Blue Max Copay (PCP) 50/50 $3300 with 2 $0 PCP Virtual Visits

Blue Cross and Blue Shield of Louisiana · 2026 plan year

Silver

Ind. medical deductible: $800
Rx deductible (separate): $0
Family deductible: $2,400
Ind. OOP max: $3,100
Family OOP max: $6,200

This plan sets a separate deductible for prescription drugs. The medical deductible shown does not cover prescriptions; they have their own.

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Standard Silver On Exchange Plan Zero Cost Sharing Plan Variation

More Blue Cross and Blue Shield of Louisiana plans in LA

Blue Max 70/50 $6700 with 2 $0 PCP Virtual Visits HSA Eligible Blue Max Copay (PCP) 50/50 $7500 Standardized HSA Eligible Blue Max 80/60 $1500 with 2 $0 PCP Virtual Visits Blue Max Copay (PCP) 75/55 $2000 Standardized Blue Max Copay (PCP) 60/40 $6000 Standardized

Live premium estimate

Benefits & cost sharing

Primary Care

Benefit	In-network
Preventive Care/Screening/Immunization	No charge
Primary Care Visit to Treat an Injury or Illness	$20.00

Specialist

Benefit	In-network
Specialist Visit	$35.00

Hospital

Benefit	In-network
Emergency Room Services	30.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	30.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	30.00% Coinsurance after deductible
Urgent Care Centers or Facilities	$35.00

Pharmacy

Benefit	In-network
Generic Drugs	$15.00 Copay after deductible
Non-Preferred Brand Drugs	30.00% Coinsurance after deductible
Preferred Brand Drugs	20.00% Coinsurance after deductible
Prescription Drugs Other	30.00% Coinsurance after deductible
Specialty Drugs	20.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	30.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services	$20.00

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	30.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	30.00% Coinsurance after deductible
Attention Deficit Disorder	$35.00
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	50.00% Coinsurance after deductible
Chemotherapy	30.00% Coinsurance after deductible
Chiropractic Care	$20.00
Clinical Trials	$35.00
Congenital Anomaly, including Cleft Lip/Palate	30.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	30.00% Coinsurance after deductible
Dental Anesthesia	30.00% Coinsurance after deductible
Dental Check-Up for Children	No charge
Diabetes Care Management	30.00% Coinsurance after deductible
Diabetes Education	30.00% Coinsurance after deductible
Dialysis	30.00% Coinsurance after deductible
Durable Medical Equipment	30.00% Coinsurance after deductible
Emergency Transportation/Ambulance	30.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	30.00% Coinsurance after deductible
Hearing Aids	30.00% Coinsurance after deductible
Home Health Care Services	30.00% Coinsurance after deductible
Hospice Services	30.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)	30.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	30.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU	30.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	30.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	30.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home Care	Not covered
Major Dental Care - Adult	Not covered
Major Dental Care - Child	50.00% Coinsurance after deductible
Non-Emergency Care When Traveling Outside the U.S.	30.00% Coinsurance after deductible
Nutritional Counseling	30.00% Coinsurance after deductible
Orthodontia - Adult	Not covered
Orthodontia - Child	50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	$20.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	30.00% Coinsurance after deductible
Outpatient Rehabilitation Services	30.00% Coinsurance after deductible
Prenatal and Postnatal Care	$35.00
Private-Duty Nursing	30.00% Coinsurance after deductible
Prosthetic Devices	30.00% Coinsurance after deductible
Radiation	30.00% Coinsurance after deductible
Reconstructive Surgery	30.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	30.00% Coinsurance after deductible
Rehabilitative Speech Therapy	30.00% Coinsurance after deductible
Routine Dental Services (Adult)	Not covered
Routine Eye Exam (Adult)	Not covered
Routine Eye Exam for Children	No charge
Routine Foot Care	Not covered
Skilled Nursing Facility	30.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	30.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	$20.00
Transplant	30.00% Coinsurance after deductible
Treatment for Temporomandibular Joint Disorders	Not covered
Weight Loss Programs	Not covered
Well Baby Visits and Care	No charge
X-rays and Diagnostic Imaging	30.00% Coinsurance after deductible

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