Administered by WebTPA and MedImpact
LSU First offers members access to 100% coverage with First Choice providers and Tier 1 generic prescriptions. This means that members will not incur any out-of-pocket expenses for covered services from First Choice Providers* and/or Tier 1 generic prescriptions. LSU First also includes an employer-paid health reimbursement account (HRA) that is used for covered medical 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. For new enrollees, both the HRA and the deductible are prorated based on the remaining number of months in the plan year.
The Plan Year runs on a calendar year, from January 1 - December 31. All Health Reimbursement Accounts (HRAs), 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.
* The fees below 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 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.
The LSU First Health Plan utilizes a 4-tier formulary, managed by MedImpact, that helps members select the most appropriate, lowest-cost medication options. The formulary is reviewed quarterly to reassess drug tiers based on the current prescription drug market. The amount you pay towards prescriptions depends on the tier the drug falls within and the cost of the medication. Beginning January 1, 2023, the HRA and Deductible do not apply to prescriptions.
- Tier 1 Generic —Tier 1 Generic medications are covered at 100%. You owe $0 for these medications.
- Tier 2 Preferred Brand — Tier 2 Preferred Brand medications are often less expensive than Non-Preferred Brands, which can save you money. They are covered at 80%. You are responsible for 20%, up to a maximum of $150 for a 30-day supply.
- Tier 3 Non-Preferred Brand — Tier 3 Non-Preferred Brand medications are covered at 80% . You are responsible for 20%, up to a maximum of $150 for a 30-day supply.
- Tier 4 Specialty — Tier 4 Specialty medications are covered at 80% with no HRA or Deductible. You are responsible for 20%, up to a maximum of $150 for a 30-day supply.
LSU First members have the option of receiving a 90-day supply of maintenance medications by mail order through MedImpact Direct or through multiple retail pharmacies nationwide, including CVS, Walgreens, and Wal-Mart, through MedImpact’s Choice90 program.
LSU First puts access at your fingertips. WebTPA, medical claims administrator, and MedImpact, pharmacy benefit manager, both have secure online portals and mobile apps that allow you to manage your healthcare. Due to HIPAA (Health Insurance Portability and Accountability Act) that protects health information, both portals require that any spouse and/or dependent over age 18 will need to create their own account to view claims information.
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.
LSU First is expanding the wellness credit for the 2024 Plan Year to include covered spouses! Employees with Employee + Spouse or Family coverage will be eligible for an additional $10/month premium credit.
To qualify or to continue the $25/month premium wellness credit ($35/month for those with a covered spouse) for the 2024 plan year, the following requirements must be met:
- Continue to be enrolled in LSU First for the 2023 and 2024 plan years.
- Employee and covered spouse (if applicable) must have a preventive visit with a Primary Care Physician (PCP) that includes biometric screening (height, weight, BMI, and blood pressure) and preventive lab work that includes a basic metabolic panel between November 1, 2022 and October 31, 2023.
- Active participation in care coordination, if identified as a candidate by HighCare, is required to maintain the wellness credit. Plan members will be contacted directly by the care coordination team through HighCare. In order to maintain the wellness credit for the duration of 2024, the employee and covered spouse (if applicable) must actively participate in care coordination if contacted by HighCare.
LSU First participants who do not complete the criteria for a Wellness Credit within the designated timeframe will not be eligible for the wellness credit for the 2024 plan year. Both the employee and spouse must meet the requirements to qualify for the credit. If either the employee or covered spouse fails to meet the requirements to qualify for the wellness credit, no premium credit will be awarded.
LSU First reserves the right to alter requirements of the wellness credit each plan year. The wellness credit does not apply to covered child(ren) or to the LSU First Medicare Retiree Plan.
Need a replacement ID card?
To print a temporary LSU First health insurance card go to lsufirst.webtpa.com. You will need to register for an account. Complete the required section with the member information to create an account. Then click on print/view temporary card.
*Please verify the address shown on the online account is correct, including apartment numbers. If the address or any other information is incorrect, please contact our office for assistance.
Need to file a claim?
At times you may have to pay out of pocket for medical services or prescriptions, particularly if you have received services from a non-network provider. In the event that you do pay out of pocket for services, you can be reimbursed for these services. You will need to complete and submit a claim form and a copy of the invoice to LSU First will then reimburse you according to the plan's guidelines.
HIPAA Release Form
Authorization for Release of Protected Health Information: HIPAA Form - Authorizing the use and disclosure of protected health information to an individual other than member.
433 Bolivar Street, 6th Floor
New Orleans, Louisiana 70112
Fax: (504) 568-2212