| Field | Data |
|---|---|
| Health Insurance Plan ID | 98780LA0070001 |
| Health Insurance Plan Year | 2023 |
| State | Louisiana |
| Health Insurance Issuer | CHRISTUS Health Plan Louisiana |
| Plan Formulary Description URL | Formulary URL |
| Plan Marketing Materials URL | Marketing URL |
| Last Plan Update Date | Fri, 16 Sep 2022 00:00 GMT |
| Last Import Date | Fri, 31 Mar 2023 05:06 GMT |
| Health Insurance Plan Variant | 98780LA0070001-04 |
| Available Variants of the Health Plan | |
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 0.739662003 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 2 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2023 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | 73% AV Level Silver Plan |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $600 per group |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $300 per person |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $300 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 45.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $600 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $300 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $300 |
| DEHBDedOutOfNetFamilyPerGroup | $600 per group |
| DEHBDedOutOfNetFamilyPerPerson | $300 per person |
| Drug EHB Deductible, Out of Network, Individual | $300 |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Diabetes |
| EHB Percent of Total Premium | 0.959324635 |
| First Tier Utilization | 100% |
| Formulary ID | LAF003 |
| Formulary URL | URL |
| HIOS Product ID | 98780LA007 |
| Import Date | 1/25/2023 1:00 |
| 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 | 98780 |
| Issuer Marketplace Marketing Name | CHRISTUS Health Plan |
| 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 | $13700 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $6850 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $6,850 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 50.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $13700 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $6850 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $6,850 |
| Medical EHB Deductible, Out of Network, Family Per Group | $13700 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $6850 per person |
| Medical EHB Deductible, Out of Network, Individual | $6,850 |
| Metal Level | Silver |
| 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 | 1/1/2023 |
| Plan Expiration Date | 12/31/2023 |
| Plan ID (Standard Component ID with Variant) | 98780LA0070001-04 |
| Plan Marketing Name | CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness |
| Plan Type | HMO |
| Plan Variant Marketing Name | CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $400 |
| SBC Scenario, Having a Baby, Deductible | $6,850 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $1,100 |
| SBC Scenario, Having Diabetes, Deductible | $1,200 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $200 |
| SBC Scenario, Treatment of a Simple Fracture, Deductible | $2,300 |
| SBC Scenario, Treatment of a Simple Fracture, Limit | $0 |
| Service Area ID | LAS003 |
| Source Name | HIOS |
| Specialty Drug Maximum Coinsurance | $150 |
| Plan ID | 98780LA0070001 |
| State Code | LA |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $14500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $7250 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $7,250 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $14500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $7250 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $7,250 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $14500 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $7250 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $7,250 |
| Unique Plan Design | No |
| URL for Enrollment Payment | URL |
| URL for Summary of Benefits & Coverage | URL |
| Wellness Program Offered | No |
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|---|---|---|---|---|---|
| Non preferred brand | 1 month in retail | $95.0 | After deductible | 0% | YES | |
| Non preferred brand | 3 month in mail | $285.0 | After deductible | 0% | YES | |
| Non preferred generic | 1 month in retail | $0 | 0% | YES | ||
| Non preferred generic | 3 month in mail | $0 | 0% | YES | ||
| Preferred brand | 1 month in retail | $60.0 | After deductible | 0% | YES | |
| Preferred brand | 3 month in mail | $180.0 | After deductible | 0% | YES | |
| Preferred generic | 1 month in retail | $0 | No charge | 0% | No charge | YES |
| Preferred generic | 3 month in mail | $0 | No charge | 0% | No charge | YES |
| Specialty | 1 month in retail | $0 | 45.0% | After deductible | YES | |
| Specialty | 3 month in mail | $0 | 45.0% | After deductible | YES | |
| Zero cost share preventive | 1 month in retail | $0 | No charge | 0% | No charge | YES |
| Zero cost share preventive | 3 month in mail | $0 | No charge | 0% | No charge | YES |
Frequently Asked Questions(FAQ) about CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness, 98780LA0070001 Health Insurance Plan, 98780LA0070001
Does CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness Health Insurance Plan, 98780LA0070001 support Mail Ordering?
Yes, CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness Health Insurance
Plan, 98780LA0070001 supports mail ordering for the next drug tiers: Non preferred brand, Non preferred generic, Preferred brand, Preferred generic, Specialty, Zero cost share preventive
What are the Generic Medications coinsurance & copay options with CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness (98780LA0070001) Health Insurance Plan?
For non preferred generic drug tier, non preferred generic drug tier, preferred generic drug tier copay (No charge) is $0.0 and coinsurance (No charge) is 0.0%, preferred generic drug tier copay (No charge) is $0.0 and coinsurance (No charge) is 0.0%
What are the copay and coinsurance options for Brand Drugs with CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness Health Insurance Plan (98780LA0070001)?
For non preferred brand drug tier copay (After deductible) is $95.0, non preferred brand drug tier copay (After deductible) is $285.0, preferred brand drug tier copay (After deductible) is $60.0, preferred brand drug tier copay (After deductible) is $180.0
What are the copay and coinsurance options for Brand Drugs with CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness Health Insurance Plan (98780LA0070001)?
, non preferred brand drug tier copay (After deductible) is $95.0, non preferred brand drug tier copay (After deductible) is $285.0, preferred brand drug tier copay (After deductible) is $60.0, preferred brand drug tier copay (After deductible) is $180.0
Does (98780LA0070001) Health Insurance Plan, Variant (98780LA0070001-04) offer Disease Management Programs?
Yes, and here is the list of available programs: Diabetes
Does (98780LA0070001) Health Insurance Plan, Variant (98780LA0070001-04) have Out Of Country Coverage?
Yes. Details: Emergency Services Only
Does (98780LA0070001) Health Insurance Plan, Variant (98780LA0070001-04) 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 (98780LA0070001) Health Insurance Plan, Variant (98780LA0070001-04) offer Disease Management Programs?
Yes, and here is the list of available programs: Diabetes
Does CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness Health Insurance Plan, Variant (98780LA0070001-04) offer Disease Management Programs for Diabetes?
Yes, the CHRISTUS Silver Plus HD-2 Free PCP;$25 PCP;$40 SPE;$0 PrefGen;Adult vision,dental,fitness Health Insurance Plan Variant 98780LA0070001-04 offers Disease Management Program for Diabetes.
Disclaimer: This is based on the import(Date: Fri, 31 Mar 2023 05:06 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