March 21, 2010

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Blue Cross Blue Shield of Louisiana – BLUE SAVER PPO 100/80 – LOUISIANA

A comparison of the BLUE SAVER PPO 100/80 offered by Blue Cross Blue Shield of Louisiana is detailed out below for both Network and Non-Network coverage.

  Network Non-Network
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Network See Provider See Provider
Application BLUE SAVER PPO 100/80 Application BLUE SAVER PPO 100/80 Application
Brochure BLUE SAVER PPO 100/80 Brochure BLUE SAVER PPO 100/80 Brochure
Copay N/A N/A
Office Visit Subject to deductible and coinsurance. Subject to deductible and coinsurance.
Deductible $1,200 Individual, $2,400 Family $1,200 Individual, $2,400 Family
Coinsurance 100% after deductible 80% after deductible
Coinsurance Limit BLUE SAVER PPO 100/80 BLUE SAVER PPO 100/80
Out-of-Pocket Maximum Out-of-pocket maximums- (Deductible and coinsurance accrued): $3,400 Individual, $6,800 Family Out-of-pocket maximums- (Deductible and coinsurance accrued): $3,400 Individual, $6,800 Family
Lifetime Maximum $5 million for each covered member. $5 million for each covered member.
Prescription Drugs After deductible is met:
  • Generic is covered 100%
  • Brand-name is covered 80%
    		•  After deductible is met:
  • Generic is covered 100%
  • Brand-name is covered 80%
    		•
    Emergency Room Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Adult Preventative Care Covered 100%- One routine Pap smear per benefit period, one prostate (PSA) screening and one digital rectal exam per benefit period, one mammography exam per benefit period, one routine physical exam per benefit period, one routine colon (hemoccult) test per benefit period, one routine pelvic exam per benefit period. Subject to deductible and coinsurance.
    Child Preventative Care Covered 100%- Routine exams and immunizations Subject to deductible and coinsurance.
    Lab / X-Ray Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Maternity Optional Benefit- Subject to deductible and coinsurance Optional Benefit- Subject to deductible and coinsurance
    Physical Therapy
  • Physical and Occupational Theraies:
    • Subject to deductible and coinsurance.
    • Limited to $4,500 combined maximum each Benefit Period.
    		•
  • Physical and Occupational Theraies:
    • Subject to deductible and coinsurance.
    • Limited to $4,500 combined maximum each Benefit Period.
    		•
    Skilled Nursing Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Home Health Care Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Mental Health Not covered Not covered
    Hospital Care Subject to deductible and coinsurance. Subject to deductible and coinsurance.
    Optional Benefits Pregnancy Care Option- Subject to deductible and coinsurance Pregnancy Care Option- Subject to deductible and coinsurance