2016 Annual Enrollment Guide For Employees of the Louisiana State University System

WHAT’S INSIDE

Benefits Overview 2

Changes 3

AE Schedule 4

LSU First 5

Office of Group Benefits 6

Dental 7

Vision 8

Life with optional AD&D 9

AD&D 10

Long-Term Disability 11

Flexible Spending Accounts 12

Critical Illness 13

Accident Protection Plan 15

Unum Long Term Care 16

BENEFITS OVERVIEW The Louisiana State University System is proud to offer a comprehen-sive benefits package to eligible, full-time employees who work 30 hours per week and are appointed for a duration of at least one semester or 120 days. This comprehensive benefit package is briefly summarized in this booklet, however for a full description of the benefit plan terms and condi-tions please refer to the summary plan descriptions or certificates of cover-age provided by the administrator for each respective benefit plan offered.

You share the costs of your health insurance premium with the LSU Sys-tem. In addition, there are voluntary benefits that you can purchase through LSU payroll deductions.

Annual Enrollment occurs from October 1st to October 31st, 2015. Any changes made during this period will become effective January 1, 2016. During this time you can enroll, cancel or make changes to your health and voluntary benefit plans. We encourage you review your benefit elections and make selections/changes consistent with your individual needs.

BENEFIT PLANS OFFERED

Medical

LSU First

Option 1

Option 2

Office of Group Benefits

Pelican HRA 1000

Pelican HSA 775

Magnolia Local

Magnolia Local Plus

Magnolia Open Access

Vantage Medical Home HMO

Dental

Vision

Life Insurance with optional AD&D

Accidental Death and Dismemberment

Long-Term Disability

Flexible Spending Accounts

Critical Illness

Accident Protection

Long Term Care

This guide is designed to be a brief overview of the 2016 benefit offerings. We encourage you to contact your

HR department or the carriers directly if you have questions about any of the information in this booklet. If

differences exist between this summary and your Certificate of Coverage, the Certificate of Coverage will

govern.

Current Health Plan members:

For 2016, there will be a passive enrollment. If you are currently enrolled and do not wish to make any changes to your health plan elections, no action is required. You are encouraged to confirm that your address and any dependent information

is up to date.

BENEFIT 2016 CHANGES

LSU First HRA, Deductible, and Maximum Out-of-Pocket amounts will remain the same. Addition-

al services have been added to the Pre-authorization list. Please see the Benefits web-

site at www.lsu.edu/benefits for a list of pre-certification services. There will be a 5%

increase in premiums.

Office of Group Benefits

Health Plans

The Pelican and Magnolia Plans will continue to be administered by Blue Cross Blue

Shield. It is strongly recommended that you visit www.groupbenefits.org to view 2016

plan information, attend an OGB meeting or call 1-800-272-8451 for information on all

OGB plans.

Dental Dental insurance will continue to be administered by UnitedHealthcare. There will be no

changes in premiums or plan design for both Dental plans. During Annual Enrollment

you can enroll, cancel or change plan options.

Vision Vision insurance will continue to be administered by UnitedHealthcare. There will be no

changes in premiums or plan design. Eye exams are covered at 100% and there is a

$130 allowance for frames.

Life with optional AD&D Life insurance will continue to be administered by UnitedHealthcare. Current participants

can increase their coverage by 1 time their basic annual salary, up to a total of

$500,000, without evidence of insurability. Currently enrolled spouses can increase their

coverage by $5,000 without evidence of insurability. If you do not currently have Volun-

tary Life insurance, employees can enroll during Annual Enrollment for $10,000 on a

guaranteed issue basis.

Stand Alone AD&D Stand Alone AD&D insurance will continue to be administered by UnitedHealthcare.

There are no changes in premiums or plan design.

Long-Term Disability LTD will continue to be administered by UnitedHealthcare. If you are not currently en-

rolled in LTD, you can apply for coverage any time throughout the year by completing

the medical underwriting process.

Flexible Spending

Account(s)

Healthcare and Dependent Care Spending Accounts will continue to be administered by

Boon-Chapman. There are no changes for 2016.

Critical Illness

Critical Illness will continue to be administered by UnitedHealthcare. There will be no

changes in premiums or plan design. Employees can enroll in this plan during Annual

Enrollment without medical underwriting.

Accident Protection Plan Accident Protection will continue to be administered by UnitedHealthcare. There will be

no changes in premiums or plan design. Employees can enroll in this plan during Annual

Enrollment without medical underwriting.

Long-Term Care Long-Term Care will continue to be administered by UNUM. There will be no changes in

premiums or plan design. If you are not currently enrolled in LTC, you can apply for

coverage any time throughout the year by completing the medical underwriting process.

ANNUAL ENROLLMENT SCHEDULE

Annual Enrollment occurs from October 1 to October 31, 2015. Any changes made during this period will become effective January 1, 2016. During this time you can enroll, cancel or make changes to your health and voluntary benefit plans. We en-courage you review your benefit elections and make selections/changes consistent with your individual needs.

During the month of October, Benefit Fairs and presentations will be held throughout the state to inform LSU employees of the 2016 benefit offerings. We encourage you to attend one of the fairs or presentations in your area!

Date Time Campus Address Meeting

Monday 10/5 1 pm—4 pm LSU Ag Center 212 Macon Ridge Road

Winnsboro, LA 71302

Presentation

Tuesday 10/6 9 am; 2 pm

10 am—4 pm

Health Science Center—

Shreveport

1501 Kings Highway

Shreveport, LA 71103

Presentation

Fair

Wednesday 10/7 10:30

9 am—1 pm

LSU Shreveport One University Place

Shreveport, LA 71115

Presentation

Fair

Thursday 10/8 10 am

10 am—2 pm

LSU Alexandria 8100 Hwy 71 South

Alexandria, LA 71302

Presentation

Fair

Friday 10/9 1:30 pm—

3:30 pm

LSU A&M LSU Student Union

Capital Chamber Room

Presentation

Monday 10/12 9 am—12 pm LSU Ag Center 214 Efferson Hall

Baton Rouge, LA 70803

Presentation

Tuesday 10/13 9 am—11 am LSU A&M LSU Student Union, Capital Chamber Room

Baton Rouge, LA 70803

Presentation

Tuesday 10/13 2 pm—4 pm Pennington Biomedical

Research Center

6400 Perkins Road

Baton Rouge, LA 70808

Presentation

Wednesday 10/14 9 am—11 am LSU A&M LSU Student Union – Cotillion Ballroom

Baton Rouge, LA 70893

Presentation

Wednesday 10/14 2 pm—5 pm Lallie Kemp Medical Center 52579 Hwy 51 South

Independence, LA 70443

Fair

Thursday 10/15 10 am—3 pm LSU A&M LSU Student Union - Cotillion Ballroom

Baton Rouge, LA 70893

Fair

Tuesday 10/20 9 am

10 am—2 pm

Health Science Center—New

Orleans

Medical Education Building—3rd Floor

1901 Perdido St

New Orleans, LA 70112

Presentation

Fair

Wednesday 10/21 10 am—2 pm LSU Eunice 2048 Johnson Hwy

Eunice, LA 70535

Fair

Thursday 10/22 9 am—12 pm LSU Ag Center 157 Cherokee Drive

Crowley, LA 70526

Presentation

Comprehensive and preventive healthcare coverage is important in protecting you and your family from the financial risks of unex-pected illness and injury.

LSU First is a self-insured plan that gives you options and con-trol over how to spend your healthcare dollars. There are two options: Option 1 has a higher premium, but a lower deductible. Option 2 has a lower premium, but a higher deductible you must meet before the Plan pays at the co-insurance/co-payment levels. Option 2 may be a good choice if you have rollover HRA dollars from previous plan years or if you know you will have minimal healthcare costs during the Plan Year.

LSU First includes a Health Reimbursement Account (HRA), with the ability for unused dollars to be rolled over from year to year. After the HRA is exhausted, you have a deductible that must be met. The deductibles vary based on plan option and can be seen below. After both the HRA is exhausted and the deductible is satisfied, the Plan will pay medical claims at 90% In-Network (you are responsible for 10%) and 60% of MRC Out-of-Network (you are responsible for 40% plus the overage of the MRC). If you exhaust your HRA and meet your Deductible, you will pay a co-pay for your prescriptions. Generic drugs will have a $0 co-pay, brand name drugs will have a $40 co-pay per 30-day supply and specialty drugs have a $150 co-pay per 30-day supply.

An advantage of the LSU First Health Plan is the First Choice Network, a specialized network of doctors and hospitals within Louisiana. Once you have exhausted your HRA, services by First Choice Providers will be covered at 100%. Additionally, once you have exhausted your HRA, generic drugs will be covered at 100%. LSU First has two networks – Verity HealthNet, a localized net-

LSU FIRST HEALTH PLAN Administered by WebTPA and CitizensRx

Option 1 Option 2

12 Month Employee

Employee Only $155.92 $139.22

Employee + Spouse $450.80 $392.60

Employee + Child(ren) $224.40 $213.82

Employee + Family $539.70 $473.34

9 Month Employee

Employee Only $207.89 $185.63

Employee + Spouse $601.07 $523.47

Employee + Child(ren) $299.20 $285.09

Employee + Family $719.60 $631.12

Retiree with No Medicare/Rehired Retiree

Employee Only $155.92 $139.22

Employee + Spouse $450.80 $392.60

Employee + Child(ren) $224.40 $213.82

Employee + Family $539.70 $473.34

Retiree with one member on Medicare

Employee Only $93.70 $81.02

Employee + Spouse $332.68 $287.63

Employee + Child(ren) $163.28 $160.20

Employee + Family $459.20 $401.46

Retiree with two members on Medicare

Employee + Spouse $166.80 $144.22

Employee + Family $209.96 $194.13

work in Louisiana, and Aetna ASA, a national network. Both networks are covered at 90% after deductible. Pro-viders that are not a part of these networks (First Choice, Verity, or Aetna ASA) will be paid at the 60% of MRC.

If you are currently in LSU First and wish to remain, no action is necessary.

HRA

Option 1 Remaining

Deductible

Option 2 Remaining

Deductible

LSU First Annual HRA and Remaining Deductible

Employee Only

$1,000 $500 $1,500

Employee + Spouse

$1,500 $750 $2,250

Employee + Child(ren)

$1,500 $750 $2,250

Employee + Family

$2,000 $1,000 $3,000

Website: www.lsufirst.org | www.lsufirst.webtpa.com

Customer Service: 1 (855) 346-5781

Policy Number: LSUFIRST

Scan the code to go to

the LSU First website

OFFICE OF GROUP BENEFITS HEALTH PLANS Administered by Blue Cross Blue Shield of Louisiana and Vantage

Pelican

HRA 1000

Pelican

HSA 775

Magnolia Local

Magnolia

Local Plus

Magnolia

Open Access

Vantage HMO

Benefits

Employer contribution to HRA or HSA X X

Out-of-Network coverage X X X X

Disease Management X X X X X X

Wellness X X X X X X

Emergency Coverage X X X X X X

Available to Retirees without Medicare X X X X X

www.groupbenefits.org | 1 (800) 272-8451

www.bcbsla.com/ogb | 1 (800) 392-4089

www.vhp-stategroup.com | 1 (800) 823-1910

The Pelican and Magnolia plans will continue to be administered to Blue Cross Blue Shield.

It is STRONGLY RECOMMENDED that you visit www.groupbenefits.org, attend an

OGB regional meeting (schedule on OGB website) or call 1-800-272-8451 for information

on all OGB plans. There are several factors to consider when you select a health plan. Net-

work coverage, prescription benefits, out of pocket costs and wellness programs all influ-

ence the value of the health care you receive. A full benefits comparison is available on the

LSU Benefits website, www.lsu.edu/benefits.

www.groupbenefits.org | 1 (800) 272-8451

www.bcbsla.com/ogb | 1 (800) 392-4089

www.vhp-stategroup.com | 1 (800) 788-2949

Contact Information

OGB Customer Service

1-800-272-8451 www.groupbenefits.org

Blue Cross Blue Shield of

Louisiana

1-800-392-4089 www.bcbsla.com/ogb

Vantage 1-800-788-2949 www.vhp-stategroup.com

DENTAL INSURANCE Administered by UnitedHealthcare

Deductible Applies to basic and major services only - $50 per person, up to $150 per family

Preventive Services

Exams, cleanings, x-rays – 100% coverage (Does not apply to Annual Max)

Basic

Services

Fillings, simple extractions – plan payments are based on a Fee Schedule

Major

Services

Oral surgery, root canals, crowns – plan payments are based on a Fee Schedule

Annual

Maximum

The Basic plan pays a maximum of $1,500 per year per covered person.

Orthodontia Not Covered

Deductible No deductible

Preventive Services

Exams, cleanings, x-rays – 100% coverage (Does not apply to Annual Max)

Basic

Services

Fillings, simple extractions - Plan pays 80% of U&C

Major

Services

Oral surgery, root canal, periodon-tics, dentures, crowns – Plan pays 50% of U&C

Annual

Maximum

The Enhanced plan pays a maxi-mum of $1,500 per year per cov-ered person.

Orthodontia The Enhanced plan pays a maxi-mum of $1,500 per lifetime per cov-ered person.

Basic Plan

Good oral care enhances overall physical health, appearance and mental well-being. Keep your teeth healthy and your smile bright with the LSU dental plan offered through UnitedHealthcare.

The Basic plan is designed with two goals in mind: to promote good dental hygiene through preventive care and to provide you with the dental care you need at a low cost. The Basic Plan pays 100% of the Usual and Customary (U&C) fee allowance for Pre-ventive Services and features a benefit schedule for all other services. The benefit schedule lets you know up front, in fixed dollar amounts, how much the Plan pays for Basic and Major services. To use these schedules, check your dentist’s fee and then deter-mine how much the Plan will pay according to the scheduled amounts. The Basic Plan has an annual deductible of $50/person up to $150/family for non-preventive services.

The Enhanced Plan offers comprehensive dental coverage in an easy-to-use format. The Plan will cover a percentage of U&C charges, including 100% of preventive claims. All dentists in network have agreed to honor the negotiated rates, and most dentists not in the network charge similarly, helping you to limit your out-of-pocket costs. Orthodontia is also included in the Enhanced Plan, making it a good choice for families with more extensive dental needs. The Enhanced Plan does not have a deductible.

For 2016, you can enroll, change plan options, or cancel your dental coverage. To do so, complete the Voluntary Benefits Enroll-ment Form and submit to your local HR department.

Enhanced Plan

Monthly Premium

BASIC DENTAL

Employee Only $17.88

Employee + Spouse $33.60

Employee + Children $46.45

Employee + Family $62.16

Monthly Premium

ENHANCED DENTAL

Employee Only $32.87

Employee + Spouse $64.33

Employee + Children $78.19

Employee + Family $109.62

Website: www.myuhc.com

Customer Service: 1 (877) 816-3596

Policy Number: 903022

Scan the code for a

short video about

the Dental benefit

VISION INSURANCE Administered by UnitedHealthcare

Regular eye examinations can not only determine your need for corrective eyewear but also may detect general health problems in their earliest stages.

LSU partners with UnitedHealthcare to provide you and your family with valuable vision insurance at affordable rates. The Vision plan meets the needs of you and your family by including coverage for exams, lenses, frames, and contacts. Access the care your family needs through UnitedHealthcare’s network and select retail partners, such as Walmart, Sam’s Club, and Costco.

You can enroll or cancel your vision coverage during Annual Enrollment. To do so, please complete the Voluntary Benefits Enrollment Form and submit to your local HR department.

In-Network Out-of-Network

Eye Exam – once every 12 months Included $40 allowance

LENSES — ONCE EVERY 12 MONTHS

Single Vision

Bifocal

Trifocal

Included

Included

Included

$25 allowance

$40 allowance

$50 allowance

Progressive

Standard

Premium

Included

$150 Copay

$50 allowance

MATERIALS — ONCE EVERY 12 MONTHS

Contact Lenses

Elective

Medically Necessary

Fit and Follow-Up

Formulary: 4 Boxes

Non-Formulary: $130 Allowance

Included

Formulary: Included

Non-Formulary: Applies to allowance

$130 allowance

Frames $130 Allowance + 30% Off $130 allowance

Monthly Premium

VOLUNTARY VISION

Employee Only $7.39

Employee + Spouse $12.45

Employee + Children $12.72

Employee + Family $20.50

Website: www.myuhcvision.com

Customer Service: 1 (800) 638-3120

Policy Number: 903022

Scan the code for a

short video about

the Vision benefit

LIFE INSURANCE WITH OPTIONAL AD&D Administered by UnitedHealthcare

Age Bands Rates

Amounts per $10,000

< 24 $0.32

25-29 $0.39

30-34 $0.45

35-39 $0.57

40-44 $0.71

45-49 $1.00

50-54 $1.70

55-59 $2.60

60-64 $3.94

65-69 $6.50

70-74 $12.23

75-79 $20.46

80-84 $36.33

85 < $68.66

Coverage Monthly Premium

Dependent Life Coverage and Rates

$5,000 $0.35

$10,000 $0.70

$15,000 $1.05

$20,000 $1.40

Rates

AD&D Rates

Per $10,000 $0.31

Optional AD&D coverage provides benefits due to

certain injuries or accidental death. If purchased, cover-

age amount must equal amount of life insurance.

No one wants to think about the possibility of death, but it’s

important that you ensure your family’s financial security in

the event that something happens. Term Life insurance of-

fers financial security for you, your spouse, and your child

(ren).

If you are currently enrolled:

Employee = you can increase your coverage by 1 time

your basic annual salary, up to a total of $500,000, with-

out evidence of insurability.

Spouse = you can increase by $5,000, up to a total

amount of $100,000, not to exceed 50% of employee

coverage, without evidence of insurability.

Eligible children (up to age 26) = you may enroll in

increments of $5,000, up to $20,000. No evidence of

insurability is required.

If you are not currently enrolled:

Employee = you can enroll for $10,000 of coverage

without evidence of insurability..

Spouse = you are not eligible to enroll for coverage

without completing evidence of insurability and being

approved by UnitedHealthcare

Eligible children (up to age 26) = you may enroll in

increments of $5,000, up to $20,000. No evidence of

insurability is required.

Customer Service: 1 (888) 299-2070

Policy Number: 303972

Scan the code for a

short video about the

Life Insurance benefit

Employee and spouse premiums are age based; there-

fore, premiums will increase each time you move up an

age band. Child(ren) rates are based on amount of cov-

erage, not age.

To calculate your monthly premium, multiply the rates

below by the amount of coverage you would like to

purchase. Please note the rates are per $10,000. For

example, if you would like $50,000 you would multiply

your rate by 5.

Administered by UnitedHealthcare

ACCIDENTIAL DEATH & DISMEMBERMENT

An accident that ends in death or disabling injury has a dev-

astating effect on the lives of your loved ones. The loss of a

family wage earner puts strain in a family and raises con-

cerns as to how they will manage financially. Even if you are

unmarried, remaining family members could be left fulfilling

your financial responsibilities or taking care of you.

LSU partners with UnitedHealthcare to provide you and

your family with valuable AD&D insurance at affordable

rates. This benefit pays in the event of death or dismember-

ment resulting from an accident. You may select coverage

for yourself, your spouse and/or your children.

Family members may be insured for a portion of your

principal sum:

Spouse = 50% your principal sum or 40% if you have

eligible children

Eligible children = 15% your principal sum or 10%

if you have an eligible spouse

You may apply for this benefit at any time without evidence

of insurability. Benefits are effective the first of the month

following enrollment.

Employee Only Family

AD&D Premiums

$27,500 $0.83 $1.24

$55,000 $1.65 $2.48

$82,500 $2.48 $3.71

$110,000 $3.30 $4.95

$165,000 $4.95 $7.43

$220,000 $6.60 $9.90

$275,000 $8.25 $12.38

$300,000 $9.00 $13.50

Benefit Paid

Injury

Death 100%

Loss of both hands or feet 100%

Loss of sight in both eyes 100%

Quadriplegia 100%

Paraplegia 75%

Loss of one hand or foot 50%

Coma 50%

Loss of speech or hearing 50%

Thumb and Index Finger 25%

Below is a list of injuries and payouts based on your amount

of coverage. Please see plan document for more infor-

mation on covered benefits.

Customer Service: 1 (888) 299-2070

Policy Number: 303972

Scan the code for a

short video about

the AD&D benefit

LONG-TERM DISABILITY Administered by UnitedHealthcare

A lengthy disability can be devastating and may be more com-

mon than you think. Your ability to earn an income may be

your most important asset. People don’t think twice about in-

suring their homes, cars, or health, but many do not recognize

the need to insure their income.

LSU partners with UnitedHealthcare to provide affordable

Long Term Disability coverage to help you continue to meet

your family’s needs in the event of a disabling illness or injury.

If you become disabled and qualify for benefits, LTD coverage

will pay you 60% of your monthly salary, up to a maximum

of $12,000 a month. Disability benefits are paid if you are con-

sidered disabled and you satisfy a waiting period of 90 days and

exhaust your sick leave. If you are disabled before the age of

60, the benefit will continue until Social Security Normal Re-

tirement Age. If you are disabled after you turn 60, a reduced

benefit period applies based on the year you become disabled.

If you are not currently covered, you can apply anytime during

the year with medical underwriting.

Rates

Per $100 $0.482

Your premium is based on your salary. To calculate

your monthly premium, calculate your monthly salary

by dividing your annual salary by 12. Multiply your

monthly salary by 0.00482.

Annual Salary Monthly Premium

$30,000 $12.05

$40,000 $16.07

$50,000 $20.08

$75,000 $30.13

$100,000 $40.17

Customer Service: 1 (888) 299-2070

Policy Number: 303972

Scan the code for a short

video about the Long

Term Disability benefit

Below are examples of your monthly premium based on

the annual salaries shown. This will give you a range of

what you should expect to pay for LTD coverage.

FLEXIBLE SPENDING ACCOUNT(S) Administered by Boon-Chapman

This benefit provides you with the opportunity to set aside pre-tax dollars for out-of-pocket health care or

dependent care expenses incurred by you and/or your eligible dependents. You must determine an annual target amount to

be withheld. You should determine the amount to be withheld by forecasting your out-of-pocket health care and/or depend-

ent care expenses for the entire Plan year, plus the grace period (January 1 through March 15).

For healthcare spending accounts, you will be provided with a pre-loaded debit card with this amount for your use through-

out the Plan Year. The deduction is made before taxes, thus making the spending account dollars income tax-free. To access

the money in your account, you can either use your FSA Debit Card at the time of service, or you can file a paper claim re-

questing reimbursement for eligible out-of-pocket expenses.

LSU will no longer offer the Premiums Only Plan (POP). This means that your premiums for medical, dental, and vision

insurance will automatically be deducted before taxes from your paycheck. There is no cost or tax liability. Due to the tax

advantages under this program, you can only change or cancel this election during Annual Enrollment or if you experience a

qualifying event. If you are currently set up to have your premiums come out after taxes, LSU will automatically change your

contributions to pre-tax effective January 1, 2016. For 2016, you must re-enroll and elect your contributions. Contact

your HR department for instructions on how to enroll.

Monthly Fee

Tax-Saving Benefits

FSA—12 Month EEs $5.10

FSA—9 Month EEs $6.80

Minimum Contribution Maximum Contribution

Types of Accounts

Health Care Spending $100 $2,550

Dependent Care Spending $100 $5,000

USE IT OR LOSE IT Flexible Spending Accounts have a

provision. This means that if you do

not use your full election by the end of

the plan year, you will

forfeit the remaining balance.

Eligible Expenses include:

Health Care Spending = medical or prescription expenses, dental care and orthodontia, eye exams and glasses or

contacts

Dependent Care Spending = Day-care costs for children 12 or younger; before and after school care for children 12

years or younger

Website: www.boonchapman.com

Customer Service: 1 (800) 252-9653

CRITICAL ILLNESS Administered by UnitedHealthcare

LSU partners with UnitedHealthcare to provide you and

your family with valuable Critical Illness insurance.

This benefit is designed to help protect you and your fami-

ly’s financial health. Critical Illness insurance can help fill a

financial gap if you or a family member experiences a severe,

life-threatening illness, such as cancer, heart attack, or major

organ transplant. Upon diagnosis of a covered illness, you

can receive a lump-sum benefit.

Covered illnesses include the following:

Category 1 (Cancer) —Cancer-100%; Carcinoma in

Situ-25%

Category 2 (Cardiovascular) —Heart Attack, Stroke,

Heart Transplant, Ruptured Aneurysm-100%; Coro-

nary Artery Bypass-25%

Category 3 (Other)—Chronic Renal Failure, Paralysis,

Severe Burns, Severe Brain Damage, Coma, Major

Organ Transplant-100%

You are eligible to receive payment one time for each cate-

gory listed. There is a reoccurrence/restoration rider you

may be eligible for after 12 months. For example, if you

receive a lump sum payment due to a critical illness diagno-

sis and then are later diagnosed with another critical illness

in the same category, this restoration benefit would pay an

additional one time benefit for the same category.

This insurance plan also provides a wellness benefit. It will

pay out $100 per year for certain health-screening tests, such

as mammograms, colonoscopies, chest x-rays. A more de-

tailed list can be found in the Plan Document.

For 2016, you can enroll for employee only, employee/

spouse, employee/child(ren), or family coverage with no

medical underwriting.

Lump Sum Amounts

Coverage Levels

Employee $10,000

$20,000

Spouse $5,000

$10,000

Child(ren) $2,500

Age Bands $5,000 $20,000 $10,000

< 24 $1.85 $7.40 $3.70

25-29 $2.92 $11.68 $5.84

30-34 $3.65 $14.58 $7.29

35-39 $4.89 $19.54 $9.77

40-44 $6.90 $27.60 $13.80

45-49 $9.87 $39.48 $19.74

50-54 $13.79 $55.16 $27.58

55-59 $19.03 $76.10 $38.05

60-64 $26.42 $105.66 $52.83

65-69 $35.45 $141.80 $70.90

70-74 $49.31 $197.24 $98.62

75 < $62.72 $250.88 $125.44

Employees have two options when purchasing this cover-

age: A low option of $10,000; and a high option of $20,000.

Spouses can be covered for 50% of the employees coverage

at either $5,000 or $10,000. The child(ren) benefit is $2,500.

Customer Service: 1 (888) 299-2070

Policy Number: 303972

Rates for employee and spouse are the same and based on

age of employee. The child(ren) rate is $0.56. To calculate

your monthly premium, look for the employee age band and

coverage amount you would like. Add spouse rate and child

(ren) rate, if applicable.

Scan the code for a

short video about the

Critical Illness benefit

ACCIDENT PROTECTION Administered by UnitedHealthcare

Monthly Premium

Accident

Employee Only $9.15

Employee + Spouse $13.60

Employee + Children $12.36

Employee + Family $16.81

The Accident Protection provides coverage if an acci-

dent occurs, on or off the job you may be surprised at the

expenses that can add up. This insurance is designed to

protect your finances by helping you pay for those unex-

pected costs associated with an accidental injury.

This benefit covers a wide range of common injuries and

accidents. If you or a covered family member become

injured, Accident protection will pay you a direct cash

benefit. The amount of money you receive depends on the

type and severity of the injury and can be used any way

you choose.

Benefit Paid

Doctor Visit $40

Ground Ambulance $200

Emergency Room $100

Hospital Admission $800

Coma $10,000

AD&D $20,000

Customer Service: 1 (888) 299-2070

Policy Number: 303972

Scan the code for a

short video about the

Accident benefit

LSU partners with UnitedHealthcare to provide you and

your family with valuable accident protection. For 2016,

you can enroll in accident protection for you and your

family. There is no medical underwriting with this benefit.

Below is a summary of the cash benefit you could receive

based on the type of service received for an accident.

More services and their benefit payout can be located in

the Plan Document.

LONG TERM CARE INSURANCE Administered by Unum

Today, Long Term Care (LTC) insurance is important for

people of all ages if they want to preserve financial security

and independence in the event of an extended disability.

Despite popular misconceptions, the need for long-term

care isn’t restricted to the elderly because many working

age adults have disabling injuries and illnesses as well.

Americans who need long-term care have more choice

than ever. Many are able to remain in their homes and still

receive the care they need. If you become disabled for any

reason and couldn’t live independently, how would you

pay for the care you need? The financial impact of long-

term care is significant, no matter where it is provided, and

government programs don’t always pay for services.

Customer Service: 1 (800) 227-4165

Policy Number: 100057

Did you know?

The national average cost of a private room in a nurs-

ing home is about $70,000 a year and an average stay

is 24-26 months.

The average base rate for a private room in assisted

living care is about $33,000 per year.

Medical insurance does not cover most long-term

care cost. Medicare only covers short-term, skilled

nursing home care following hospitalization, and only

pays for short-term assistance for care at home. Medi-

caid only pays after you have depleted your personal

assets. .

LSU partners with Unum to provide you and your family with valuable long-term care insurance. Coverage is available to bene-

fits-eligible employees, retirees, their spouses, parents, and grandparents, and their spouses’ parents and grandparents.

Unum offers a variety of plan options to LSU employees. These options can be found on the Benefits website at

www.lsu.edu/benefits. Employees can apply for coverage at any time throughout the year, but are subject to medical underwrit-

ing and approval by Unum.