LAC 32:V.503
A. Plan Participants When OGB Is the Primary Payer for All Plan Participants
| 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 |
B. Plan Participants When Medicare Is the Primary Payer for at Least One Plan Participant
| 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.
AUTHORITY NOTE: Promulgated in accordance with R.S. 42:801(C) and 802(B)(1).
HISTORICAL NOTE: Promulgated by the Office of the Governor, Division of Administration, Office of Group Benefits, LR 41:364 (February 2015), effective March 1, 2015, amended LR 50:1470 (October 2024), effective January 1, 2025.