Brochure PDF: Health Plans for Montana Large Groups2019 Montana Large Group Plans

The information on this page is for large group plans beginning January 1, 2019. 

Medical Plans

Medical handbook samples (PDFs):


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 Maximum

Preventive Services
No deductible, member pays:

Office Visits
After deductible, member pays:

SBCs (PDFs)
by Network
(
Revised 11/27/18)
Summaries (PDFs)
by Network
500+20_20 $500 $5,000 Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
750+20_20 $750  $5,000 Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
1000+20_20  $1,000 $5,000 Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
1500+20_20 $1,500 $5,500 Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
2000+20_30  $2,000 $6,000 Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
2500+20_30 $2,500 $6,000  Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
3000+20_30 $3,000 $6,000  Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
4000+20_30 $4,000 $6,000  Covered in Full $20* PacificSource / SmartHealth PacificSource / SmartHealth
HSA 3000_50+Rx $3,000 $6,350 Covered in Full 50% PacificSource / SmartHealth PacificSource / SmartHealth
HSA 3000+Rx $3,000 $3,000 Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth
HSA 4000+Rx $4,000 $4,000 Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth
HSA 5000+Rx $5,000 $5,000 Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth

 * Not subject to deductible.

 

Dental Plans 

Dental handbook samples (PDFs): 


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  
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. 

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

 

Pharmacy Plans (PDFs, revised October 9, 2018)


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

 

Vision Plans (PDFs)


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

 

Brochures and Forms (PDFs)


Brochures:

Forms:

Visit our Montana Forms and Materials page for more sales materials.

Brokers: You can now order sales kits for large group clients online!

Order printed materials today >  

  

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
  • Flathead
  • Lake
  • Lewis and Clark
  • 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.