversion eligible insurance deductions
Premium Conversion – Eligible Insurance Deductions
  • Cancer insurance deduction*
  • Dental insurance deduction
  • Hospital indemnity insurance deduction
  • Intensive care insurance deduction
  • Vision insurance deduction

*Policy can not have a cash value or a return of premium rider

fsa participation
FSA Participation

Employees can participate in Flexible Spending Arrangement:

  • General-Purpose (Health Care) FSA
  • Limited-Purpose (Dental & Vision) FSA
  • Dependent Care FSA

Even if they are...

    • Not enrolled in Premium Conversion option
    • Not enrolled in an OGB health plan
limited purpose fsa new option
Limited-Purpose FSA – New Option

Limited-Purpose (Dental & Vision) Flexible Spending Arrangement

  • Minimum amount $300; maximum amount $2,500;
  • Can be usedonly for dental and vision medical expenses;
  • Can be used in conjunction with a Health Savings Account; and
  • Cannot participate in both General-Purpose (Health Care) Flexible Spending Arrangement (GPFSA) and Limited-Purpose Flexible Spending Arrangement (LPFSA).
eligibility and enrollment rules
Eligibility and Enrollment Rules

General-Purpose FSA and Limited-Purpose FSA

  • Must be active, full-time employee (as defined by employer) in a participating payroll system
  • Must be continuously employed as active, full-time employee for at least 12 consecutive months from July 1, 2010, through June 30, 2011
  • Can enroll during Annual Enrollment or after experiencing an IRS qualified event
  • Must re-enroll each year to continue participation
new dependent coverage rule
New Dependent Coverage Rule

Reimbursement of eligible out-of-pocket

medical expenses for children up to age 26is

available through:

General-Purpose (Health Care) FSA


Limited-Purpose (Dental &Vision) FSA

dependent care fsa
Dependent Care FSA
  • For eligible dependent care expenses while you work
  • Submission of DCFSA claims can be reduced by signing up for DCFSA Recurring Expense Service
  • Reimbursement limited to current amount in account
  • Must re-enroll each year to continue participation
  • Minimum amount is $300
  • Must file an IRS Form 2441
dcfsa new rule
DCFSA – New Rule
  • Employees can use the remaining balance in their DCFSA, after termination of employment, while looking for work.
  • Claim reimbursement request must be submitted by October 30.
easy participation fsa card
Easy Participation… FSA card

mySource FSA card can be used to pay providers who accept MasterCard for eligible expenses…

    • General-Purpose (Health Care) FSA
    • Limited-Purpose (Dental and Vision) FSA
    • Dependent Care FSA expenses
  • Full amount of General-Purpose (Health Care) FSA funds available immediately (interest-free loan)
  • Full amount of Limited-Purpose (Dental and Vision) FSA funds available immediately (interest-free loan)
  • Dependent Care FSA funds available upon deposit
easy participation fsa card67
Easy Participation… FSA card
  • Fax receipts within 2 weeks upon request
  • No receipts needed for:
    • Hospitals
    • Physician Providers
    • Dental Providers
    • Vision Providers
  • Doctor’s prescriptions and receipts are needed for reimbursement of FSA-eligible over-the-counter drugs and medicines:
    • Albertsons
    • CVS Pharmacy
    • Kroger
    • Sam’s Club
    • Sav-A-Center
    • SuperFresh
    • Target
    • Walgreens
    • Walmart
    • Winn-Dixie
    • IPS
over the counter drugs and medicines
Over-the-Counter Drugs and Medicines*
  • Employees must have a doctor’s prescription to be reimbursed from General-Purpose Flexible Spending Arrangements (GPFSA) account for purchases of over-the-counter drugs and medications such as allergy and cold medicines, ointments and pain relievers. (Affordable Care Act of 2010)
  • Employees can continue to use the GPFSA mySource FSA card for purchases of non-medicine items such as bandages, reading glasses and diabetes monitoring supplies.
  • These rules are subject to change due to pending federal legislation.
grace period and run out period
Grace Period and Run-Out Period
  • Grace Period

January 1, 2012 – March 15, 2012

Employees can incur eligible expenses during this period to be paid with money remaining in FSA for immediately preceding plan year that ends December 31

  • Run-Out Period

March 16, 2012 – April 29, 2012

Must receive claims for reimbursement by April 29, 2012

flexible benefits key facts
Flexible Benefits – Key Facts
  • No fee for Premium Conversion option or Health Savings Account option
  • The Administrative Fee ($18 per account) applies to General-Purpose (health care) FSA, Limited-Purpose (dental and vision) FSA and Dependent Care FSA
  • “Use or lose” rule applies to all FSAs
  • Locked in for the Plan Year – except in case of qualifying event as defined by IRS
flexible benefits annual enrollment period
Flexible Benefits Annual Enrollment Period

Flexible Benefits

Annual Enrollment Period

April 1 to May 13

May vary by agency – check with your HR department

datapath administrative services
DataPath Administrative Services

Phone (toll-free):1.877.685.0655



life insurance
Life Insurance

Prudential Insurance Company of America

  • Group term life insurance plan
  • State pays half of premium for employees & retirees
  • Employee pays full premium for dependent life insurance
  • 25% reduction in coverage & appropriate reduction in premiums on July 1 after plan member reaches age 65 & age 70
life insurance77
Life Insurance
  • Accidental Death and Dismemberment (AD&D) benefits available to all active & retired employee covered under Basic or Basic Plus plan
  • Retirees over age 70 not eligible for AD&D
  • ALL inquiries & changes in life insurance must be made through your agency’s HR department
sources of information
Sources of Information
  • OGB Website Links to All Plans
  • OGB (PPO) – 1.800.272.8451
  • Blue Cross and Blue Shield of Louisiana (HMO) – 1.800.392.4089
  • Vantage Health Plan (Medical Home HMO and Regional HMO) – 1.888.823.1910
  • UnitedHealthcare (CDHP-HSA) – 1.888.393.6765
  • Catalyst Rx – 1.866.358.9530
  • Living Well Louisiana Program – 1.800.383.0115
  • Diabetic Sense Program – 1.877.852.3512
  • ValueOptions – 1.866.477.8208