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Insurance
Plan

Blue Connect 80/60 $3200 (S)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (L)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (N)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 50/50 $7500 Standardized Plan (S)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (L)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (N)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 60/40 $5000 Standardized Plan (S)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (L)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (N)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Connect Copay (PCP, Specialist, Urgent Care) 75/55 $1500 Standardized Plan (S)

Type

POS

Coverage

Individual

Insurer

HMO Louisiana

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Cross® Premier PPO Bronze Extra

Type

PPO

Coverage

Individual

Insurer

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
Insurance
Plan

Blue Cross® Premier PPO Bronze HSA

Type

PPO

Coverage

Individual

Insurer

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Icon Dental Plan
Icon National Network
ValidityFrom Jan 01 2025 : To Dec 31 2025
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