MAGNOLIA LOCAL
The Magnolia Local plan is a traditional plan that offers $25 primary care co-pays and $50 specialty care co-pays for members who live in specific coverage areas. Community Blue and Blue Connect networks in Shreveport, New Orleans and Baton Rouge are available for OGB members.
This plan is ideal for members who live in the parishes within the available networks and don’t plan to utilize out-of-network care. However, out-of-network care is provided in emergencies.
Community Blue
Community Blue is a select, local network designed for members who live in the parishes of Ascension, East Baton Rouge, Livingston and West Baton Rouge. This means healthcare providers work as a team led by a primary care doctor.
BlueConnect
BlueConnect is a select, local network designed for members who live in the parishes of Acadia, Bossier, Caddo, Evangeline, Iberia, Jefferson, Lafayette, Orleans, Plaquemines, St. Bernard, St. Charles, St. James, St. John the Baptist, St. Landry, St. Martin, St. Tammany, Terrebonne and Vermilion. BlueConnect is a great health plan for people who want local access, a new approach to health and a lower priced insurance plan.
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MEDICAL COVERAGE
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Single
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Employee
+ Spouse
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Employee
+ Children
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Family
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Deductible – Active Retiree (on or after 3/1/2015)
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$400
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$800
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$1,200
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$1,200
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Deductible Retiree (with or without Medicare before 3/1/2015)
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$0
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$0
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$0
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$0
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Co-pay(In-Network)
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$25/$50
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$25/$50
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$25/$50
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$25/$50
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Out-of-Pocket Maximum – Active Employee/Non-Medicare Retiree On or After 3/1/15
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$2,500
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$5,000
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$7,500
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$7,500
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Out-of-Pocket Maximum – Retiree (with or without Medicare Before 3/1/15)
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$1,000
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$2,000
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$3,000
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$3,000
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PHARMACY BENEFITS – Liviniti
OGB uses the Liviniti formulary to help Active Employees and Non-Medicare Retirees select the most appropriate, lowest-cost options. Medicare Retirees will continue to use the SilverScript formulary. The formulary is reviewed regularly to reassess drug tiers based on the current prescription drug market. Members will continue to pay a portion of the cost of their prescriptions in the form of a co-pay or coinsurance. The amount members pay toward their prescription depends on whether or not they receive a generic, preferred brand, non-preferred brand name drug, or specialty drug.
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Tier
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Member Co-Pay*
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Generic
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50% up to $30
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Preferred
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50% up to $55
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Non-Preferred
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65% up to $80
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Specialty
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50% up to $80
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Once you pay $1,500:
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Generic
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$0
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Preferred
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$20
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Non-Preferred
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$40
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Specialty
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$40
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*Member responsibility is for a prescription drug benefit of up to a 31-day supply.
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OGB Customer Service
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1-800-272-8451
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8:00 AM – 4:30 PM CT Monday-Friday
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Blue Cross and Blue Shield of LA
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www.bcbsla.com/ogb
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1-800-392-4089
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8:00 AM – 5:00 PM CT Monday-Friday
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Liviniti Customer Service
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| 1-833-925-2770 |
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Microsite.liviniti.com
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24/7 Member Service Support
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SilverScript
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1-877-996-0104
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24 Hours a day
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Provider Directory
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Community Blue
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BlueConnect
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