Blue Cross Blue Shield Blue Max copay 70/50 $2500 (Louisiana)

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Company Blue Cross Blue Shield Louisiana
Plan Year 2014
State Louisiana
Metal Tier Silver
Plan Type PPO
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Cost Sharing Benefits (In Network)

These details are for the standard Silver plan. For reduced Cost Sharing versions scroll down below

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $2,500
Deductible (Family) $7,500
Coinsurance 30%
Out of Pocket Maximum (Individual) $6,350
Out of Pocket Maximum (Family) $12,700

Doctors Visits

Primary Care Visit $40
Specialist Visit $55
In Patient Hospital Services 30% Coinsurance after deductible
Emergency Room Services 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) Data Not Available
Laboratory Outpatient and Professional Services Data Not Available
X-ray and Diagnostic Imaging Data Not Available

Other

Mental / Behavioral Health 30% coinsurance
Rehabilitative Speech Therapy 30% coinsurance
Rehabilitative Occupational & Physical Therapy 30% coinsurance
Outpatient Facility Data Not Available
Outpatient Surgery Data Not Available

Prescription Drugs

Generic Rx $15
Preferred Brand Rx $40
Non Preferred Brand Rx $70
Specialty Drugs 10% Coinsurance after deductible

73% Cost Sharing Benefits

Households with incomes between 200% to 250% of FPL qualify for the following cost sharing benefits for this silver plan. To understand how cost sharing reductions work and how they work for you see our article about Obamacare Cost Sharing Reduction Discounts

Deductibles and Cost Sharing

Deductible (Individual) $2,500.00
Deductible (Family) $7,500.00
Out of Pocket Maximum (Individual) $4,500.00
Out of Pocket Maximum (Family) $9,000.00
Primary Care Physician $40
Specialists $55
Emergency Room 30% Coinsurance after deductible
Inpatient Facility 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $15.00
Preferred Brand Rx $40
Non Preferred Brand Rx $70
Specialty Drugs 10% Coinsurance after deductible

87% Cost Sharing Benefits

Households with incomes between 150% to 200% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $400.00
Deductible (Family) $1,200.00
Out of Pocket Maximum (Individual) $2,150.00
Out of Pocket Maximum (Family) $4,300.00
Services In Network Out of Network
Primary Care Physician $20
Specialists $35
Emergency Room 20% Coinsurance after deductible
Inpatient Facility 20% Coinsurance after deductible
Inpatient Physician 20% Coinsurance after deductible
Prescription Drugs In Network Out of Network
Generic Rx $7.00
Preferred Brand Rx $30
Non Preferred Brand Rx $70
Specialty Drugs 10% Coinsurance after deductible

94% Cost Sharing Benefits

Households with incomes between 138% to 150% of FPL qualify for the following cost sharing benefits for this silver plan.

Deductibles and Cost Sharing In Network Out of Network
Deductible (Individual) $100.00
Deductible (Family) $300.00
Out of Pocket Maximum (Individual) $2,150.0
Out of Pocket Maximum (Family) $4,300.00
Services In Network Out of Network
Primary Care Physician $20
Specialists $35
Emergency Room No Charge
Inpatient Facility No Charge
Inpatient Physician No Charge
Prescription Drugs In Network Out of Network
Generic Rx $7.00
Preferred Brand Rx $30
Non Preferred Brand Rx $70
Specialty Drugs 10% Coinsurance after deductible

Other Plans

Other plans that are available in the state.

Plan Name
Blue Cross and Blue Shield of Louisiana $1500, a Multi-State Plan
Blue Cross and Blue Shield of Louisiana $2000, a Multi-State Plan
Blue Max copay 80/60 $250
Blue Max 70/50 $0
Blue Max copay 80/60 $500
Blue Max copay 80/60 $750
Blue Max copay 80/60 $1000
Blue Max 50/50 $0
Blue Max 70/50 $1500
Blue Max copay 70/50 $2500
Blue Max 70/50 $3000
Blue Max 80/60 $4000
Blue Max 80/60 $5000
Blue Max copay 100/80 $6250
Blue Saver 100/80 $1300
Blue Saver 80/60 $1900
Blue Saver 100/80 $2800
Blue Saver 70/50 $3300
Blue Saver 100/80 $5000

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