MAGNOLIA OPEN ACCESS

The Magnolia Open Access Plan offers coverage both inside and outside of the Blue Cross nationwide network.

Though the premiums for the Magnolia Open Access plan are higher than OGB’s other plans, its moderate deductibles combined with a nationwide network make it an attractive plan for members who live out of state or travel regularly.

MEDICAL COVERAGE

 

Single

Employee
+ Spouse

Employee
+ Children

Family

Deductible – Active Employee/Non-Medicare Retiree (on or after 3/1/2015)

$900

$1,800

$2,700

$2,700

Deductible Retiree (with or without Medicare before 3/1/2015)

$300

$600

$900

$900

Coinsurance – Active Employee/Non-Medicare Retiree (In-Network)

10%

10%

10%

10%

Coinsurance – Medicare Retiree (In-Network)

20%

20%

20%

20%

Active Employee/Non-Medicare Retiree (Out-of-Network)

30%

30%

30%

30%

Out-of-Pocket Maximum – Active Employee/Non-Medicare Retiree On or After 3/1/15

$3,500

$6,000

$8,500

$8,500

Out-of-Pocket Maximum – Non-Medicare Retiree (In-Network Before 3/1/15)

$2,300 individual; plus $1,300 per additional
person up to 2; plus $1,000 per additional
person up to 10 people; $12,700 for a family of 12+

Out-of-Pocket Maximum – Medicare Retiree (Out-of-Network Before 3/1/15)

$3,300 individual; plus $2,300 per additional person up to 2; plus $2,000 per additional person up to 2 additional people; $12,700 for a family of 5+

 

PHARMACY BENEFITS – EXPRESS SCRIPTS

OGB uses the Express Scripts formulary to help members select the most appropriate, lowest-cost options. 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.

Tier

Member Co-Pay

Generic

50% up to $30

Preferred

50% up to $55

Non-Preferred

65% up to $80

Specialty

50% up to $80

Once you pay $1,500:

Generic

$0

Preferred

$20

Non-Preferred

$40

Specialty

$40

 

MAGNOLIA OPEN ACCESS

Blue Cross and Blue Shield of LA

www.bcbsla.com/ogb

1-800-392-4089

8:00 AM – 5:00 PM CT Monday-Friday

Express Scripts

www.express-scripts.com

1-877-417-8952

24 Hours, Seven Days a Week

Active Employee & Non-Medicare Retiree Formulary

Express Scripts Medicare

1-866-823-5178

24 Hours a day

Seven Days a Week

Medicare Retiree Formulary

Louisiana Provider Directory

National Provider Directory

2022 Schedule of Benefits

2022 Benefit Plan

Benefit Comparison

Premium Rates

Retiree 100