(844) 967-1917
Blue Cross Blue Shield Louisiana

Blue POS 100/80 $3500

Plan Overview

Combined Medical and Drug Deductible
  • Individual: $3,500.00
  • Family: $10,500
  • Per Person: $3,500
Combined Medical and Drug Out of Pocket Maximum
  • Individual: $8,700.00
  • Family: $17,400
  • Per Person: $8,700

Office Visit

Primary Doctor
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: The Physician Office Copayment may be reduced or waived when services are rendered by a Provider participating in the Quality Blue Primary Care Program (QBPC). QBPC Providers include family practitioners, general practitioners, internists, nurse practitioners, geriatricians and physician assistants.
Specialist
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered

Prescription Drug Information

Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Exclusions: Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions.
  • Benefit Explanation: Quantity per dispensing (QPD) limits/allowances are placed on certain medications and are based on the manufacturer's recommended dosage and duration of therapy, common usage for episodic or intermittent treatment, FDA-approved recommendations and/or clinical studies, and/or as determined by us. Note that for 3-tier plans, if a generic equivalent exists for a brand-name drug, plan participant must pay the Tier 1 copayment, plus the difference in cost between the brand-name drug dispensed and its generic equivalent. For 2-tier plans, the plan participant must pay the generic drug coinsurance, plus the difference in cost between the brand-name drug dispensed and its generic equivalent.
Non Preferred Brand Drugs
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Exclusions: Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions.
  • Benefit Explanation: Quantity per dispensing (QPD) limits/allowances are placed on certain medications and are based on the manufacturer's recommended dosage and duration of therapy, common usage for episodic or intermittent treatment, FDA-approved recommendations and/or clinical studies, and/or as determined by us. Note that for 3-tier plans, if a generic equivalent exists for a brand-name drug, plan participant must pay the tier 1 copayment, plus the difference in cost between the brand-name drug dispensed and its generic equivalent. For 2-tier plans, the plan participant must pay the generic drug coinsurance, plus the difference in cost between the brand-name drug dispensed and its generic equivalent.
Generic Drugs
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Exclusions: Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions.
  • Benefit Explanation: Quantity per dispensing (QPD) limits/allowances are placed on certain medications and are based on the manufacturer's recommended dosage and duration of therapy, common usage for episodic or intermittent treatment, FDA-approved recommendations and/or clinical studies, and/or as determined by us. All pharmacy plans have preventive drugs per USPSTF for $0. For 2-tier pharmacy plans, additional selected generic preventive care drugs in certain classes cost $0. For 3-tier pharmacy plans, additional selected drugs in certain classes used to treat selected chronic conditions cost $0.
Specialty Drugs
  • CoPay: Not Applicable
  • CoInsurance: 20.00% Coinsurance after deductible
  • Covered: Covered
  • Exclusions: Certain exclusion apply - Please see the contract book for a full list of pharmacy exclusions.
  • Benefit Explanation: Specialty drugs are distributed throughout all tiers on both the 2-tier and 3-tier plans and the member is responsible to pay the applicable deductible/copay/coinsurance for that tier. Retail day supply limits (typically 30-day supply) apply. In addition, quantity per dispensing (QPD) limits/allowances are placed on certain specialty medications and are based on the manufacturer's recommended dosage and duration of therapy, common usage for episodic or intermittent treatment, FDA-approved recommendations and/or clinical studies, and/or as determined by us

Inpatient Coverage

Hospital Services
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Inpatient Bed, Board and General Nursing Services include but not limited to: 1. Hospital room and board and general nursing services. 2. In a Special Care Unit for a critically ill Member requiring an intensive level of care. 3. In a Skilled Nursing Facility or Unit or while receiving skilled nursing services in a Hospital, for the maximum number of days per Benefit Period shown in the Schedule of Benefits. 4. In a Residential Treatment Center for Members with Mental Disorders and Alcohol and/or Drug Abuse Benefits. B. Other Hospital Services (Inpatient and Outpatient) 1. Use of operating, delivery, recovery and treatment rooms and equipment. 2. Drugs and medicines including take-home Prescription Drugs. 3. Blood transfusions, including the cost of whole blood, blood plasma and expanders, processing charges, administrative charges, equipment and supplies. 4. Anesthesia, anesthesia supplies and anesthesia services rendered by a Hospital employee. 5. Medical and surgical supplies, casts, and splints. 6. Diagnostic Services rendered by a Hospital employee. 7. Physical Therapy provided by a Hospital employee. 8. Psychological testing when ordered by the attending Physician and performed by an employee of the hospital.
Inpatient Services
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: Surgical services examples include but not limited to: 1. The Allowable Charge for Inpatient and Outpatient Surgery includes all pre-operative and postoperative medical visits. 2. Multiple Surgical Procedures - When Medically Necessary multiple procedures (concurrent, successive, or other multiple surgical procedures) are performed at the same surgical setting 3. Assistant Surgeon 4. General anesthesia services are covered when requested by the operating Physician and performed by a certified registered nurse anesthetist (CRNA) or Physician, other than the operating Physician or the assistant surgeon, for covered surgical services. Inpatient Medical Services - Subject to provisions in the sections pertaining to Surgery and Pregnancy Care in this Benefit Plan, Inpatient Medical Services include: 1. Inpatient medical care visits 2. Concurrent Care 3. Consultation (as defined in this Benefit Plan)

Emergency and Urgent Care

Emergency Room
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
  • Benefit Explanation: The ER copayment is waived if the visit results in an Inpatient Admission.
Urgent Care Facility
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered

Maternity

Labor and Delivery Hospital Stay
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered
Pre and Postnatal Office Visit
  • CoPay: Not Applicable
  • CoInsurance: 0.00% Coinsurance after deductible
  • Covered: Covered

Vision

Routine Eye Exams For Children
  • CoPay: No Charge
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per Year

Major Dental Care

Routine Dental Checkups for Children
  • CoPay: No Charge
  • CoInsurance: No Charge
  • Covered: Covered
  • Limit Quantity: 1
  • Limit Unit : Visit(s) per 6 Months
  • Benefit Explanation: Limitations may apply. Subject to Dental deductible, if applicable.
Routine Dental Checkups for Adults
  • Covered: Not Covered
Related Articles
You may be interested in these relevant articles from across the HealthMarkets.com network.
© 2021 HealthMarkets Insurance Agency. All rights reserved.
Attention: This website is operated by HealthMarkets Insurance Agency and is not the Health Insurance Marketplace® website. In offering this website, HealthMarkets Insurance Agency is required to comply with all applicable federal laws, including the standards established under 45 C.F.R. § 155.220(c) and (d) and standards established under 45 C.F.R. § 155.260 to protect the privacy and security of personally identifiable information. This website may not display all data on Qualified Health Plans (QHPs) being offered in your state through the Health Insurance Marketplace® website. To see all available data on Qualified Health Plan options in your state, go to the Health Insurance Marketplace® website at HealthCare.gov.
HealthMarkets Insurance Agency offers the opportunity to enroll in either QHPs or off-Marketplace coverage. Please visit HealthCare.gov for information on the benefits of enrolling in a QHP. Off-Marketplace coverage is not eligible for the cost savings offered for coverage through the Marketplaces.
1. HealthMarkets Insurance Agency, Inc. is licensed as an insurance agency in all 50 states and DC. Not all agents are licensed to sell all products. Service and product availability varies by state. Sales agents may be compensated based on a consumer’s enrollment in a health plan. No obligation to enroll. Agent cannot provide tax or legal advice. Contact your tax or legal professional to discuss details regarding your individual business circumstances. Our quoting tool is provided for your information only. All quotes are estimates and are not final until consumer is enrolled. Medicare has neither reviewed nor endorsed this information.
2. HealthMarkets is ranked “Excellent” (5 out of 5 stars) by 92% of customers on Trustpilot: Based on 3,101 customer reviews on Trustpilot in the health insurance agency category as of 4/29/21. Learn more at www.trustpilot.com/review/healthmarkets.com
3. Premium subsidies vary by address and subject to eligibility. Those with incomes between 100% and 150% of the federal poverty level (FPL) may qualify for a zero-dollar premium silver plan (after tax credits). They may also qualify for a zero-dollar premium bronze plan (after tax credits). Cost sharing (deductibles and coinsurance) may be higher.
46513-HM-1020 46512-HM-0121
HealthMarkets Insurance Agency BBB Business Review
Verified Badge