Blue Max 90/70 $1500 - 97176LA0340015 Health Insurance Plan

Louisiana Health Service & Indemnity Company health insurance plan with the Plan ID 97176LA0340015. The plan is called Blue Max 90/70 $1500.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 81.84% (we converted the output of AV Calculator to percentage to compare with data provided by Issuer, it shows the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 18.16% of the costs of all covered benefits (according to the AV Calculator by CMS.gov). More information about AV Calculator methodology.

Health Insurance Plan ID 97176LA0340015
Health Insurance Plan Year 2025
State Louisiana
Health Insurance Issuer Louisiana Health Service & Indemnity Company
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 97176LA0340015-01
Provider Network(s) NOT-APPLICABLE
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 13 May 2025 06:05 GMT).

Providers Louisiana All US States
All 27119 73647
PCP 3324 3581
Allergy 10 14
OB/GYN 124 132
Dentists 641 693
Available Variants of the Health Plan

Standard Off Exchange Plan - 97176LA0340015-00

Standard On Exchange Plan - 97176LA0340015-01

Open to Indians below 300% FPL - 97176LA0340015-02

Open to Indians above 300% FPL - 97176LA0340015-03

Last Plan Update Date Wed, 11 Sep 2024 00:00 GMT
Last Import Date Tue, 13 May 2025 06:05 GMT

Blue Max 90/70 $1500 Health Insurance Plan Variant 97176LA0340015-01 Attributes

Plan Attribute Value
AV Calculator Output Number 0.818407001528985
Begin Primary Care Cost-Sharing After Number Of Visits 0
Begin Primary Care Deductible Coinsurance After Number Of Copays 0
Business Year 2025
Child-Only Offering Allows Adult and Child-Only
Composite Rating Offered No
CSR Variation Type Standard Gold On Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy
EHB Percent of Total Premium 1.0
First Tier Utilization 100%
Formulary ID LAF012
Formulary URL URL
HIOS Product ID 97176LA034
Import Date 2024-09-11 01:01:35
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan Existing
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 97176
Issuer Marketplace Marketing Name Blue Cross and Blue Shield of Louisiana
Market Coverage Individual
Medical Drug Deductibles Integrated Yes
Medical Drug Maximum Out of Pocket Integrated Yes
Metal Level Gold
Multiple In Network Tiers No
National Network Yes
Network ID LAN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency and non-emergency coverage subject to Blue Card Worldwide rules.
Out of Service Area Coverage Yes
Out of Service Area Coverage Description Coverage available for covered benefits
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 97176LA0340015-01
Plan Marketing Name Blue Max 90/70 $1500
Plan Type PPO
Plan Variant Marketing Name Blue Max 90/70 $1500
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,110
SBC Scenario, Having a Baby, Copayment $0
SBC Scenario, Having a Baby, Deductible $1,500
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $320
SBC Scenario, Having Diabetes, Copayment $0
SBC Scenario, Having Diabetes, Deductible $1,500
SBC Scenario, Having Diabetes, Limit $60
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $130
SBC Scenario, Treatment of a Simple Fracture, Copayment $0
SBC Scenario, Treatment of a Simple Fracture, Deductible $1,500
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID LAS001
Source Name HIOS
Plan ID 97176LA0340015
State Code LA
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $55200 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $27600 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $27,600
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $13500 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $4500 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $4,500
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 10.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $4500 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $1500 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $1,500
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $9000 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $3000 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $3,000
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual $9,200
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group $36800 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $18400 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $18,400
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of Blue Max 90/70 $1500 Health Insurance Plan, 97176LA0340015

Drug Tier Pharmacy Type Copay amount Copay option Coinsurance rate Coinsurance option Mail Order

Frequently Asked Questions(FAQ) about Blue Max 90/70 $1500, 97176LA0340015 Health Insurance Plan, 97176LA0340015

  • Does Blue Max 90/70 $1500 Health Insurance Plan, 97176LA0340015 support Mail Ordering?

    Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.

  • Does (97176LA0340015) Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

    Does (97176LA0340015) Health Insurance Plan, Variant (97176LA0340015-01) have Out Of Country Coverage?

    Yes. Details: Emergency and non-emergency coverage subject to Blue Card Worldwide rules.

    Does (97176LA0340015) Health Insurance Plan, Variant (97176LA0340015-01) have Out of Service Area Coverage?

    Yes. Details: Coverage available for covered benefits

    Does (97176LA0340015) Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs?

    Yes, and here is the list of available programs: Asthma, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Pregnancy

    Does Blue Max 90/70 $1500 Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs for Asthma?

    Yes, the Blue Max 90/70 $1500 Health Insurance Plan Variant 97176LA0340015-01 offers Disease Management Program for Asthma.

    Does Blue Max 90/70 $1500 Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs for Heart disease?

    Yes, the Blue Max 90/70 $1500 Health Insurance Plan Variant 97176LA0340015-01 offers Disease Management Program for Heart disease.

    Does Blue Max 90/70 $1500 Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs for Diabetes?

    Yes, the Blue Max 90/70 $1500 Health Insurance Plan Variant 97176LA0340015-01 offers Disease Management Program for Diabetes.

    Does Blue Max 90/70 $1500 Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs for High blood pressure & high cholesterol?

    Yes, the Blue Max 90/70 $1500 Health Insurance Plan Variant 97176LA0340015-01 offers Disease Management Program for High blood pressure & high cholesterol.

    Does Blue Max 90/70 $1500 Health Insurance Plan, Variant (97176LA0340015-01) offer Disease Management Programs for Pregnancy?

    Yes, the Blue Max 90/70 $1500 Health Insurance Plan Variant 97176LA0340015-01 offers Disease Management Program for Pregnancy.

 

Disclaimer: This is based on the import(Date: Tue, 13 May 2025 06:05 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