2019 Montana Small Group Plans 

The information on this page is for small group plans beginning January 1, 2019. 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 (PDFs): 


Plan

Deductible

Out-of-pocket Maximum

Preventive Services
No deductible, member pays:

Office Visits
After deductible, member pays:

SBCs (PDFs)
by Network
Summaries (PDFs)
by Network
Gold 1000  $1,000 $5,000 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Gold 1000 VH
with adult vision
$1,000 $5,000 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Gold 2000 $2,000 $5,000 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Gold 2000 VH
with adult vision
$2,000 $5,000 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Silver 3500 $3,500 $7,350  Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Silver 3500 VH
with adult vision
$3,500 $7,350  Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Silver 4000 $4,000 $7,350 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Silver 4000 VH
with adult vision
$4,000 $7,350 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Silver 5000  $5,000 $7,350 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Silver 5000 VH
with adult vision
$5,000 $7,350 Covered in Full Primary/Urgent Care: $30 co-pay*
Specialist: $60 co-pay*
PacificSource / SmartHealth PacificSource / SmartHealth
Bronze 7600 $7,600 $7,600  Covered in Full Primary/Urgent Care: $35 co-pay*
Specialist: Covered in Full
PacificSource / SmartHealth PacificSource / SmartHealth
Gold HSA 3000 $3,000 $3,000 Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3000 $3,000 $6,650  Covered in Full 20% PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 4000 $4,000 $4,000 Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 5400 $5,400 $5,400 Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth
Bronze HSA 5200 $5,200 $6,650  Covered in Full 50% PacificSource / SmartHealth PacificSource / SmartHealth
Bronze HSA 6650 $6,650 $6,650  Covered in Full Covered in Full PacificSource / SmartHealth PacificSource / SmartHealth

 *Not subject to deductible.

 

Dental Plans 

Dental handbook samples (PDFs): 

Summaries (PDFs):

Dental Choice Core^  
Dental Choice 0-20-50 750    
Dental Choice 0-20-50 1000^ Dental Choice 0-20-50 1500^
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^
Kids Dental Choice 0-20-50^ Kids Dental Choice 20-40-50^
Ortho 1000 WP^*  

^ Available direct from PacificSource only.

* Additional eligibility requirements may apply.
 

 

Brochures and Forms 


Brochures:

  SMG71_080918_Montana_Medical_SmallGroup_cover

You can order sales kits for individual and small group clients online!

Order printed materials today > 

Brochures (PDFs):

Quote Request and Enrollment Forms (PDFs): 

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
  • 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.