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2021- Louisiana Evidence of Coverage
2021 Louisiana Health Insurance Exchange- Evidence of Coverage (PDF)
2021 Louisiana Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)
2020 - Louisiana Evidence of Coverage
2020 Louisiana Health Insurance Exchange- Evidence of Coverage (PDF)
2020 Louisiana Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)
2021 Texas Evidence of Coverage
2021 Texas Health Insurance Exchange- Evidence of Coverage Complete Plan (PDF)
2021 Texas Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)
2021 Texas Health Insurance Exchange- Evidence of Coverage (PDF)
2020 - Texas Evidence of Coverage
2020 Texas Health Insurance Exchange- Evidence of Coverage Complete Plan (PDF)
2020 Texas Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)
2020 Texas Health Insurance Exchange- Evidence of Coverage (PDF)
Glossary of Terms
Glossary of Terms (PDF)
Online Glossary of Terms
Payment Authorization
Payment Authorization Form (PDF)
Provider & Pharmacy Directories
2021
2021 Louisiana Provider & Pharmacy Directory (PDF)
2021 Texas Provider & Pharmacy Directory (PDF)
2020
2020 Louisiana Provider & Pharmacy Directory (PDF)
2020 Texas Provider & Pharmacy Directory (PDF)
Provider Search Tool
Online Searchable Provider Directories
RX Claim Form
RX Claim Form (PDF)
2021- Louisiana Summaries of Benefits
Summary of Benefits- English
Louisiana American Indian Zero Cost Sharing (PDF)
Louisiana Summary of Benefits - Bronze (PDF)
Louisiana Summary of Benefits - Bronze HSA (PDF)
Louisiana Summary of Benefits- Bronze HSA Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Bronze Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Bronze Plus (PDF)
Louisiana Summary of Benefits - Bronze Plus Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Gold (PDF)
Louisiana Summary of Benefits - Gold Limited Cost Sharing (PDF)
Louisiana Summary of Benefits- Silver Basic (PDF)
Louisiana Summary of Benefits- Silver Basic 73% (PDF)
Louisiana Summary of Benefits- Silver Basic 87% (PDF)
Louisiana Summary of Benefits- Silver Basic 94% (PDF)
Louisiana Summary of Benefits - Silver HD (PDF)
Louisiana Summary of Benefits - Silver HD 73% (PDF)
Louisiana Summary of Benefits- Silver HD 87% (PDF)
Louisiana Summary of Benefits- Silver HD 94% (PDF)
Louisiana Summary of Benefits- Silver HD Limited Cost Sharing (PDF)
Louisiana Summary of Benefits- Silver Plus HD (PDF)
Louisiana Summary of Benefits- Silver Plus HD 73% (PDF)
Louisiana Summary of Benefits- Silver Plus HD 87% (PDF)
Louisiana Summary of Benefits- Silver Plus HD 94% (PDF)
Louisiana Summary of Benefits - Silver LD (PDF)
Louisiana Summary of Benefits - Silver LD 73% (PDF)
Louisiana Summary of Benefits - Silver LD 87% (PDF)
Louisiana Summary of Benefits - Silver LD 94% (PDF)
Louisiana Summary of Benefits - Silver Low Deductible Limited Cost Sharing (PDF)
2020- Louisiana Summaries of Benefits
Summary of Benefits- English
Louisiana American Indian Zero Cost Sharing (PDF)
Louisiana Summary of Benefits - Bronze (PDF)
Louisiana Summary of Benefits - Bronze HSA (PDF)
Louisiana Summary of Benefits - Bronze HSA Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Bronze Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Gold (PDF)
Louisiana Summary of Benefits - Gold Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Silver HD (PDF)
Louisiana Summary of Benefits - Silver HD 73% (PDF)
Louisiana Summary of Benefits- Silver HD 87% (PDF)
Louisiana Summary of Benefits- Silver HD 94% (PDF)
Louisiana Summary of Benefits- Silver HD Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Low Deductible (PDF)
Louisiana Summary of Benefits - Low Deductible 73% (PDF)
Louisiana Summary of Benefits - Low Deductible 87% (PDF)
Louisiana Summary of Benefits - Low Deductible 94% (PDF)
Louisiana Summary of Benefits - Low Deductible Limited Cost Sharing (PDF)
Summary of Benefits- Spanish
Louisiana Summary of Benefits - Bronze HSA Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Bronze Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Gold (PDF)
Louisiana Summary of Benefits - Gold Limited Cost Sharing (PDF)
Louisiana Summary of Benefits - Silver HD (PDF)
Louisiana Summary of Benefits - Silver HD 73% (PDF)
Louisiana Summary of Benefits- Silver HD 87% (PDF)
Louisiana Summary of Benefits- Silver HD 94% (PDF)
Louisiana Summary of Benefits - Low Deductible (PDF)
Louisiana Summary of Benefits - Low Deductible 73% (PDF)
Louisiana Summary of Benefits - Low Deductible 87% (PDF)
Louisiana Summary of Benefits - Low Deductible 94% (PDF)
Louisiana Summary of Benefits - Low Deductible Limited Cost Sharing (PDF)
2021- Texas Summaries of Benefits
Summary of Benefits - English
Texas Bronze Summary of Benefits (PDF)
Texas Bronze Summary of Benefits HSA (PDF)
Texas Bronze Summary of Benefits HSA Limited Cost Sharing (PDF)
Texas Bronze Summary of Benefits - Limited Cost Sharing (PDF)
Texas Bronze Plus Summary of Benefits (PDF)
Texas Catastrophic Summary of Benefits (PDF)
Texas Gold Summary of Benefits (PDF)
Texas Gold Summary of Benefits - Limited Cost (PDF)
Texas Platinum Summary of Benefits (PDF)
Texas Silver Summary of Benefits - High Deductible (PDF)
Texas Silver Summary of Benefits - High Deductible Limited (PDF)
Texas Silver Summary of Benefits - High Deductible 73% (PDF)
Texas Silver Summary of Benefits - High Deductible 87% (PDF)
Texas Silver Summary of Benefits - High Deductible 94% (PDF)
Texas Silver Summary of Benefits - Low Deductible (PDF)
Texas Silver Summary of Benefits - Low Deductible Limited (PDF)
Texas Silver Summary of Benefits - Low Deductible 73%(PDF)
Texas Silver Summary of Benefits - Low Deductible 87% (PDF)
Texas Silver Summary of Benefits - Low Deductible 94% (PDF)
Texas Silver Plus Summary of Benefits- High Deductible (PDF)
Texas Silver Plus Summary of Benefits- High Deductible 73% (PDF)
Texas Silver Plus Summary of Benefits- High Deductible 87% (PDF)
Texas Silver Plus Summary of Benefits- High Deductible 94% (PDF)
Texas American Indian Zero Cost Sharing (PDF)
2020- Texas Summaries of Benefits
Summary of Benefits - English
Texas Bronze Summary of Benefits (PDF)
Texas Bronze Summary of Benefits HSA (PDF)
Texas Bronze Summary of Benefits HSA Limited Cost Sharing (PDF)
Texas Bronze Summary of Benefits - Limited Cost Sharing (PDF)
Texas Catastrophic Summary of Benefits (PDF)
Texas Gold Summary of Benefits (PDF)
Texas Gold Summary of Benefits - Limited Cost (PDF)
Texas Silver Summary of Benefits - High Deductible (PDF)
Texas Silver Summary of Benefits - High Deductible Limited (PDF)
Texas Silver Summary of Benefits - High Deductible 73% (PDF)
Texas Silver Summary of Benefits - High Deductible 87% (PDF)
Texas Silver Summary of Benefits - High Deductible 94% (PDF)
Texas Silver Summary of Benefits - Low Deductible (PDF)
Texas Silver Summary of Benefits - Low Deductible Limited (PDF)
Texas Silver Summary of Benefits - Low Deductible 73%(PDF)
Texas Silver Summary of Benefits - Low Deductible 87% (PDF)
Texas Silver Summary of Benefits - Low Deductible 94% (PDF)
Texas American Indian Zero Cost Sharing (PDF)
Summary of Benefits - Spanish
Texas Bronze Summary of Benefits (PDF)
Texas Bronze Summary of Benefits HSA (PDF)
Texas Bronze Summary of Benefits HSA Limited Cost Sharing (PDF)
Texas Bronze Summary of Benefits - Limited Cost Sharing (PDF)
Texas Catastrophic Summary of Benefits (PDF)
Texas Gold Summary of Benefits (PDF)
Texas Gold Summary of Benefits - Limited Cost (PDF)
Texas Silver Summary of Benefits - High Deductible (PDF)
Texas Silver Summary of Benefits - High Deductible Limited (PDF)
Texas Silver Summary of Benefits - High Deductible 73% (PDF)
Texas Silver Summary of Benefits - High Deductible 87% (PDF)
Texas Silver Summary of Benefits - High Deductible 94% (PDF)
Texas Silver Summary of Benefits - Low Deductible (PDF)
Texas Silver Summary of Benefits - Low Deductible Limited (PDF)
Texas Silver Summary of Benefits - Low Deductible 73%(PDF)
Texas Silver Summary of Benefits - Low Deductible 87% (PDF)
Texas Silver Summary of Benefits - Low Deductible 94% (PDF)
Texas American Indian Zero Cost Sharing (PDF)
2020- Texas Platinum Summary of Benefits
Summary of Benefits- English
2020 Texas Platinum Summary of Benefits (PDF)
Summary of Benefits- Spanish
2020 Texas Platinum Summary of Benefits en Espanol (PDF)
MM161 & MM162
Last Updated:
08/05/2020