Here are some plan features and benefits:
Plan Name |
Bridge Blue POS
|
Bridge Blue POS
|
Bridge Blue POS Copay 70/50 $4,500 |
Bridge Blue POS Copay 70/50 $9,000 |
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Here are the basics: | |||||||
Deductible (single) | $6,000 | $3,400 | $4,500 | $9,000 | |||
Most you pay out of pocket (single) | $7,900 | $7,900 | $7,900 | $15,800 | |||
Coinsurance we pay in network | 70% | 80% | 70% | 70% | |||
Coinsurance you pay in network | 30% | 20% | 30% | 30% | |||
Coinsurance we pay out of network | 50% | 60% | 50% | 50% | |||
Coinsurance you pay out of network | 50% | 40% | 50% | 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 | Deductible then 20% coinsurance | $40 per visit | $45 per visit | |||
Quality Blue, you pay | Deductible then 30% coinsurance | Deductible then 20% coinsurance | $40 per visit | $45 per visit | |||
Specialist, you pay | Deductible then 30% coinsurance | Deductible then 20% coinsurance | $60 per visit | $65 per visit | |||
Urgent Care, you pay | Deductible then 30% coinsurance | Deductible then 20% coinsurance | $60 per visit | $65 per visit | |||
Outpatient ambulatory surgical center, you pay | Deductible then 30% coinsurance | Deductible then 20% coinsurance | Deductible then 30% coinsurance | Deductible then 30% coinsurance | |||
Emergency room | Deductible then 30% coinsurance | Deductible then 20% coinsurance | Deductible then 30% coinsurance | Deductible then 30% coinsurance | |||
Admitted as inpatient to hospital, you pay | Deductible then 30% coinsurance | Deductible then 20% coinsurance | Deductible then 30% coinsurance | Deductible then 30% coinsurance | |||
What you'll pay for prescription drugs and other medical services: | |||||||
Drug deductible per member | The medical and drug deductible is integrated | The medical and drug deductible is integrated | $1,000 | The medical and drug deductible is integrated | |||
Prescription drugs per fill, you pay |
Tier 1: Medical deductible then 30% Generic coinsurance Tier 2: Medical deductible then 50% Brand coinsurance
|
Tier 1: Medical deductible then 20% Generic coinsurance Tier 2: Medical deductible then 40% Brand coinsurance
|
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: Medical deductible then 30% Generic coinsurance Tier 2: Medical deductible then 50% Brand coinsurance |
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Preventive care services | Covered; excludes contraceptives | Covered; excludes contraceptives | Covered; excludes contraceptives | Covered; excludes contraceptives | |||
Pregnancy care office visit | Separate Maternity deductible of $7,500 then 30% coinsurance |
Separate Maternity deductible of $7,500 then 20% coinsurance | Separate Maternity deductible of $7,500 then 30% coinsurance | Separate Maternity deductible of $9,000 then 30% coinsurance | |||
Physical, occupational, speech therapy rehabilitation services | Deductible then 30% coinsurance; Maximum $5,000 limit per benefit period | Deductible then 20% coinsurance; Maximum $5,000 limit per benefit period | $40 per visit; Maximum $5,000 limit per benefit period | $45 per visit; Maximum $5,000 limit per benefit period | |||
Mental health and substance use disorder (office visit) | Deductible then 30% coinsurance | Deductible then 20% coinsurance | $40 per visit | $45 per visit | |||
Mental health and substance use disorder (inpatient) | Deductible then 30% coinsurance | Deductible then 20% coinsurance | Deductible then 30% coinsurance | Deductible then 30% coinsurance | |||
Mental health and substance use disorder (outpatient) | Deductible then 30% coinsurance | Deductible then 20% coinsurance | Deductible then 30% coinsurance | Deductible then 30% coinsurance | |||
Pediatric dental and vision | Excluded |
Plan Name |
Bridge Blue POS 70/50 $6,000 |
||||||
---|---|---|---|---|---|---|---|
Here are the basics | |||||||
Deductible (single) | $6,000 | ||||||
Most you pay out of pocket (single) | $7,900 | ||||||
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 20% coinsurance | ||||||
Quality Blue, 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 | The medical and drug deductible is integrated | ||||||
Prescription drugs per fill, you pay |
Tier 1: Medical deductible then 30% Generic coinsurance Tier 2: Medical deductible then 50% Brand coinsurance
|
||||||
Preventive care services | Covered; excludes contraceptives | ||||||
Pregnancy care office visit | Separate Maternity deductible of $7,500 then 30% coinsurance | ||||||
Physical, occupational, speech therapy rehabilitation services | Deductible then 30% coinsurance; Maximum $5,000 limit per benefit period | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Pediatric dental and vision | Excluded |
Plan Name |
Bridge Blue POS 80/60 $3,400 |
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---|---|---|---|---|---|---|---|
Here are the basics | |||||||
Deductible (single) | $3,400 | ||||||
Most you pay out of pocket (single) | $7,900 | ||||||
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 | $45 per visit | ||||||
Quality Blue, you pay | $45 per visit | ||||||
Specialist, you pay | $65 per visit | ||||||
Urgent Care, you pay | $65 per visit | ||||||
Outpatients ambulatory surgical center, you pay | Deductible then 20% 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 | The medical and drug deductible is integrated | ||||||
Prescription drugs per fill, you pay |
Tier 1: Medical deductible then 20% Generic coinsurance Tier 2: Medical deductible then 40% Brand coinsurance
|
||||||
Preventive care services | Covered; excludes contraceptives | ||||||
Pregnancy care office visit | Separate Maternity deductible of $7,500 then 20% coinsurance | ||||||
Physical, occupational, speech therapy rehabilitation services | Deductible then 20% coinsurance; Maximum $5,000 limit per benefit period | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 20% coinsurance | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 20% coinsurance | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 20% coinsurance | ||||||
Pediatric dental and vision | Excluded |
Plan Name |
Bridge Blue POS Copay 70/50 $4,500 |
||||||
---|---|---|---|---|---|---|---|
Here are the basics | |||||||
Deductible (single) | $4,500 | ||||||
Most you pay out of pocket (single) | $7,900 | ||||||
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 | ||||||
Quality Blue, you pay | $40 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 | 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 | $1,000 | ||||||
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 | Covered; excludes contraceptives | ||||||
Pregnancy care office visit | Separate Maternity deductible of $7,500 then 30% coinsurance | ||||||
Physical, occupational, speech therapy rehabilitation services | $40 per visit; Maximum $5,000 limit per benefit period | ||||||
Mental health and substance use disorder (inpatient & outpatient) | $40 per visit | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Pediatric dental and vision | Excluded |
Plan Name |
Bridge Blue POS Copay 70/50 $9,000 |
||||||
---|---|---|---|---|---|---|---|
Here are the basics | |||||||
Deductible (single) | $9,000 | ||||||
Most you pay out of pocket (single) | $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 | ||||||
Quality Blue, 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 | The medical and drug deductible is integrated | ||||||
Prescription drugs per fill, you pay |
Tier 1: Medical deductible then 30% Generic coinsurance Tier 2: Medical deductible then 50% Brand coinsurance |
||||||
Preventive care services | Covered; excludes contraceptives | ||||||
Pregnancy care office visit | Separate Maternity deductible of $9,000 then 30% coinsurance | ||||||
Physical, occupational, speech therapy rehabilitation services | $45 per visit; Maximum $5,000 limit per benefit period | ||||||
Mental health and substance use disorder (inpatient & outpatient) | $45 per visit | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Mental health and substance use disorder (inpatient & outpatient) | Deductible then 30% coinsurance | ||||||
Pediatric dental and vision | Excluded |
*Bridge Blue POS plans are products of HMO Louisiana, Inc., a subsidiary of Blue Cross and Blue Shield of Louisiana. Both companies are independent licensees of the Blue Cross Blue Shield Association. Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company.