A Health Reimbursement Arrangement, or HRA, is an account that employers use to reimburse employees’ healthcare expenses, such as deductibles, medical co-pays, eligible medical costs, and does not include prescription drugs. The HRA funds are available as long as you remain enrolled in the Pelican HRA1000 health plan.

Your agency contributes $1,000 annually for a single (employee only) and $2,000 annually for a family to your HRA at the beginning of the plan year.

The HRA is handled by BCBS on behalf of the employee. BCBS uses the HRA account to pay the provider (doctor or hospital)when a medical claim is submitted. The HRA is only for eligible medical expenses and does not include prescription drugs.

The HRA is funded by the employer. This means, when medical expenses occur and qualify for reimbursement, BCBS claims administration applies HRA funds from the member’s HRA account.

Yes. Unused funds will rollover until it reaches the in-network out-of-pocket maximum. So for example, if you are on an employee-only plan, the unused funds will rollover until it reaches $5,000.

HRAs are not portable – meaning if you get a new job with a non-OGB participating employer, you will not be able to take your account with you or use the funds still in it.

No, only eligible medical services may be reimbursed by HRA funds.

You may contact Blue Cross at 1-800-392-4089.

Yes, if you are an active full-time employee, a General-Purpose FSA or Limited-Purpose FSA may be used with an HRA.

The HRA pays for 100% of covered out-of-pocket medical expenses until the HRA is exhausted. Blue Cross Blue Shield of Louisiana’s Explanation of Benefits will indicate the funds available for reimbursement. Then, you will pay the full contracted amount for that service, until you meet the remaining balance of your deductible and/or any coinsurance amount.

Orthodontia expenses are eligible under the Health FSA. Most orthodontia is paid in monthly installments. The monthly payments within your plan year are eligible for reimbursement. We require a copy of the financial contract between you and the orthodontist. Also, the down payment is eligible as long as it is billed within your current plan year.

Optum Financial will try to contact the participant three times via letter/email to notify them of the request for more information.

The standard timeline for claim follow-up for unsubstantiated claims is:

• Sixty days after an unsubstantiated claim is received, communication (via email if employee has one on file, letter if not provided) is sent to the employee.
• Sixty days after the initial communication, a second communication (via mail) is sent to the employee.
• Forty-five days after the second communication, a third communication (via mail) is sent to the employee. It states that if documentation is not received within 10 days of the date of this final letter, the card will be suspended.
• Fifteen days after the third communication (180 days after the initial card swipe), cards will be suspended if proper documentation has not been provided.

Yes, the money put in is yours to use for qualified expenses. However, in order to utilize this money without paying taxes you must follow the IRS rules. As such, the plan is required to substantiate claims for all debit card transactions. For debit card transactions that can be approved by one of the IRS approved electronic methods, you will not need to provide a receipt, but you will need to keep copies of all receipts for all services you use the debit card for.

The IRS requires that participants provide:

• Date service was received or purchase made
• Description of service or item purchased
• Dollar amount (after insurance, if applicable)
• Name of merchant/provider

The easiest and quickest ways to upload supporting documentation is by downloading the TASC mobile app or registering online at www.tasconline.com.

Yes, please save all receipts related to your FSA purchases. For some expenses, you may be required to provide additional information, including itemized receipts or explanation of benefits, to verify eligibility of the expense. Besides saving all receipts, be sure to provide them promptly when requested. If you fail to submit documentation when requested, the FSA plan administrator is required to declare those expenses ineligible and you’ll have to reimburse your account.

Yes, as long as they are full-time active and the deductions comes from their active check.

Unfortunately, not all expenses from a hospital or dental office are FSA-eligible. For example, some hospital gift stores sell flowers that could still be coded as “hospital” expenses, and some dental offices provide elective services like teeth whitening that could still be coded as “dental” expenses. Unfortunately, these are not FSA-eligible. By obtaining supporting documentation, we’re able to verify the eligibility of the expense to maintain compliance with IRS regulations.

Yes. There are some situations in which a debit card transaction can be denied by a pharmacy or other location. This can happen if:

• You may be at an ineligible location
• You may be asking for more money than what you have elected and/or contributed
• Your card might have been temporarily suspended because your account is not in good standing OR because there is additional information required for previous transaction(s)
• The card might not have been correctly re-activated since being suspended for additional information subsequently received
• The valid location you are at has been identified in the system as an invalid location
• The card’s magnetic strip has been compromised
• The merchant’s “credit swipe machine” may be malfunctioning
• You have swiped the card yourself and indicated “debit” (which refers to a bank account card) rather than indicating “charge”

You should go ahead and pay for the service and then contact the FSA plan administrator, TASC, to determine if it is due to funds availability or card technicality. You can then submit a manual claim for reimbursement from your account.

You can visit your FSA portal to view your account activity and current balance. Or you can call the FSA plan administrator, Total Administrative Services Corporation (TASC), at 1-844-237-9222. It’s a good idea to know your account balance before you make a purchase with your debit card.

Your debit card is good for three years. So hang on to it. Even if you deplete this year’s funds, you’ll be able to use the card again next year when you re-enroll in the FSA plan.

You will forfeit the money that remains in your account. Any excess funds are kept by the employer and can be used to offset the costs of administering the program. The IRS regulations require this, and do not allow employers to return the money to plan participants or to carry unused funds over to the next plan year.

No, expenses must be incurred during the current plan year. The only exception to this rule is orthodontics. You can use your FSA to cover payments made for braces, even if the braces were put on before the start of the current plan year.

You will need to submit a copy of the orthodontia contract specifying start date, length of treatment, total cost for the treatment and the payment schedule.

You will have a specific amount of time, called the run-out period, during which you can submit claims that were incurred prior to your termination date. The run-out period for the prior plan year ends on April 30 of the subsequent year. For example, the run-out period for Plan Year 2023 ends April 30, 2024. You may not be reimbursed for any claims incurred after your termination date. However, you may be able to continue your Health Care FSA coverage under COBRA.

There is no amount that will be right for everyone. FSA elections vary greatly, depending on the individual participant and his or her particular situation. You should make your election by carefully examining your expected out of pocket health care expenses for the upcoming year.

No, you can use the Dependent Care FSA to cover expenses for anyone who watches your children while you and your spouse are working. It can even be a family member, as long as that person is not your tax dependent. The only rules that apply are that you must provide the Social Security number or Tax ID of your daycare provider, and that person must claim the income.

No, the regulations state that care must be rendered so that both you and your spouse can be gainfully employed, look for gainful employment or attend school.

No, you can use funds only for the purpose for which the election was initially made. IRS regulations do not allow funds to be transferred or commingled between accounts. So, the money in your Health Care FSA may only be used for health care expenses and your Dependent Care FSA may only pay for dependent care expenses.

A flexible benefits plan allows you to pay for certain benefits before your money is taxed. For example, with a flexible benefit plan you can transfer money out of every paycheck and put it in a Flexible Spending Arrangement (FSA) option before its taxed. The FSA you choose allows you to set aside money, before it’s taxed, to pay for health care, out-of-pocket expenses, dental and vision expenses and dependent care expenses. The FSA Visa Debit card is provided to pay for expenses at doctor’s offices, hospitals, and pharmacies.

If you’re not enrolled in an OGB health plan, you can still take advantage of flexible benefits. We offer the following options: General-Purpose FSA; Limited-Purpose FSA; Dependent Care FSA.

The General-Purpose FSA (GPFSA) allows you to set aside money every month that you can use for out-of-pocket medical expenses like co-pays, deductibles, prescriptions, braces, crowns, dentures, contacts, eyeglasses, laser eye surgery and other costs. The benefit is that your money is set aside before it’s taxed. So, enrolling in the GPFSA means you have more to spend on those expenses than you would if you waited and spent the money after it was in your paycheck and taxed. You must re-enroll each year to continue participation.

The Limited-Purpose FSA is a similar concept to the GPFSA, but like the name says, it’s more limited. It can only be used for dental and vision expenses. You must re-enroll each year to continue participation.

No. You can’t be enrolled in both plans at the same time.

A Dependent Care FSA allows you to set aside pre-tax money to pay for dependent care expenses while you’re at work. That includes your young children under age 13 who reside in your household, in daycare or elderly or disabled dependents, who cannot care for themselves. And like the other FSA options, you must re-enroll each year.

The amount you can set aside for dependent care expenses is limited to: $2,500 for single parents or married couples who file taxes separately; and $5,000 for married couples who file jointly and single, head of household.

When you enroll in a flexible benefits plan, you agree to contribute a portion of your salary to pay for qualified benefits. Because you never receive that portion of your salary, it’s not considered wages for federal income tax purposes. That money goes directly into the account you specify and can be used according to the IRS rules.

To be eligible, you must be an active, full-time employee. You have thirty (30) days from the date of hire to decide to enroll. If you do not enroll after 30 days of your hire date, you can enroll during next year’s annual enrollment or after an IRS qualifying life event like childbirth or marriage.

Both the General-Purpose FSA and the Limited-Purpose FSA plan options also allow you to be reimbursed for medical expenses for your dependent children up to age 26.

You select an option and elect a contribution amount for the plan year. The minimum and the maximum are determined each year by the I.R.S. For 2024 plan year, the minimum was $600 and the maximum was $3,050 for the General-Purpose FSA and Limited-Purpose FSA. You will receive a Visa debit card, which is your FSA card, and it works like a debit card for your flexible spending account. Your pre-tax money is in your account and can be used to pay for eligible expenses at your doctor’s office, pharmacy or other provider. The election is like a loan and monies are immediately available for the General-Purpose FSA and Limited-Purpose FSA. A per pay period amount is taken out of your check and placed into your account.

Generally, no. Flexible benefits contributions are reported as non-taxable wages and income on your W-2. If the IRS audits you, you will need to show total expenses and receipts from your service provider(s). So keep a copy of your reimbursement request forms and receipts for your records.

However, it is important to note: Your benefits may become taxable wages reportable on your W-2 Form if you fail to timely substantiate (verify) a debit card transaction as a qualifying medical expense or use your debit card for ineligible expenses.

When you enroll in one of OGB’s health plans, you automatically become a participant in the Flex Plan under the Premium Conversion option. The premium conversion option means that you pay for your health plan with pre-tax dollars, giving you more take-home pay in each paycheck. If you’re not enrolled in an OGB health plan, but enroll in another voluntary product, you will also become a participant in the premium conversion option. Once you enroll in the premium conversion option, you don’t have to re-enroll. You will stay enrolled until you choose to end your participation in an OGB health plan.

Total Administrative Services Corporation (TASC) is OGB’s third-party administrator for the flexible spending arrangement (FSA). Participants may call TASC, toll-free, at 1-800-422-4661, or visit online at www.tasconline.com, or send a fax to 1-501-687-3282.

No. However, you can elect to have a Limited-Purpose FSA for dental and vision only.

No. You must enroll in a FSA every year. Additionally, unused contribution amounts do not carry over to the next Plan Year.

Yes. When you enroll in a FSA you also agree to pay the administrative annual fee, which is $11.52 annually divided equally per the number of pay periods in the Flex Plan Year.

There are times when you may want to enroll in a General-Purpose (medical) or Dependent Care FSA in the middle of the year. Say you have a baby and want to start paying for daycare through a FSA. You can enroll in the middle of the year if you experience an OGB Plan Recognized Qualified Life Event. You have 30 days from the date of your Qualified Life Event to enroll. The list of Qualifying Events is available on the OGB website, under Resources, and helps you to determine whether or not you can enroll in a FSA outside of annual enrollment.

No. The I.R.S. has a “use it or lose it” rule for FSAs. Participants are encouraged to use their FSA monies during the Flex plan year which is January 1 through December 31, and before the end of the Grace Period which is March 15th of the following year.

Two of the most important concepts to understand about FSAs are the Grace Period and Run-Out Period. Money in a FSA account should be used by the end of December for the calendar year enrolled. For example, if you enroll in a FSA during annual enrollment of 2015, you should use your funds by December of 2016.

But, there is a Grace Period following the Flex Plan Year that lasts until March 15 of each year, which allows you to use the previous year’s flexible spending funds to pay for expenses incurred during the Grace Period. If you still haven’t used the money in your account by the end of the Grace Period, you’ll lose it.

The Run-Out Period lasts until April 30 for submitting claims. You have to have all your claims in by April 30, to be able to cover your expenses with your previous year’s money.

You can enroll in a FSA only after experiencing an OGB Plan Recognized Qualified Life Event provided for in the FSA Plan Document, or the Flexible Benefits Plan Summary, located on the OGB website.

Only if the annual elected amount is less than the annual maximum amount and only after experiencing an OGB Plan Recognized Qualified Life Event that is provided for in the FSA Plan Document, or the Flexible Benefits Plan Summary.

Yes, as long as they are your taxed dependents and you are enrolled in a GPFSA.

Yes. However, you both cannot get reimbursed for the same receipts.

Live Better Louisiana is a proactive approach to prevent illness and to manage any conditions that do appear. The program is available to OGB members enrolled in a Blue Cross and Blue Shield Pelican or Magnolia plan. The goal of this plan is to keep OGB members healthier by providing improved access to preventive healthcare and resources to help them better manage their health, understand their risk factors, and make educated choices related to their care. You can receive a wellness credit by participating in the Live Better program.

Please contact OGB customer service with the following information:

1. Name
2. Date of birth
3. How you completed your wellness visit requirement (i.e.- attending a Catapult Health on-site clinic or visiting your doctor, having them complete the Primary Care Provider form and sending it to Catapult Health)
4. Date you completed the wellness visit requirement

OGB will work with Catapult Health and Blue Cross to research your eligibility for the wellness credit.

Only the primary plan member is eligible to participate in the Live Better Louisiana program.

The primary plan member can receive a wellness credit (through their payroll system) by participating in the Live Better Louisiana program, which is a simple one-step process.

1. Receive a preventive health screening or have your doctor complete a primary care provider form (PCP) after your annual wellness visit. OGB is providing clinics across the state that screen for cholesterol, glucose levels and liver function. You’ll leave the clinic with a personalized health plan and referrals to appropriate specialists, primary care physicians or disease management programs.
   The process must be completed each year.

We are currently working on our clinic schedule for the plan year 2024. Please check the Catapult Health Scheduler web page for the list of clinics scheduled to date.

Members will receive a $120 annual ($10 monthly) premium credit on their BCBSLA health coverage.

Yes. There is a form available that you can bring to your physician that can be used to show you had your annual physical. The primary care physician form can be found on the OGB website under Resource>Forms>Live Better Louisiana.

Yes. Blue Cross members can sign up for the Blue365, which offers exclusive health and wellness deals that can help keep you healthy and happy—every day of the year! With categories like fitness, apparel, healthy eating, alternative medicine, healthy living, weight management, experiences, personal care, financial care and wellness, you’re sure to find something to enhance your life.

The federal Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985, made allowance for those who lost health coverage, due to job loss, to continue health benefits for a period of time. If you have recently changed employment status (left your employer), you are eligible for a temporary extension of group health coverage, and you have received a letter from TASC. TASC is OGB’s third-party administrator for FSA, COBRA and FSA COBRA.

If you are a new hire to state government, you have received a COBRA Specific Rights Notice Letter provided to all newly hired employees for information purposes only to let you know your rights as an employee.

You may contact TASC by visiting their website at https://www.tasconline.com/about-tasc/contact-us

The most common qualifying events that result in a loss of coverage can be:

1. Reduction in hours of the covered employee’s employment;
2. Voluntary or involuntary termination of the covered employee’s employment other than for reason of gross misconduct (note that a retirement is considered a termination of employment);
3. Death of the covered employee;
4. Divorce or legal separation of the covered employee from the employee’s spouse;
5. Dependent child ceasing to be a dependent child under the generally applicable requirements of the plan.

Once you are termed by your agency, your information is entered into the TASC COBRA system. TASC will generate a COBRA Specific Rights Notice Letter to the plan member to the current mailing address on file at OGB. The packet will include a waive or accept COBRA and/or FSA COBRA form; a date of the last day of election; premium cost; where to mail the premium and form (not to OGB); how to pay online; and more. According to COBRA regulations, the plan member has 60 days from the date of the COBRA Specific Rights Notice Letter to elect coverage under COBRA.

Yes, please refer to the health plan guide for information on who qualifies as an eligible dependent. For example, a child born or placed for adoption can be added to the coverage within 30 days of the birth or adoption.

18 months – If you are an employee that has lost coverage due to reduction in hours or termination of employment, you and any covered dependents may be eligible to continue coverage under COBRA for up to 18 months. The 18-month continuation period may be extended to a maximum of 36 months for covered dependents if a second qualifying event occurs during the 18-month continuation period. Second qualifying events may include death of the former employee, divorce or legal separation, and loss of dependent status under the plan. It is your responsibility to notify TASC and the Office of Group Benefits if you experience one of these events while on COBRA. Notification must be made within 60 days of the second qualifying event. Submit a completed Second Qualifying Event Form PDF along with a copy of the death certificate or the divorce decree, if applicable.

29 months – If you or one of your covered dependents is determined by the Social Security Administration to have been totally disabled on the date the Covered Person became eligible for continued coverage or within the initial 18 months of coverage, coverage under this Plan for all qualified beneficiaries with respect to the qualifying event may be extended at his or her own expense up to a maximum of 29 months from the date coverage would have otherwise terminated. Premiums during the additional 11 months of coverage may be at a substantially higher rate.

In order to apply for the disability extension, submit a completed Social Security Disability Extension (SSDE) Form PDF along with a copy of the determination letter.

36 months – When covered dependents lose coverage due to death of the employee, divorce or legal separation, loss of dependent status under the plan, or the employee becoming covered by Medicare, they may be eligible to continue coverage under COBRA for up to 36 months.

Please contact Office of Group Benefits and TASC if any of the circumstances apply to you.

Your initial premium payment must be postmarked within 45 days from the date you sent your election paperwork to TASC. The initial premium includes all payments due between your first day of COBRA and the current month. For example, if your first day of COBRA is in July and you are making your initial premium payment in August, the first payment should include the premiums due for both July and August. Once TASC processes your initial premium payment, your coverage will be reinstated retroactively back to your first day of COBRA. Your right to continue coverage under the plan will end if payment is not made within the required time.

Please mail all COBRA payments to:

TASC COBRA
2302 International Ln
Madison, WI 53704-3140

Include the Member ID in the memo field of the last 4 of the SSN. Also, any payment mailed should always be post marked by USPS. Any payments not mailed to the address above will not be processed.

No. To ensure your COBRA premium is processed timely, please mail all COBRA payments directly to TASC (see above question for address). You can also choose to pay online, with an additional fee.

Yes, by visiting their website at https://www.tasconline.com.

1-800-422-4661

Their hours of operation are Monday-Friday, *8:00am – *5:00pm (all time zones)
*According to area code

• You may login to your account on: tasconline.com and click “Contact Us”
• You may also fax documents to with attention to COBRA: 608-663-2753

It depends on your years of participation in an OGB health plan.

A future retiree may request their participation at any time through their human resources department.

No. You can enroll in Medicare Part A and upon retirement enroll in Medicare Part B.

OGB becomes the secondary plan for a retiree who has Medicare A and B. When that occurs, the retiree’s monthly premium decreases. However, the premium reduction only applies for those retirees who have both Medicare A and Medicare B.

If you are enrolled in Medicare A and/or B and a Blue Cross health plan, VibrantRx will become your pharmacy provider. VibrantRx will provide you with a new prescription card. You should not enroll in a separate Medicare part D plan.

• Medicare Part A covers hospitalization and is usually paid for in full at age 65.
• Medicare Part B covers physician’s visits and requires a monthly premium to keep in force.
• Medicare Part C is privately- offered plans that serve as an option to regular Medicare. It is most commonly referred to as Medicare Advantage.
• Medicare Part D is prescription drug.

No.

Yes. If you are eligible for Medicare Parts A & B, you are required by OGB rules to enroll in both. Failure to follow this rule will result in reduction or loss of claim benefits.

Yes, but when you sign up for Medicare Part A & Part B, your OGB premiums are reduced. Visit our Premium Rates page for more information.

Yes.

Medicare Advantage plans are private plans that act as direct substitutions for Medicare. Eligible retirees can enroll in Medicare Advantage plans and, once they do so, those plans take over totally for Medicare. They can vary greatly in medical and drug benefits as well as premiums. In fact, some plans do not require a monthly premium.

Medicare Advantage plans can vary: in deductibles, co-payments, prescription drug coverage, and provider networks. They also vary in the geographical area covered. OGB encourages you to research your options and select a plan that best suits your needs.

Prudential Insurance Company of America (Prudential)

No. There is no time limit on filing claims.

Supplemental insurance can be canceled during the annual enrollment period or if they experience a plan recognized qualified life event (QLE). Also if the product is not a flexed product, they can cancel anytime. Click here to see the OGB Life Insurance QLE chart.

QLE chart

Yes, the EOI must be submitted before the November 15th deadline.

The employee will pay the same premiums until January of the following year.

No, EOI is not needed to decrease life coverage, however if a member decides to increase coverage, EOI will need to be completed.

Employees should have completed a premium conversion form upon employment that would allow all deductions to be made pre-tax. If you are not sure, please verify with your human resources department as to if you completed a premium conversion form.

Employee Term Life coverage
Dependents Term Life coverage
Accidental Death & Dismemberment coverage

The policy through Prudential is Term insurance. Term Life insurance is a pure transference of risk in exchange for the payment of premium. Prudential, and prior carriers, have been providing coverage and assuming risk for the payment of premium. In the event a covered person were to pass, Prudential would honor their obligation/contract and pay the benefit. Absent that event, the insurer has earned the premium for the assumption of risk of the insurance. The Term Life policy has no cash value or paid up provision and to return premium at a later date would mean that Prudential provided free insurance coverage during the time they assumed the risk of the insured passing away.

No, this is a term life policy

Yes, your legal spouse, and children until they reach age 26.

Yes, the life insurance will have two automatic reduction of 25%
January 1 following your 65th and 70th birthday. (also premium reduces)

Newly hired employees who enroll within 30 days of employment are
eligible for life insurance without providing evidence of insurability.

If enrollment is after 30 days evidence of insurability is required.

Active: Contact your human resources department.
Retired: Contact the human resources department where you retired or OGB.

OGB: website www.groupbenefits.org
OGB Home page, OGB forms, Prudential Life Insurance

Employee has a right to choose one or more beneficiaries. The employee is to complete a form and submit it to their HR Department.

Beneficiaries or estate should complete the Group Life Insurance Claim form and submit it to the deceased employee/retiree’s HR Department.

Life insurance claims cannot be done after 10 year period.

Yes, when an employee’s employment terminates, the employee can convert their group term life coverage to an individual term life insurance contract policy.

Yes, a terminally ill employee whose life expectancy is 6 months or less may apply for an accelerated payment of death benefits. Proof of terminal illness must be received by Prudential within six months or less of life expectancy.

No

Yes.

Yes, spouses and children up to age 26. Plan members currently enrolled who wish to add dependent life coverage for a spouse can by providing evidence of insurability. Eligible dependent children can be added without providing evidence of insurability.

No, the employee pays 100% of dependent life premiums.

Full-time employees & retirees under age 70

Active employees: contact your Human Resources Department.
Retirees: contact the agency HR Department you retired from or OGB

Active employees should check with their human resources department. Retirees may contact OGB or send a letter to OGB requesting amount. Make sure to sign and date the information.