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2014 Plan Year. WHAT’S NOT CHANGING FOR 2014. Premiums will remain the SAME First Choice providers and Generic Medications are STILL NO COST TO YOU once your HRA is exhausted HRA remains the SAME Deductible remains the SAME
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WHAT’S NOT CHANGING FOR 2014 • Premiums will remain the SAME • First Choice providers and Generic Medications are STILL NO COST TO YOU once your HRA is exhausted • HRA remains the SAME • Deductible remains the SAME • Plan pays 100% for certain wellness services, with no HRA involvement
New in 2014 • Increased Out-of-Pocket Maximums • Enhanced Drug Management Programs • Discontinued Life Insurance Benefit • Aetna ASA network www.aetna.com/asa
New in 2014 – Out of Pocket Maximums • Out of Pocket Maximums will be increasing by: • $500 for Employee Only to $2000 • $750 for Employee + Spouse to $3000 • $750 for Employee + Children to $3000 • $1,000 for Employee + Family to $4000 No immediate impact! Will only affect your 10% Co-Insurance AFTER you reach your Deductible.
Continuing for 2014 – Pharmacy Co-Pays • Aftera Member’s Deductible is met, the Member pays a fixed Co-Pay for a 30-day supply of Brand name and Specialty medications • $40 Brand Name / $120 Specialty • Limits a Member’s monthly cost for typically expensive prescription medications • If the cost of a prescription is less than the Co-Pay amount, Member pays the lesser of the two amounts • Remember that Generics are still $0 Out-of-Pocket to Members Co-Pay System limits your financial exposure and helps you to budget for monthly expenses!
Continuing for 2014 – Pharmacy Co-Pays Member Pays Remaining Deductible Plan Pays HRA Deductible Medical Co-Insurance Pharmacy Co-Pays 10% In Network $40 Brand $120 Specialty
Enhanced for 2014 – Drug Management Programs • Enhanced Drug Management programs will limit over-spending and medication drug waste – saves YOU and LSU First money! • Drug Management Programs: • Select Home Delivery (opt-out mail order) • Step Therapy with Grandfathering • Supplemental Prior Authorizations • Drug Quantity Management
Continuing for 2014 – Drug Management Programs • SelectHome Delivery – opt-out mail order • Requires Members to contact Express Scripts regarding their mail order preferences for maintenance medications • Fast, accurate home delivery available directly from Express Scripts—no more monthly trips to the pharmacy! • Receive 3 months’ supply at a time (3 Co-Pays will apply) • Members who take maintenance medications will begin to receive notifications via mail and phone in November • Express Scripts’ Customer Service will work with your retail pharmacist to set up Home Delivery for you!
Continuing for 2014 – Drug Management Programs • Step Therapy with Grandfathering • Requires Members to try first-line medications before pricey brand name drugs on NEW prescriptions • Grandfathering allows Members currently receiving brand name medications to continue without first trying alternatives • Any Rx medication not filled during the previous 130 days will be considered NEW and will be subject to the step therapy program In most cases, first-line medications are JUST AS EFFECTIVE as higher-cost medications!
Continuing in 2014 – Drug Management Programs • Supplemental Prior Authorizations • Program already in place with some drugs – just added a few more to the list • Few Members affected • If a Member’s prescribed medication is on a Supplemental Prior Authorization List, Express Scripts will contact the Member’s physician to discuss alternate treatment options or provide authorization to dispense the medication as written Express Scripts and your Physician will work together to find the most effective care for you.
Continuing for 2014 – Drug Management Programs • Drug Quantity Management • Aligns dispensed quantity of prescription with FDA-approved dosage guidelines • Eliminates wasteful spending – ensures the most cost effective product strength is dispensed • For example, if a Member receives two monthly prescriptions for a low dose of one medication, s/he could achieve the same outcome with one monthly prescription at a higher dose Drug Quantity Management can help you eliminate multiple co-pays for Brand name medications.
Important Plan Features Remember, once your Health Reimbursement Account (HRA) dollars are exhausted: LSU First pays 100% for covered services from First Choice Providers LSU First pays 100%for generic drugs Remember, LSU First pays $5,000 for Critical Illness Benefits Stroke Heart Attack Invasive Cancer Remember, LSU First reimburses your Transplant-related travel expenses for you and one dependent up to $10,000 • Major Organ Transplants • Renal Failure • Coronary Artery Bypass Surgery
Important Plan Features Remember, Free Preventive Care with First Choice and In-Network Providers without using HRA dollars Routine Preventive Care Well-Baby Care and Well-Child Care Annual Wellness exam for adults One routine vision exam per Plan Year Immunizations Based on age and gender Routine Mammogram, PSA, Pap Smear Based on age and gender • Visit LSU First atwww.lsufirst.orgfor more Wellness information
LSU First Website • www.lsufirst.org • See your medical and pharmacy claims and account information • Search for First Choice and Verity network providers • View Summary of Benefits and Coverage • View complete Summary Plan Description • Download claim and reimbursement forms
Assistance and More Information • LSU First Website: • www.lsufirst.org • E-mail • LSUFirstinfo@lsu.edu • Call an experienced Member Advocate • 1-866-607-5325 or 225-906-1275