Pelican HRA 1000
Administered by Blue Cross Blue Shield and CVS Caremark
The Office of Group Benefits (OGB) offers multiple health plans, including the Pelican HRA1000. The claims administrator is Blue Cross and Blue Shield of Louisiana, while the pharmacy benefit manager is CVS Caremark. It features lower premiums than Magnolia plans in exchange for higher deductibles. The Pelican HRA 1000 utilizes the Blue Cross and Blue Shield of Louisiana Preferred Care Providers and Blue Cross National Providers.
The Pelican HRA 1000 includes $1,000 in annual employer contributions for employee-only plans and $2,000 for family plans in a health reimbursement arrangement that can be used to offset deductibles and other out-of-pocket medical, not pharmacy, costs throughout the year.
A Health Reimbursement Arrangement, or HRA, is an account used to reimburse employees’ medical expenses and other medical costs. These funds are available as long as you remain employed by an OGB-participating employer. Any unused funds roll up to the in-network, out-of-pocket maximum (see following chart), allowing members to build up balances that cover eligible medical expenses.
Members do not have direct access to the funds. The out-of-pocket portion of a claim will be paid directly by Blue Cross Blue Shield of Louisiana from the member’s account. Funds can only be used to cover eligible medical expenses, such as coinsurance, co-pays, deductibles, and services. Pharmacy, dental, and vision claims are not considered eligible medical expenses and therefore will not be paid for out of the HRA funds.
|Medical Coverage||Employee Only||Employee + 1 (Spouse or Child)||Employee + Children||Family|
|Employer Contribution to HRA||$1,000||$2,000||$2,000||$2,000|
|Out-of-pocket max (in-network)||$5,000||$10,000||$10,000||$10,000|
|Out-of-pocket max (out-of-network)||$10,000||$20,000||$20,000||
*Once a member's deductible for allowable charges is met, he or she will pay 40% of the allowable charge, plus 100% of the difference between the allowable charge and billed amount.
The Pelican HRA 1000 uses the CVS Caremark formulary. Members will continue to pay a portion of the cost of their prescriptions in the form of a co-pay or coinsurance. The amount members pay toward their prescription depends on whether or not they receive a generic, preferred brand, non-preferred brand or specialty drug.
|Tier||Member Responsibility||Once you pay $1,500|
|Generic||50% up to $30||$0 co-pay|
|Preferred||50% up to $55||$20 co-pay|
|Non-Preferred||65% up to $80||$40 co-pay|
|Specialty||50% up to $80||$40 co-pay|