Blue Point of Service (POS) (2019)

Blue Point of Service* uses the HMO network, a smaller network of quality doctors and hospitals throughout the state. It has several copayment, coinsurance and deductible plan options to meet your needs.

*Our series of point-of-service (POS) plans and HMO plans are offered by HMO Louisiana, Inc., a wholly owned subsidiary of Blue Cross and Blue Shield of Louisiana.

HMO

NETWORK

=

Blue Point of Service

PLAN

  • GOLD
  • SILVER
  • BRONZE

Here are some plan features and benefits:


Three-tier copayment and coinsurance structure or a two-tier coinsurance structure for prescription drugs, depending on the plan you buy.


Drug deductibles range from $0-500, depending on the plan you buy. If there is no separate drug deductible, medical deductible applies.


We pay 100 percent of preventive care services in network. 


For pediatric dental and vision, $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor.

Plan Name

Blue POS Copay 80/60 $1,000

G Gold

Blue POS Copay 70/50 $2,500

S Silver

Blue POS 80/60 $3,400

S Silver

Blue POS Copay 60/40 $3,600

S Silver

Blue POS 100/80 $3,500

S Silver

Blue POS 70/50 $4,500

B Bronze

Blue POS 60/40 $6,500

B Silver
Here are the basics:
Deductible (single) $1,000 $2,500 $3,400 $3,600 $3,500 $4,500 $6,500
Deductible (family) $3,000 $7,500 $10,200 $10,800 $10,500 $13,500 $15,800
Most you pay out of pocket (single) $7,900 $7,900 $7,100 $7,900 $7,900 $7,900 $7,900
Most you pay out of pocket (family) $15,800 $15,800 $14,200 $15,800 $15,800 $15,800 $15,800
Coinsurance we pay in network 80% 70% 80% 60% 100% 70% 60%
Coinsurance you pay in network 20% 30% 20% 40% 0% 30% 40%
Coinsurance we pay out of network 60% 50% 60% 40% 80% 50% 40%
Coinsurance you pay out of network 40% 50% 40% 60% 20% 50% 60%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay $40 per visit $40 per visit Deductible then 20% coinsurance $40 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
QBPC, you pay $25 per visit $25 per visit Deductible then 20% coinsurance $25 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Specialist, you pay $60 per visit $60 per visit Deductible then 20% coinsurance $60 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Urgent Care, you pay $60 per visit $60 per visit Deductible then 20% coinsurance $60 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Outpatient ambulatory surgical center, you pay Deductible then 20% coinsurance Deductible then 30% coinsurance Deductible then 20% coinsurance Deductible then 40% coinsurance Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Emergency room $350 copay per visit; waived if admitted $350 copay per visit; waived if admitted Deductible then 20% coinsurance $450 copay per visit; waived if admitted Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Admitted as inpatient to hospital, you pay Deductible then 20% coinsurance Deductible then 30% coinsurance Deductible then 20% coinsurance Deductible then 40% coinsurance Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member $500 separate drug deductible No separate drug deductible; medical deductible applies No separate drug deductible; medical deductible applies $500 separate drug deductible No separate drug deductible; medical deductible applies No separate drug deductible; medical deductible applies No separate drug deductible; medical deductible applies
Prescription drugs per fill, you pay

Tier 1: Generic Drug deductible then $7 copay

Tier 2: Preferred Brand Drug deductible then 20% coinsurance ($250 max)

Tier 3: Non-preferred Brand Drug deductible then 30% coinsurance ($250 max)

 

Tier 1: Generic 30% after deductible

Tier 2: Brand 50% after deductible

 

Tier 1: Generic 20% after deductible

Tier 2: Brand 40% after deductible

 

Tier 1: Generic Drug deductible then $15 copay

Tier 2: Preferred Brand Drug deductible then 20% coinsurance ($250 max)

Tier 3: Non-preferred Brand Drug deductible then 30% coinsurance ($250 max

Tier 1: Generic 0% after deductible

Tier 2: Brand 20% after deductible

Tier 1: Generic 30% after deductible

Tier 2: Brand 50% after deductible

Tier 1: Generic 40% after deductible

Tier 2: Brand 60% after deductible

Preventive care services Plan pays 100% in network Plan pays 100% in network Plan pays 100% in network Plan pays 100% in network Plan pays 100% in network Plan pays 100% in network Plan pays 100% in network
Pregnancy care office visit $60 per visit $60 per visit Deductible then 20% coinsurance $60 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Physical, occupational, speech therapy rehabilitation services $40 per visit $40 per visit Deductible then 20% coinsurance $40 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Mental health and substance use disorder (office visit) $40 per visit $40 per visit Deductible then 20% coinsurance $40 per visit Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Mental health and substance use disorder (inpatient) Deductible then 20% coinsurance Deductible then 30% coinsurance Deductible then 20% coinsurance Deductible then 40% coinsurance Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Mental health and substance use disorder (outpatient) Deductible then 20% coinsurance Deductible then 30% coinsurance Deductible then 20% coinsurance Deductible then 40% coinsurance Deductible Deductible then 30% coinsurance Deductible then 40% coinsurance
Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS Copay 80/60 $1,000

G Gold
Here are the basics
Deductible (single) $1,000
Deductible (family) $3,000
Most you pay out of pocket (single) $7,900
Most you pay out of pocket (family) $15,800
Coinsurance we pay in network 80%
Coinsurance you pay in network 20%
Coinsurance we pay out of network 60%
Coinsurance you pay out of network 40%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay $40 per visit
QBPC, you pay $25 per visit
Specialist, you pay $60 per visit
Urgent Care, you pay $60 per visit
Outpatients ambulatory surgical center, you pay Deductible then 20% coinsurance
Emergency room $350 copay per visit; waived if admitted
Admitted as inpatient to hospital, you pay Deductible then 20% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member $500 separate drug deductible
Prescription drugs per fill, you pay

Tier 1: Generic Drug deductible then $7 copay

Tier 2: Preferred Brand Drug deductible then 20% coinsurance ($250 max)

Tier 3: Non-preferred Brand Drug deductible then 30% coinsurance ($250 max)

 

Preventive care services Plan pays 100% in network
Pregnancy care office visit $60 per visit
Physical, occupational, speech therapy rehabilitation services $40 per visit
Mental health and substance use disorder (inpatient & outpatient)

$40 per visit

Deductible then 20% coinsurance

Deductible then 20% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS Copay 70/50 $2,500

S Silver
Here are the basics
Deductible (single) $2,500
Deductible (family) $7,500
Most you pay out of pocket (single) $7,900
Most you pay out of pocket (family) $15,800
Coinsurance we pay in network 70%
Coinsurance you pay in network 30%
Coinsurance we pay out of network 50%
Coinsurance you pay out of network 50%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay $40 per visit
QBPC, you pay $25 per visit
Specialist, you pay $60 per visit
Urgent Care, you pay $60 per visit
Outpatients ambulatory surgical center, you pay Deductible then 30% coinsurance
Emergency room $350 copay per visit; waived if admitted
Admitted as inpatient to hospital, you pay Deductible then 30% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill, you pay

Tier 1: Generic 30% after deductible

Tier 2: Brand 50% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit $60 per visit
Physical, occupational, speech therapy rehabilitation services $40 per visit
Mental health and substance use disorder (inpatient & outpatient)

$40 per visit

Deductible then 30% coinsurance

Deductible then 30% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS 80/60 $3,400

S Silver
Here are the basics
Deductible (single) $3,200
Deductible (family) $9,600
Most you pay out of pocket (single) $6,600
Most you pay out of pocket (family) $13,200
Coinsurance we pay in network 80%
Coinsurance you pay in network 20%
Coinsurance we pay out of network 60%
Coinsurance you pay out of network 40%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay Deductible then 20% coinsurance
QBPC, you pay Deductible then 20% coinsurance
Specialist, you pay Deductible then 20% coinsurance
Urgent Care, you pay Deductible then 20% coinsurance
Outpatients ambulatory surgical center, you pay Deductible then 20% coinsurance
Emergency room Deductible then 20% coinsurance
Admitted as inpatient to hospital, you pay Deductible then 20% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill, you pay

Tier 1: Generic 20% after deductible

Tier 2: Brand 40% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible then 20% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 20% coinsurance
Mental health and substance use disorder (inpatient & outpatient)

Deductible then 20% coinsurance

Deductible then 20% coinsurance

Deductible then 20% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS Copay 60/40 $3,600

S Silver
Here are the basics
Deductible (single) $3,300
Deductible (family) $9,900
Most you pay out of pocket (single) $7,900
Most you pay out of pocket (family) $15,800
Coinsurance we pay in network 60%
Coinsurance you pay in network 40%
Coinsurance we pay out of network 40%
Coinsurance you pay out of network 60%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay $40 per visit
QBPC, you pay $25 per visit
Specialist, you pay $60 per visit
Urgent Care, you pay $60 per visit
Outpatients ambulatory surgical center, you pay Deductible then 40% coinsurance
Emergency room $450 copay per visit; waived if admitted
Admitted as inpatient to hospital, you pay Deductible then 40% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member $500 separate drug deductible
Prescription drugs per fill, you pay

Tier 1: Generic Drug deductible then $15 copay

Tier 2: Preferred Brand Drug deductible then 20% coinsurance ($250 max)

Tier 3: Non-preferred Brand Drug deductible then 30% coinsurance ($250 max

Preventive care services Plan pays 100% in network
Pregnancy care office visit $60 per visit
Physical, occupational, speech therapy rehabilitation services $40 per visit
Mental health and substance use disorder (inpatient & outpatient)

$40 per visit

Deductible then 40% coinsurance

Deductible then 40% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS 100/80 $3,500

S Silver
Here are the basics
Deductible (single) $3,500
Deductible (family) $10,500
Most you pay out of pocket (single) $7,900
Most you pay out of pocket (family) $15,800
Coinsurance we pay in network 100%
Coinsurance you pay in network 0%
Coinsurance we pay out of network 80%
Coinsurance you pay out of network 20%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay Deductible
QBPC, you pay Deductible
Specialist, you pay Deductible
Urgent Care, you pay Deductible
Outpatients ambulatory surgical center, you pay Deductible
Emergency room Deductible
Admitted as inpatient to hospital, you pay Deductible
What you'll pay for prescription drugs and other medical services:
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill, you pay

Tier 1: Generic 0% after deductible

Tier 2: Brand 20% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible
Physical, occupational, speech therapy rehabilitation services Deductible
Mental health and substance use disorder (inpatient & outpatient)

Deductible

Deductible

Deductible

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS 70/50 $4,500

B Bronze
Here are the basics
Deductible (single) $4,500
Deductible (family) $13,500
Most you pay out of pocket (single) $7,900
Most you pay out of pocket (family) $15,800
Coinsurance we pay in network 70%
Coinsurance you pay in network 30%
Coinsurance we pay out of network 50%
Coinsurance you pay out of network 50%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay Deductible then 30% coinsurance
QBPC, you pay Deductible then 30% coinsurance
Specialist, you pay Deductible then 30% coinsurance
Urgent Care, you pay Deductible then 30% coinsurance
Outpatients ambulatory surgical center, you pay Deductible then 30% coinsurance
Emergency room Deductible then 30% coinsurance
Admitted as inpatient to hospital, you pay Deductible then 30% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill, you pay

Tier 1: Generic 30% after deductible

Tier 2: Brand 50% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible then 30% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 30% coinsurance
Mental health and substance use disorder (inpatient & outpatient)

Deductible then 30% coinsurance

Deductible then 30% coinsurance

Deductible then 30% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor

Plan Name

Blue POS 60/40 $6,500

B Bronze
Here are the basics
Deductible (single) $6,500
Deductible (family) $15,800
Most you pay out of pocket (single) $7,900
Most you pay out of pocket (family) $15,800
Coinsurance we pay in network 60%
Coinsurance you pay in network 40%
Coinsurance we pay out of network 40%
Coinsurance you pay out of network 60%
What you'll pay if you go to the following places:
If you go to Primary Care doctor, you pay Deductible then 40% coinsurance
QBPC, you pay Deductible then 40% coinsurance
Specialist, you pay Deductible then 40% coinsurance
Urgent Care, you pay Deductible then 40% coinsurance
Outpatients ambulatory surgical center, you pay Deductible then 40% coinsurance
Emergency room Deductible then 40% coinsurance
Admitted as inpatient to hospital, you pay Deductible then 40% coinsurance
What you'll pay for prescription drugs and other medical services:
Drug deductible per member No separate drug deductible; medical deductible applies
Prescription drugs per fill, you pay

Tier 1: Generic 40% after deductible

Tier 2: Brand 60% after deductible

Preventive care services Plan pays 100% in network
Pregnancy care office visit Deductible then 40% coinsurance
Physical, occupational, speech therapy rehabilitation services Deductible then 40% coinsurance
Mental health and substance use disorder (inpatient & outpatient)

Deductible then 40% coinsurance

Deductible then 40% coinsurance

Deductible then 40% coinsurance

Pediatric dental and vision You will pay $0 for diagnostic and preventive dental and routine eye exams and hardware when received from a network doctor