Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible - 97176LA0400002 Health Insurance Plan
Louisiana Health Service & Indemnity Company health insurance plan with the Plan ID 97176LA0400002. The plan is called Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 83.00% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 17.00% of the costs of all covered benefits (according to the Issuer).
| Health Insurance Plan ID | 97176LA0400002 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2022 | ||||||||||||||||||
| State | Louisiana | ||||||||||||||||||
| Health Insurance Issuer | Louisiana Health Service & Indemnity Company | ||||||||||||||||||
| Plan Marketing Materials URL | Marketing URL | ||||||||||||||||||
| Health Insurance Plan Variant | 97176LA0400002-00 | ||||||||||||||||||
| Provider Network(s) | ['LAN002'] | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 14 May 2024 06:16 GMT). |
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| Available Variants of the Health Plan | |||||||||||||||||||
| Last Plan Update Date | Thu, 19 Aug 2021 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 14 May 2024 06:16 GMT |
Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible Health Insurance Plan Variant 97176LA0400002-00 Attributes
| Plan Attribute | Value |
|---|---|
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2022 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Standard High Off Exchange Plan |
| Dental Only Plan | Yes |
| First Tier Utilization | 100% |
| HIOS Product ID | 97176LA040 |
| Import Date | 8/19/2021 15:35 |
| Inpatient Copayment Maximum Days | 0 |
| Guaranteed Rate | Guaranteed Rate |
| New/Existing Plan | Existing |
| Issuer Actuarial Value | 83.00% |
| Issuer ID | 97176 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Louisiana |
| Market Coverage | SHOP (Small Group) |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out | Not Applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Combined In/Out of Network, Individual | Not Applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | per person not applicable |
| Medical EHB Deductible, In Network (Tier 1), Individual | $50 |
| Medical EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Medical EHB Deductible, Out of Network, Family Per Person | per person not applicable |
| Medical EHB Deductible, Out of Network, Individual | Not Applicable |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group | $700 per group |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person | $350 per person |
| Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual | $350 |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group | per group not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person | per person not applicable |
| Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual | Not Applicable |
| Metal Level | High |
| Multiple In Network Tiers | No |
| National Network | Yes |
| Network ID | LAN002 |
| Out of Country Coverage | No |
| Out of Service Area Coverage | Yes |
| Out of Service Area Coverage Description | Coverage available for covered benefits |
| Plan Brochure | URL |
| Plan Effective Date | 1/1/2022 |
| Plan Expiration Date | 12/31/2022 |
| Plan ID (Standard Component ID with Variant) | 97176LA0400002-00 |
| Plan Marketing Name | Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
| Plan Type | PPO |
| Plan Variant Marketing Name | Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible |
| QHP/Non QHP | Off the Exchange |
| Service Area ID | LAS022 |
| Source Name | HIOS |
| Plan ID | 97176LA0400002 |
| State Code | LA |
Copay & Coinsurance of Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible Health Insurance Plan, 97176LA0400002
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
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Frequently Asked Questions(FAQ) about Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible, 97176LA0400002 Health Insurance Plan, 97176LA0400002
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Does Blue Dental Preferred Certified- $1,000 Annual Benefit Maximum per Adult, 100%/80%/50% coinsurance, $50 deductible Health Insurance Plan, 97176LA0400002 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (97176LA0400002) Health Insurance Plan, Variant (97176LA0400002-00) have Out Of Country Coverage?
No, unfortunately there
is no Out Of Country Coverage for this Health Insurance Plan
(variant of plan).
Does (97176LA0400002) Health Insurance Plan, Variant (97176LA0400002-00) have Out of Service Area Coverage?
Yes. Details: Coverage available for covered benefits
Disclaimer: This is based on the import(Date: Tue, 14 May 2024 06:16 GMT) of the data from Healthcare Issuers listed by CMS. While we make every effort to ensure that data is accurate, you should assume all results are unvalidated. Source: CMS.gov, HealthPorta HEALTHCARE MRF API