Submission Dates: November 4, 2024 - December 2, 2024
Changes Effective: January 1, 2025

Starting January 1, 2025, UMR will administer the Lincoln Parish School Board (LPSB) medical and dental PPO plans.

Listed below are a condensed summary of benefits for Lincoln Parish School Board’s group insurance plans.  Until the complete 2025 schedule of benefits and plan documents are published, please refer to the current 2024 benefit plan documents for a more detailed description of benefits here.

Medical PPO Plan Summary of Benefits and Coverage - Active Employees and Retirees Under 65

Medical PPO Plan Summary of Benefits and Coverage - Retirees with Medicare Parts A&B

Summary of Benefits- Dental PPO Plan

Provider Networks:

• Pharmacy: OptumRx

  • UHC Ruston area in network pharmacies

• Medical: UnitedHealthcare Choice Plus

• Dental: UMR Managed Dental

1. What are the major changes to the self-funded medical and dental programs for 2025?

• UMR, a UnitedHealthcare company, will be the new third-party administrator of Lincoln Parish School Board’s self-funded medical and dental PPO plans.  UMR will handle all claims management and payment processing, prior authorizations, claims review, member care programs, COBRA notifications and enrollment, coordination of benefits with Medicare and other insurers, online member benefits portal. (UMR replaces BlueCross BlueShield.)

• UMR has partnered with OptumRx to manage the pharmacy benefits in the Medical PPO plan.  (OptumRx replaces Express Scripts.)

2. When will these changes take effect?

• Changes will be effective January 1, 2025. Payroll deductions reflecting the new rates will start in January 2025.

3. Are there any changes to my plan benefits?

• No.  Medical (including pharmacy) and dental benefits listed in the current 2024 medical and dental summary of benefits and plan documents will remain the same in 2025.  This means deductibles, coinsurance, co-pays, out-of-pocket maximums, number of visits, and other benefits listed in the current documents will remain the same.   The 2024 documents can be found on the Lincoln Parish School Board’s Employee Benefits webpage.

4. Will there be any rate increases?

• Yes. Both health and dental plan rates are increasing in 2025. Rate changes for each coverage type (e.g., employee only, employee & spouse) are detailed here.

5.  Are medical insurance rate classes changing?

• Yes.  Currently, the medical plan rates have 3 coverage classes:  Employee Only, Employee +1 dependent, and Family.  For 2025, there will be 5 coverage classes:  Employee, Employee and Spouse, Employee and One Child, Employee and Children, and Family.  For the deductions on the January 2025 payroll, the rate classes will be automatically assigned to the class that that represents the members currently enrolled on the plan.

6. Would the rate increases still occur if we stayed with BlueCross BlueShield?

• Yes. The rate increases would actually have been higher with BlueCross and are needed to cover the actual cost of drugs, medical services, and dental services funded by the Lincoln Parish School Board on a weekly basis as claims are paid.

7. Where can I find the 2025 benefits booklets for medical and dental plans?

• The new 2025 benefit booklets are not published at this time.  The installation of the Lincoln Parish School Board medical and dental plans and account setup with UMR is currently in process, and new 2025 benefits booklets will not be available until early January 2025.  Until then, the 2024 summary of benefits and plan documents currently posted on the website are still valid to use for determining your 2024 and 2025 medical and dental benefits, because there is no change in benefits. As soon as the new 2025 benefit booklets are available, they will be posted to the Lincoln Parish School Board’s Employee Benefits webpage. 

8. Who will pay my medical bills starting January 1, 2025?

• UMR will process provider claims for eligible services performed on or after January 1, 2025.

9. What if my provider has not submitted claims for services I received prior to January 1, 2025, will those services be paid and by whom?

• BlueCross BlueShield of Louisiana will continue to process claims for eligible services performed prior to January 1, 2025 if timely received from providers.  LPSB health and dental plans require the timely filing of claims within 90 days of the service date.  Claims processing by BlueCross BlueShield for all LPSB plans will terminate on June 30, 2025.

10.  How will the new provider networks impact my healthcare providers?

• The provider network for the Medical PPO plan will be the UnitedHealthcare Choice Plus network.  The providers currently used by LPSB medical plan members match 99% of the in-network providers on the UnitedHealthcare Choice Plus network.

• The provider network for the Dental PPO plan will be UMR Managed Dental.  There is a limited number of dentists in the UMR network, as is the case in the current Advantage Plus Dental Network 2.0 through United Concordia.  The dental plan will still pay eligible claims received from non-network dentists, but providers may bill members for any additional charges not covered by the plan.

• Members can search or confirm in-network providers at www.UMR.com.

11.  I searched the provider list at UMR.com, and did not find the provider I have used for years on the list.  Can I still use my provider?

• Members can choose to continue receiving services from an out-of-network (OON) provider, but the member may be subject to a higher deductible, co-insurance and a separate OON annual maximum limit, as well as balanced-billing from the provider.

• Members can also give the Your Provider Can Join the UHC Network flyer to their OON provider and ask them to join the UnitedHealthcare Choice Plus Network.

12. Will my pharmacy change?

• OptumRx is the new pharmacy benefits administrator for LPSB’s Medical PPO plan.  The drug tier for 98.2% of previous paid drug claims will be paid under the same drug tier with OptumRx. Members can verify their drug tier classification, quantity limits, step-therapy and prior authorization requirements in the OptumRx Member Booklet.

13. Where can I find a list of in-network pharmacies in Lincoln Parish?

• A current list of Ruston-area pharmacies in the OptumRx network is posted here.   After you receive your new UMR Insurance ID card, you will be able to setup your OptumRx user account at www.optumrx.com and search for in-network pharmacies locally and nationwide and begin managing your pharmacy benefits online.

14. I am currently enrolled in benefits with BlueCross BlueShield.  What do I need to do to re-enroll with UMR?

• No action is required by you to enroll in UMR.  Your coverage information on file in the LPSB Insurance Department will be electronically transferred to setup your benefits account with UMR.  UMR will mail new insurance ID cards in late December. After you receive your ID card, you will be able to create a user ID and password to sign in to your account to Use the UMR Portal to Manage Your Benefits.

15. I am enrolled in both LPSB Medical and Dental PPO plans.  Will I receive two ID cards, one for each plan?

• No.  Coverage benefits for medical and dental will both be listed on one ID card.

16. Will I need to take any additional steps once I receive my UMR insurance ID card?

• Yes.  Please call the number on the sticker to verify your identity and confirm other health coverage for enrolled members. Also be sure to give your card to your care provider and pharmacy to update your insurance information.

17. What should I do if I want to make changes to my medical or dental coverage?

• From now until Open Enrollment ends on Monday, December 2, 2024 for LPSB group health insurance programs, employees should contact the LPSB Insurance Department to request the proper form to make changes to health coverages.  Final changes must be received by 4:00 PM on December 2, 2024.  All changes will be effective for January 1, 2025. 

• If you choose to not make changes to your current medical and dental coverage during this year’s Open Enrollment, unless there is a qualifying special enrollment event as defined in IRS regulations, you will not be able to make changes again until the next year’s open enrollment period.

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