GSU 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 University offers you a choice of medical benefit plans. The premiums are eligible for tax sheltering under the University’s Cafeteria Plan (Tax Saver Flexible Benefits Plan).
This section summarizes the main points of each plan. Each plan is governed by a legal document called a plan document. In the event of a conflict between this summary and the plan document, the terms of the plan document will prevail.
Frequently Asked Questions:
Which plans are available?
Below is a list of various health insurances provided to Grambling State University Employees. New employees must enroll in a group benefit plan within the first 30 days of employment. If this deadline is missed the employee may still enroll as a late applicant, but they must provide proof of insurability, which is subject to approval by the insurance plan selected. Also, a pre-existing condition clause may be imposed on the applicant for a period of 1 year from the date of coverage. The portability law may be applicable in some cases for late applicants who had other health insurance coverage within 60 days prior to the effective date of coverage with the GSU health plan. If an employee declines to enroll in health insurance a waiver of coverage MUST be filled out within the first 30 days of employment.
NOTIFICATION OF CHANGE ERROR: It is the employee’s responsibility to notify the program of any change or error in classification of coverage or any other error affecting his contribution amount. Any failure later determined will be corrected on the first of the following month. All refunds shall be limited to six months from the date notice is received by State Employees Group Benefits.
EFFECTIVE JULY 1, 2002: All employees enrolled in health insurance plans sponsored by Grambling State University, through the Office of Group Benefits will be eligible for Louisiana Dental Plan. Louisiana Dental Plan is a value added service (no additional cost.) For more information and a list of providers, visit their provided home page.
Office of Group benefits – EPO
An EPO (exclusive provider plan) consists of a network of providers offering benefits modeled after an HMO for most basic health care services. There are fixed co-payments
The EPO plan has a $15.00 co-pay and no claim forms when a member visits a primary care physician (family medicine, internal medicine, general practitioner, pediatrician, or OB/GYN). When visiting a specialist, the co-pay is $25.00. Also, members may go directly to see a specialist without a referral. Plan members choose their own participating specialist and make their own appointments. $2 million is the lifetime maximum under this plan.
There will be a $300 deductible for services not otherwise subject to co-pay (such as x-rays, lab work, etc. ). A separate $300 deductible will also apply if you go out of the network and then there will be only 70% coverage after that.
There is no prescription drug deductible under the EPO plan. The employee pays 50% of the cost of prescription drugs up to $50.00 per prescription.
EPO Enrollees and PPO Deductibles
Enrollees in the EPO plan can utilize a PPO provider and receive reimbursement at 70% of eligible charges after deductible.
2003-04 Rate Schedules are Posted on the HR Bulletin Board, Room 151 and Room 242 of Long-Jones Hall. You may also visit the website of Office of Group Benefits at www.groupbenefits.org
Office of Group Benefits – PPO
The PPO (preferred provider plan) Program is an indemnity health insurance plan that utilizes most of the major hospitals, pharmacies, and many doctors as Preferred Provider Organizations (PPO). This plan provides 90% coverage, after deductibles, when the plan member uses a PPO provider. If a plan member uses a non-provider when a PPO provider is available, the coverage is 70% after deductibles. If there is no PPO provider available the coverage is 80% after deductibles. There is a $500 deductible per family member with a maximum of $1500. The Office of Group Benefits uses a utilization review company to review all hospitalizations and some outpatient surgeries. Failure to notify the utilization review company will result in a penalty incurred against the plan member (maximum penalty to $2000.00) A list of PPO providers is available from the Office of Human Resources. Coverage for non PPO services for plan members who reside out of state will not be 90%.
For more information please call 1-800-272-8451 or visit their website at www.groupbenefits.org
FARA-MCO Plan is a Managed Care Option. There is no lifetime maximum for this plan. There are local physicians and pharmacy providers in the surrounding area. There is no deductible for physicians’ visits or prescription drugs. There is a $15 copay for primary care physician visits and a $25 copay for specialist visits.
Prescription Drug benefit – Mandatory Generic, and Formulary applies. Mrmber pays 50% of the prescription cost with a maximum of $50.00 per 34-day fill. After $1200 per person per plan year co-pay’s are $15 for Brand, and $0.0 for Generic Drugs.
There are no out of network benefits with this plan, except for life and limb threatening emergencies.
More information can be obtained at their web site www.farabenefits.com
Am I eligible for coverage?
If you are an active employee of the University, you are eligible for coverage under any of the above medical plans, provided you also meet the following conditions:
You are employed at 75 percent full-time effort or greater (30 or more hours/week);
You have a job appointment duration of at least one year.
Are my dependents eligible?
Your eligible dependents include your legal spouse and each of your never-married children younger than 21.
Children older than 21 are also eligible for coverage if they meet one of the following requirements:
They are never-married, full-time students between the ages of 21 and 24, enrolled in an accredited school and dependent on you or your spouse for principal support.
If a never-married dependent child is incapable of self-sustaining employment by reason of mental retardation or physical incapacity, became incapable prior to the termination age for children, as defined above, and is dependent on the covered employee for support, the coverage for such dependent child may be continued under the plan. However, the program must receive satisfactory proof of mental retardation or physical incapacity. Coverage will continue for as long as such incapacity continues. Mental illness shall not constitute mental retardation.
When can I enroll?
You can enroll in the plan of your choice within 30 days of the date of your employment or eligibility by completing the appropriate enrollment form. Coverage will not be subject to pre-existing condition exclusions.
What if I do not enroll when first eligible?
If you and/or eligible dependents do not enroll within 30 days, coverage may be added at any time during the year; however, coverage may be subject to a one-year preexisting condition exclusion.
When does my coverage begin?
If you are a new employee, coverage for you and your eligible dependents begins on the first day of the month following one full calendar month of employment, provided you complete and return your enrollment form to the Human Resources Office within 30 days of your date of employment or eligibility.
Who pays for this coverage?
The cost of your medical coverage under any of the above medical plans is paid by you and by the state. Employees on nine or ten month appointments will have a full year of premiums withheld from their nine-month salaries. If you elect to participate in the University’s Cafeteria Plan, your share of the cost will be made on a before tax basis, which lowers the current income tax you pay. For more details about how the before-tax feature works for you, refer to the section on Cafeteria Plan.
When should I add newly acquired dependents?
To add newly eligible dependents acquired through marriage, birth, or adoption, you must submit a change form to the Human Resources Department within 30 days of the event. Failure to do so will result in a delayed effective date of coverage and the dependent’s being considered a late applicant, possibly subject to a preexisting condition exclusion.
Are newborn children automatically covered?
No. See the paragraph above on adding newly acquired dependents.
When can I delete ineligible dependents?
You must submit a change form to delete a dependent to the Human Resources Office within 30 days of eligibility for any of the following events:
Children no longer dependent on you or your spouse for support
Deceased spouse or children
When can I change plans?
You are allowed to change plans during the Annual Enrollment Period, which begins April 1st and ends April 30th.
When does my medical insurance coverage end?
Your medical insurance coverage under any of the plans will end on the earliest of the following dates:
On the date 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 reduced to less than 30 hours/week or 75 percent 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 extends through September 30th of the same year.
If your contributions are paid on a before-tax basis, you may not discontinue coverage during the year, unless the change is in connection with a family status change. (See section on Cafeteria Plan).
Under what conditions can I continue medical insurance coverage?
Federal law requires that the plans offer covered employees and dependents the opportunity to continue medical benefits coverage when coverage would normally end for certain specified reasons. This law is called the Consolidated Omnibus Budget Reconciliation Act (COBRA). The following provisions outline the requirements for continued coverage in accordance with the law.
You and your covered dependents may continue coverage for up to 18 months if coverage ends because of either a permanent reduction in the number of hours worked or termination of employment for any reason other than gross misconduct. You and/or your covered dependent must make application within 60 days of the date coverage ends.
Special rules exist for a temporary reduction in the number of hours worked and for employees on leave without pay.
Your dependents may continue their coverage under the group plan for up to 36 months if their coverage ends for any of the following reasons:
divorce from the employee
death of the employee; or
the dependent child reaches the limiting age or otherwise ceases to qualify as a dependent under the plan
Upon your death, your surviving legal spouse may continue medical coverage by making application within 60 days of your death and paying the applicable monthly premium. Your surviving dependent children, if you are an employee or retiree, may continue coverage until they are eligible for coverage as an employee or until they become no longer eligible as a dependent on GSU’s plans.
These periods of continued coverage begin on the first of the month following the date of the event that caused the loss of coverage; for instance, the date you leave the University, or the date a dependent becomes ineligible.
Can I continue coverage after retirement?
You may continue your medical plan upon retirement if you meet the eligibility requirements for age and years of service under the Teachers’ Retirement System of Louisiana or Louisiana State Employees’ Retirement System. If you are a member of TRSLA’s Optional Retirement Plan, you must meet the eligibility requirements, as defined by the TRSLA, to continue coverage. If you elect to cancel medical insurance as a retiree, coverage can never be reinstated.
SUPPLEMENTAL INSURANCE PLANS
GSU offers a number of supplemental insurance programs. As a GSU employee, you are responsible for 100 percent of the premium for these insurance programs. The exceptions are the State Employees Group Benefits Life Insurance Program and Long Term Disability described later in this section. GSU pays one half of the premium for the employee or retiree (retirees not covered on long term disability).
CONSECO HEALTH INSURANCE (Cancer, Heart/Stroke and Intensive Care)
This program offers coverage for cancer with payments available for hospital confinement and payments while out of the hospital. The heart and stroke policy helps cover the indirect costs associated with heart disease, heart attacks, and strokes. The Accidental Disability policy helps pay indirect costs, such as deductibles, co-payments, and lost income. The Intensive Care provision can be purchased as a stand-alone policy, or as a rider to the Cancer expense policy.
For a more detailed description of the coverages offered through Conseco Health approved payroll deduction, and for premium cost information contact:
Toll Free Number 800-824-2726
Suzanne Britnell - 318-680-4103