Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 - 97176LA0340010 Health Insurance Plan
Louisiana Health Service & Indemnity Company health insurance plan with the Plan ID 97176LA0340010. The plan is called Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300.
Based on the data of Health Plan Issuer, this plan has an actuarial value of 70.86% (the percentage of total average costs for covered benefits that a plan will cover). So, on average, you would be responsible for 29.14% of the costs of all covered benefits (according to the Issuer).
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 70.42% (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 29.58% 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 | 97176LA0340010 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 97176LA0340010-00 | ||||||||||||||||||
| Provider Network(s) | NOT-APPLICABLE | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 27 May 2025 18:07 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 97176LA0340010-00 Standard On Exchange Plan - 97176LA0340010-01 Open to Indians below 300% FPL - 97176LA0340010-02 Open to Indians above 300% FPL - 97176LA0340010-03 73% AV Silver Plan - 97176LA0340010-04 |
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| Last Plan Update Date | Wed, 11 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 27 May 2025 18:07 GMT |
Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan Variant 97176LA0340010-00 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.70421180147361 |
| 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 Silver Off Exchange Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $500 per person |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $500 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 20.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | per group not applicable |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $500 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $500 |
| Drug EHB Deductible, Out of Network, Family Per Group | per group not applicable |
| Drug EHB Deductible, Out of Network, Family Per Person | $500 per person |
| Drug EHB Deductible, Out of Network, Individual | $500 |
| 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 | LAF010 |
| 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 Actuarial Value | 70.86% |
| Issuer ID | 97176 |
| Issuer Marketplace Marketing Name | Blue Cross and Blue Shield of Louisiana |
| Market Coverage | Individual |
| Medical Drug Deductibles Integrated | No |
| Medical Drug Maximum Out of Pocket Integrated | Yes |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Group | $29700 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $9900 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $9,900 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $9900 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $3300 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $3,300 |
| Medical EHB Deductible, Out of Network, Family Per Group | $19800 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $6600 per person |
| Medical EHB Deductible, Out of Network, Individual | $6,600 |
| Metal Level | Silver |
| 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) | 97176LA0340010-00 |
| Plan Marketing Name | Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 |
| Plan Type | PPO |
| Plan Variant Marketing Name | Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $3,880 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $3,310 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $680 |
| SBC Scenario, Having Diabetes, Copayment | $490 |
| SBC Scenario, Having Diabetes, Deductible | $510 |
| SBC Scenario, Having Diabetes, Limit | $60 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $130 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,300 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | LAS001 |
| Source Name | HIOS |
| Specialty Drug Maximum Coinsurance | $250 |
| Plan ID | 97176LA0340010 |
| 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 |
| 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 | Yes |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
Copay & Coinsurance of Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, 97176LA0340010
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300, 97176LA0340010 Health Insurance Plan, 97176LA0340010
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Does Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, 97176LA0340010 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (97176LA0340010) Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs?
Does (97176LA0340010) Health Insurance Plan, Variant (97176LA0340010-00) have Out Of Country Coverage?
Does (97176LA0340010) Health Insurance Plan, Variant (97176LA0340010-00) have Out of Service Area Coverage?
Does (97176LA0340010) Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs?
Does Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs for Asthma?
Does Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs for Heart disease?
Does Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs for Diabetes?
Does Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs for High blood pressure & high cholesterol?
Does Blue Max Copay (PCP, Specialist, Urgent Care) 50/50 $3300 Health Insurance Plan, Variant (97176LA0340010-00) offer Disease Management Programs for Pregnancy?
Disclaimer: This is based on the import(Date: Tue, 27 May 2025 18:07 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