LSU Health Sciences Center Human Resource Management
 

Premium Only  Plan

Under the provisions of Section 125 of the Internal Revenue Service Code (IRC), LSUHSC offers employees appointed to work a minimum of 30 hours (75%) or more per week the opportunity to participate in the Cafeteria Plan.

Participants may tax shelter (through pre-tax deductions) certain types of insurance premiums.  Your insurance premiums will automatically continue to be sheltered each year unless you request to drop out of the plan during the Annual Enrollment period.

Your decision to participate/not participate in this plan is irrevocable for the entire Flex Plan year.  You cannot change your decision during the plan year unless you experience a Qualifying Event and have an approved "Change in Status".  It is to your advantage to submit your change as soon as possible after the Qualifying Event occurs.  Retroactive changes/refunds are not allowed.  For example, if you get divorced in January, but do not submit an enrollment/change form until April, you will not be refunded the difference in premiums for the months from January-May even if you did not have coverage for your ex-spouse during those months.

Premiums which qualify for sheltering under the Cafeteria Plan are:

Please note:

  • Must enroll within 30 days of appointment date; or wait until October Annual Enrollment period.

  • The employee is responsible for initiating and completing the required forms to effect necessary changes.

Qualifying Events:

  • Marriage - Your spouse may be added to your coverage within 30 days of the marriage date, and the additional premium amount qualifies under the Cafeteria Plan.

  • Divorce - You must drop insurance on your spouse within 30 days of the divorce.  Legal separation does not qualify.  Children can be dropped for coverage if custody is awarded to the spouse.

  • Birth or adoption of child - Newborn or adopted children must be added within 30 days of the date of birth or adoption.

  • Death of a spouse or dependent - A deceased spouse or child must be deleted from coverage within 30 days of death.

  • Termination or commencement of coverage for employee, spouse or dependent (including strike or lockout) - may add or drop coverage within 30 days of event.

  • Change in eligibility of a dependent - (such as ineligible due to age, marriage, enlisting in the military) Over age children must be deleted from coverage within 30 days of ineligibility.  Never-married children through age 25 are eligible for coverage.

  • Change of spouse's employment status (full time to part time or vice versa).

  • Reduction or increase in employment hours.

  • Significant change in spouse's eligibility for health benefits (such as the first time offering insurance benefits).

  • Judgment or Order - May change coverage to provide/cancel coverage for your dependents child pursuant to a judgment, decree or order resulting from a divorce, legal separation, annulment or change in legal custody.

  • HIPAA Special Enrollment - If you decline enrollment for yourself and your dependents because of other coverage, you may in the future be able to enroll yourself and your dependents in this plan under special enrollment, provided you request enrollment within 30 days after your other coverage ends.  In addition, if you have a new dependent as a result of marriage, birth, adoption or placement for adoption, you may be able to add any and all eligible dependents to your coverage.

  • Medicare or Medicaid (gain or loss of eligibility) -  If employee, spouse or dependent becomes entitled to or lose eligibility under Medicare or Medicaid, coverage may add or delete coverage of the affected individual.

  • Unpaid Leave of Absence or Family and Medical Leave (FMLA) - If employee takes an unpaid leave under the FMLA, coverage can be cancelled.

  • Significant curtailment of coverage under a health plan - May revoke election if coverage is significantly curtailed or ceases during the year.

  • Change in place or residence or workplace - The change must affect your eligibility for coverage (example: You cannot drop health coverage merely because you moved, unless the move made you ineligible for a particular health benefit).

  • Significant increase in health plan premium rates.

  • Spouse's Annual Enrollment - You may make coverage changes to correspond with changes made by your spouse during their annual enrollment.  You must provide proof that changes were made and your changes cannot be effective prior to the effective date of changes made by your spouse.