FREQUENTLY ASKED QUESTIONS
What is the Office of Group Benefits (OGB)?
OGB is an agency, authorized by state statute to provide health and life insurance benefits to active and retired state employees and their eligible dependents, as well as employees and retirees of other participating groups.
What is the cost of an OGB health plan?
It depends upon the plan option you choose, the number of dependents you cover, and your status as either an active employee or retiree with or without Medicare. Visit our premium rates to see the cost for the coverage level you fall into. For retirees, please refer to the rate schedule that applies to your participation schedule.
What is the OGB Customer Service phone number and what are the hours of operation?
OGB Customer Service can be reached at 1-800-272-8451 from 8:00 a.m. to 4:30 p.m. Monday through Friday. OGB customer service will be closed periodically for employee training and all official State of Louisiana holidays.
How do I get in touch with my plan provider?
I have moved. How do I change my address with OGB?
Active employees should change their address with their human resources department.
Retirees should mail or fax documentation to OGB. That documentation should include your social security number, old address and new address. You can mail your notice to:
OGB Eligibility Department
The fax number for retirees only is 225-342-9917.
Who do I call for answers about my medical claims?
Claims inquiries should be made to the administrator of the insurance plan. The number for your plan administrator can be found on the back of your insurance ID card.
My spouse has coverage through his/her employer. Can I be covered under my spouse’s plan and an OGB plan?
You can be covered under more than one health plan. Please keep in mind that there are special rules that determine which plan will pay as the primary insurer and which will pay as the secondary insurer. Please refer to the OGB plan document for further information. (Members may not be covered under more than one OGB health plan.)
Who should I call if I do not receive my insurance ID card or FSA debit card?
What’s the difference between a co-pay and coinsurance?
A copay is a flat fee for a specific service. Coinsurance, however, is a percentage of the contractually allowed cost of a specific service.
How are deductibles applied if I have coverage for my spouse and myself?
The entire deductible must be met before your coinsurance applies. Deductibles are based on the number of covered individuals on your plan. Deductibles are applied in total, not on an individual basis.
I am a newly eligible employee. When can I enroll in an OGB health plan?
Newly eligible employees have 30 days from their date of eligibility to enroll in an OGB health plan. If the employee misses the 30 day deadline, he/she can enroll during the next annual enrollment period usually held in October for the next plan year or upon an OGB Plan Recognized Qualified Life Event.
When can I add life coverage?
How do I add dependents?
Please visit your human resources department to add dependents to your plan. You must provide proof of the legal relationship of each covered dependent. Without that documentation, your enrollment cannot be completed. Acceptable documents include: your marriage certificate, birth letter or birth certificate, legal adoption or custody papers, if applicable, for each covered dependent. Your agency will verify the eligibility of dependents. Retirees should contact OGB for assistance.
Can I drop my coverage?
Yes, you may drop your coverage during annual enrollment or upon an OGB Plan Recognized Qualified Life Event. Retirees should note that if coverage is dropped, you may not get it back.
What are the OGB Plan Recognized Qualified Life Events which allow a member to add or delete a dependent and/or make a change to a health plan?
Please refer to the OGB Plan Recognized Qualified Life Event document for a list of these events.
How long do I have to pick up coverage once I have an OGB Plan Recognized Qualified Life Event?
The application must be submitted within 30 days unless otherwise specified in the OGB health plan document.
I’m pregnant. When can I add my baby to my plan?
In order for a newborn to be added as a dependent, you must complete an application and provide your human resources department with a birth certificate or a copy of the birth letter within 30 days of the child’s birth date. The birth letter will suffice as proof of parentage only if it contains the relationship of the child and the employee. If the birth certificate or birth letter is not received, enrollment may not take place until the next annual enrollment period or an OGB Plan Recognized Qualified Life Event.
Can I continue coverage if the primary plan member is deceased?
The surviving legal spouse and/or legal dependent of an employee or retiree may continue coverage unless or until the surviving legal spouse and/or legal dependent is or becomes eligible for coverage in a Group Health Plan other than Medicare.
HEALTH PLANS OFFERED BY OGB
What plans am I eligible for?
HEALTH SAVINGS ACCOUNT (HSA) - BLUE CROSS and BLUE SHIELD of LOUISIANA PELICAN HSA775
How does an HSA work?
A Health Savings Account, or HSA, is an employee-owned account used to pay for qualified medical expenses, including deductibles, medical co-pays, prescriptions and other eligible medical, dental and vision costs. To enroll in an OGB HSA, you must enroll in the Pelican HSA775. Both employees and employers can contribute to a HSA, but the funds are owned by the employee. The HSA funds are available even if you are no longer employed by an OGB-participating employer. The Pelican HSA plan is only available to Active Employees. For a list of covered expenses visit www.mysmartsaver.com.
Are there Eligibility Rules that apply to HSA accounts?
Yes. The Pelican HSA775 Plan is a high deductible health plan which may be used in conjunction with an HSA for those eligible to participate in such an account. Eligibility to participate in and contribute to an HSA must be met on a monthly basis. It is your responsibility to ensure that you are eligible to maintain an HSA. The below factors affect your eligibility to participate in and/or make contributions to an HSA:
How do I enroll into an HSA? Do I have to complete an application and fax it to HealthEquity?
To enroll in an OGB HSA, you must first enroll in the Pelican HSA775 health plan. You can setup your HSA deduction with your human resources department or during annual enrollment. Your contributions are taken out of your check, pre-taxed, as a payroll deduction.
Does it rollover every year?
Yes. Unused funds will rollover year after year. You won’t lose your money if you don’t spend it within the year.
Is there a maximum amount you can rollover in the HSA yearly?
No. There is no maximum on the amount you can rollover in the HSA account.
Can retirees participate in the HSA plan?
No. The Pelican HSA plan is only available to Active Employees, who have not enrolled in a Medicare Plan (i.e. Medicare Part A or Medicare Part B).
What happens if I get a new job?
If you get a new job with a non-OGB participating employer, you can still use your HSA. It is yours to keep and the funds in it will remain available for your use.
How do I use the money?
You will receive a debit card that can be used to pay for eligible expenses. You may also order checks from HealthEquity after your account has been set up successfully.
Who should I contact if I have questions about my Health Savings Account?
You have 24/7 access to Health Equity’s Customer Service Center at: 1-877-987-8123
How long does it take to receive the welcome kit and debit card after HSA is opened?
A debit card and welcome kit will arrive in separate mailings within 10 business days of HSA being opened. The welcome kit will introduce you to how your HSA works, how to access your account online, ways to contribute and use your HSA funds, the benefits of maximizing your contributions, and useful online banking tools and HSA resources.
I received my card and welcome packet from HealthEquity. Do I have to return anything?
Yes. You must complete and return the HSA Signature Card and beneficiary election form that is enclosed in your welcome letter. Please review the information, make any necessary additions or corrections, sign it where indicated, and return the form to HealthEquity, the custodian of your HSA, in the provided envelope within 10 business days of receiving it.
Can I still order MySmar$aver checks?
No. Paper checks will no longer be issued for MySmart$aver HSA beginning Dec. 4, 2015. Beginning Dec. 7, 2015, all MySmart$aver transactions will need to be made through the new MySmart$aver debit card.
How much can an employee contribute to their HSA?
The maximum annual contribution that can be made to an HSA during 2019, including employer contributions, is:
How much does my employer contribute to my HSA?
Agencies contribute $200, initially, to employees’ HSA at the beginning of each plan year. They will also match employee’s tax-free contributions dollar-for-dollar up to an additional $575 through payroll deduction each plan year. Employees must have the Pelican HSA775 in order to receive initial deposit and matching contributions.
Can I change my monthly contributions throughout the year?
You must set up an initial deduction amount when you first enroll in the plan. However, you can change the amount of the deduction throughout the policy year, up to once a month.
Can I contribute additional monies over the maximum to the HSA?
An employee who is over 55 years of age may contribute an additional $1000 to their HSA account yearly.
How do I set up my HSA deductions?
You can set up your HSA deduction with your human resources department or you can enroll during annual enrollment.
Who can contribute to my HSA?
Anyone can contribute to your HSA.
Will these deductions be monthly or bi-weekly?
The deduction is based on your payroll schedule.
When will the HSA $200.00 employer contribution be available to the employee?
The $200.00 employer contribution is available the month following OGB’s receipt of payment from the agency.
When will my contributed deductions or employer match contributions be available?
HSA employee contributions and employer match contributions will be available the following month after the deductions or employer match contributions are taken from the employee’s check. Example: Deductions taken in the month of March will be available for the employee in the month of April.
Will debit card transactions be allowed at ATMs?
No. New MySmart$aver debit cards can no longer be used at ATMs and debit card PINS will not be issued.
Do employees need to keep track of deposits and withdrawals from their HSA?
Yes. Employees should keep a record of all transactions in and out of their HSA so they can supply documentation on their deposits and expenditures, if needed. It is up to the accountholder to monitor the deposits and withdrawals made to and from their HSA.
How do I check my HSA balance?
Upon enrollment, you will receive a welcome kit with instructions on how to access your account.
Can my employer control how I spend my money?
You own the money in your HSA. Your employer cannot control how you use the funds.
Can the HSA money be used for a family member not on my plan?
Yes. HSA funds can be used for you, your spouse or eligible dependents (as identified on your Federal tax return) even if they are not covered by the Pelican HSA775 plan.
What are the benefits of enrolling into a HSA and a Limited-Purpose FSA?
Putting monies in a Limited-Purpose FSA for dental and vision expenses frees up the HSA monies to be used for medical expenses or be rolled over to create a larger HSA balance to be used in the future.
HEALTH REIMBURSEMENT ARRANGEMENT (HRA) BLUE CROSS and BLUE SHIELD of LOUISIANA PELICAN HRA1000
What is a Health Reimbursement Arrangement?
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 employed by an OGB-participating employer.
How much does my agency contribute to the HRA?
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.
How does an HRA work?
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.
Who can contribute to the HRA account?
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.
Does it rollover every year?
Yes. Unused funds will rollover until it reaches your in-network out-of-pocket maximum. So for example, if you are on an employee-only plan, your unused funds will rollover until it reaches $5,000.
What happens if I get a new job?
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.
Can I use HRA funds for pharmacy charges?
No, only eligible medical services may be reimbursed by HRA funds.
Whom do I contact if I have a question about the funds in my HRA?
You may contact Blue Cross at 1-800-392-4089.
Can I enroll into a Flexible Spending account if I have an HRA?
Yes, if you are an active full-time employee, a General-Purpose FSA or Limited-Purpose FSA may be used with an HRA.
How will I know when my HRA funds are exhausted?
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.
What is Via Benefits?
Via Benefits is a broker that offers members access to individual Medicare plans from multiple carriers. Via Benefits is an OGB-approved broker of individual Medicare plans.
What do they do?
They offer retirees with Medicare access to individual Medicare plans from multiple carriers and are available to counsel retirees to select the best plan for them.
Are they the insurer?
No, they are the Broker of Record.
Do they provide prescription drug coverage?
The plans they offer may or may not have a drug component – it will depend on the individual plan. You are encouraged to speak with a Via Benefits Benefit Advisor for more detailed benefit information, 1-855-663-4228.
What are my plan options with Via Benefits?
Via Benefits works with the top national and regional insurance companies to ensure that you will have quality individual plan options. There will likely be individual plans available that are similar to your current group plan, but there may be plans better suited to your needs. Multiple options give you the ability to find a plan that closely matches your specific needs. We encourage you to contact Via Benefits and speak with a Benefit Advisor, 1-855-663-4228.
If I enroll in a plan through Via Benefits, can I return to an OGB plan at a later date?
Does Via Benefits offer plans that cover me in multiple states? Are there plans that cover me when I travel domestically or internationally?
Medigap plans are accepted by every Medicare-participating provider in the United States, with some emergency benefits worldwide. If you travel frequently or live part of the year out-of-state, these plans may be right for you. Part D plans provide nationwide coverage from participating pharmacies. While Medicare Advantage plans cover urgent and emergency services nationwide, some may not provide nationwide coverage for non-emergency services. If you live part of the year out-of-state, Medicare Advantage plans may not be right for you.
How much will I receive in my HRA account?
Via Benefits plan also includes an employer contribution of $200 (retiree only) to $300 (retiree and spouse) per month which can be used to offset eligible medical costs.
What is Medigap?
Medigap (also known as Medicare Supplement) plans work with Medicare. Medicare continues to be the primary payer of medical expenses. A Medigap plan pays for expenses that Medicare partially covers. You must have Medicare Part A & Part B in order to enroll in a Medigap plan.
Do I need to keep paying my Medicare Part B premium?
Yes. To qualify for a Medigap or Medicare Advantage plan, beneficiaries must be enrolled in and continue to pay for Medicare Part B.
Will I have to pay for my new health plan when I enroll?
When you enroll, you will need to begin making premium payments to the insurance company to maintain your coverage. Some companies may require the first month’s premium payment during the application process. In this case, expect to make a payment within a few days of your enrollment. To expedite your enrollment call, have your payment information ready when you contact us. Most insurance companies give you several billing options for ongoing payments: direct billing, Electronic Funds Transfer from your checking account, or automatic deduction from your Social Security check.
If I need assistance can someone else speak with a benefit advisor on my behalf?
Yes, but this person can only complete your enrollment if they have your medical Power of Attorney. You may provide your Power of Attorney information to us online in advance of your call to expedite your enrollment.
What is a Zero Premium Plan?
A plan that has no premium.
FLEXIBLE BENEFITS OFFERED BY OGB
What is a Flexible Benefits plan?
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.
What options do I have?
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.
What is a General-Purpose 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.
What is a Limited-Purpose FSA?
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.
Can I have a General-Purpose FSA and a Limited-Purpose FSA?
No. You can’t be enrolled in both plans.
What is the Dependent Care FSA?
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.
What are the Dependent Care limits?
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.
How does a Flexible Benefits plan work?
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 27.
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 2015 plan year, the minimum was $600 and the maximum was $2550 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.
If I join the Flexible Benefits Plan, will I ever have to pay taxes on the money I put into the plan?
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.
What is “Automatic Enrollment” in the Flexible Benefits Premium Conversion?
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.
How can I contact the flexible spending arrangement administrator, if I have a question about my account?
Discovery Benefits, Inc. (DBI) is OGB’s third-party administrator for the flexible spending arrangement (FSA). Participants may call DBI, toll-free, at 1-866-451-3399, or visit online at www.DiscoveryBenefits.com, or send a fax at 1-866-451-3245.
Can I have a General-Purpose FSA with a Health Savings Account?
No. However, you can elect to have a Limited-Purpose FSA for dental and vision only.
Does the FSA roll over to the next year?
No. You must enroll in a FSA every year.
Do I have to pay an annual fee?
Yes. When you enroll in a FSA you also agree to pay the administrative annual fee, which is $34.80 annually divided equally per the number of pay periods in the Flex Plan Year.
What if I didn’t sign up during annual enrollment, but I get married or have a baby during the year and would like to have a FSA?
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. 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.
What if I don’t use all of my money? Do I get it reimbursed to me at the end of the year?
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.
What is a Grace Period and Run-Out Period?
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.
What happens after I enroll in a FSA and I want to get reimbursed?
The FSA Visa debit card will auto-substantiate for office providers and co-pays. See below for the process.
General-Purpose or Limited-Purpose FSA Reimbursement Process
Dependent Care Reimbursement Process
Can I enroll in a FSA during the middle of the year?
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.
Can I increase my FSA elected amount in the middle of the year?
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.
Can the out-of pocket medical expenses for my wife and dependents be reimbursed through the General-Purpose FSA?
Yes, as long as they are your taxed dependents and you are enrolled in a GPFSA.
I am a state employee and my spouse is a state employee, can we each have a General-Purpose FSA?
Yes. However, you both cannot get reimbursed for the same receipts.
LIVE BETTER LOUISIANA
What is Live Better Louisiana?
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.
What if I qualified for the wellness credit but it is not showing up on my pay check?
Please contact OGB customer service with the following information:
OGB will work with Catapult Health and Blue Cross to research your eligibility for the wellness credit.
Who is eligible to participate in the Live Better Louisiana program?
Only the primary plan member is eligible to participate in the Live Better Louisiana program.
How does it work?
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.
Where can I find a list of clinics in my area?
We are currently working on our 2015-2016 clinics schedule. Please check back soon.
What’s the discount for participating in the Live Better wellness program?
Members will receive a $120 annual ($10 monthly) premium credit on their 2019 BCBSLA health coverage.
If I can’t go to a clinic, can I still get a discount?
Yes. There is a form available that you can bring to your physician that can be used to show you had your annual physical.
Are there any discounts on gym memberships or other services?
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.
InHEALTH: BLUE HEALTH SERVICES - BLUE CROSS and BLUE SHEILDs DISEASE MANAGEMENT
What is the disease management program offered to BCBSLA members?
InHealth: Blue Health Services is Blue Cross and Blue Shield of Louisiana’s disease management program for Active Employees and Non-Medicare Retirees. This program offers support for members who have chronic conditions such as health coaching, low cost prescriptions, and educational materials.
Who is eligible for InHealth: Blue Health Services?
To enroll, you must:
How do I join InHealth?
This program is part of your health plan as long as Medicare is not your primary coverage. If eligible, you must enroll and speak with a Blue Cross Health Coach at least once every three months (or 90 days) or more often as requested by the health coach to remain an active participant in the program.
To enroll or confirm your enrollment, call a Blue Cross Health Coach toll-free at 1-800-363-9159.
What can InHealth do for me?
What is a Health Coach?
Health coaches are Blue Cross nurses or healthcare professionals who:
How can InHealth save you money on prescriptions?
Participation in the disease management program can save money on certain prescriptions. Prior to August 1, 2014, PPO, HMO, and CDHP members pay only $15 for certain brand-name drugs, when a generic is not available and $0 for certain generic drugs. Beginning August 1, 2014, PPO and HMO members will continue to receive certain no cost generic prescriptions and will receive certain name-brand prescriptions for $20 (31 day supply) / $40 (62 day supply) / $50 (93 day supply). The disease management prescription incentive for the HSA plan will remain with Express Scripts and will not change.
Covered drugs include certain drugs specifically prescribed for treating diabetes, coronary artery disease, heart failure, asthma, and COPD.
VANTAGE WELLNESS and DISEASE MANAGEMENT PROGRAMS
I’m a member of a Vantage Health Plan. What are my options for wellness?
Members of a Vantage Health Plan can participate in Vantage Wellness. This is an online program designed to encourage healthy lifestyle habits. The new website has tools that allow you to track your progress and exercise routines, learn about healthy activities, and keep up with earned Wellness Points. Then you can use those points to register for prize drawings.
How do I earn points on the Vantage Plans?
Members can earn up to three points per week. Points can be earned by:
If I select a Vantage plan, how do I sign up for their Wellness program?
Does Vantage offer gym membership discounts?
The newest incentive offered by Vantage Wellness includes discounted gym memberships with local popular gyms. This option allows participants the opportunity to establish a regular workout regimen in a health-centered environment at a more affordable price. Along with the new website, Vantage Wellness has also developed a free smartphone app, which makes tracking your progress even easier and more convenient.
What are Vantage’s Disease Management Programs?
Vantage Health Plan’s Disease Management Programs (DMPs) are educational programs for members with certain chronic conditions. The purpose of the DMPs is to help members better self-manage their chronic conditions. Vantage Health Plan offers the following DMPs:
How do Vantage’s DMPs work?
Once enrolled in one of the DMPs, a clinical pharmacist will contact the member to talk about their chronic conditions. The pharmacist will also send educational and health-reminder mailings, perform a complete medication review, and offer daily self-care tips to help better manage their conditions and set health care goals.
What is the cost to participate?
Vantage Health Plan’s DMPs are available at no cost to members.
How do I sign up?
Call a Vantage Clinical Disease Management Pharmacist toll-free at (888) 316-7907.
THE CONSOLIDATED OMNIBUS BUDGET RECONCILIATION ACT of 1985 (COBRA)
I received a letter in the mail about COBRA. What is COBRA?
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 Discovery Benefits Inc. Discovery Benefits 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.
Who do I contact about COBRA coverage?
Contact Discovery Benefits, Inc., OGB’s third-party administrator for FSA, COBRA and FSA COBRA, toll-free, at 1-866-451-3399, click option 1, click option 2.
What are qualifying events for COBRA?
The most common qualifying events that result in a loss of coverage can be:
How do I elect COBRA coverage?
Once you are termed by your agency, your information is entered into the Discovery Benefits, Inc. (DBI) COBRA system. DBI 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 ($20 fee 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.
Can I add dependents to my coverage while I’m on 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.
How long may I and/or my dependents continue coverage under COBRA?
Depending on the circumstances, you and/or your dependents may be eligible to continue coverage under COBRA for 18, 29, or 36 months.
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.
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 Discovery Benefits if any of the circumstances apply to you.
When are my COBRA premium payments due?
Your initial premium payment must be postmarked within 45 days from the date you sent your election paperwork to Discovery Benefits. 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 Discovery Benefits 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. Discovery Benefits sends weekly paid through reports to the carriers on Tuesday mornings and then they allow at least 48 hours for the carriers to update their system to reflect active. Therefore, payments need to be applied on their accounts by midnight on Monday night in order to show up on the Tuesday paid through report.
Where do I mail my COBRA payments?
Please mail all COBRA payments to COBRA Processing Center:
Can I mail or bring my COBRA premium to OGB?
No. To ensure your COBRA premium is processed timely, please mail all COBRA payments directly to Discovery Benefits (see above question for address). You can also choose to pay online, with an additional fee.
Can I pay my COBRA premiums online?
Yes, payments can be made online through Benefits Employer Portal.
What is Discovery Benefits’ telephone number?
Discovery Benefits’ toll-free customer service telephone number for COBRA inquiries is 1-866-451-3399, press option 1 and then press option 2.
What are the Discovery Benefits’ hours of operation and how do I get payment information?
Discovery Benefits hours of operation are Monday through Friday, 6:00 am – 9:00 pm CT. If you would like to reach them after hours, they do have an interactive voice response available 24/7. The outline of Discovery Benefits’ after-hours IVR system to call and get payment information is:
Can I email Discovery Benefits if I have a question?
Yes, please direct all inquiries to email@example.com. Please do not submit documentation to this address, only inquiries. In addition to emailing DBI, you can also utilize the online chat feature available on https://www.discoverybenefits.com (click the orange Chat Button at the top of the screen).
How much will my employer contribute to my premium upon retirement?
It depends on your years of participation in an OGB health plan.
When can I request my participation?
Not more than 120 days before your scheduled date of retirement.
If I am actively employed and over 65, do I have to enroll in Medicare A & B?
No. You can enroll in Medicare Part A and upon retirement enroll in Medicare Part B.
How can I get reduced rates once I receive my Medicare card?
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.
What is Medicare GenerationRx?
If you are enrolled in Medicare A and/or B and a Blue Cross health plan, Medicare GenerationRx will become your pharmacy provider. Medicare GenerationRx will provide you with a new prescription card. You should not enroll in a separate Medicare part D plan.
I understand there are different parts of Medicare. Can you explain what the most common parts are?
Can retirees participate in the HSA plan?
I have OGB coverage and I am also eligible for Medicare Parts A & B. Do I have to enroll in both?
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.
If I get Part B of Medicare, does that mean that I will be paying the full cost for OGB coverage and paying Medicare B coverage premium as well?
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.
If I have Medicare Parts A and B along with an OGB policy, does my coverage include prescription drug benefits?
Can you tell me more about Medicare Advantage plans?
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.
How much can Medicare Advantage plans vary?
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.
What is the name of my Life Insurance company through the Office of Group Benefits?
Prudential Insurance Company of America
What coverage is offered?
Employee Term Life coverage
Does the Life Insurance Plan have a cash value?
No, this is a term life policy
Can I add my legal dependents?
Yes, your legal spouse, and children until they reach age 26.
Does my life insurance have a reduction in coverage?
Yes, the life insurance will have two automatic reduction of 25%
Do I have to prove good health for the Life Insurance?
Newly hired employees who enroll within 30 days of employment are
If enrollment is after 30 days evidence of insurability is required.
How do I change my beneficiaries?
Active: Contact your human resources department.
Where can I review Life Insurance information, premiums and forms?
OGB: website www.groupbenefits.org
Employee has a right to choose one or more beneficiaries. The employee is to complete a form and submit it to their HR Department.
How does the beneficiary submit a death certificate?
Beneficiaries or estate should complete the Group Life Insurance Claim form and submit it to the deceased employee/retiree’s HR Department.
What is the timeline for filing a life insurance claim?
Life insurance claims cannot be done after 10 year period.
If I am terminated from employment can I convert my policy?
Yes, when an employee’s employment terminates, the employee can convert their group term life coverage to an individual term life insurance contract policy.
Does the life insurance policy have a living benefit option?
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.
Do I have to re-enroll if I already have a life insurance plan through OGB?
Will I still be able to carry my life Insurance coverage after I retire?
Can I add my spouse and/or dependents to my life insurance plan?
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.
Does the employer contribute to my spouse or dependent contribution?
No, the employee pays 100% of dependent life premiums.
Am I eligible for Accidental Death and Dismemberment coverage?
Full-time employees & retirees under age 70
Who do I need to speak with to get answers about Life insurance questions?
Active employees: contact your Human Resources Department.
How do I find out the face value of my Life Insurance?
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.