Individual and Family Plans

English

• 2021 Louisiana Health Insurance Exchange- Evidence of Coverage (PDF)
• 2021 Louisiana Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)

Spanish

• 2021 Louisiana Health Insurance Exchange- Evidence of Coverage en Espanol (PDF)
• 2021 Louisiana Health Insurance Exchange- Evidence of Coverage Off Exchange en Espanol (PDF)

English

• 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)

Spanish

• 2021 Texas Health Insurance Exchange- Evidence of Coverage Complete Plan en Espanol (PDF)
• 2021 Texas Health Insurance Exchange- Evidence of Coverage Off Exchange en Espanol (PDF)
• 2021 Texas Health Insurance Exchange- Evidence of Coverage en Espanol (PDF)

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)

Summary of Benefits - Spanish

• Louisiana American Indian Zero Cost Sharing (PDF)
• Louisiana American Indian Zero Cost Sharing Plus SPA (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)

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 - Basic High Deductible (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible Limited (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible 73% (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible 87% (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible 94% (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)

Summary of Benefits - Spanish

 

• Texas American Indian Zero Cost Sharing (PDF)
• Texas American Indian Plus - Zero Cost Sharing (PDF)
• 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 Bronze Plus 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 Platinum Summary of Benefits (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible Limited (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible 73% (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible 87% (PDF)
• Texas Silver Summary of Benefits - Basic High Deductible 94% (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)
  
  

• Glossary of Terms (PDF)
• Online Glossary of Terms

• Payment Authorization Form (PDF)

2021

• 2021 Louisiana Provider & Pharmacy Directory (PDF)
• 2021 Texas Provider & Pharmacy Directory (PDF) 

Provider Search Tool

• Online Searchable Provider Directories

• RX Claim Form (PDF)