2017 Montana Large Group Plans

The information on this page is for large group plans beginning January 1 and April 1, 2017. 

Medical Plans

Medical handbook samples:


Deductible and out-of-pocket limit amounts shown below are the costs for individuals. Amounts for families are twice the individual amounts. If members receive services from out-of-network providers, their deductible and out-of-pocket limit will be higher than the amounts listed in the table below.  

Plan

Deductible

Out-of-pocket limit

Co-pay for office visits
Services performed during an office visit may be billed separately.

Co-insurance
after deductible

SBCs
effective January 1

by Network
SBCs
effective April 1

by Network
Summaries
by Network
500+20_20 $500 $5,000 $20 20% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
750+20_20 $750  $5,000 $20 20% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
1000+20_20  $1,000 $5,000 $20 20% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
1500+20_20 $1,500 $5,500 $20 20% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
2000+20_30  $2,000 $6,000 $20 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
2500+20_30 $2,500 $6,000  $20 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
3000+20_30 $3,000 $6,000  $20 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
4000+20_30 $4,000 $6,000  $20 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
HSA 3000+50+Rx $3,000 $6,350 No co-pay 50% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
HSA 3000+Rx $3,000 $3,000 No co-pay No charge after deductible PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
HSA 4000+Rx $4,000 $4,000 No co-pay No charge after deductible PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
HSA 5000+Rx $5,000 $5,000 No co-pay No charge after deductible PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth

 

Dental Plans 

Dental handbook samples:


Dental Choice Plus 0-20-50 25-1000   Dental Choice Plus 0-20-50 50-1000
Dental Choice Plus 0-20-50 25-1500   Dental Choice Plus 0-20-50 50-1500   
Dental Choice Plus 0-20-50 25-2000 Dental Choice Plus 0-20-50 50-2000
Dental Defined (effective April 1, 2017)  
Kids Dental Choice 0/20/50 Kids Dental Choice 20/40/50
Orthodontia 1000 Orthodontia 1500

Voluntary Dental Option Plans

Our Voluntary Dental option is available to businesses with ten or more enrolled employees. For information and requirements, please see our Voluntary Dental flier.

Dental Choice 0/20/50 50-1000 Voluntary Dental Choice 0/20/50 25-1500 Voluntary  
Dental Choice 0/20/50 50-1500 Voluntary   Dental Choice 0/20/50 50-2000 Voluntary

 

Pharmacy Plans


MT 3000D MDL MT 50P MDL
MT 4000D MDL MT 10-50P-50P MDL
MT 5000D MDL MT 10-35-60 MDL
  MT 10-35-60 150D MDL

 

Chiropractic Manipulation and Acupuncture


Summary

 

Vision Plans


Vision 10-150 Vision Plus
Vision 10-300 Vision Exam Only

 

Network Availability (Medical)


Network availability varies depending on geographic location.

PacificSource Network (PSN)

 

Availability: All Montana businesses can choose health plans on the PacificSource Network, regardless of location.

Notable features: The PacificSource Network (PSN) includes the broadest access to in-network providers and facilities, such as hospitals and urgent care centers. Plans on the PacificSource Network will typically cost more because members will have more providers to choose from.

 

SmartHealth Network

 

Availability: Businesses located in the following counties can choose plans on the SmartHealth Network:

  • Carbon
  • Missoula
  • Musselshell
  • Park
  • Stillwater
  • Sweet Grass
  • Yellowstone

Notable features: The SmartHealth Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care for members at a lower cost.