2017 Montana Small Group Plans

The information on this page is for small group plans beginning January 1 and April 1, 2017. Small groups in Montana are employers with one to 50 employees.

Medical Plans

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 chart below. All network plans are available direct with PacificSource and through HealthCare.gov, unless noted.

Medical handbook samples:


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
Bronze HSA 6550
$6,550
$6,550 
No charge
No charge
Bronze 7150
$7,150
$7,150 
$20 co-pay^+, then no charge
No charge
Silver HSA 3600
$3,600
$3,600 
No charge
No charge
Silver 2500
$2,500
$7,150
$20 co-pay^
30%
Silver 2500 VH
$2,500
$7,150
$20 co-pay^
30%
Silver 3000
$3,000
$7,150 
$20 co-pay^ 
30%
Silver 3000 VH
$3,000
$7,150 
$20 co-pay^ 
30%
Silver 4000
$4,000
$7,150
$20 co-pay^
30%
Silver 4000 VH
$4,000
$7,150
$20 co-pay^
30%
Silver 5000 
$5,000
$7,150
$20 co-pay^
30%
Silver 5000 VH
$5,000
$7,150
$20 co-pay^
30%
Gold 1000
$1,000
$4,000
$20 co-pay^
20%
Gold 1000 VH
$1,000
$4,000
$20 co-pay^
20%

^Not subject to annual deductible.

+The first five office visits combined are paid at 100 percent after any applicable co-pay. After that, office visits are subject to deductible and co-insurance.

 

Dental Plans

Dental handbook samples:


Dental Choice Core
 
Dental Choice 0/20/50 50-750  
 
Dental Choice 0/20/50 50-1000 *
Dental Choice Plus 0/20/50 25-1000 *
Dental Choice Plus 0/20/50 25-1500 *
Kids Dental Choice 0/20/50 *
Ortho 1000 WP *  

*Available direct from PacificSource only.

 

Brochure and Forms 


 

Montana Small Group Brochure

You can now order sales packets for individual, small group, and large group clients online!

Order printed materials today >  

 

 Brochures: 
Quote Request and Enrollment Forms: 

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

 

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.