Download Office of Group Benefits Health Plans

Pelican
HRA1000
Meeting Schedule
Active Employees and Retirees without Medicare
DATE
LOCATION
START TIME
October 1
R.W. Johnson Conference Center (Franklinton Primary School)
610 T.W. Barker Dr., Franklinton, LA 70438
10:00 AM
4:00 PM
October 6
BREC’s Independence Park Theater
7800 Independence Blvd., Baton Rouge, LA 70806
9:00 AM*
2:00 PM
October 6
Lake Charles Civic Center
900 Lakeshore Drive, Lake Charles, LA 70602
9:00 AM
2:00 PM
October 7
Bossier City Civic Center
620 Benton Road, Bossier City , LA 71111
9:00 AM
2:00 PM
October 13
West Monroe Civic Center
901 Ridge Ave., West Monroe, LA 71291
9:00 AM
2:00 PM
October 13
Greater Covington Center Fuhrmann Auditorium
317 N. Jefferson Ave., Covington, LA 70433
9:00 AM
2:00 PM
October 15
University of New Orleans (University Center Ballroom)
2000 Lakeshore Drive, New Orleans, LA 70148
9:00 AM
2:00 PM
October 19
Sai Hotel and Convention Center
2301 N. MacArthur Dr., Alexandria, LA 71301
9:00 AM
2:00 PM
October 20
Heymann Center
1373 South College Rd., Lafayette, LA 70503
9:00 AM
2:00 PM
October 20
Houma Civic Center (Rooms 1 and 2)
346 Civic Center Blvd., Houma, LA 70360
9:00 AM
2:00 PM
Pelican
HRA1000
Meeting Schedule
Retirees with Medicare
DATE
LOCATION
START
TIME
October 2
R.W. Johnson Conference Center (Franklinton Primary School)
610 T.W. Barker Dr., Franklinton, LA 70438
10:00 AM
4:00 PM
October 7
BREC’s Independence Park Theater
7800 Independence Blvd., Baton Rouge, LA 70806
9:00 AM*
2:00 PM
October 7
Lake Charles Civic Center (Contraband Room)
900 Lakeshore Drive, Lake Charles, LA 70602
9:00 AM
2:00 PM
October 8
Bossier City Civic Center
620 Benton Road, Bossier City , LA 71111
9:00 AM
2:00 PM
October 14
West Monroe Civic Center
901 Ridge Ave., West Monroe, LA 71291
9:00 AM
2:00 PM
October 14
Greater Covington Center Fuhrmann Auditorium
317 N. Jefferson Ave., Covington, LA 70433
9:00 AM
2:00 PM
October 16
University of New Orleans (University Center Ballroom)
2000 Lakeshore Drive, New Orleans, LA 70148
9:00 AM
2:00 PM
October 20
Sai Hotel and Convention Center
2301 N. MacArthur Dr., Alexandria, LA 71301
9:00 AM
2:00 PM
October 21
Heymann Center
1373 South College Rd., Lafayette, LA 70503
9:00 AM
2:00 PM
October 21
Houma - Terrebonne Civic Center
346 Civic Center Blvd., Houma, LA 70360
9:00 AM
2:00 PM
Pelican Plans
OGB’s Pelican benefit options offer low premiums,
in combination with employer contributions, to
create the most affordable options for enrollees in
2016.
Pelican plans offer coverage within the Blue Cross
and Blue Shield nationwide network, as well as
out-of-network coverage.
Pelican HRA1000
The Pelican HRA1000 includes $1,000 in annual employer
contributions for employee-only plans and $2,000 for family
plans in a health reimbursement arrangement that can be used
to offset deductibles and other out-of-pocket medical, not
pharmacy, costs throughout the year.
The HRA funds are available as long as you remain employed by
an OGB-participating employer. Any unused funds roll up to the
in-network, out-of-pocket maximum (see following chart),
allowing members to build up balances that cover eligible
medical expenses.
Pelican
HRA1000
Pelican HRA1000
Prescription Coverage
Medical Coverage
EmployeeOnly
Employer Contribution to
HRA
$1,000
Deductible (in-network)
$2,000
Deductible (out-ofnetwork)
Out-of-pocket max (innetwork)
Out-of-pocket max (outof-network)
Employee + 1
Employee
(Spouse or
+ Children
Child)
$2,000
Family
$2,000
$2,000
$4,000
$4,000
$4,000
$4,000
$8,000
$8,000
$8,000
$5,000
$10,000
$10,000
$10,000
$10,000
$20,000
$20,000
$20,000
Coinsurance (in-network)
20%
20%
20%
20%
Coinsurance (out-ofnetwork) *
40%
40%
40%
40%
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
*Once a member’s deductible for allowable is met, he or she will pay 40% of the allowable charge, plus 100% of the
difference between the allowable charge and billed amount.
Pelican HSA775
The Pelican HSA775 offers our lowest premium in addition to a
health savings account funded by both employers and
employees. Employers contribute $200, then match any
employee contributions up to $575. Employees can contribute
additional funds on a pre-tax basis, up to $3,350 for an individual
and $6,750 for a family, to cover out-of-pocket medical and
pharmacy costs.
Unused funds are rolled over every year with no limit. Unlike the
HRA option, the money in an HSA follows the member even if he
or she changes jobs or retires.
This plan is available to Active Employees only.
Pelican HSA775 (Active Employees only)
Medical Coverage
EmployeeOnly
Employer Contribution to
HSA
Deductible (in-network)
Employee +
1 (Spouse or
child)
Prescription Coverage
Employee +
Children
Family
$200, plus up to $575 more dollar-for-dollar match
of employee contributions
Tier
Member
Responsibility*
Generic
$10 co-pay
$2,000
$4,000
$4,000
$4,000
Preferred
$25 co-pay
$4,000
$8,000
$8,000
$8,000
Non-Preferred
$50 co-pay
$5,000
$10,000
$10,000
$10,000
Specialty
$50 co-pay
Out-of-pocket max (outof-network)
$10,000
$20,000
$20,000
$20,000
Coinsurance (in-network)
20%
20%
20%
20%
Coinsurance (out-ofnetwork)**
40%
40%
40%
40%
Deductible (out-ofnetwork)
Out-of-pocket max (innetwork)
*Subject to deductible and applicable copayment (except maintenance medications)
**Once a member’s deductible for allowable charges is met, he or she will pay 40% of the allowable charge, plus
100% of the difference between the allowable charge and billed amount.
HRA vs. HSA
HRA vs. HSA
Health Reimbursement Arrangement (HRA)
Health Savings Account (HSA)
Funding
Employer funds HRA
Employer and employee fund HSA
Funds stay with the employer if an employee leaves an
OGB-participating employer
Funds go with the employee when he/she leaves an OGBparticipating employer
Contributions are not taxable
Contributions are made on a pre-tax basis
Only employers may contribute
Employers or employees may contribute
Flexibility
Employer selects maximum contribution
IRS determines maximum contribution
Must be paired with the Pelican HRA1000
Must be paired with the Pelican HSA 775
Contributions are the same for each employee
Contributions are determined by employee and employer
May be used with a General-Purpose FSA
May be used only with a Limited-Purpose FSA
Simplicity
HRA claims processed by the claims administrator
Employee manages account and submits expenses to the
HSA trustee for reimbursement
IRS regulations and the Pelican HRA 1000 plan document
govern expenses, funding and participation
IRS regulations govern expenses, funding and participation
Eligible expenses
Can be used for medical expenses only
Can be used for pharmacy and medical expenses
Magnolia Local Plus
(Nationwide In-Network Providers)
The Magnolia Local Plus option offers the benefit of
nationwide in-network providers. The Local Plus plan
provides the predictability of co-payments rather than using
employer funding to offset out-of-pocket costs.
This plan provides care in the Blue Cross and Blue Shield
nationwide network. Out-of-network coverage is provided in
emergencies only and may be subject to balance billing.
Magnolia Local Plus
Active Employees and non-Medicare retirees – retirement date on or AFTER 3-1-2015
Medical Coverage
EmployeeOnly
Employee +
1 (Spouse
or Child)
Prescription Coverage
Employee +
Children
Family
Employer Contribution to
HRA/HSA
$0
$0
$0
$0
Deductible (in-network)
$400
$800
$1,200
$1,200
Deductible (out-of-network)
No coverage
No coverage No coverage No coverage
Out-of-pocket max (in-network)
$2,500
$5,000
Out-of-pocket max (out-ofnetwork)
No coverage
No coverage No coverage No coverage
$7,500
$25/$50
$7,500
Co-Payment (in-network)
$25 / $50
$25 / $50
$25/$50
Co-Payment (out-of-network)
No coverage
No coverage No coverage No coverage
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Magnolia Local Plus
non-Medicare retirees – retirement date BEFORE 3-1-2015
Medical Coverage
EmployeeOnly
Employee +
1 (Spouse
or Child)
Prescription Coverage
Employee +
Children
Family
Employer Contribution to
HRA/HSA
$0
Deductible (in-network)
$0
$0
Deductible (out-of-network)
No coverage
No coverage No coverage No coverage
$0
$0
$0
$3,000
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
$0
$0
Out-of-pocket max (in-network)
$1,000
$2,000
Out-of-pocket max (out-ofnetwork)
No coverage
No coverage No coverage No coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
Co-Payment (out-of-network)
No coverage
No coverage No coverage No coverage
$25/$50
Tier
$3,000
$25/$50
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Magnolia Open Access
(Nationwide Providers)
The Magnolia Open Access Plan offers coverage both inside and
outside of Blue Cross’s nationwide network. It differs from the other
Magnolia plans in that members enrolled in the open access plan will
not pay co-payments at physician visits. Instead, once a member’s
deductible for allowable charges is met, he or she will pay 10% of the
allowable amount for in-network care and 30% of the allowable amount
for out-of-network care. Out-of-network care may be balance billed.
Though the premiums for the open access plan are higher than OGB’s
other plans, its moderate deductibles combined with a nationwide
network make it an attractive plan for members who live out of state or
travel regularly.
Magnolia Open Access
Active Employees and non-Medicare retirees – retirement date on or AFTER 3-1-2015
Medical Coverage
EmployeeOnly
Employer Contribution to
HRA/HSA
Prescription Coverage
Employee
+1
Employee +
(Spouse or
Children
Child)
Family
Tier
Member
Responsibility
Generic
50% up to $30
$0
$0
$0
$0
Preferred
50% up to $55
Deductible (in-network)
$900
$1,800
$2,700
$2,700
Non-Preferred
65% up to $80
Deductible (out-of-network)
$900
$1,800
$2,700
$2,700
Specialty
50% up to $80
Out-of-pocket max (in-network)
$2,500
$5,000
$7,500
$7,500
Out-of-pocket max (out-ofnetwork)
$3,700
$7,500
$11,250
$11,250
Coinsurance(in-network)
10%
10%
10%
Coinsurance (out-of-network)
30%*
30%*
30%*
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
10%
Non-Preferred
$40 co-pay
30%*
Specialty
$40 co-pay
*Once a member’s deductible for allowable charges is met, he or she will pay 30% of the allowable
charge, plus 100% of the difference between the allowable charge and billed amount for out-ofnetwork care.
Magnolia Open Access
non-Medicare retirees – retirement date BEFORE 3-1-2015
Medical Coverage
EmployeeOnly
Employer Contribution to
HRA/HSA
Deductible (in & out-of-network)
Prescription Coverage
Employee
+1
Employee +
(Spouse or
Children
Child)
Family
Tier
Member
Responsibility
Generic
50% up to $30
$0
$0
$0
$0
Preferred
50% up to $55
$300
$600
$900
$900
Non-Preferred
65% up to $80
Specialty
50% up to $80
Out-of-pocket max (in-network)
$1,300 individual; plus $1,300 per additional person up
to 2; plus $1,00 per additional person up to 10 people;
$12,700 for a family of 12+
Out-of-pocket max (out-ofnetwork)
$3,300 individual; plus $3,000 per additional person up
to 2;$12,700 for a family of 4+
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Coinsurance(in-network)
10%
10%
10%
10%
Non-Preferred
$40 co-pay
Coinsurance (out-of-network)
30%*
30%*
30%*
30%*
Specialty
$40 co-pay
*Once a member’s deductible for allowable charges is met, he or she will pay 30% of the allowable
charge, plus 100% of the difference between the allowable charge and billed amount for out-ofnetwork care.
Magnolia Local
(Limited In-Network Provider Only Plan)
The Magnolia Local plan is a limited provider in-network only
plan for members who live in specific coverage areas. Out-ofnetwork coverage is provided in emergencies only and may be
subject to balance billing.
o Community Blue
Community Blue is a select, local network designed for members
who live in the parishes of East Baton Rouge, West Baton
Rouge, Ascension, Caddo and Bossier.
o BlueConnect
BlueConnect is a select, local network designed for members
who live in the parishes of Jefferson, Orleans and St. Tammany.
You must stay in your network when receiving care. Your
residence determines which Magnolia Local network you are
in.
Magnolia Local
Active Employees and non-Medicare retirees – retirement date on or AFTER 3-1-2015
Medical Coverage
Prescription Coverage
EmployeeOnly
Employee
+1
(Spouse or
Child)
Employee
+ Children
Employer Contribution to
HRA/HSA
$0
$0
$0
$0
Deductible (in-network)
$400
$800
$1,200
$1,200
Deductible (out-of-network)
No
coverage
No
coverage
No
coverage
No
coverage
Out-of-pocket max (in-network)
$2,500
$5,000
$7,500
$7,500
Out-of-pocket max (out-ofnetwork)
No
coverage
No
coverage
No
coverage
No
coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
Co-Payment (out-of-network)
No
coverage
No
coverage
$25/$50
No
coverage
Family
$25/$50
No
coverage
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Magnolia Local
non-Medicare retirees – retirement date BEFORE 3-1-2015
Medical Coverage
Prescription Coverage
EmployeeOnly
Employee
+1
(Spouse or
Child)
Employee
+ Children
Employer Contribution to
HRA/HSA
$0
$0
$0
$0
Deductible (in-network)
$0
$0
$0
$0
Deductible (out-of-network)
No
coverage
No
coverage
No
coverage
No
coverage
Out-of-pocket max (in-network)
$1,000
$2,000
$3,000
$3,000
Out-of-pocket max (out-ofnetwork)
No
coverage
No
coverage
No
coverage
No
coverage
Co-Payment (in-network)
$25 / $50
$25 / $50
Co-Payment (out-of-network)
No
coverage
No
coverage
$25/$50
No
coverage
Family
$25/$50
No
coverage
Tier
Member
Responsibility
Generic
50% up to $30
Preferred
50% up to $55
Non-Preferred
65% up to $80
Specialty
50% up to $80
Once you pay $1,500:
Generic
$0 co-pay
Preferred
$20 co-pay
Non-Preferred
$40 co-pay
Specialty
$40 co-pay
Vantage Medical Home HMO
Vantage Medical Home HMO is a patient-centered
approach to providing cost-effective and comprehensive
primary health care for children, youth and adults. This plan
creates partnerships between the individual patient and his
or her personal physician and, when appropriate, the
patient’s family. This plan includes a preferred provider
network, Affinity Health Network (AHN), which has lower
co-payments for certain covered services as indicated by
“AHN.” This plan also includes Out-of-Network coverage.
Vantage Medical Home HMO
Medical Coverage
Deductible (Tier I)
Deductible (Tier II & Out-of-Network)
$400
$1,500
Employee +1
(Spouse or
child)
$800
$3,000
Out-of-pocket max (Tier I)
$2,500
$5,000
$5,000
$7,500
Out-of-pocket max (Tier II & Out-of-Network) Unlimited
Unlimited
Unlimited
Unlimited
Co-Payment PCP (Tier I)
$10 AHN/$20
$10 AHN/$20
$10 AHN/$20
$10 AHN/$20
Co-Payment Specialist (Tier I)
$35 AHN/$45
$35 AHN/$45
$35 AHN/$45
$35 AHN/$45
EmployeeOnly
Employee +
Children
Family
$1,200
$4,500
$1,200
$4,500
Coinsurance – PCP (Out-of-Network)
50% coverage; subject to out-of-network deductible
Coinsurance – Specialist (Out-of-Network)
50% coverage; subject to out-of-network deductible
Prescription Coverage
Tier
Tier 1 Preferred Generics
Tier 2 Non-Preferred
Generics
Tier 3 Preferred Brand
Tier 4 Non-Preferred
Brand
Tier 5 Specialty
Member
Responsibility
$5
$20
Tier I Providers
Members seeing Tier I providers pay the Tier I co-pays, co-insurance and
deductibles as listed in the Certificate of Coverage and Cost Share Schedule.
Tier I consists of two networks:
•
A preferred provider network, Affinity Health Network (AHN), which has
lower co-payments for certain covered services; and
•
A standard provider network
$50
$80
$150
Tier II Providers
Members who chose to see these providers will have to pay an additional
20% coinsurance in addition to their Tier I cost share, after the applicable
deductible is met.
Retiree Plans
OGB retirees with Medicare have several additional options available to
them. Retirees who have Medicare Part A and Part B coverage can
select from four-OGB sponsored Medicare Advantage plans: the
Peoples Health HMO-POS; the Vantage Premium HMO-POS; the
Vantage HMO-POS; and the Vantage Zero-Premium HMO-POS. They
can also choose a Medicare Advantage plan through OneExchange
(formerly Extend Health) and be enrolled in a health reimbursement
arrangement (HRA) receiving HRA credits of $200 to $300 per month.
Retirees can also select from five OGB plans during annual enrollment:
the Pelican HRA1000 and the Magnolia plans, administered by Blue
Cross and Blue Shield of Louisiana, and the Vantage Medical Home
HMO plan. These plans will be secondary to Medicare.
Individual Medicare Plans through
Sampling of plans available through
OneExchange
OneExchange: Customize your insurance
Towers Watson's OneExchange is an Individual Medicare Market Exchange
offered to OGB retirees and spouses who have Medicare Parts A and B.
OneExchange offers a variety medical, prescription drug, and dental plans
based on an individual's provider preferences, prescription drug needs,
geographic location and medical conditions. These plans may include Medicare
Advantage, Medicare Supplement (or Medigap) and Medicare Part D
Prescription Drug coverage.
Plan Advice and Enrollment Assistance
OneExchange gives you access to licensed benefit advisors and online tools
combined with comprehensive knowledge of the Medicare market. Licensed
benefit advisors are available to assist you before, during and after enrollment.
You can contact benefit advisors at (855) 663-4228, Monday through Friday
from 8:00 a.m. until 8:00 p.m. central standard time.
OneExchange Health Reimbursement Arrangement (HRA)
Retirees enrolled in a medical plan through OneExchange receive a Health
Reimbursement Arrangement. The OneExchange HRA allows for tax-free
reimbursement of qualifying medical expenses to the extent that funds are
available in the HRA account. A single retiree will receive HRA credits of $200
per month and a retiree plus spouse will receive HRA credits of $300 per month
from the agency you retired.
Compare Plans
OneExchange offers a variety of tools to help you compare insurance plans and
premiums. They also offer a Prescription Profiler™ that uses your current and
projected medication expenses to determine which plans will have the lowest
estimated annual out-of-pocket cost.
For a complete list of plans and providers visit:
medicare.oneexchange.com/ogb or call OneExchange at
1-855-663-4228.
OneExchange
Peoples Health
Medicare Advantage
The Peoples Health Medicare Advantage plan offers much more than
Medicare, with extra benefits like vision and dental coverage, free health club
membership and prescription drug coverage. As a Peoples Health Group
Medicare member, retirees pay a premium in addition to paying their Medicare
Part B premium; retirees receive 100 percent coverage for many services with
NO Medicare deductibles.
COVERED BENEFIT
PEOPLES HEALTH HMO-POS
PLAN YEAR DEDUCTIBLE $0
MAXIMUM OUT-OF-POCKET EXPENSE (IN-NETWORK) $2,500
MAXIMUM OUT-OF-POCKET EXPENSE (OUT-OF-NETWORK) 20%
OFFICE VISIT - PRIMARY CARE / SPECIALIST $5 / $10 co-pay per visit
EMERGENCY ROOM $50 ER co-pay per visit
INPATIENT HOSPITAL $50 per day (days 1-10)
PRESCRIPTION DRUGS (PART D)
Preferred Generics

$0 co-pay
Non-Preferred Generics

$0 co-pay
Preferred Brand

$20 co-pay (30-day supply)
Non-Preferred Brand

$40 co-pay (30-day supply)
Specialty

20%
Vantage Health Plan
Medicare Advantage
For retirees who are 65 and over, Vantage offers several great Medicare Advantage
plans as an alternative to Medicare. One benefit to Vantage’s Medicare Advantage
plans is that a network of providers is already contracted with the plan throughout
Louisiana. These physicians, hospitals and specialty medical facilities have already
agreed to provide health care services to treat Medicare Advantage members.
COVERED BENEFIT
Vantage Premium HMO-POS
VANTAGE POS PLAN
VANTAGE ZERO-PREMIUM HMO-POS
N/A
$2,000
N/A
$3,000
N/A
$6,700
$5/$20 co-pay per visit or
$0/$10 AHN co-pay per visit
$10/$40 co-pay per visit or
$0/$30 AHN co-pay per visit
$15/$50 co-pay per visit or
$5/$40 AHN co-pay per visit
EMERGENCY ROOM
$50 co-pay per visit;
worldwide coverage
$75 ER co-pay per visit worldwide coverage
$75 ER co-pay per visit - worldwide
coverage
INPATIENT HOSPITAL
$50/per day (days 1-10)
$300/day (days 1-5)
$345/day (days 1-5)
$5 co-pay
$10 co-pay
$25 co-pay
$50 co-pay
20% coinsurance
$4 co-pay
$10 co-pay
$47 co-pay
$100 co-pay
33% coinsurance
PLAN YEAR DEDUCTIBLE
MAXIMUM OUT-OF-POCKET EXPENSE
OFFICE VISIT
PRIMARY CARE / SPECIALIST
PRESCRIPTION DRUGS (PART D)
Tier 1 – Preferred Generics
Tier 2 – Non-Preferred Generics
Tier 3 – Preferred Brand
Tier 4 – Non-Preferred Brand
Tier 5 – Specialty
$4 co-pay
$10 co-pay
$47 co-pay
$100 co-pay (after $125 deductible)
25% coinsurance (after $125
deductible)
Dependents
The following people can be enrolled as dependents:
• Legal spouse
• Children until they reach age 26
Children are defined as:
• Natural child of plan member or Spouse
• Legally adopted child or child placed for adoption
• Child under court ordered custody or court ordered legal
guardianship (two participating plan members cannot
cover the same dependent)
Dependents
To add a newborn as a dependent, the member must
provide human resources with a birth certificate or a
copy of the birth letter within 30 days of the child’s birth
date.
The birth letter will suffice as proof of parentage only if it
contains the relationship of the child and the employee.
If the birth certificate or birth letter is not received
within 30 days, enrollment cannot take place until
the next annual enrollment period*.
* Subject to Plan exceptions
Dependent Verification
Members must provide human resources with proof of the
legal relationship of each newly eligible dependent. Without
that documentation, enrollment cannot be completed.
Acceptable documents include:
• Marriage Certificate
• Birth letter or birth certificate
• Legal adoption or placement for adoption papers, court
ordered custody papers or court ordered legal
guardianship papers, if applicable.
Human Resources must verify the eligibility of newly
eligible dependents.
Retirees
• OGB coverage must be in effect immediately prior to a member’s
retirement to be eligible for retiree coverage. If the member started
participation or rejoined state service on or after January 1, 2002, the
state contribution of their premium is based on the number of
participation years in an OGB health plan. This also applies to
surviving spouse who started coverage after July 1, 2002.
• The participation schedule below shows the number of years a
member must participate in an OGB health plan to receive a specified
state contribution.
Retiree Participation Schedule
Years of OGB Plan Participation
State’s Share of Total Monthly Premium
20 years or more
75 percent
15 years but less than 20 years
56 percent
10 years but less than 15 years
38 percent
less than 10 years
19 percent
Retirees – Medicare Eligibility
If a retiree or the covered spouse of a retiree is eligible for premium-free
Medicare Part A (hospitalization insurance), he or she MUST ALSO enroll
in Medicare Part B (medical insurance) to receive OGB benefits on
Medicare Part B claims
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•
•
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If the above applies to the member or covered spouse, he or she should visit
the local Social Security office to enroll for Medicare Part B coverage at least
3 months before his or her 65th birthday.
This does not apply to anyone who reached age 65 before July 1, 2005
If the plan member is retired but has not yet reached age 65, this will apply to
the member when he or she reaches age 65.
If the member reached age 65 on or after July 1, 2005, but has not retired,
this will apply to the member when he or she retires.
This applies to the member and covered spouse regardless of whether each
has individual Medicare eligibility (under his/her own Social Security number)
or one person is eligible as the dependent of another person.
Retirees should bring the name(s) and social security number(s) of previous
spouses (divorced or deceased spouse) so that Social Security can
determine which spouse they may qualify under.
Sponsored by Blue Cross
and Blue Shield of Louisiana
• Provides resources to help monitor health, understand risk
factors, make educated choices that can prevent illness &
manage health conditions
• Complete two steps to qualify for annual premium discount:
1. Schedule a wellness checkup through Catapult Health or
see your MD for wellness visit and submit completed
Primary Care Provider form
2. Fill out Personal Health Assessment online survey at
www.bcbsla.com/OGB
• Participation information on the 2016 plan year will be
forthcoming
Contact Information
Blue Cross Blue Shield of Louisiana
 1-800-392-4089
 www.bcbsla.com/ogb
Peoples Health
 1-866-912-8304
 www.peopleshealth.com
MedImpact/Medicare Generations Rx
 1-800-788-2949
 https://mp.medimpact.com/ogb
 1-877-633-7943
 www.medicaregenerationrx.com/ogb
Vantage Health Plan
 1-888-823-1910
 www.vhp-stategroup.com
OneExchange
1-855-663-4228
medicare.oneexchange.com/ogb
Discovery Benefits
 1-866-451-3399
 www.discoverybenefits.com
SUPPLEMENTAL RETIREMENT PLANS
– 457 – DEFERRED COMP
– 403B – FIDELITY, METLIFE, TIAA-CREF, VALIC &
VOYA
– CAN ENROLL AT ANY TIME.
INCREASE/DECREASE/STOP DEDUCTS AT ANY
TIME.
– EXCELLENT WAY TO SAY ADDITIONAL MONEY FOR
RETIREMENT.
THINGS TO REMEMBER
LSU FIRST AND VOLUNTARY PLANS – ENROLLMENT ENDS 10/31/15
OGB PLANS - ENROLLMENT ENDS 11/15/15
ADDING/DELETING DEPENDENTS – USE PAPER FORM AND SUBMIT
MARRIAGE/BIRTH CERTIFICATE
FOREIGN DOCUMENTS MUST BE TRANSLATED PRIOR TO SUBMISSION
GRANDCHILDREN – ONLY COVERED WITH A COURT ORDERED CUSTODY OR
GUARDIANSHIP. CURRENT GRANDCHILDREN ARE GRANDFATHERED IN.
FLEX SPENDING ACCOUNTS REQUIRE A NEW ENROLLMENT FORM – MYLSU
ACCOUNT
UPDATE ADDRESS – LSU FIRST MEMBERS RECEIVE NEW CARDS
PREMIUMS ONLY PLAN (PRE-TAXED DEDUCTION) – IS NOW MANDATORY – MUST
HAVE QUALIFYING EVENT TO ADD/DELETE/CANCEL FOR ALL ELIGIBLE PLANS.
LSU FIRST MEMBERS – MAY NEED A NEW 90 DAY PRESCRIPTION IF YOU USE
MAILORDER