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2013 Plan Year

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New in 2013

Out of Pocket Maximums

Pharmacy Co-Pays

Drug Management Programs

Balanced Premiums

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New in 2013 – Out of Pocket Maximums

Out of Pocket Maximums will be increasing by:

$500 for Employee Only to $1500

$750 for Employee + Spouse to $2250

$750 for Employee + Children to $2250

$1,000 for Employee + Family to $3000

Note: These numbers represent the In-Network OOP Max. Out-of-Network OOP is also increasing.

No immediate impact!

Will only affect your Co-Insurance

AFTER you reach your Deductible.

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New in 2013 – Pharmacy Co-Pays

$40 Brand$120

Specialty

Pharmacy Co-Pays

Deductible

Member Pays

Remaining Deductible

Plan Pays HRA

MedicalCo-Insurance

10% In Network

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After a Member’s Deductible is met, the Member will begin paying only a Co-Pay for Brand name and Specialty medications, instead of Co-Insurance

$40 Brand Name / $120 Specialty

Limits a Member’s Out-of-Pocket expenses for typically expensive prescription medications

If cost of prescription is less than 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!

New in 2013 – Pharmacy Co-Pays

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New in 2013 – Drug Management Programs

New Drug Management programs will limit over-spending and medication drug waste – saves YOU and LSU First money!

New Programs: Select Home Delivery

Step Therapy with Grandfathering

Supplemental Prior Authorizations

Drug Quantity Management

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New in 2013 – Drug Management Programs

Select Home Delivery• Encourages Members to fill their maintenance medications

using Express Scripts Mail Order Pharmacy

• ESI will reach out to members who take maintenance medications to offer the choice

• Members will need to choose to “opt-out” of mail order

• Fast, at-home service – No extra trips to the pharmacy!

• Receive 3 months supply at a time (Co-Pays will apply)

Express Scripts Customer Service will work with you to

set up your Home Delivery for you!

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New in 2013 – Drug Management Programs

Step Therapy with Grandfathering• Requires Members to try Generic medications at $0 cost

before pricey brand name drugs on NEW prescriptions

• Grandfathering allows Members currently receiving brand name medications to continue without first trying generics

• Any existing prescription not refilled within 130 days will be considered NEW and will be required to be filled as generic at the time it is filled

Generic medications are JUST AS effective as

name brand medications at $0 cost to you!

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New in 2013 – Drug Management Programs

Supplemental Prior Authorizations• Already in place with some drugs – just added a few more to

the list

• Very few Members affected

• If a Member’s prescribed medication is on a Supplemental Prior Authorization List, the Member’s physician will be contacted to discuss alternate treatment options or provide authorization to dispense medication as written

Express Scripts and your Physician will be

involved to find the most effective care for you.

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Drug Quantity Management can help you

eliminate multiple co-pays

for Brand name medications.

New in 2013 – Drug Management Programs

Drug Quantity Management• Aligns dispensed quantity of prescription with FDA-approved

dosage guidelines

• Will eliminate wasteful spending – ensures the most cost effective product strength is dispensed

• If a Member receives two monthly prescriptions for a low dose of one medication, they could receive one monthly prescription at a higher dose for just as effective treatment

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New in 2013 – Balanced Premiums

LSU First Plan’s value far outweighs the Employee Share cost, and balancing is needed to provide a fair value to all Members

Employee Cost will STILL be lowest of all OGB offered plans

Few tiers experienced premium balancing:• Employee + Spouse

• Some Employee + Family rates

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LSU First Review of Current Benefits

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LSU System - Sponsors LSU First and is financially responsible for paying your claims.

CIGNA - Your medical claims administrator, including an extensive medical management program, and your provider for a wide-ranging national network.

ESI - Your pharmacy benefits administrator for retail and mail order service.

Verity HealthNet - Provides your robust Verity local network coverage and your First Choice Provider Network Coverage.

Meet Your LSU First Team

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Important Plan Features

Remember, once your Health Reimbursement Account (HRA) dollars are

exhausted: LSU First pays 100% for 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

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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° Adult Care° One routine vision exam per Plan Year

Immunizations° Based on age, gender and family history

Routine Mammogram, PSA, Pap Smear° Based on age, gender and family history

Visit LSU First at www.lsufirst.org for more Wellness information

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CIGNA’s Clinical Programs

Comprehensive Oncology• One on one support every step of the way• Specially trained cancer support nurse• 24 Hour Health Information Line• End of life care

Chronic Condition Support• Manage a chronic health condition• Create a personal care plan• Understand medications or doctor’s orders• Identify triggers that affect your condition• Make educated decisions on your treatment

Health Advisor• Specialized trained nurses• Coaches• Nutritionist• Clinicians

Lifestyle Management Programs• Need help making healthy changes?• Get Telephonic or Online Support• Self Paced Format• Support available 24/7

Tobacco Cessation Weight Management Stress Management

Healthy Pregnancies, Healthy Babies

• Prenatal Support Program• Cash bonus for program completion

• $250 if enrolled by end of First Trimester

• $125 if enrolled by end of Second Trimester

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Additional Programs

Health Risk Assessment Predicts future health issues fairly

accurately

Gives you control to start making simple changes to improve your health

Creates a deeper understanding of your health risk and offers effective solutions

Online coaching is available to you

Totally confidential

Logon to myCIGNA.com to complete

Employee Assistance Program (EAP)

Provides a Wide Range of Support for YOU Legal Issues Childcare, Eldercare, even Pet Boarding Managing Stress Relocation Assistance And more!

These valuable services are free and can be utilized by calling 1.866.929.5781

Up to three (3) visits with an In-Network counselor are available for all Members

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Websites for CIGNA and Express Scripts

www.lsufirst.org

Manage Your Accounts with CIGNA and Express Scripts

Search for First Choice, CIGNA Open Access Plus, and Verity Providers

Download claim and reimbursement forms

View Communication Newsletters

View contact information your LSU First team

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Key Contact information

Please ensure you update your contact information with your HR team

CIGNA Clinical Outreach is successful when we have current phone numbers on file

CIGNA’s Health Assessment completions trigger outreach calls based on risk factors and current

information

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Assistance and More Information

LSU First toll-free phone line (for any questions and concerns)

1.866.929.LSU1 (1.866.929.5781)

LSU First Website:

www.lsufirst.org

Follow LSU First on Facebook or Twitter

E-mail

LSUFirstinfo@lsu.edu

Call an experienced Member Advocate

1-866-607-5325 or 225-906-1249

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Questions