Individual and Family Plans

English

• 2024 Louisiana Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Louisiana Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

Spanish

• 2024 Louisiana Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Louisiana Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

English

• Louisiana Silver HD Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Louisiana Silver HD Limited Summary of Benefits (PDF)
• Louisiana Silver HD 73% Summary of Benefits (PDF)
• Louisiana Silver HD 87% Summary of Benefits (PDF)
• Louisiana Silver HD 94% Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Limited Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Limited Summary of Benefits (PDF)
• Louisiana Silver Summary of Benefits (PDF)
• Louisiana Silver Limited Summary of Benefits (PDF)
• Louisiana Silver 73% Summary of Benefits (PDF)
• Louisiana Silver 87% Summary of Benefits (PDF)
• Louisiana Silver 94% Summary of Benefits (PDF)
• Louisiana Gold Plus Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Louisiana Gold Plus Limited Summary of Benefits (PDF)
• Louisiana Bronze Basic Summary of Benefits (PDF)
• Louisiana Bronze Basic Limited Summary of Benefits (PDF)
• Louisiana Standard Silver Summary of Benefits (PDF)
• Louisiana Standard Silver Limited Summary of Benefits (PDF)
• Louisiana Standard Silver 73% Summary of Benefits (PDF)
• Louisiana Standard Silver 87% Summary of Benefits (PDF)
• Louisiana Standard Silver 94% Summary of Benefits (PDF)
• Louisiana Standard Gold Summary of Benefits (PDF)
• Louisiana Standard Gold Limited Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Summary of Benefits (PDF)

Spanish

• Louisiana Silver HD Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Louisiana Silver HD Limited Summary of Benefits (PDF)
• Louisiana Silver HD 73% Summary of Benefits (PDF)
• Louisiana Silver HD 87% Summary of Benefits (PDF)
• Louisiana Silver HD 94% Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Limited Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Limited Summary of Benefits (PDF)
• Louisiana Silver Summary of Benefits (PDF)
• Louisiana Silver Limited Summary of Benefits (PDF)
• Louisiana Silver 73% Summary of Benefits (PDF)
• Louisiana Silver 87% Summary of Benefits (PDF)
• Louisiana Silver 94% Summary of Benefits (PDF)
• Louisiana Gold Plus Summary of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Louisiana Gold Plus Limited Summary of Benefits (PDF)
• Louisiana Bronze Basic Summary of Benefits (PDF)
• Louisiana Bronze Basic Limited Summary of Benefits (PDF)
• Louisiana Standard Silver Summary of Benefits (PDF)
• Louisiana Standard Silver Limited Summary of Benefits (PDF)
• Louisiana Standard Silver 73% Summary of Benefits (PDF)
• Louisiana Standard Silver 87% Summary of Benefits (PDF)
• Louisiana Standard Silver 94% Summary of Benefits (PDF)
• Louisiana Standard Gold Summary of Benefits (PDF)
• Louisiana Standard Gold Limited Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Summary of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Summary of Benefits (PDF)

English

• Louisiana American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Louisiana Bronze Schedule of Benefits (PDF)
• Louisiana Bronze Basic Schedule of Benefits (PDF)
• Louisiana Bronze Basic Limited Schedule of Benefits (PDF)
• Louisiana Bronze Limited Schedule of Benefits (PDF)
• Louisiana Gold Schedule of Benefits (PDF)
• Louisiana Gold Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Schedule of Benefits (PDF)
• Louisiana Gold Plus Limited Schedule of Benefits (PDF)
• Louisiana Silver Schedule of Benefits (PDF)
• Louisiana Silver 73% Schedule of Benefits (PDF)
• Louisiana Silver 87% Schedule of Benefits (PDF)
• Louisiana Silver 94% Schedule of Benefits (PDF)
• Louisiana Silver HD Limited Schedule of Benefits (PDF)
• Louisiana Silver Limited Schedule of Benefits (PDF)
• Louisiana Silver HD Schedule of Benefits (PDF)
• Louisiana Silver HD 73% Schedule of Benefits (PDF)
• Louisiana Silver HD 87% Schedule of Benefits (PDF)
• Louisiana Silver HD 94% Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Louisiana Standard Gold Schedule of Benefits (PDF)
• Louisiana Standard Gold Limited Schedule of Benefits (PDF)
• Louisiana Standard Silver Schedule of Benefits (PDF)
• Louisiana Standard Silver 73% Schedule of Benefits (PDF)
• Louisiana Standard Silver 87% Schedule of Benefits (PDF)
• Louisiana Standard Silver 94% Schedule of Benefits (PDF)
• Louisiana Standard Silver Limited Schedule of Benefits (PDF)

Spanish

• Louisiana American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Louisiana American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Louisiana Bronze Basic Limited Schedule of Benefits (PDF)
• Louisiana Bronze Basic Schedule of Benefits (PDF)
• Louisiana Bronze Limited Schedule of Benefits (PDF)
• Louisiana Bronze Schedule of Benefits (PDF)
• Louisiana Gold Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Limited Schedule of Benefits (PDF)
• Louisiana Gold Plus Schedule of Benefits (PDF)
• Louisiana Gold Schedule of Benefits (PDF)
• Louisiana Silver 73% Schedule of Benefits (PDF)
• Louisiana Silver 87% Schedule of Benefits (PDF)
• Louisiana Silver 94% Schedule of Benefits (PDF)
• Louisiana Silver Limited Schedule of Benefits (PDF)
• Louisiana Silver Schedule of Benefits (PDF)
• Louisiana Silver HD 73% Schedule of Benefits (PDF)
• Louisiana Silver HD 87% Schedule of Benefits (PDF)
• Louisiana Silver HD 94% Schedule of Benefits (PDF)
• Louisiana Silver HD Limited Schedule of Benefits (PDF)
• Louisiana Silver HD Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Louisiana Standard Expanded Bronze Schedule of Benefits (PDF)
• Louisiana Standard Gold Limited Schedule of Benefits (PDF)
• Louisiana Standard Gold Schedule of Benefits (PDF)
• Louisiana Standard Silver 73% Schedule of Benefits (PDF)
• Louisiana Standard Silver 87% Schedule of Benefits (PDF)
• Louisiana Standard Silver 94% Schedule of Benefits (PDF)
• Louisiana Standard Silver Limited Schedule of Benefits (PDF)
• Louisiana Standard Silver Schedule of Benefits (PDF)

English

• 2023 Louisiana Health Insurance Exchange- Evidence of Coverage (PDF)
• 2023 Louisiana Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)

Spanish

• 2023 Louisiana Health Insurance Exchange- Evidence of Coverage  (PDF)
• 2023 Louisiana Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)

 

English

• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits HSA (PDF)
• Louisiana Bronze Summary of Benefits HSA Limited Cost Sharing (PDF)
• Louisiana Bronze Summary of Benefits - Limited Cost Sharing (PDF)
• Louisiana Bronze - $0 PrefGen Summary of Benefits- (PDF)
• Louisiana Bronze - $0 PrefGen Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Bronze Plus Summary of Benefits (PDF)
• Louisiana Bronze Plus Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Gold Plus Summary of Benefits - Limited Cost Sharing (PDF)
• Louisiana Gold Plus Summary of Benefits- Plus (PDF)
• Louisiana Silver Summary of Benefits- (PDF)
• Louisiana Silver Summary of Benefits - Limited (PDF)
• Louisiana Silver Summary of Benefits - 73% (PDF)
• Louisiana Silver Summary of Benefits - 87% (PDF)
• Louisiana Silver Summary of Benefits - 94% (PDF)
• Louisiana Silver Summary of Benefits - High Deductible (PDF)
• Louisiana Silver Summary of Benefits - High Deductible Limited (PDF)
• Louisiana Silver Summary of Benefits - High Deductible 73% (PDF)
• Louisiana Silver Summary of Benefits - High Deductible 87% (PDF)
• Louisiana Silver Summary of Benefits - High Deductible 94% (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible Limited (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible 73%(PDF)
• Louisiana Silver Summary of Benefits - Low Deductible 87% (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible 94% (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible 73% (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible 87% (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible 94% (PDF)
• Louisiana Silver Plus Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana American Indian Zero Cost Sharing (PDF)
• Louisiana American Indian Zero Cost Plus Sharing (PDF)
• Louisiana Standard Bronze Summary of Benefits- (PDF)
• Louisiana Standard Bronze Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Standard Silver Summary of Benefits- (PDF))
• Louisiana Standard Silver Summary of Benefits- 73% (PDF)
• Louisiana Standard Silver Summary of Benefits- 87% (PDF)
• Louisiana Standard Silver Summary of Benefits- 94% (PDF)
• Louisiana Standard Gold Summary of Benefits- (PDF)
• Louisiana Standard Gold Summary of Benefits- Limited Cost Sharing (PDF)

Spanish

• Louisiana Bronze Summary of Benefits (PDF)
• Louisiana Bronze Summary of Benefits HSA (PDF)
• Louisiana Bronze Summary of Benefits HSA Limited Cost Sharing (PDF)
• Louisiana Bronze Summary of Benefits - Limited Cost Sharing (PDF)
• Louisiana Bronze - $0 PrefGen Summary of Benefits- (PDF)
• Louisiana Bronze - $0 PrefGen Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Bronze Plus Summary of Benefits (PDF)
• Louisiana Bronze Plus Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Gold Summary of Benefits (PDF)
• Louisiana Gold Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Gold Plus Summary of Benefits - Limited Cost Sharing (PDF)
• Louisiana Gold Plus Summary of Benefits- Plus (PDF)
• Louisiana Silver Summary of Benefits- (PDF)
• Louisiana Silver Summary of Benefits - Limited (PDF)
• Louisiana Silver Summary of Benefits - 73% (PDF)
• Louisiana Silver Summary of Benefits - 87% (PDF)
• Louisiana Silver Summary of Benefits - 94% (PDF)
• Louisiana Silver Summary of Benefits - High Deductible (PDF)
• Louisiana Silver Summary of Benefits - High Deductible Limited (PDF)
• Louisiana Silver Summary of Benefits - High Deductible 73% (PDF)
• Louisiana Silver Summary of Benefits - High Deductible 87% (PDF)
• Louisiana Silver Summary of Benefits - High Deductible 94% (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible Limited (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible 73%(PDF)
• Louisiana Silver Summary of Benefits - Low Deductible 87% (PDF)
• Louisiana Silver Summary of Benefits - Low Deductible 94% (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible 73% (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible 87% (PDF)
• Louisiana Silver Plus Summary of Benefits- High Deductible 94% (PDF)
• Louisiana Silver Plus Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana American Indian Zero Cost Sharing (PDF)
• Louisiana American Indian Zero Cost Plus Sharing (PDF)
• Louisiana Standard Bronze Summary of Benefits- (PDF)
• Louisiana Standard Bronze Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Standard Silver Summary of Benefits- (PDF)
• Louisiana Standard Silver Summary of Benefits- Limited Cost Sharing (PDF)
• Louisiana Standard Silver Summary of Benefits- 73% (PDF)
• Louisiana Standard Silver Summary of Benefits- 87% (PDF)
• Louisiana Standard Silver Summary of Benefits- 94% (PDF)
• Louisiana Standard Gold Summary of Benefits- (PDF)
• Louisiana Standard Gold Summary of Benefits- Limited Cost Sharing (PDF)

English

• Louisiana Schedule of Benefits Bronze Plus - (PDF)
• Louisiana Schedule of Benefits Bronze HSA- (PDF)
• Louisiana Schedule of Benefits Bronze - (PDF)
• Louisiana Schedule of Benefits Bronze $0 PrefGen - (PDF)
• Louisiana Schedule of Benefits Gold Plus - (PDF)
• Louisiana Schedule of Benefits Gold - (PDF)
• Louisiana Schedule of Benefits Gold Standard - (PDF)
• Louisiana Schedule of Benefits Silver 73% - (PDF)
• Louisiana Schedule of Benefits Silver 87% - (PDF)
• Louisiana Schedule of Benefits Silver 94% - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD 73% - (PDF
• Louisiana Schedule of Benefits Silver Plus HD 87% - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD 94% - (PDF)
• Louisiana Schedule of Benefits Silver - (PDF)
• Louisiana Schedule of Benefits Bronze Standard - (PDF)
• Louisiana Schedule of Benefits Silver Standard 73% - (PDF)
• Louisiana Schedule of Benefits Silver Standard 87% - (PDF)
• Louisiana Schedule of Benefits Silver Standard 94% - (PDF)
• Louisiana Schedule of Benefits Silver Standard - (PDF)
• Louisiana Schedule of Benefits Silver LD 73% - (PDF)
• Louisiana Schedule of Benefits Silver LD 94% - (PDF)
• Louisiana Schedule of Benefits Silver LD 87% - (PDF)
• Louisiana Schedule of Benefits Silver LD - (PDF)
• Louisiana Schedule of Benefits Silver HD - (PDF)
• Louisiana Schedule of Benefits Silver HD 73% - (PDF)
• Louisiana Schedule of Benefits Silver HD 87% - (PDF)
• Louisiana Schedule of Benefits Silver HD 94% - (PDF)

 

Spanish

• Louisiana Schedule of Benefits Bronze HSA- (PDF)
• Louisiana Schedule of Benefits Bronze - (PDF)
• Louisiana Schedule of Benefits Gold Plus - (PDF)
• Louisiana Schedule of Benefits Silver 73% - (PDF)
• Louisiana Schedule of Benefits Silver 87% - (PDF)
• Louisiana Schedule of Benefits Silver 94% - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD 87% - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD 94% - (PDF)
• Louisiana Schedule of Benefits Silver - (PDF)
• Louisiana Schedule of Benefits Bronze Standard - (PDF)
• Louisiana Schedule of Benefits Gold Standard - (PDF)
• Louisiana Schedule of Benefits Silver Standard 73% - (PDF)
• Louisiana Schedule of Benefits Silver Standard 87% - (PDF)
• Louisiana Schedule of Benefits Silver Standard 94% - (PDF)
• Louisiana Schedule of Benefits Silver Standard - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD - (PDF)
• Louisiana Schedule of Benefits Silver HD 73% - (PDF)
• Louisiana Schedule of Benefits Silver LD 94% - (PDF)
• Louisiana Schedule of Benefits Silver LD 87% - (PDF)
• Louisiana Schedule of Benefits Silver LD 73% - (PDF)
• Louisiana Schedule of Benefits Silver LD - (PDF)
• Louisiana Schedule of Benefits Gold - (PDF)
• Louisiana Schedule of Benefits Silver HD - (PDF)
• Louisiana Schedule of Benefits Silver HD 94% - (PDF)
• Louisiana Schedule of Benefits Silver HD 87% - (PDF)
• Louisiana Schedule of Benefits Silver Plus HD 73% - (PDF)
• Louisiana Schedule of Benefits Bronze Plus - (PDF)

English

• 2024 Texas Health Insurance Exchange - Platinum Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

Spanish

• 2024 Texas Health Insurance Exchange - Platinum Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - Off Exchange Evidence of Coverage (PDF)
• 2024 Texas Health Insurance Exchange - On Exchange Evidence of Coverage (PDF)

English

• Texas American Indian Zero Cost Sharing Summary of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Summary of Benefits (PDF)
• Texas Bronze Summary of Benefits (PDF)
• Texas Bronze Limited Summary of Benefits (PDF)
• Texas Bronze Plus Summary of Benefits (PDF)
• Texas Bronze Plus Limited Summary of Benefits (PDF)
• Texas Catastrophic Summary of Benefits (PDF)
• Texas Gold Summary of Benefits (PDF)
• Texas Gold Limited Summary of Benefits (PDF)
• Texas Gold Plus Summary of Benefits (PDF)
• Texas Gold Plus Limited Summary of Benefits (PDF)
• Texas Platinum Summary of Benefits (PDF)
• Texas Silver Summary of Benefits (PDF)
• Texas Silver 73% Summary of Benefits (PDF)
• Texas Silver 87% Summary of Benefits (PDF)
• Texas Silver 94% Summary of Benefits (PDF)
• Texas Silver HD Summary of Benefits (PDF)
• Texas Silver HD 73% Summary of Benefits (PDF)
• Texas Silver HD 87% Summary of Benefits (PDF)
• Texas Silver HD 94% Summary of Benefits (PDF)
• Texas Silver HD Limited Summary of Benefits (PDF)
• Texas Silver Limited Summary of Benefits (PDF)
• Texas Standard Expanded Bronze Summary of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Summary of Benefits (PDF)
• Texas Standard Gold Summary of Benefits (PDF)
• Texas Standard Gold Limited Summary of Benefits (PDF)
• Texas Standard Silver Summary of Benefits (PDF)
• Texas Standard Silver 73% Summary of Benefits (PDF)
• Texas Standard Silver 87% Summary of Benefits (PDF)
• Texas Standard Silver 94% Summary of Benefits (PDF)
• Texas Standard Silver Limited Summary of Benefits (PDF)

Spanish

• Texas American Indian Zero Cost Sharing Summary of Benefits - Spanish (PDF)
• Texas American Indian Zero Cost Sharing Plus Summary of Benefits - Spanish (PDF)
• Texas Bronze Summary of Benefits - Spanish (PDF)
• Texas Bronze Limited Summary of Benefits - Spanish (PDF)
• Texas Bronze Plus Summary of Benefits - Spanish (PDF)
• Texas Bronze Plus Limited Summary of Benefits - Spanish (PDF)
• Texas Catastrophic Summary of Benefits - Spanish (PDF)
• Texas Gold Summary of Benefits - Spanish (PDF)
• Texas Gold Limited Summary of Benefits - Spanish (PDF)
• Texas Gold Plus Summary of Benefits - Spanish (PDF)
• Texas Gold Plus Limited Summary of Benefits - Spanish (PDF)
• Texas Platinum Summary of Benefits - Spanish (PDF)
• Texas Silver Summary of Benefits - Spanish (PDF)
• Texas Silver 73% Summary of Benefits - Spanish (PDF)
• Texas Silver 87% Summary of Benefits - Spanish (PDF)
• Texas Silver 94% Summary of Benefits - Spanish (PDF)
• Texas Silver HD Summary of Benefits - Spanish (PDF)
• Texas Silver HD 73% Summary of Benefits - Spanish (PDF)
• Texas Silver HD 87% Summary of Benefits - Spanish (PDF)
• Texas Silver HD 94% Summary of Benefits - Spanish (PDF)
• Texas Silver HD Limited Summary of Benefits - Spanish (PDF)
• Texas Silver Limited Summary of Benefits - Spanish (PDF)
• Texas Standard Expanded Bronze Summary of Benefits - Spanish (PDF)
• Texas Standard Expanded Bronze Limited Summary of Benefits - Spanish (PDF)
• Texas Standard Gold Summary of Benefits - Spanish (PDF)
• Texas Standard Gold Limited Summary of Benefits - Spanish (PDF)
• Texas Standard Silver Summary of Benefits - Spanish (PDF)
• Texas Standard Silver 73% Summary of Benefits - Spanish (PDF)
• Texas Standard Silver 87% Summary of Benefits - Spanish (PDF)
• Texas Standard Silver 94% Summary of Benefits - Spanish (PDF)
• Texas Standard Silver Limited Summary of Benefits - Spanish (PDF)

English

• Texas American Indian Zero Cost Sharing Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Texas Bronze Schedule of Benefits (PDF)
• Texas Bronze Limited Schedule of Benefits (PDF)
• Texas Bronze Plus Schedule of Benefits (PDF)
• Texas Bronze Plus Limited Schedule of Benefits (PDF)
• Texas Catastrophic Schedule of Benefits (PDF)
• Texas Gold Schedule of Benefits (PDF)
• Texas Gold Limited Schedule of Benefits (PDF)
• Texas Gold Plus Schedule of Benefits (PDF)
• Texas Gold Plus Limited Schedule of Benefits (PDF)
• Texas Platinum Schedule of Benefits (PDF)
• Texas Silver Schedule of Benefits (PDF)
• Texas Silver 73% Schedule of Benefits (PDF)
• Texas Silver 87% Schedule of Benefits (PDF)
• Texas Silver 94% Schedule of Benefits (PDF)
• Texas Silver HD Limited Schedule of Benefits (PDF)
• Texas Silver Limited Schedule of Benefits (PDF)
• Texas Silver HD Schedule of Benefits (PDF)
• Texas Silver HD 73% Schedule of Benefits (PDF)
• Texas Silver HD 87% Schedule of Benefits (PDF)
• Texas Silver HD 94% Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Texas Standard Gold Schedule of Benefits (PDF)
• Texas Standard Gold Limited Schedule of Benefits (PDF)
• Texas Standard Silver Schedule of Benefits (PDF)
• Texas Standard Silver 73% Schedule of Benefits (PDF)
• Texas Standard Silver 87% Schedule of Benefits (PDF)
• Texas Standard Silver 94% Schedule of Benefits (PDF)
• Texas Standard Silver Limited Schedule of Benefits (PDF)

Spanish

• Texas American Indian Zero Cost Sharing Plus Schedule of Benefits (PDF)
• Texas American Indian Zero Cost Sharing Schedule of Benefits (PDF)
  
• Texas Bronze Limited Schedule of Benefits (PDF)
  
• Texas Bronze Plus Limited Schedule of Benefits (PDF)
  
• Texas Bronze Plus Schedule of Benefits (PDF)
  
• Texas Bronze Schedule of Benefits (PDF)
  
• Texas Catastrophic Schedule of Benefits (PDF)
  
• Texas Gold Plus Schedule of Benefits (PDF)
  
• Texas Gold Limited Schedule of Benefits (PDF)
  
• Texas Gold Plus Limited Schedule of Benefits (PDF)
  
• Texas Gold Schedule of Benefits (PDF)
• Texas Platinum Schedule of Benefits (PDF)
• Texas Silver 73% Schedule of Benefits (PDF)
• Texas Silver 87% Schedule of Benefits (PDF)
• Texas Silver 94% Schedule of Benefits (PDF)
• Texas Silver Limited Schedule of Benefits (PDF)
• Texas Silver Schedule of Benefits (PDF)
• Texas Silver HD 73% Schedule of Benefits (PDF)
• Texas Silver HD 87% Schedule of Benefits (PDF)
• Texas Silver HD 94% Schedule of Benefits (PDF)
• Texas Silver HD Limited Schedule of Benefits (PDF)
• Texas Silver HD Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Limited Schedule of Benefits (PDF)
• Texas Standard Expanded Bronze Schedule of Benefits (PDF)
• Texas Standard Gold Limited Schedule of Benefits (PDF)
• Texas Standard Gold Schedule of Benefits (PDF)
• Texas Standard Silver 73% Schedule of Benefits (PDF)
• Texas Standard Silver 87% Schedule of Benefits (PDF)
• Texas Standard Silver 94% Schedule of Benefits (PDF)
• Texas Standard Silver Limited Schedule of Benefits (PDF)
• Texas Standard Silver Schedule of Benefits (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 - $0 PrefGen Summary of Benefits- (PDF)
• Texas Bronze - $0 PrefGen 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 Sharing (PDF)
• Texas Gold Plus Summary of Benefits - Limited Cost Sharing (PDF)
• Texas Gold Summary of Benefits- Plus (PDF) 
• Texas Platinum Summary of Benefits (PDF)
• Texas Silver Summary of Benefits- (PDF)
• Texas Silver Summary of Benefits - Limited (PDF)
• Texas Silver Summary of Benefits - 73% (PDF) 
• Texas Silver Summary of Benefits - 87% (PDF)
• Texas Silver Summary of Benefits - 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 Silver Plus Summary of Benefits- Limited Cost Sharing (PDF)
• Texas American Indian Zero Cost Sharing (PDF)
• Texas American Indian Zero Cost Plus Sharing (PDF)
• Texas Standard Bronze Summary of Benefits- (PDF) 
• Texas Standard Bronze Summary of Benefits- Limited Cost Sharing (PDF) 
• Texas Standard Silver Summary of Benefits- (PDF)
• Texas Standard Silver Summary of Benefits- Limited Cost Sharing (PDF) 
• Texas Standard Silver Summary of Benefits- 73% (PDF)
• Texas Standard Silver Summary of Benefits- 87% (PDF)
• Texas Standard Silver Summary of Benefits- 94% (PDF)
• Texas Standard Gold Summary of Benefits- (PDF)
• Texas Standard Gold Summary of Benefits- Limited 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 Bronze - $0 PrefGen Summary of Benefits (PDF)
• Texas Bronze - $0 PrefGen 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 Sharing (PDF)
• Texas Gold Plus Summary of Benefits - Limited Cost Sharing (PDF)
• Texas Gold Summary of Benefits- Plus (PDF)
• Texas Platinum Summary of Benefits (PDF)
• Texas Silver Summary of Benefits (PDF)
• Texas Silver Summary of Benefits - Limited (PDF)
• Texas Silver Summary of Benefits - 73% (PDF)
• Texas Silver Summary of Benefits - 87% (PDF)  
• Texas Silver Summary of Benefits - 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 
• 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%
• 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 Silver Plus Summary of Benefits- Limited Cost Sharing (PDF)
• Texas American Indian Zero Cost Sharing (PDF)
• Texas American Indian Zero Cost Plus Sharing (PDF)
• Texas Standard Bronze Summary of Benefits (PDF)
• Texas Standard Bronze Summary of Benefits- Limited Cost Sharing (PDF)
• Texas Standard Silver Summary of Benefits (PDF)
• Texas Standard Silver Summary of Benefits- Limited Cost Sharing (PDF)
• Texas Standard Silver Summary of Benefits- 73% (PDF) 
• Texas Standard Silver Summary of Benefits- 87% (PDF)
• Texas Standard Silver Summary of Benefits- 94% (PDF)
• Texas Standard Gold Summary of Benefits (PDF)
• Texas Standard Gold Summary of Benefits- Limited Cost Sharing (PDF)

English

• Texas Schedule of Benefits Bronze $0 PrefGen (PDF)
• Texas Schedule of Benefits Bronze HSA (PDF)
• Texas Schedule of Benefits Bronze (PDF)
• Texas Schedule of Benefits Gold Plus (PDF)
• Texas Schedule of Benefits Silver 73% (PDF)
• Texas Schedule of Benefits Silver 87% (PDF)
• Texas Schedule of Benefits Silver 94% (PDF)
• Texas Schedule of Benefits Silver Plus HD 87% (PDF)
• Texas Schedule of Benefits Silver Plus HD 94% (PDF)
• Texas Schedule of Benefits Silver (PDF)
• Texas Schedule of Benefits Bronze Standard (PDF)
• Texas Schedule of Benefits Gold Standard (PDF)
• Texas Schedule of Benefits Silver Standard 73% (PDF)
• Texas Schedule of Benefits Silver Standard 87% (PDF)
• Texas Schedule of Benefits Silver Standard 94% (PDF)
• Texas Schedule of Benefits Silver Standard (PDF)
• Texas Schedule of Benefits Silver Plus HD (PDF)
• Texas Schedule of Benefits Silver HD 73% (PDF)
• Texas Schedule of Benefits Silver LD 94% (PDF)
• Texas Schedule of Benefits Silver LD 87% (PDF)
• Texas Schedule of Benefits Silver LD 73% (PDF)
• Texas Schedule of Benefits Silver LD (PDF)
• Texas Schedule of Benefits Gold (PDF)
• Texas Schedule of Benefits Silver HD (PDF)
• Texas Schedule of Benefits Silver HD 94% (PDF)
• Texas Schedule of Benefits Silver HD 87% (PDF)
• Texas Schedule of Benefits Silver Plus HD 73% (PDF)
• Texas Schedule of Benefits Bronze Plus (PDF)
• Texas Schedule of Benefits Platinum (PDF)
• Texas Schedule of Benefits Catastrophic (PDF)

 

Spanish

• Texas Schedule of Benefits Bronze $0 PrefGen  (PDF)
• Texas Schedule of Benefits Bronze HSA  (PDF)
• Texas Schedule of Benefits Bronze (PDF)
• Texas Schedule of Benefits Gold Plus  (PDF)
• Texas Schedule of Benefits Silver 73%  (PDF)
• Texas Schedule of Benefits Silver 87%  (PDF)
• Texas Schedule of Benefits Silver 94%  (PDF)
• Texas Schedule of Benefits Silver Plus HD 87%  (PDF)
• Texas Schedule of Benefits Silver Plus HD 94%  (PDF)
• Texas Schedule of Benefits Silver  (PDF)
• Texas Schedule of Benefits Bronze Standard  (PDF)
• Texas Schedule of Benefits Gold Standard  (PDF)
• Texas Schedule of Benefits Silver Standard 73%  (PDF)
• Texas Schedule of Benefits Silver Standard 87%  (PDF)
• Texas Schedule of Benefits Silver Standard 94%  (PDF)
• Texas Schedule of Benefits Silver Standard  (PDF)
• Texas Schedule of Benefits Silver Plus HD (PDF)
• Texas Schedule of Benefits Silver HD 73% (PDF)
• Texas Schedule of Benefits Silver LD 94% (PDF)
• Texas Schedule of Benefits Silver LD 87% (PDF)
• Texas Schedule of Benefits Silver LD 73% (PDF)
• Texas Schedule of Benefits Silver LD (PDF)
• Texas Schedule of Benefits Gold (PDF)
• Texas Schedule of Benefits Silver HD (PDF)
• Texas Schedule of Benefits Silver HD 94% (PDF)
• Texas Schedule of Benefits Silver HD 87% (PDF)
• Texas Schedule of Benefits Bronze Plus (PDF)
• Texas Schedule of Benefits Platinum (PDF)
• Texas Schedule of Benefits Catastrophic (PDF) 

English

• 2023 Texas Health Insurance Exchange- Evidence of Coverage Complete Plan (PDF)
• 2023 Texas Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)
• 2023 Texas Health Insurance Exchange- Evidence of Coverage (PDF)

Spanish

• 2023 Texas Health Insurance Exchange- Evidence of Coverage Complete Plan (PDF)
• 2023 Texas Health Insurance Exchange- Evidence of Coverage (PDF)
• 2023 Texas Health Insurance Exchange- Evidence of Coverage Off Exchange (PDF)

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

• Payment Authorization Form (PDF)

Provider & Pharmacy Directory

• 2023/2024 Louisiana Provider & Pharmacy Directory (PDF)
• 2023/2024 Texas Provider & Pharmacy Directory (PDF)

Provider Search Tool

• Online Searchable Provider Directories

• RX Claim Form (PDF)

If you are a 2023 member in a CHRISTUS Health Plan Bronze Plus, Silver Plus or Gold Plus plan you are eligible for the fitness reimbursement which provides access to a qualified fitness program.

• Health Exchange Plus Plan Fitness Reimbursement- Texas (PDF)
• Health Exchange Plus Plan Fitness Reimbursement- Louisiana (PDF)

• Transplant Travel Claim Form

• Medical Reimbursement Form