Effective January 1, 2012, all LSU benefits will be moving to a Calendar Year (January 1 – December 31).
All LSU First Health Reimbursement Accounts, Remaining Deductibles, and Out-of-Pocket Maximums will be reduced by half for the July 1 – December 31, 2011 Plan Year and will be reset to full amounts effective January 1, 2012.
Changes in the Health Plan due to the Affordable Care Act:
- Children under the age of 26 may be added to LSU First regardless of student status, tax dependent status, residence or marital status
- Pre-existing condition exclusions will be removed on enrollees under the age of 19
- Lifetime and annual maximums will be removed for essential benefits defined as:
- Ambulatory Patient Services
- ER Services
- Maternity and newborn care
- Mental Health/ Substance Use Disorder including behavioral health treatment
- Prescription Drugs
- Rehabilitative and habilitative services and devices
- Laboratory services
- Preventive and wellness services
- Chronic disease management
- Pediatric services, including oral and vision care
- a full-time Employee of the Louisiana State University System (“full-time Employee” means a person employed at 75% effort or greater per pay period (average 30 hours per week), with an appointment of more than 120 days or one academic semester. No person appointed on a restricted appointment, or a temporary appointment, will be considered an eligible Employee.
The following persons can be enrolled for coverage as Dependents, if they are not also covered as an Employee:
- The covered Employee’s legal spouse;
- A biological, legally adopted, or Child for which you are the legal guardian of from date of birth up to 26 years of age;
- You may also enroll an eligible Dependent during the year if a court orders you to cover an eligible Dependent (e.g., a QMCSO). See the Section entitled “Qualified Medical Child Support Order” for more details regarding a QMCSO. Coverage will take effect the first day of the month following the date of receipt by your Employer of all required forms prior to the fifteenth of the month, or the first day of the second month following the date of the receipt by your Employer of all required forms on or after the fifteenth of the month.
Late Applicant Provision for all Benefits
Employee/Dependent Date of Coverage for Late Applicants
A “Late Applicant” is an Eligible Employee/Dependent who applies for Coverage after the expiration of 30 days from the date the Employee first became Eligible for Coverage. With respect to Dependents, a “Late Applicant” is an Eligible Dependent for whom the application for Coverage was not completed within 30 days from either the Employee’s first Eligibility Date or from the Dependent’s first Eligibility Date.
The terms of the following paragraphs apply to Late Applicants. The effective date of coverage will be:
- The first day of the month following the date the Plan receives all required forms as of the 14th of the month; for example, if Late Applicant forms are submitted by July 14th, coverage will be Effective August 1st.
- The first day of the second month following the date the Plan receives all required forms on or after the 15th of the month; for example, if Late Applicant forms are submitted after July 14th coverage will be Effective September 1st.
Enrollment- Late Applicant
- The Plan will require that all Late Applicants complete a “Statement of Physical Condition” form and an “Acknowledgement of Pre-existing Condition” form.
- Medical expenses incurred during the first 12 months following enrollment of the Employee and/or Dependent will not be considered as covered medical expenses if they are in connection with a Pre-Existing Condition (a disease, illness, accident, or injury for which medical advice, diagnosis, care, or treatment was recommended or received during the six-month period immediately prior to the enrollment date of coverage). The Pre-Existing Condition provisions of this section do not apply to pregnancy or to Children under age 19.
- If the Covered Person was previously covered under a Group Health Plan, Medicare, Medicaid or other Creditable Coverage as defined in the Health Insurance Portability and Accountability Act of 1996 (HIPAA), credit will be given for previous coverage that occurred continuously for 63 days or more for the duration of prior coverage against the initial 12-month period. Any coverage occurring prior to a break in coverage 63 days or more will not be credited against a pre-existing condition exclusion period.
Some benefits may require you to complete an Evidence of Insurability application and be approved by underwriting before coverage will become effective. For complete details please visit the Certificate and/or Plan Document of the benefit for which you would like to enroll.