La. Admin. Code tit. 32 § V-503
Out-of-Pocket Maximum Per Benefit Period (Includes All Eligible Deductibles, Coinsurance Amounts and Copayments) | ||
Network | Non-Network | |
Individual | $5,000 | $10,000 |
Family | $10,000 | $20,000 |
Out-of-Pocket Maximum1 Per Benefit Period (Includes All Eligible Deductibles, Coinsurance Amounts and Copayments) | ||
Network | Non-Network | |
Individual | Medical: $3,000 Prescription: $2,000 | $10,000 |
Family (Medicare Paying Primary for One) | Medical: $8,000 Prescription: $2,000 | $20,000 |
Family (Medicare Paying Primary for Two) | Medical: $6,000 Prescription: $2,000 per participant | $20,000 |
Family (Medicare Paying Primary for Three) | Medical: $4,000 Prescription: $2,000 per participant | $20,000 |
1 Medical Out-of-Pocket Maximum applies to medical expenditures for all Plan Participants and to Prescription expenditures for Plan Participants when OGB is the primary payer. Prescription Out-of-Pocket Maximum applies to each Plan Participant when Medicare is the primary payer.
La. Admin. Code tit. 32, § V-503