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Understanding your deductible
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Your deductible is the first part of your out-of-pocket expenses. LSU funds a Health Reimbursement Account (HRA) for you at the beginning of each plan year. These HRA dollars are then used to help you meet your deductible.
Your deductible applies to all covered expenses, including medical and pharmacy costs, regardless of whether you see a First Choice, In-Network, or Out-of-Network provider.
LSU First offers two options. The difference between the two is the deductible.
Option 1 has a lower deductible and a higher premium rate while Option 2 has a higher deductible and a lower premium rate.
There are four levels of coverage (Employee, Employee + Spouse, Employee + Child(ren), and Family). The chart at the right is an example of how a deductible works under Option 1, Employee Only Coverage.
Your deductible is based on your level of coverage and your effective date of coverage. If you have family coverage, the expenses for all family members contribute to your deductible. The expenses of just one or all family members combined could satisfy the entire deductible.
Before you’ve met your deductible, you are responsible for 100% of covered expenses (including medical and pharmacy). HRA dollars pay for 100% of covered expenses from any provider. Once HRA dollars are exhausted, you pay $0 out-of- pocket for First Choice Providers and generic drugs. For all other providers, you pay the remaining balance of the deductible. Unused HRA dollars are rolled over and added to your HRA for the next plan year.
The Plan Year begins July 1st and ends June 30th. For those changing their level of coverage during the plan year or for newly hired employees with an effective date after July 1st, your deductible, including your HRA, will be pro-rated based on the remaining number of months in the plan year. After you satisfy your deductible, you will be responsible for Co-Insurance.
In our next newsletter, we will address Co-Insurance, the Out-of-Pocket Maximum, and how your HRA rollover applies.