CHRISTUS Gold Plus - 98780LA0210003 Health Insurance Plan
CHRISTUS Health Plan Louisiana health insurance plan with the Plan ID 98780LA0210003. 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 | 98780LA0210003 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| 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 | 98780LA0210003-03 | ||||||||||||||||||
| Provider Network(s) | NONPREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Fri, 14 Nov 2025 22:16 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 98780LA0210003-00 Standard On Exchange Plan - 98780LA0210003-01 |
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| Last Plan Update Date | Tue, 24 Sep 2024 00:00 GMT | ||||||||||||||||||
| Last Import Date | Fri, 14 Nov 2025 22:16 GMT |
Benefits of CHRISTUS Gold Plus Health Insurance Plan, 98780LA0210003-03
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
Exclusions: nan nan |
NO | ||
| Accidental Dental
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Acupuncture
Exclusions: nan nan |
NO | ||
| Allergy Testing
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Attention Deficit Disorder
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Bariatric Surgery
Exclusions: nan nan |
NO | ||
| Basic Dental Care - Adult
Limit: 1000.0 Dollars per Year Exclusions: nan 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
Exclusions: nan nan |
YES | 20.00% |
20.00% |
| Chemotherapy
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Chiropractic Care
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $60.00 |
100.00% |
| Clinical Trials
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Congenital Anomaly, including Cleft Lip/Palate
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Cosmetic Surgery
Exclusions: nan nan |
NO | ||
| Delivery and All Inpatient Services for Maternity Care
Exclusions: nan 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 dont get preauthorization, benefits will be denied. |
YES | $950.00 |
100.00% |
| Dental Anesthesia
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months Exclusions: nan nan |
YES | 0.00% |
0.00% |
| Diabetes Care Management
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Diabetes Education
Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Dialysis
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Durable Medical Equipment
Exclusions: nan 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
Exclusions: nan nan |
YES | $950.00 |
$950.00 |
| Emergency Transportation/Ambulance
Exclusions: nan nan |
YES | 40.00% |
40.00% |
| Eye Glasses for Adults
Limit: 1.0 Item(s) per Year Exclusions: nan 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 Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Fitness Benefit - Adult
Exclusions: nan No charge for access to a fitness center in the American Specialty Health Active&Fit network. |
YES | 0.00% |
100.00% |
| Gender Affirming Care
Exclusions: nan nan |
NO | ||
| Generic Drugs
Exclusions: nan 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
Exclusions: nan 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 Exclusions: nan To restore or correction of impaired speech or hearing loss. |
YES | 40.00% |
100.00% |
| Home Health Care Services
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | 40.00% |
100.00% |
| Hospice Services
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | 40.00% |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $400.00 |
100.00% |
| Infertility Treatment
Exclusions: nan nan |
NO | ||
| Infusion Therapy
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Inherited Metabolic Disorder - PKU
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Inpatient Hospital Services (e.g., Hospital Stay)
Exclusions: nan 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 | $950.00 Copay per Stay |
100.00% |
| Inpatient Physician and Surgical Services
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | No Charge |
100.00% |
| Laboratory Outpatient and Professional Services
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Long-Term/Custodial Nursing Home Care
Exclusions: nan nan |
NO | ||
| Major Dental Care - Adult
Limit: 1000.0 Dollars per Year Exclusions: nan 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
Exclusions: nan nan |
YES | 50.00% |
50.00% |
| Mental/Behavioral Health Inpatient Services
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $950.00 Copay per Stay |
100.00% |
| Mental/Behavioral Health Outpatient Services
Exclusions: nan 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
Exclusions: nan 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
Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Orthodontia - Adult
Exclusions: nan nan |
NO | ||
| Orthodontia - Child
Exclusions: nan 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)
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | 40.00% |
100.00% |
| Outpatient Rehabilitation Services
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $60.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | 40.00% |
100.00% |
| Preferred Brand Drugs
Exclusions: nan 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
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Preventive Care/Screening/Immunization
Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
Exclusions: nan nan |
YES | $5.00 |
100.00% |
| Private-Duty Nursing
Exclusions: nan Inpatient Private Duty Nursing Services are not covered. |
YES | 40.00% |
100.00% |
| Prosthetic Devices
Exclusions: nan Medically necessary foot orthotics are not subject to a calendar year maximum. |
YES | 40.00% |
100.00% |
| Radiation
Exclusions: nan nan |
YES | 40.00% |
100.00% |
| Reconstructive Surgery
Exclusions: nan 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
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $60.00 |
100.00% |
| Rehabilitative Speech Therapy
Exclusions: nan 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 Exclusions: nan 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 Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Routine Eye Exam for Children
Limit: 1.0 Visit(s) per Year Exclusions: nan nan |
YES | 0.00% |
100.00% |
| Routine Foot Care
Exclusions: nan nan |
NO | ||
| Skilled Nursing Facility
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | 40.00% |
100.00% |
| Specialist Visit
Exclusions: nan nan |
YES | $60.00 |
100.00% |
| Specialty Drugs
Exclusions: nan 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
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $950.00 Copay per Stay |
100.00% |
| Substance Abuse Disorder Outpatient Services
Exclusions: nan 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
Exclusions: nan Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $950.00 |
100.00% |
| Treatment for Temporomandibular Joint Disorders
Exclusions: nan nan |
NO | ||
| Urgent Care Centers or Facilities
Exclusions: nan No charge for virtual urgent care through CHRISTUS Health System. |
YES | $60.00 |
100.00% |
| Weight Loss Programs
Exclusions: nan nan |
NO | ||
| Well Baby Visits and Care
Exclusions: nan nan |
YES | 0.00% |
100.00% |
| X-rays and Diagnostic Imaging
Exclusions: nan nan |
YES | $60.00 |
100.00% |
CHRISTUS Gold + Dental & Vision + Fitness Limited ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) Health Insurance Plan Variant 98780LA0210003-03 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.808516444782751 |
| 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 | Limited Cost Sharing Plan Variation |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Diabetes |
| EHB Percent of Total Premium | 0.974319313588209 |
| 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) | 98780LA0210003-03 |
| Plan Marketing Name | CHRISTUS Gold Plus |
| Plan Type | HMO |
| Plan Variant Marketing Name | CHRISTUS Gold + Dental & Vision + Fitness Limited ($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 | LAS001 |
| Source Name | HIOS |
| Plan ID | 98780LA0210003 |
| 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, 98780LA0210003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about CHRISTUS Gold Plus, 98780LA0210003 Health Insurance Plan, 98780LA0210003
-
Does CHRISTUS Gold Plus Health Insurance Plan, 98780LA0210003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (98780LA0210003) Health Insurance Plan, Variant (98780LA0210003-03) offer Disease Management Programs?
Does (98780LA0210003) Health Insurance Plan, Variant (98780LA0210003-03) have Out Of Country Coverage?
Does (98780LA0210003) Health Insurance Plan, Variant (98780LA0210003-03) have Out of Service Area Coverage?
Does (98780LA0210003) Health Insurance Plan, Variant (98780LA0210003-03) offer Disease Management Programs?
Does CHRISTUS Gold + Dental & Vision + Fitness Limited ($0 Deductible, $5 PCP, $0 Generic Rx, $0 Virtual Urgent Care) Health Insurance Plan, Variant (98780LA0210003-03) offer Disease Management Programs for Diabetes?
Disclaimer: This is based on the import(Date: Fri, 14 Nov 2025 22:16 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