Coventry Healthcare Louisiana former Maxicare LA

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General Information

Plan Name:	Coventry Healthcare Louisiana former Maxicare LA
Service Area:	Baton Rouge area
Brochure:	PDF Version
Brochure:	Text Version
NCQA Accreditation:	No
JCAHO Accreditation:	No
URAC Accreditation:	No
Plan Type:	HMO
Enrollment Code-Self:	JA1
Enrollment Code-Self & Family:	JA2
Link to Plan Home Page:	http://www.chclouisiana.com
Telephone:	800/341-6613

Benefits

Doctor Care/ Primary Office Visits:	$15
Hospital Inpatient Room and Board Charges:	$100/day
RX/ Generic/ Retail:	$10
RX/ Brand/ Retail:	$20
RX/ Brand/ NonFormulary:	$45

Rates

Non-Postal
___Biweekly	Self: $36.38	Self: & Family: $88.36
___Twice Biweekly	Self: $72.76	Self: & Family: $176.72
___Monthly	Self: $78.82	Self: & Family: $191.44
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Annuitants
___Monthly	Self: $78.82	Self: & Family: $191.44
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U.S. Postal Service Employees (Type A)
___Monthly	Self: $40.56	Self: & Family: $104.04
___Biweekly	Self: $18.72	Self: & Family: $48.02
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U.S. Postal Service Employees (Type B)
___Biweekly	Self: $25.01	Self: & Family: $76.63
___Monthly	Self: $54.18	Self: & Family: $166.03
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Worker's Compensation Recipients
___Twice Biweekly	Self: $72.76	Self: & Family: $176.72
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Certain Temporary Employees
___Biweekly	Self: $134.24	Self: & Family: $311.77
___Monthly	Self: $290.85	Self: & Family: $675.50
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Former Spouse Enrollees
___Biweekly	Self: $134.24	Self: & Family: $311.77
___Monthly	Self: $290.85	Self: & Family: $675.50
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Temporary Continuation of Coverage
___Biweekly	Self: $136.92	Self: & Family: $318.01
___Monthly	Self: $296.67	Self: & Family: $689.01
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FDIC
___Biweekly	Self: $18.72	Self: & Family: $48.02
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Department of Defense Demo Project
___Monthly	Self: $50.90	Self: & Family: $330.35
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Department of Defense Demo Project Temporary Continuation of Coverage
___Monthly	Self: $207.67	Self: & Family: $830.70
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