Important Changes for 2011 Plan Year
The Office of Group Benefits will hold Annual Enrollment
from April 1 through 30, 2011
Benefits Annual Enrollment
is April 1 through May 13
(or may end earlier for some agencies).
There will be a short 6-month plan year (July 1 through December 31, 2011) for 2011
OGB to change to a plan year that coincides with the calendar year (January 1 through December 31) beginning in 2012. The short plan year also applies to Flexible Benefits.
OGB will offer expanded coverage in several key areas for the upcoming plan
year that begins July 1, 2011, as mandated by federal law (the Affordable Care
Act and the Mental Health Parity and Addiction Equity Act):
• The pre-existing condition (PEC) exclusion will no longer apply to any employee or
• OGB will offer coverage for dependent children up to age 26, regardless of student,
marital or tax status. A covered child under age 26 who is or becomes incapable of self-sustaining employment is eligible to continue coverage as an overage dependent if OGB receives required medical documents verifying his or her incapacity before he or she reaches age 26. The definition of incapacity has been broadened to include mental and physical incapacity.
OGB will hold a Special Enrollment
from April 1 through July 31
to enable employees and
retirees to enroll or re-enroll newly eligible children for health coverage and life insurance
effective July 1 with no pre-existing condition exclusion. This Special Enrollment period
applies to children who lost coverage or were not eligible for coverage because they reached
the previous maximum age for dependent coverage. However, any such child enrolled after
July 31 will be considered a late applicant, and a pre-existing condition exclusion will apply if
the child is age 19 or older, unless portability applies.
• The individual lifetime maximum for benefits has been eliminated. Annual dollar limits
on essential benefits are also eliminated.
• Preventive care (wellness) will be paid at 100 percent (no deductibles, co-payments,
coinsurance) if services are provided by a network provider. Preventive care benefit limits no longer apply.
• The plan member cost-share (deductible, coinsurance, or co-payment) for inpatient
and outpatient medical care and surgery will also apply to inpatient and outpatient mental health and substance abuse (MHSA) treatment. There will no longer be a separate plan member cost-share for MHSA benefits.
OGB will also make other important changes for the 2011 plan year effective
July 1, 2011:
• A new Regional HMO health plan (insured by Vantage Health Plan) will be available in
Baton Rouge, Alexandria, Shreveport and Monroe. To enroll, a plan member must live in a zip code where the plan is offered (Ascension, Avoyelles, Bienville, Bossier, Caddo, Caldwell, Catahoula, Claiborne, Concordia, DeSoto, East Baton Rouge, East Carroll, East Feliciana, Franklin, Grant, Iberville, Jackson, LaSalle, Lincoln, Livingston, Madison, Morehouse, Natchitoches, Ouachita, Pointe Coupee, Rapides, Red River, Richland, Sabine, Tensas, Union, Vernon, Webster, West Baton Rouge, West Carroll, West Feliciana and Winn parishes)
• OGB will also offer a new Limited-Purpose Flexible Spending Arrangement (LPFSA)
that allows plan members to use pre-tax dollars to pay eligible out-of-pocket dental and vision expenses only. Plan members cannot participate in the General-Purpose FSA and the Limited-Purpose FSA at the same time. However, plan members who enroll in the Consumer Driven health plan with a Health Savings Account option (CDHP-HSA) can also participate in the LPFSA option.
• The plan member cost-share for the PPO and HMO (Blue Cross) health plans will not
reset on July 1, 2011. Instead, if the plan member has already met your deductible or out-of -pocket maximum for the 2010-11 plan year, the plan member cost-share will not reset until January 1, 2012.
• The plan member cost-share for the Consumer Driven health plan will reset on July 1,
2011. This means CDHP-HSA plan members will have only 6 months to meet the annual deductible due to the short 6-month plan year, so the state’s HSA contribution for 2011 will increase. The state will make a one-time contribution to a plan member’s HSA equal to half of the deductible amount—in addition to what the state normally contributes. This additional one-time contribution will be based on the plan member’s level of coverage on July 1. The state’s standard contribution rate is $100 per plan year, plus a match of additional plan member HSA contributions, dollar-for-dollar, up to $400 per plan year.
• The prescription drug benefit for the PPO and HMO (Blue Cross) health plans will
cover over-the-counter proton pump inhibitor (PPI) medications for heartburn and
gastroesophageal reflux disease (GERD), such as Prilosec OTC and Prevacid. A prescription from a physician is required. The plan member will pay 50 percent of the cost of the drug at the point of purchase up to a maximum of $50 per 30-day supply. These OTC medications, once available by prescription only, are equally effective for most people and far less costly. This saves money for both the plan member and the health plan, which helps OGB keep premium rates as low as possible.
Flexible Benefits Annual Enrollment
The OGB Flexible Benefits Plan gives active employees a way to take home more money in
every paycheck! When you sign up for the Premium Conversion option, your eligible health
plan premiums and dependent care expenses are deducted from your gross salary before
taxes. Therefore, you pay less in taxes and your spendable income increases.
Flexible Benefits Annual Enrollment is April 1 through May 13, 2011
(or may end earlier for
some agencies). Due to the short 6-month plan year (July 1 through December 31, 2011),
Flexible Benefits Plan elections are effective for only 6 months.
Plan members can enroll in one or several Flexible Benefits Plan options:
• Premium Conversion
• General-Purpose Health Care Flexible Spending Arrangement (GPFSA)
Limited-Purpose Dental/Vision Flexible Spending Arrangement (LPFSA)
• Dependent Care Flexible Spending Arrangement
• Health Savings Account (HSA)
May 13, 2011, is the last day for employee administrators to enter Flexible Benefits options in e-Enrollment. Statewide miscellaneous insurance deductions can be entered in eEnrollment until June 1, 2011. If the employee was hired in the middle of the plan year, the agency must fax the Flexible Spending Arrangement enrollment form after all of the employee’s data has been entered in eEnrollment. If not, there is no need to fax the enrollment form.
Breast Pump Purchase with GPFSA
Effective February 28, 2011, plan members who participate in the General-Purpose (Health
Care) Flexible Spending Arrangement can purchase breast pumps and related equipment
(according to IRS Bulletin 2011-9).
Birth Certificate Deadline for Newborns
Effective July 1, 2011, a birth certificate for newborns must be received within 6 months from
the date of birth. A birth letter will suffice for the first 6 months only if the letter is received
within 30 days of the date of birth. The plan member will receive only one reminder letter 90
days after the date of birth. If the birth certificate is not received, coverage will be dropped. Coverage for Influenza Vaccinations
Immunization shots for influenza are a covered benefit under the PPO plan (OGB), the HMO
plan (Blue Cross), the Medical Home HMO plan (Vantage Health Plan) and the CD-HSA plan
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