Blue POS 80/60 $3200 with 2 $0 PCP Virtual Visits

HMO Louisiana

Silver

Ind. deductible: $3,200
Family deductible: $3,200
Ind. OOP max: $9,100
Family OOP max: $9,100

Other cost-sharing reduction variants for this plan:

73% AV Level Silver Plan 87% AV Level Silver Plan 94% AV Level Silver Plan Limited Cost Sharing Plan Variation Standard Silver Off Exchange Plan Zero Cost Sharing Plan Variation

Monthly premiums by age

Age	Individual	Individual + tobacco
21	$570	—
30	$647	—
40	$729	—
50	$1,019	—
60	$1,548	—

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% Coinsurance after deductible

Specialist

Benefit	In-network
Specialist Visit	10.00% Coinsurance after deductible

Hospital

Benefit	In-network
Emergency Room Services	20.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)	20.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services	10.00%
Urgent Care Centers or Facilities	20.00% Coinsurance after deductible

Pharmacy

Benefit	In-network
Generic Drugs	20.00% Coinsurance after deductible
Non-Preferred Brand Drugs	$0.00
Preferred Brand Drugs	$0.00
Prescription Drugs Other	$0.00
Specialty Drugs	40.00% Coinsurance after deductible

Mental Health

Benefit	In-network
Mental/Behavioral Health Inpatient Services	$0.00
Mental/Behavioral Health Outpatient Services	20.00% Coinsurance after deductible

Other

Benefit	In-network
Abortion for Which Public Funding is Prohibited	Not covered
Accidental Dental	20.00% Coinsurance after deductible
Acupuncture	Not covered
Allergy Testing	20.00% Coinsurance after deductible
Attention Deficit Disorder	20.00% Coinsurance after deductible
Bariatric Surgery	Not covered
Basic Dental Care - Adult	Not covered
Basic Dental Care - Child	50.00% Coinsurance after deductible
Chemotherapy	20.00% Coinsurance after deductible
Chiropractic Care	20.00% Coinsurance after deductible
Clinical Trials	20.00% Coinsurance after deductible
Congenital Anomaly, including Cleft Lip/Palate	20.00% Coinsurance after deductible
Cosmetic Surgery	Not covered
Delivery and All Inpatient Services for Maternity Care	10.00% Coinsurance after deductible
Dental Anesthesia	20.00% Coinsurance after deductible
Dental Check-Up for Children	No charge
Diabetes Care Management	20.00% Coinsurance after deductible
Diabetes Education	20.00% Coinsurance after deductible
Dialysis	10.00% Coinsurance after deductible
Durable Medical Equipment	20.00% Coinsurance after deductible
Emergency Transportation/Ambulance	20.00% Coinsurance after deductible
Eye Glasses for Children	No charge
Habilitation Services	20.00% Coinsurance after deductible
Hearing Aids	10.00%
Home Health Care Services	10.00%
Hospice Services	10.00%
Imaging (CT/PET Scans, MRIs)	10.00% Coinsurance after deductible
Infertility Treatment	Not covered
Infusion Therapy	10.00% Coinsurance after deductible
Inherited Metabolic Disorder - PKU	10.00% Coinsurance after deductible
Inpatient Physician and Surgical Services	10.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services	10.00% 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.	40.00% Coinsurance after deductible
Nutritional Counseling	10.00% Coinsurance after deductible
Orthodontia - Adult	Not covered
Orthodontia - Child	50.00% Coinsurance after deductible
Other Practitioner Office Visit (Nurse, Physician Assistant)	10.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)	10.00%
Outpatient Rehabilitation Services	20.00% Coinsurance after deductible
Prenatal and Postnatal Care	20.00% Coinsurance after deductible
Private-Duty Nursing	20.00% Coinsurance after deductible
Prosthetic Devices	20.00% Coinsurance after deductible
Radiation	20.00% Coinsurance after deductible
Reconstructive Surgery	20.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy	20.00% Coinsurance after deductible
Rehabilitative Speech Therapy	20.00% 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	20.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services	20.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services	20.00% Coinsurance after deductible
Transplant	$0.00
Treatment for Temporomandibular Joint Disorders	Not covered
Weight Loss Programs	Not covered
Well Baby Visits and Care	$0.00
X-rays and Diagnostic Imaging	20.00% Coinsurance after deductible

Plan rules

Service area

This plan covers 56 geographic areas.