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BLUE CROSS BLUE SHIELD OF LA

1-800-392-4089

VISIT BCBS

8:00 a.m. - 5:00 p.m.

Monday - Friday

EXPRESS SCRIPTS

1-866-781-7533

VISIT EXPRESS SCRIPTS

6:00 a.m.  11:00 p.m.

Seven days a week

HEALTHEQUITY, INC. ACCOUNT MENTORS

Toll free: 1-877-987-8123

EMAIL HEALTHEQUITY

24 hours/ 7 days a week

OGB

1-800-272-8451

VISIT OGB

8:00 a.m. - 4:30 p.m. 

Monday - Friday 

Pelican HSA 775       BCBS

Administered by Blue Cross Blue Shield of Louisiana and Express Scripts

The Office of Group Benefits offers multiple health plans, including the Pelican HSA 775.The claims administrator is Blue Cross and Blue Shield of Louisiana, while the pharmacy benefit manager is Express Scripts. It features lower premiums than Magnolia plans in exchange for higher deductibles. The Pelican HSA 775 utilizes the Blue Cross and Blue Shield of Louisiana Preferred Care Providers and Blue Cross National Providers Networks. Note that this plan is only available to Active employees. Retirees are not eligible to participate in a Health Savings Account (HSA).

Health Savings Account (HSA)

The Pelican HSA 775 Plan is a high deductible health plan which may be used in conjunction with a HSA for those eligible to participate in such an account. Eligibility to participate in and contribute to a HSA must be met on a monthly basis. It is your responsibility to ensure that you are eligible to maintain an HSA. The below factors affect your eligibility to participate in and/or make contributions to an HSA:

  • Neither you nor your spouse may be covered by Medicare at any time during the Plan year (Medicare Part A coverage begins six months back from the date one applies for Medicare, social security, or railroad retiree benefits, but no earlier than the first month one was eligible for Medicare. Therefore, the general advisory is that you stop contributing to your health savings account at least six months before you apply for any of those benefits.)
  • You must not be covered by any other health plan that is not a high-deductible health plan.
  • You may not be covered by Veteran’s services during the last three months.
  • You may not be active-duty military with Tricare coverage.
  • You may not be claimed as a dependent on another person’s tax return.
  • Neither you nor your spouse may be participating in a Healthcare Flexible Spending Account (FSA).

Employers contribute $200, then match any employee contributions up to $575. This $775 total amount counts toward the maximum U.S. Internal Revenue Service Annual limits of $3,600 for employee only coverage and $7,200 for family coverage, for the 2021 plan year –plus an additional $1,000 if you are age 55 or older. Employees can contribute additional funds on a pre-tax basis, up to the limits listed above, to cover out-of-pocket medical and pharmacy costs. Unused funds are rolled over every year with no limit. Unlike the Health Reimbursement Arrangement option, the money in an HSA follows the member even if he or she changes jobs or retires.

How does it work? Members will be issued a debit card that can be used to cover eligible medical expenses, such as coinsurance, co-pays, deductibles, and services as well as pharmacy, dental, and vision expenses.

Members enrolled in OGB’s HSA 775 are eligible for a personal tax-free health savings account (HSA). HealthEquity, Inc. is Blue Cross Blue Shield’s third party administrator for MySmart$aver HSA banking. The HealthEquity website features other tools to help you understand the benefits of your HSA. To learn more, visit HealthyEquity's webpage. To learn more about how to maximize your HRA, please visit MySmart$aver.  

Medical Coverage

Pelican HSA Covrg

Prescription Coverage

Blue Cross and Blue Shield of Louisiana works in partnership with Express Scripts to administer your prescription formulary drug program for the Pelican HSA 775. Prescriptions are subject to the plan deductible with the exception of maintenance medications.

Tier Member Responsibility*
Generic $10 co-pay
Preferred $25 co-pay
Non-Preferred $50 co-pay
Specialty $50 co-pay

*Subject to deductible and applicable co-payment. Maintenance drugs are not subject to the deductible.