Bridge Community Blue Point of Service (POS) (2021)

Bridge Community Blue POS* is a short-term medical select network, patient-centered plan. This means local healthcare providers, led by a primary care doctor, work as a team to manage your healthcare.

Ascension, East Baton Rouge, Livingston, and West Baton Rouge parishes

Community Blue HMO/POS

NETWORK

=

Bridge Community Blue POS

PLAN

Here are some plan features and benefits:


Medical and Prescription Drug coverage for up to 11 months.


Coverage can begin as soon as the first day of the next month, pending application approval.


We pay 100 percent of preventive care services in network, excluding contraceptive drugs and devices.


Provides coverage for a range of treatments, including office visits, emergency services, hospitalization, lab tests, blood work, X-rays and mental healthcare.


Pediatric dental and vision coverage are excluded.


Separate maternity deductible of $7,500 (In-Network) and $15,000 (Out-of-Network) that does not apply to the max out-of-pocket total.


Plan is available to residents of Ascension, East Baton Rouge, Livingston and West Baton Rouge parishes.


Participating providers include Baton Rouge Clinic**, Baton Rouge General Physicians Group and Baton Rouge General Medical Center.
**Does not include gastroenterologists and ear, nose and throat (ENT) physicians at Baton Rouge Clinic.


You get a team of healthcare doctors, nurses and hospitals who work together to help you get the right care in the right place.


Staying in-network is very important! As long as you get care within your Community Blue network, you will always pay less than if you get care outside of the network.


You must pick a primary care doctor in the Community Blue network.

Plan Name

Bridge Community Blue 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:
Primary Care, you pay $40 per visit
QBPC, you pay $40 per visit
Specialist, you pay $60 per visit
Urgent Care, you pay $60 per visit
Outpatient ambulatory surgical center, you pay Deductible then 30% coinsurance
Emergency room, you pay Deductible then 30% coinsurance; 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 $1,000
Prescription drugs per fill

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 Fully 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
Mental health and substance use disorder (office visit) $40 per visit
Mental health and substance use disorder (inpatient) Deductible then 30% coinsurance
Mental health and substance use disorder (outpatient) Deductible then 30% coinsurance
Pediatric dental and vision Excluded

Plan Name

Bridge Community Blue 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:
Primary Care, you pay $40 per visit
QBPC, you pay $40 per visit
Specialist, you pay $60 per visit
Urgent Care, you pay $60 per visit
Outpatient ambulatory surgical center, you pay Deductible then 30% coinsurance
Emergency room, you pay Deductible then 30% coinsurance; 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 $1,000
Prescription drugs per fill

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 Fully 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
Mental health and substance use disorder (office visit) $40 per visit
Mental health and substance use disorder (inpatient) Deductible then 30% coinsurance
Mental health and substance use disorder (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 and Blue Shield Association. Blue Cross and Blue Shield of Louisiana is incorporated as Louisiana Health Service & Indemnity Company.