SMG71_080918_Montana_Medical_SmallGroup_cover2019 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 (PDFs):   

Quote Request and Forms (PDFs):

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

 

Choose a Medical Plan in One of Two Networks


Access more providers with our PacificSource Network.

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 your employees will
have more providers to choose from.

PacificSource Network Availability

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

 

Lower your costs with our SmartHealth Network.

The SmartHealth Network is designed to give your employees a coordinatedcare experience through select provider groups and facilities. This level of provider collaboration means great care for your employees at a lower cost.

SmartHealth Network Availability

If your business is in one of the following counties, you can choose plans on the SmartHealth Network:

  • Carbon
  • Flathead
  • Lake
  • Lewis and Clark
  • Missoula
  • Musselshell
  • Park
  • Stillwater
  • Sweet Grass
  • Yellowstone