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M139-2 - Exhibit B - 2018.08.03 - KYHC - Shepherd Opinion & Order

https://ldi.la.gov/docs/default-source/documents/financialsolvency/receivership/louisiana-health-cooperative/lahc/m139-2---exhibit-b---2018-08-03---kyhc---shepherd-opinion-order.pdf?sfvrsn=dd804c52_2

interest. Plaintiff also argues that Miller and the Board failed to seek outside assistance in the hiring process. • KYHC’s decision to hire CGI: KYHC hired CGI as a business process outsourcing, relied on Miller’s recommendation without obtaining an outside opinion. • Initial rate development, that the entity providing the information is unreliable, incompetent, or acting outside the scope of its, or incompetent actuarial consultant or was otherwise acting outside the scope of its professional competence

Vernon

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/vernonde5c232a8b9e6b8a94f4ff0000585bf2.pdf?sfvrsn=34c54852_6

contact plan No contact plan Chemo Drugs 20% 20% 20% 20% Out-of-Pocket Maximum $6,700 in network $10,000 out of net $6,700 in network $10,000 out of net $6,700.00 $5,000 in network $10,000 out, Monthly Consolidated Premium $0.00 $53.00 $87.00 $45.00 Health Plan Deductible $1000 out of network $1000 out of network $1000 out of network $1,000 PCP Co-Pay $0 in network $15 in network $15, Drugs 20% 20% 20% 20% Out of Pocket Maximum $6,700.00 $6,700.00 $6,700.00 $6,700 in network

Morehouse

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/morehousebf28242a8b9e6b8a94f4ff0000585bf2.pdf?sfvrsn=6ab64f52_6

$0.00 $150.00 $0 in network; $1,000 out of network $0.00 PCP Co-Pay $5.00 $5 $0.00 $0.00, Coverage in the Gap Yes Yes Yes Out-of-Pocket Maximum $6,400 in network; $10,000 combined, Health Plan Deductible $0.00 $1000 out of network $1000 Out-of Network $0 PCP Co-Pay $10.00 $5.00, in the Gap No No No Out of Pocket Maximum $6,700 $6,700 in network; $10,000 combined $6,700 In-Network, $1000 Out-of-Network $1000 out of network $1000 out of network $1000 out of network PCP Co-Pay $15

Natchitoches

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/natchitochesc328242a8b9e6b8a94f4ff0000585bf2.pdf?sfvrsn=6bb64f52_6

Deductible $150 Out-of-Network $150 Out-of-Network $0 In-Network; $1,000 Out-of-Network $0 PCP Co, Yes Yes Yes Out-of-Pocket Maximum $6,400 In-Network; $10,000 Combined $6,000 In-Network, Premium $21.30 $44 $0 $82 Health Plan Deductible $500 Out-of-Network $1,000 Out-of-Network $1,000 Out-of-Network $1,000 Out-of-Network PCP Co-Pay 20% $5/30% $0 In-Network $15 In-Network Specialist Co, Annual Drug Deductible $435 $435 $435 Additional Coverage in the Gap No No No Out-of-Pocket

Winn Parish

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/winn-parish.pdf?sfvrsn=c6b64f52_6

Deductible $150 Out-of-Network $150 Out-of-Network $0 In-Network; $1,000 Out-of-Network $0 PCP Co-Pay, Yes Yes Yes Out-of-Pocket Maximum $6,400 In-Network; $10,000 Combined $6,000 In-Network; $10,000, Deductible $1000 Out-of Network TBD $1000 Out-of-Network $1000 Out-of-Network PCP Co-Pay $0 20% $5, Additional Coverage in the Gap No No No Out-of-Pocket Maximum $6,700 In-Network; $10,000 Combined $6,700, MSA Monthly Consolidated Premium $0 $82 $110 $0 Health Plan Deductible $1,000 Out-of-Network

Lafayette

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/lafayette8e24242a8b9e6b8a94f4ff0000585bf2.pdf?sfvrsn=abc4f52_6

Shield of Louisiana, PPO Total Monthly Premium $0 $0 $0 $75 Health Plan Deductible $150 Out-of Network $150 Out-of Network $0 $0 In-Network; $1,000 Out-of Network PCP Co-Pay $5 $5 $0 $0, Drug Deductible $200 $0 $0 Additional Coverage in the Gap Yes No Yes Out-of-Pocket Maximum, Humana, Local PPO Total Monthly Premium $0 $0 $0 $44 Health Plan Deductible $0 $0 $1000 Out-of Network $1000 Out-of-Network PCP Co-Pay $0 $0 $0 $5 Specialist Co-Pay $40 $35 $35 45 ER $90 $90 $90

Terrebonne

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/terrebonne3c2a242a8b9e6b8a94f4ff0000585bf2.pdf?sfvrsn=f6b64f52_6

Shield of Louisiana, PPO Total Monthly Premium $0 $0 $0 $75 Health Plan Deductible $150 out-of-Network $0 $0 $1000 Out-of-Network PCP Co-Pay $5 $5 $0 $0 Specialist Co-Pay $35 $35 $35 $35 ER, Additional Coverage in the Gap Yes Yes Yes Out-of-Pocket Maximum $6,400 In-Network $10,000, Monthly Premium $21 $0 $78 $44 Health Plan Deductible $0 $1000 Out-of-Network $1000 Out-of-Network $1000 Out-of-Network PCP Co-Pay $5 $0/$35 $15 In-Network $5 In-Network Specialist Co-Pay $50 $35

Iberia

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/iberia1624242a8b9e6b8a94f4ff0000585bf2.pdf?sfvrsn=14bc4f52_6

Plan Deductible $0 $0 In-Network; $1,000 Out-of-Network $0 In-Network $1000 Out-of-Network PCP, Yes No No Out-of-Pocket Maximum $4,900 In-Network $3,500 In-Network; $7,000 Combined $6,700, Plan Deductible $1000 Out-of-Network $1000 Out-of-Network $1000 Out-of Network $1000 Out-of-Network, : Days 1-6 (In-Network) $275 per day: Days 1-7 $195 per day: Days 1-6 (In-Network) Out-of-Network, in the Rx Gap No No Out-of-Pocket Maximum $6,700 In-Network; $10,000 Combined $6,700

De Soto

https://ldi.la.gov/docs/default-source/documents/shiip/medicare-advantage-plans/de-soto.pdf?sfvrsn=36bc4f52_6

of Louisiana, PPO Total Monthly Premium $0 $0 $0 $75 Health Plan Deductible $150 Out-of-Network $150 Out-of-Network $0 $1000 Out-of-Network PCP Co-Pay $5 $5 $0 $0 In-Network Specialist Co-Pay $35 $35, Deductible $100 $0 $0 Additional Coverage in the Rx Gap Yes Yes Yes Out-of-Pocket Maximum $6,400, Deductible $1000 Out-of-Network *Coming Soon $1000 Out-of-Network $1,000 Out-of-Network PCP Co, Deductible $435 $400 $400 Additional Coverage in the Rx Gap No No No Out-of-Pocket Maximum $6,700

8 Public Comment - Sheila Person

https://ldi.la.gov/docs/default-source/documents/legaldocs/public-comments-dec23/8-public-comment---sheila-person.pdf?sfvrsn=10bd4552_0

 Submitted on February 08, 2024 | 05:47 PM Comment Type Public Comment First Name Sheila Last Name Person Email [email protected] Received Date Publish Status Comment Please say NO to the Elevance buy out of Blue Cross of LoUiSiAna