The LSU System offers employees and their eligible dependents financial protection against a wide range of health care expenses resulting from illness or injury. As part of our continuing effort to provide benefits to meet the varying needs of our employees, the System offers you a choice of health insurance plans. The premiums are eligible for tax sheltering under the Tax-Saver Premiums Only Plan.
Health Plans Offered (January 1, 2013 - December 31, 2013)
- LSU First Health Plan administered by Cigna
- PPO Plan administered by Blue Cross Blue Shield
- HMO Plan administered by Blue Cross Blue Shield
- Consumer Driven Health Plan administered by Blue Cross Blue Shield
- Medical Home HMO administered by Vantage*
*Available only for employees who live in designated regions
Any active employee of the LSU System is eligible for health insurance provided the following:
• Employed at 75% of full-time effort per pay period (avg. of 30 hours/week) or greater
• Appointed for a duration of at least one semester or 120 days or greater.
Effective Date of Coverage
Timely Applicant*: If you enroll within your first 30 days of full-time employment, your coverage will be effective the first of the month following your first full calendar month of employment.
• For example: Date of hire = August 20; Effective Date = October 1
Late Applicant*: If you enroll yourself and/or your dependents into a Health Plan after your first 30 days of employment, you are considered a late applicant. The GB-01 form and Insurance Portability Law Application must be received by Benefits staff no later than the 14th of the month for coverage to be effective the first of the following month.
• For example: For coverage effective October 1, applications are due by September 14
*Whether you are a Timely Applicant or a Late Applicant, proof of prior creditable coverage as defined by HIPAA must be submitted in order to remove the 12-month pre-existing condition exclusion from your policy. A HIPAA Certificate of Coverage must be obtained from your prior Health Plan to verify the 12 months of previous, creditable coverage. Do not delay submission of your enrollment paperwork for this certification.
To change or correct a name*, address, or date of birth with your health insurance plan, use the GB-01 form and return to the Office of Human Resource Management in 110 Thomas Boyd Hall.
*Name change: Your name must match the name on your social security card. Please bring your social security card with you to our office so we may verify the match.
An eligible dependent is defined as:
• The covered Employee’s legal spouse;
• A Child from date of birth up to 26 years of age;
• A Child of any ages who meets the criteria for “Over-Age Dependents” in the entitled “Over-Dependents” listed below.
• An eligible Dependent during the year if a court orders the Employee to cover an eligible Dependent (e.g., 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 15th of the month, or the first day of the second month following the date of receipt by your Employer of all required forms on or after the 15th of the month.
*Over-age Dependents: If a dependent child is incapable (and became incapable prior to attainment of age 26) of self-sustaining employment by reason of mental retardation or physical incapacity, and is dependent upon the covered Employee for support, the coverage for the Dependent Child may be continued for the duration of incapacity.
Prior to the Dependent Child reaching age 26, an application for continued coverage with current medical information from the Dependent Child’s attending Physician must be submitted to the Plan Administrator to establish eligibility for continued coverage as set forth above. The Plan Administrator, in its discretion, may consider applications and attending Physician’s information submitted after the Child reaches age 26, if the application and information indicate that the Child’s incapacity was present prior to the Child reaching age 26, but was not apparent or diagnosed until after the Child reached age 26.
• Upon receipt of the application for continued coverage, the Plan Administrator may require additional medical documentation regarding the Dependent’s Child’s mental retardation or physical incapacity as often as he may deem necessary thereafter.
Adding New Dependents
To add newly eligible dependents acquired through marriage, birth, or adoption, you must submit the GB-01 form and Status Change form to our Benefits staff within 30 days of the event. Coverage will be effective as of the date of the event as long as the paperwork is submitted within the 30 day timeframe. Failure to submit paperwork within that 30 day timeframe will result in a delayed effective date of coverage and the dependent will be considered a late applicant.
IMPORTANT NOTE: Newborns are not automatically added to your policy. You must complete both forms in order to effectively add them to your coverage.
In order to delete a dependent, you must submit a GB-01 form and Status Change form to our Benefits staff within 30 days of losing eligibility for any of the following events:
• Divorced Spouse
• Over-age children
• Children no longer dependent on you or your spouse for support
• Deceased spouse or child
* If you are in the Premiums Only Tax-Sheltering Plan: When adding or deleting a spouse and/or dependent to your health insurance coverage, the change must be due to a qualifying life event. A new GB-01 form should be completed and be accompanied by a Status Change form. Otherwise, you may cancel coverage during Annual Enrollment in October for a January 1 effective date.
To deter fraud, abuse, and assure the proper use of public funds and Plan Members’ premium dollars, The Office of Group Benefits must receive proof that the dependents covered are legal dependents of the Employee. All active and retired employees are required to provide written proof that each dependent who they would like to cover under their health plan is their actual legal dependent.
A member of our Benefits staff must see a certified copy, but will only be required to retain a photocopy of the document. The certified copy will be returned to the employee. Failure to comply with these requirements will result in cancellation of your dependents’ coverage. Documents that will be considered acceptable to satisfy the verification policy requirements and provide continued coverage to eligible dependents are listed below. The GB-01 form (health insurance enrollment form) with completion of Employee’s Personal Information, Level of Medical Coverage selected, and employee’s signature will need to be submitted with acceptable documents.
Spouse: An original or certified copy of marriage license indicating date and place of marriage.
Child under the age of 26: For natural or a legally adopted child of a plan member, provide a certified copy of birth certificate which lists the Plan Member as parent, or a certified copy of a legal acknowledgment of paternity signed by Plan Member, or certified copy of adoption decree naming Plan Member as adoptive parent.
Stepchild: A certified copy of a marriage license for the spouse and a birth certificate listing that spouse as natural or adoptive parent.
Child placed with your family for adoption by agency or irrevocable act of surrender for private adoption: Certified copy of adoption placement order showing date of placement, or copy of signed and dated irrevocable act of surrender.
Child for whom the Plan Member has been granted guardianship or legal custody, including provisional custody: A certified copy of signed legal judgment granting legal guardianship or custody.
Grandchild for whom you do not have legal custody or guardianship but who is dependent on you for support and whose parent is a covered dependent: A certified birth certificate or adoption decree showing parent of grandchild is a dependent child on employee’s health plan and a certified copy of birth certificate showing dependent child is a parent of the employee's grandchild.
Child age 26 or older who is incapable of self-sustaining employment due to mental retardation or physical incapacity who was covered prior to age 26: A Certified copy of birth certificate listing Plan Member as parent, or Certified copy of legal acknowledgement of paternity signed by Plan Member, or Certified copy of adoption decree naming Plan Member as adoptive parent. Must also apply for continued coverage prior to age 26 and provide supporting medical documentation and must provide additional medical documentation of child’s condition periodically upon request by Plan Administrator.
If you have questions about the dependent verification policy, contact the Office of Group Benefits Customer Service, toll-free, at 1-800-272-8451 or call HRM at 225-578-8200.
Termination of Medical Coverage
Your health insurance coverage under any of the plans will end on the earliest of the following dates:
• One the day the program terminates
• On the last day of the month in which your employment terminates*
• On the last day of the month in which your work hours are permanently reduced to less than 30 hours per week or less than 75% of full-time effort
• On the last day of the month in which you elect to cancel coverage
• On the last day of the month of the covered employee’s death
*If you are an academic employee who terminates employment at the end of the academic year, your coverage may be extended through September 30th of the same year. Contact our office for more details.
**If you elect to cancel coverage you will fill out the GB-01 form. If you are tax-sheltering your premiums, or if you participate in an FSA, you may only cancel coverage due to a qualifying family status change and must turn in the Status Change form with your cancellation; otherwise, you may cancel coverage during Annual Enrollment in October for a January 1 effective date.
To continue your medical coverage after termination of employment or after becoming ineligible for coverage, please see our section about COBRA.
As a Surviving Spouse or Dependent
Upon your death, your surviving legal spouse may continue his/her health insurance coverage by completing an application within 60 days of your death and paying the applicable monthly premium. Coverage would be effective the first of the month following the event.
Your surviving dependent children may continue coverage until they are no longer eligible as a dependent on health plans offered by the LSU System. If your surviving spouse or dependent later becomes employed through the State of Louisiana and thereby gains eligibility as an employee, they will no longer be eligible for coverage as a surviving spouse or dependent.
To continue your medical coverage during retirement, please see our Retiree section.