Solutions - Blue Cross and Blue Shield of Louisiana

1 Solutionsfor IndividualsHelping You Choose the Plan That s Right for YouBlue Cross and blue Shield of Louisiana and HMO Louisiana , Inc. are Qualified Health Plan Issuers on the Health Insurance Marketplace01MK4558 R11/142015If there is any discrepancy between the information in this brochure and the policy, the policy prevails. Premium will vary with the level of benefits chosen. For complete information, please refer to the are based on allowable charges. Allowable charge is defined as the lesser of the billed charge or the amount established or negotiated by blue Cross and blue Shield of Louisiana and HMO Louisiana , Inc.

2 As the maximum amount allowed for all provider services covered under the terms of the policy. Notice: Healthcare services may be provided to you at a network healthcare facility by facility-based physicians who are not in your health plan. You may be responsible for payment of all or part of any fees for those out-of-network services, in addition to applicable amounts due for copayments, coinsurance, deductibles and non-covered information about in-network and out-of-network facility-based physicians can be found at or by calling the customer service phone number on your ID Plans:2015 Individual Products.

3 2 Quality blue Primary Care .. 4 Your Online Account .. 5 blue Max .. 6 Compare blue Max Plans .. 8 BlueSaver .. 10 Compare BlueSaver Plans .. 12 blue Point-of-Service (POS) .. 14 Compare blue POS Plans .. 16 Essential Health Benefits .. 18 Pediatric Vision .. 18 Pediatric Dental .. 19 Prescription Drug Program .. 20 Preventive and Wellness Services .. 22 Wellness Program .. 23 Benefits for Better Living .. 24 What s InsideThis information is presented to help you choose a plan. It is not a contract, nor is it intended to be construed as a contract.

4 Welcome1We are proud to serve your healthcare blue Cross and HMO plans offer many benefits and features, including:We offer three different products, each with several different plans to meet your coverage needs. This booklet gives an overview of each plan by explaining what each covers and showing what you can generally expect to pay out-of-pocket. You might find the charts on pages 8, 12 and 16 especially helpful. They will help you easily compare plans to find one that fits the level of care you need and the out-of-pocket amounts that fit your budget. Our plans offer the advantages of: A large network of doctors and hospitals Direct access to specialty care without a referral Preventive and wellness services Local customer service Online tools to help you get the most from your health plan An ID card recognized around the world Exclusive member discounts and savings through Blue365 No lifetime maximumWe re the solutionyou re looking here s why.

5 2015 Individual Products22015 Individual ProductsAll 2015 Individual Plans are Qualified Health Plans All individual plans sold by blue Cross and blue Shield of Louisiana and HMO Louisiana , Inc. meet the rules set by the healthcare reform laws (The Patient Protection and Affordable Care Act or ACA). All plans will include extensive coverage, including essential health benefits. Plans sold on the Health Insurance Marketplace are divided into levels of coverage: Platinum, Gold, Silver and Bronze. These metal levels are set by a plan s actuarial value, which is how much of your total health costs your plan pays for each year.

6 Plans with higher actuarial values (such as Gold or Platinum level plans) will have lower out-of-pocket costs when benefits are used. Plans with lower actuarial values (such as Silver and Bronze level plans) will likely have lower premiums, but higher deductibles and out-of-pocket costs when benefits are I get help paying for insurance?You may be eligible for premium assistance and/or cost share reductions on the Health Insurance Marketplace. To find out if you qualify, go to Individual Products3 PlatinumGoldSilverBronzeBlue Max copay 80/60 $250 blue Max 70/50 $0 blue Max 50/50 $0 blue Max 70/50 $3,000 blue POS copay 100/70 ABlue Max copay 80/60 $500 blue Max 70/50 $1,500 blue Max 80/60 $4,000 blue POS copay 100/70 BBlue Max copay 80/60 $750 blue Max copay 70/50 $2,500 blue Max 80/60 $5,000 Community blue copay 100/70 blue Max copay 80/60 $1,000 blue POS copay 60/40 $2,000 blue Max copay 100/80 $6,250 blue Connect copay 100/70 blue POS copay 80/60 $500 blue POS copay 70/50 $3,000 blue POS 70/50 $3.

7 500 blue POS copay 80/60 $750 BlueSaver 80/60 $1,900 blue POS 70/50 $4,500 blue POS copay 80/60 $1,000 BlueSaver 100/80 $2,800 BlueSaver 70/50 $3,300 BlueSaver 100/80 $1,300 Community blue copay 70/50 $3,000 BlueSaver 100/80 $5,000 Community blue copay 80/60 blue Connect copay 70/50 $3,000 Community blue 70/50 $4,500 blue Connect copay 80/60 $1,000 blue Cross and blue Shield of Louisiana $2,000, a Multi-State PlanBlue Connect 70/50 $4,500 blue Cross and blue Shield of Louisiana $1,500, a Multi-State PlanCommunity blue copay 100/80 $6,250 blue Connect copay 100/80 $6,250 Plans sold on the Health Insurance Marketplace by Metal Level*Please review the Community blue , blue Connect, and/or Multi-State Plan brochures for specific information regarding these plan types.

8 Quality blue Primary Care4As a blue Cross and blue Shield of Louisiana member, your health is important to us. And through our Quality blue Primary Care (QBPC) program, we are working with your primary doctor to help you get advice or address your healthcare needs at any time not just when you are at the doctor s office. Because you are a blue Cross member, QBPC is part of your benefits. You do not need to take any action to be part of QBPC if you are seeing a doctor who is in the program, you are in! Check out to learn more about how this program helps you. How do I know if my doctor is in QBPC?

9 General practice, family practice and internal medicine doctors can be in QBPC. If your doctor is in one of these specialties, look up your doctor s name in our directory at QBPC doctors have a blue next to their names. Keep in mind that if your doctor is not in QBPC now, s/he could be soon. blue Cross is enrolling more doctors around the state in this program, so check back soon! What will you notice that is better with QBPC? Health Coaching - If you have a condition like high blood pressure, diabetes, heart disease or chronic kidney disease, you may receive calls from our blue Cross nurses between your doctor s appointments to help you stay healthy.

10 Focused Appointments - Your doctor will now have more information about your health history when you go in for an appointment, saving you time. You may receive notices from your doctor about screenings or shots you should have. Lower or free copays! If your doctor is in QBPC and your health plan has a copayment for primary care doctor visits, your copayment could be reduced or waived for office visits with your doctor/nurse practitioner*. Please see the benefit grid located in this brochure for your particular plan information. *The reduced or waived copayment is for office visits with a primary care doctor /nurse practitioner in QBPC only.