Blue Connect Copay (PCP) 60/40 $6000 Standardized (L)

HMO Louisiana · 2026 plan year

Silver
Ind. deductible
$6,000
Family deductible
$12,000
Ind. OOP max
$8,900
Family OOP max
$17,800

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Side by side: deductibles, out-of-pocket limits and copays.

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Monthly premiums by age

Rating Area 3

AgeIndividualIndividual + tobacco
Under 15$437$437
21$571$657
30$648$745
40$730$839
50$1,020$1,173
60$1,550$1,783
64 and over$1,713$1,970

Live premium estimate

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Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$40.00

Specialist

BenefitIn-network
Specialist Visit$80.00

Hospital

BenefitIn-network
Emergency Room Services40.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)40.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services40.00% Coinsurance after deductible
Urgent Care Centers or Facilities$60.00

Pharmacy

BenefitIn-network
Generic Drugs$20.00
Non-Preferred Brand Drugs$80.00 Copay after deductible
Preferred Brand Drugs$40.00
Prescription Drugs Other40.00% Coinsurance after deductible
Specialty Drugs$125.00 Copay after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services40.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services$40.00

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental40.00% Coinsurance after deductible
AcupunctureNot covered
Allergy Testing40.00% Coinsurance after deductible
Attention Deficit Disorder$80.00
Bariatric SurgeryNot covered
Basic Dental Care - AdultNot covered
Basic Dental Care - Child50.00% Coinsurance after deductible
Chemotherapy40.00% Coinsurance after deductible
Chiropractic Care$40.00
Clinical Trials$80.00
Congenital Anomaly, including Cleft Lip/Palate40.00% Coinsurance after deductible
Cosmetic SurgeryNot covered
Delivery and All Inpatient Services for Maternity Care40.00% Coinsurance after deductible
Dental Anesthesia40.00% Coinsurance after deductible
Dental Check-Up for ChildrenNo charge
Diabetes Care Management40.00% Coinsurance after deductible
Diabetes Education40.00% Coinsurance after deductible
Dialysis40.00% Coinsurance after deductible
Durable Medical Equipment40.00% Coinsurance after deductible
Emergency Transportation/Ambulance40.00% Coinsurance after deductible
Eye Glasses for ChildrenNo charge
Habilitation Services$40.00
Hearing Aids40.00% Coinsurance after deductible
Home Health Care Services40.00% Coinsurance after deductible
Hospice Services40.00% Coinsurance after deductible
Imaging (CT/PET Scans, MRIs)40.00% Coinsurance after deductible
Infertility TreatmentNot covered
Infusion Therapy40.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU40.00% Coinsurance after deductible
Inpatient Physician and Surgical Services40.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services40.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - Child50.00% Coinsurance after deductible
Non-Emergency Care When Traveling Outside the U.S.60.00% Coinsurance after deductible
Nutritional Counseling40.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - Child50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)$40.00
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)40.00% Coinsurance after deductible
Outpatient Rehabilitation Services$40.00
Prenatal and Postnatal Care$80.00
Private-Duty Nursing40.00% Coinsurance after deductible
Prosthetic Devices40.00% Coinsurance after deductible
Radiation40.00% Coinsurance after deductible
Reconstructive Surgery40.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy$40.00
Rehabilitative Speech Therapy$40.00
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for ChildrenNo charge
Routine Foot CareNot covered
Skilled Nursing Facility40.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services40.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services$40.00
Transplant40.00% Coinsurance after deductible
Treatment for Temporomandibular Joint DisordersNot covered
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging40.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 8 geographic areas.

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