Here are some plan features and benefits:
**Does not include gastroenterologist physicians at The Baton Rouge Clinic.
*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.
Plan Name |
Bridge Community Blue Copay 70/50 $4,500 |
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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 | ||||
Quality Blue, 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 | ||||
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) |
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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 (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 | ||||
Quality Blue, 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; Maximum $5,000 limit per benefit period | ||||
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 |