CHRISTUS Gold Plus - 98780LA0090003 Health Insurance Plan
CHRISTUS Health Plan Louisiana health insurance plan with the Plan ID 98780LA0090003. The plan is called CHRISTUS Gold Plus.
Based on the AV Calculator by CMS.gov, the plan has an actuarial value of 100.00% (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 0.00% 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 | 98780LA0090003 | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Health Insurance Plan Year | 2024 | ||||||||||||||||||
| 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 | 98780LA0090003-02 | ||||||||||||||||||
| Provider Network(s) | PREFERRED NONPREFERRED | ||||||||||||||||||
| In Network Doctors
*The data available in our database based on Health Insurance Company Open Data (update: Tue, 03 Dec 2024 06:24 GMT). |
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| Available Variants of the Health Plan | Standard Off Exchange Plan - 98780LA0090003-00 Standard On Exchange Plan - 98780LA0090003-01 |
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| Last Plan Update Date | Sat, 16 Dec 2023 00:00 GMT | ||||||||||||||||||
| Last Import Date | Tue, 03 Dec 2024 06:24 GMT |
Benefits of CHRISTUS Gold Plus Health Insurance Plan, 98780LA0090003-02
| Benefit | Covered | In Network | Out Of Network |
|---|---|---|---|
| Abortion for Which Public Funding is Prohibited
|
NO | ||
| Accidental Dental
|
YES | $0.00 |
100.00% |
| Acupuncture
|
NO | ||
| Allergy Testing
|
YES | $0.00 |
100.00% |
| Attention Deficit Disorder
|
YES | $0.00 |
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
Medically necessary. Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | 0.00% |
0.00% |
| Chemotherapy
|
YES | $0.00 |
100.00% |
| Chiropractic Care
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Clinical Trials
|
YES | $0.00 |
100.00% |
| Congenital Anomaly, including Cleft Lip/Palate
|
YES | $0.00 |
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 | $0.00 |
100.00% |
| Dental Anesthesia
|
YES | $0.00 |
100.00% |
| Dental Check-Up for Children
Limit: 1.0 Visit(s) per 6 Months |
YES | 0.00% |
0.00% |
| Diabetes Care Management
|
YES | $0.00 |
100.00% |
| Diabetes Education
|
YES | $0.00 |
100.00% |
| Dialysis
|
YES | $0.00 |
100.00% |
| Durable Medical Equipment
Preauthorization is required for some durable medical equipment. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Emergency Room Services
|
YES | $0.00 |
$0.00 |
| Emergency Transportation/Ambulance
|
YES | $0.00 |
$0.00 |
| 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 at the Trinity Fitness Center. $20 monthly reimbursement for all other fitness centers. |
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 | $0.00 |
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 | $0.00 |
100.00% |
| Hearing Aids
Limit: 1.0 Item(s) per 3 Years To restore or correction of impaired speech or hearing loss. |
YES | $0.00 |
100.00% |
| Home Health Care Services
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Hospice Services
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Imaging (CT/PET Scans, MRIs)
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Infertility Treatment
|
NO | ||
| Infusion Therapy
|
YES | $0.00 |
100.00% |
| Inherited Metabolic Disorder - PKU
|
YES | $0.00 |
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 | $0.00 |
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 | $0.00 |
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 | 0.00% |
0.00% |
| Mental/Behavioral Health Inpatient Services
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
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 | $0.00 |
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 | $0.00 |
100.00% |
| Nutritional Counseling
|
YES | $0.00 |
100.00% |
| Orthodontia - Adult
|
NO | ||
| Orthodontia - Child
|
YES | 0.00% |
0.00% |
| Other Practitioner Office Visit (Nurse, Physician Assistant)
|
YES | $0.00 |
100.00% |
| Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Outpatient Rehabilitation Services
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Outpatient Surgery Physician/Surgical Services
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
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 | $0.00 |
100.00% |
| Prenatal and Postnatal Care
|
YES | $0.00 |
100.00% |
| Preventive Care/Screening/Immunization
|
YES | $0.00 |
100.00% |
| Primary Care Visit to Treat an Injury or Illness
|
YES | $0.00 |
100.00% |
| Private-Duty Nursing
Inpatient Private Duty Nursing Services are not covered. |
YES | $0.00 |
100.00% |
| Prosthetic Devices
Medically necessary foot orthotics are not subject to a calendar year maximum. |
YES | $0.00 |
100.00% |
| Radiation
|
YES | $0.00 |
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 | $0.00 |
100.00% |
| Rehabilitative Occupational and Rehabilitative Physical Therapy
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Rehabilitative Speech Therapy
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
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
One visit and exam every 6 months. |
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 | $0.00 |
100.00% |
| Specialist Visit
|
YES | $0.00 |
100.00% |
| Specialty Drugs
Cost sharing for specialty drugs is limited to $150 per prescription for a standard 30-day supply. |
YES | $0.00 |
100.00% |
| Substance Abuse Disorder Inpatient Services
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
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 | $0.00 |
100.00% |
| Transplant
Preauthorization is required. If you don't get preauthorization, benefits will be denied. |
YES | $0.00 |
100.00% |
| Treatment for Temporomandibular Joint Disorders
|
NO | ||
| Urgent Care Centers or Facilities
|
YES | $0.00 |
100.00% |
| Weight Loss Programs
|
NO | ||
| Well Baby Visits and Care
|
YES | $0.00 |
100.00% |
| X-rays and Diagnostic Imaging
|
YES | $0.00 |
100.00% |
CHRISTUS American Indian Zero Cost Sharing Plus Health Insurance Plan Variant 98780LA0090003-02 Attributes
| Plan Attribute | Value |
|---|---|
| AV Calculator Output Number | 1.0 |
| Begin Primary Care Cost-Sharing After Number Of Visits | 0 |
| Begin Primary Care Deductible Coinsurance After Number Of Copays | 0 |
| Business Year | 2024 |
| Child-Only Offering | Allows Adult and Child-Only |
| Composite Rating Offered | No |
| CSR Variation Type | Zero Cost Sharing Plan Variation |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Group | $0 per group |
| Drug EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Drug EHB Deductible, Combined In/Out of Network, Individual | $0 |
| Drug EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Drug EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Drug EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Drug EHB Deductible, In Network (Tier 1), Individual | $0 |
| Drug EHB Deductible, Out of Network, Family Per Group | $0 per group |
| Drug EHB Deductible, Out of Network, Family Per Person | $0 per person |
| Drug EHB Deductible, Out of Network, Individual | $0 |
| Dental Only Plan | No |
| Design Type | Not Applicable |
| Disease Management Programs Offered | Diabetes |
| EHB Percent of Total Premium | 0.9603221120060241 |
| First Tier Utilization | 100% |
| Formulary ID | LAF004 |
| Formulary URL | URL |
| HIOS Product ID | 98780LA009 |
| Import Date | 2023-12-16 01:02:09 |
| 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 | $0 per group |
| Medical EHB Deductible, Combined In/Out of Network, Family Per Person | $0 per person |
| Medical EHB Deductible, Combined In/Out of Network, Individual | $0 |
| Medical EHB Deductible, In Network (Tier 1), Default Coinsurance | 0.00% |
| Medical EHB Deductible, In Network (Tier 1), Family Per Group | $0 per group |
| Medical EHB Deductible, In Network (Tier 1), Family Per Person | $0 per person |
| Medical EHB Deductible, In Network (Tier 1), Individual | $0 |
| Medical EHB Deductible, Out of Network, Family Per Group | $0 per group |
| Medical EHB Deductible, Out of Network, Family Per Person | $0 per person |
| Medical EHB Deductible, Out of Network, Individual | $0 |
| 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 | 2024-01-01 |
| Plan Expiration Date | 2024-12-31 |
| Plan ID (Standard Component ID with Variant) | 98780LA0090003-02 |
| Plan Marketing Name | CHRISTUS Gold Plus |
| Plan Type | HMO |
| Plan Variant Marketing Name | CHRISTUS American Indian Zero Cost Sharing Plus |
| QHP/Non QHP | Both |
| SBC Scenario, Having a Baby, Coinsurance | $0 |
| SBC Scenario, Having a Baby, Copayment | $0 |
| SBC Scenario, Having a Baby, Deductible | $0 |
| SBC Scenario, Having a Baby, Limit | $60 |
| SBC Scenario, Having Diabetes, Coinsurance | $0 |
| SBC Scenario, Having Diabetes, Copayment | $0 |
| SBC Scenario, Having Diabetes, Deductible | $0 |
| SBC Scenario, Having Diabetes, Limit | $20 |
| SBC Scenario, Treatment of a Simple Fracture, Coinsurance | $0 |
| SBC Scenario, Treatment of a Simple Fracture, Copayment | $0 |
| 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 | 98780LA0090003 |
| State Code | LA |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual | $0 |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group | $0 per group |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person | $0 per person |
| Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual | $0 |
| 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, 98780LA0090003
| Drug Tier | Pharmacy Type | Copay amount | Copay option | Coinsurance rate | Coinsurance option | Mail Order |
|---|
Frequently Asked Questions(FAQ) about CHRISTUS Gold Plus, 98780LA0090003 Health Insurance Plan, 98780LA0090003
-
Does CHRISTUS Gold Plus Health Insurance Plan, 98780LA0090003 support Mail Ordering?
Unfortunately, this health insurance plan does not support mail ordering or the plan data in not available.
Does (98780LA0090003) Health Insurance Plan, Variant (98780LA0090003-02) offer Disease Management Programs?
Does (98780LA0090003) Health Insurance Plan, Variant (98780LA0090003-02) have Out Of Country Coverage?
Does (98780LA0090003) Health Insurance Plan, Variant (98780LA0090003-02) have Out of Service Area Coverage?
Does (98780LA0090003) Health Insurance Plan, Variant (98780LA0090003-02) offer Disease Management Programs?
Does CHRISTUS American Indian Zero Cost Sharing Plus Health Insurance Plan, Variant (98780LA0090003-02) offer Disease Management Programs for Diabetes?
Disclaimer: This is based on the import(Date: Tue, 03 Dec 2024 06:24 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