This plan has access to the BCBS Nationwide network which utilizes most of the major
hospitals, pharmacies and many doctors as network providers. This plan includes out-of-network
providers. If an employee uses an in-network provider, the coverage is 90% of the
contracted rate after the deductible; if a non-network provider is used, the coverage
is 70% after the deductible. There is a $900 deductible per family member, with a
maximum deductible of $2,700 for 3 or more family members. There is no separate deductible
for prescription drugs. Effective July 1, 2011 there is an unlimited lifetime medical
maximum. See prescription drug information below. More information, including a
list of Blue Cross providers is available on Group Benefits website: www.groupbenefits.org or https://www.bcbsla.com/ogb
Administered by Express Scripts, Inc. (ESI) | Member Drug Questions – 1-866-781-7533Blue Cross and Blue Shield of Louisiana works with Express Scripts, Inc. (ESI) to
administer ourprescription drug program. For ESI’s list of generic, preferred brand, non-preferred
brand, specialty andmaintenance/preventive drugs, go to www.bcbsla.com/ogb.
ESI has a robust pharmacy network that consists of a large group of conveniently located
participatingretail pharmacies as well as an optional mail-service program. You may use any pharmacy
you wish, butthere are advantages to selecting a participating network pharmacy:• Lower costs• No claims to file• No waiting for reimbursement