Out-of-Pocket Maximum Per Benefit Period (Includes All Eligible Copayments, Coinsurance Amounts and Deductibles) | ||
Individual: | Network | Non-Network |
Active Employee/Retirees on or after March 1, 2015 | $3,500 | No Coverage |
Retirees prior to March 1, 2015 (With and Without Medicare) | $2,000 | No Coverage |
Individual, Plus One Dependent: | ||
Active Employee/Retirees on or after March 1, 2015 | $6,000 | No Coverage |
Retirees prior to March 1, 2015 (With and Without Medicare) | $3,000 | No Coverage |
Individual, Plus Two or More Dependents: | ||
Active Employee/Retirees on or after March 1, 2015 | $8,500 | No Coverage |
Retirees prior to March 1, 2015 (With and Without Medicare) | $4,000 | No Coverage |
La. Admin. Code tit. 32, § III-105