CHRISTUS Gold Plus - 98780LA0210001 Health Insurance Plan

CHRISTUS Health Plan Louisiana health insurance plan with the Plan ID 98780LA0210001. The plan is called CHRISTUS Gold Plus.

Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 80.85% (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 19.15% 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 98780LA0210001
Health Insurance Plan Year 2025
State Louisiana
Health Insurance Issuer CHRISTUS Health Plan Louisiana
Plan Formulary Description URL Formulary URL
Plan Marketing Materials URL Marketing URL
Health Insurance Plan Variant 98780LA0210001-00
Provider Network(s) PREFERRED NONPREFERRED
In Network Doctors

*The data available in our database based on Health Insurance Company Open Data (update: Tue, 10 Dec 2024 06:32 GMT).

Providers Louisiana All US States
All 3807 67838
PCP 723 3331
Allergy 1 6
OB/GYN 19 117
Dentists 1 12
Available Variants of the Health Plan

Standard Off Exchange Plan - 98780LA0210001-00

Standard On Exchange Plan - 98780LA0210001-01

Open to Indians below 300% FPL - 98780LA0210001-02

Open to Indians above 300% FPL - 98780LA0210001-03

Last Plan Update Date Tue, 24 Sep 2024 00:00 GMT
Last Import Date Tue, 10 Dec 2024 06:32 GMT

Benefits of CHRISTUS Gold Plus Health Insurance Plan, 98780LA0210001-00

Benefit Covered In Network Out Of Network
Abortion for Which Public Funding is Prohibited
NO
Accidental Dental
YES

40.00%

100.00%
Acupuncture
NO
Allergy Testing
YES

$60.00

100.00%
Attention Deficit Disorder
YES

$5.00

100.00%
Bariatric Surgery
NO
Basic Dental Care - Adult

Limit: 1000.0 Dollars per Year

Item limits apply. $1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

YES

20.00%

20.00%
Basic Dental Care - Child
YES

20.00%

20.00%
Chemotherapy
YES

40.00%

100.00%
Chiropractic Care

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$60.00

100.00%
Clinical Trials
YES

$60.00

100.00%
Congenital Anomaly, including Cleft Lip/Palate
YES

40.00%

100.00%
Cosmetic Surgery
NO
Delivery and All Inpatient Services for Maternity Care

Preauthorization is required for inpatient care, except for: (1) forty-eight (48) hours of Inpatient care following an uncomplicated vaginal delivery or ninety-six (96) hours of Inpatient care following an uncomplicated Cesarean section or (2) Post-Partum Care. If you don?t get preauthorization, benefits will be denied.

YES

$950.00

100.00%
Dental Anesthesia
YES

40.00%

100.00%
Dental Check-Up for Children

Limit: 1.0 Visit(s) per 6 Months

YES

0.00%

0.00%
Diabetes Care Management
YES

$5.00

100.00%
Diabetes Education
YES

0.00%

100.00%
Dialysis
YES

40.00%

100.00%
Durable Medical Equipment

Preauthorization is required for some durable medical equipment. If you don't get preauthorization, benefits will be denied.

YES

40.00%

100.00%
Emergency Room Services
YES

$950.00

$950.00
Emergency Transportation/Ambulance
YES

40.00%

40.00%
Eye Glasses for Adults

Limit: 1.0 Item(s) per Year

Limited to one item per year up to $130 per person for either glasses or contacts.

YES

0.00%

100.00%
Eye Glasses for Children

Limit: 1.0 Item(s) per Year

YES

0.00%

100.00%
Fitness Benefit - Adult

No charge for access to a fitness center in the American Specialty Health Active&Fit network.

YES

0.00%

100.00%
Gender Affirming Care
NO
Generic Drugs

Cost sharing for a 90-day supply by mail order is triple the cost sharing for a standard 30-day supply. Prescriptions for birth control are not subject to deductible, and do not have a copayment.

YES

No Charge

100.00%
Habilitation Services

Habilitative and rehabilitative limits cannot be combined for plans issued or renewed on or after January 1, 2017. Habilitation services includes autism services, and the benchmark plan does not impose age or maximums on autism coverage. MH/SUD office visits are subject to the listed copay, while MH/SUD facility outpatient treatments are subject to the outpatient facility coinsurance. Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$60.00

100.00%
Hearing Aids

Limit: 1.0 Item(s) per 3 Years

To restore or correction of impaired speech or hearing loss.

YES

40.00%

100.00%
Home Health Care Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

40.00%

100.00%
Hospice Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

40.00%

100.00%
Imaging (CT/PET Scans, MRIs)

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$400.00

100.00%
Infertility Treatment
NO
Infusion Therapy
YES

$60.00

100.00%
Inherited Metabolic Disorder - PKU
YES

40.00%

100.00%
Inpatient Hospital Services (e.g., Hospital Stay)

All usual Hospital services and supplies, including semiprivate room, intensive care, and coronary care units. Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$950 Copay per Stay

100.00%
Inpatient Physician and Surgical Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

No Charge

100.00%
Laboratory Outpatient and Professional Services
YES

$60.00

100.00%
Long-Term/Custodial Nursing Home Care
NO
Major Dental Care - Adult

Limit: 1000.0 Dollars per Year

Item limits apply. $1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

YES

50.00%

50.00%
Major Dental Care - Child
YES

50.00%

50.00%
Mental/Behavioral Health Inpatient Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$950 Copay per Stay

100.00%
Mental/Behavioral Health Outpatient Services

MH/SUD office visits are subject to the listed cost sharing, while MH/SUD facility outpatient treatments are subject to the outpatient facility coinsurance.

YES

$60.00

100.00%
Non-Preferred Brand Drugs

Cost sharing for a 90-day supply by mail order is triple the cost sharing for a standard 30-day supply. Prescriptions for birth control are not subject to deductible, and do not have a copayment.

YES

$80.00

100.00%
Nutritional Counseling
YES

0.00%

100.00%
Orthodontia - Adult
NO
Orthodontia - Child

Medically necessary. Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

50.00%

50.00%
Other Practitioner Office Visit (Nurse, Physician Assistant)
YES

$60.00

100.00%
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

40.00%

100.00%
Outpatient Rehabilitation Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$60.00

100.00%
Outpatient Surgery Physician/Surgical Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

40.00%

100.00%
Preferred Brand Drugs

Cost sharing for a 90-day supply by mail order is triple the cost sharing for a standard 30-day supply. Prescriptions for birth control are not subject to deductible, and do not have a copayment.

YES

$60.00

100.00%
Prenatal and Postnatal Care
YES

$60.00

100.00%
Preventive Care/Screening/Immunization
YES

0.00%

100.00%
Primary Care Visit to Treat an Injury or Illness
YES

$5.00

100.00%
Private-Duty Nursing

Inpatient Private Duty Nursing Services are not covered.

YES

40.00%

100.00%
Prosthetic Devices

Medically necessary foot orthotics are not subject to a calendar year maximum.

YES

40.00%

100.00%
Radiation
YES

40.00%

100.00%
Reconstructive Surgery

Examples of covered services include: Treatment provided for reconstructive surgery following cancer surgery; Reconstruction of the breast on which mastectomy has been performed.

YES

40.00%

100.00%
Rehabilitative Occupational and Rehabilitative Physical Therapy

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$60.00

100.00%
Rehabilitative Speech Therapy

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$60.00

100.00%
Routine Dental Services (Adult)

Limit: 1000.0 Dollars per Year

Item limits apply. $1,000 annual benefit maximum includes all Dental services (Routine, Basic and Major) for Adults

YES

0.00%

0.00%
Routine Eye Exam (Adult)

Limit: 1.0 Visit(s) per Year

YES

0.00%

100.00%
Routine Eye Exam for Children

Limit: 1.0 Visit(s) per Year

YES

0.00%

100.00%
Routine Foot Care
NO
Skilled Nursing Facility

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

40.00%

100.00%
Specialist Visit
YES

$60.00

100.00%
Specialty Drugs

Cost sharing for specialty drugs is limited to $150 per prescription for a standard 30-day supply.

YES

$150.00

100.00%
Substance Abuse Disorder Inpatient Services

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$950 Copay per Stay

100.00%
Substance Abuse Disorder Outpatient Services

MH/SUD office visits are subject to the listed cost sharing, while MH/SUD facility outpatient treatments are subject to the outpatient facility coinsurance.

YES

$60.00

100.00%
Transplant

Preauthorization is required. If you don't get preauthorization, benefits will be denied.

YES

$950.00

100.00%
Treatment for Temporomandibular Joint Disorders
NO
Urgent Care Centers or Facilities

No charge for virtual urgent care through CHRISTUS Health System.

YES

$60.00

100.00%
Weight Loss Programs
NO
Well Baby Visits and Care
YES

0.00%

100.00%
X-rays and Diagnostic Imaging
YES

$60.00

100.00%

CHRISTUS Gold + Dental & Vision + Fitness ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) Health Insurance Plan Variant 98780LA0210001-00 Attributes

Plan Attribute Value
AV Calculator Output Number 0.8085164447827509
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 Off Exchange Plan
Dental Only Plan No
Design Type Not Applicable
Disease Management Programs Offered Diabetes
EHB Percent of Total Premium 0.9743193135882091
First Tier Utilization 100%
Formulary ID LAF008
Formulary URL URL
HIOS Product ID 98780LA021
Import Date 2024-09-24 01:01:39
Limited Cost Sharing Plan Variation - Estimated Advanced Payment $0.00
Inpatient Copayment Maximum Days 0
HSA Eligible No
New/Existing Plan New
Notice Required for Pregnancy No
Is a Referral Required for Specialist? No
Issuer ID 98780
Issuer Marketplace Marketing Name CHRISTUS Health Plan
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 No
Network ID LAN001
Out of Country Coverage Yes
Out of Country Coverage Description Emergency Services Only
Out of Service Area Coverage No
Plan Brochure URL
Plan Effective Date 2025-01-01
Plan Expiration Date 2025-12-31
Plan ID (Standard Component ID with Variant) 98780LA0210001-00
Plan Marketing Name CHRISTUS Gold Plus
Plan Type HMO
Plan Variant Marketing Name CHRISTUS Gold + Dental & Vision + Fitness ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care)
QHP/Non QHP Both
SBC Scenario, Having a Baby, Coinsurance $1,000
SBC Scenario, Having a Baby, Copayment $1,600
SBC Scenario, Having a Baby, Deductible $0
SBC Scenario, Having a Baby, Limit $60
SBC Scenario, Having Diabetes, Coinsurance $300
SBC Scenario, Having Diabetes, Copayment $1,100
SBC Scenario, Having Diabetes, Deductible $0
SBC Scenario, Having Diabetes, Limit $20
SBC Scenario, Treatment of a Simple Fracture, Coinsurance $500
SBC Scenario, Treatment of a Simple Fracture, Copayment $900
SBC Scenario, Treatment of a Simple Fracture, Deductible $0
SBC Scenario, Treatment of a Simple Fracture, Limit $0
Service Area ID LAS003
Source Name HIOS
Plan ID 98780LA0210001
State Code LA
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual $9,200
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual $0
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance 40.00%
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual $0
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group $0 per group
Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person $0 per person
Combined Medical and Drug EHB Deductible, Out of Network, Individual $0
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 $18400 per group
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person $9200 per person
Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual $9,200
Unique Plan Design No
URL for Enrollment Payment URL
URL for Summary of Benefits & Coverage URL
Wellness Program Offered No

Copay & Coinsurance of CHRISTUS Gold Plus Health Insurance Plan, 98780LA0210001

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

Frequently Asked Questions(FAQ) about CHRISTUS Gold Plus, 98780LA0210001 Health Insurance Plan, 98780LA0210001

  • Does CHRISTUS Gold Plus Health Insurance Plan, 98780LA0210001 support Mail Ordering?

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

  • Does (98780LA0210001) Health Insurance Plan, Variant (98780LA0210001-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes

    Does (98780LA0210001) Health Insurance Plan, Variant (98780LA0210001-00) have Out Of Country Coverage?

    Yes. Details: Emergency Services Only

    Does (98780LA0210001) Health Insurance Plan, Variant (98780LA0210001-00) have Out of Service Area Coverage?

    No, unfortunately there is no Out of Service Area Coverage for this Health Insurance Plan (variant of plan).

    Does (98780LA0210001) Health Insurance Plan, Variant (98780LA0210001-00) offer Disease Management Programs?

    Yes, and here is the list of available programs: Diabetes

    Does CHRISTUS Gold + Dental & Vision + Fitness ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) Health Insurance Plan, Variant (98780LA0210001-00) offer Disease Management Programs for Diabetes?

    Yes, the CHRISTUS Gold + Dental & Vision + Fitness ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) Health Insurance Plan Variant 98780LA0210001-00 offers Disease Management Program for Diabetes.

 

Disclaimer: This is based on the import(Date: Tue, 10 Dec 2024 06:32 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