Blue - Blue Cross Blue Shield Basic

Montana, 2017

  • Plan Type

    PPO

  • Metal Tier

    Bronze

  • Out of Pocket Maximum

    $7,150

  • Deductible

    $6,100

Enroll Now
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Call (855) 866-5590 to speak with a licensed agent about a new health plan.

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Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,100
Deductible (Family) $12,200
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility $750 Copay per stay before deductible + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $1000 Copay before deductible + 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay before deductible + 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $750 Copay per stay before deductible + 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient No charge
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility $400 Copay before deductible + 30% Coinsurance after deductible
Outpatient Surgery $400 Copay before deductible + 30% Coinsurance after deductible

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Montana

Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Focus Silver POS Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Focus Bronze POS Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Focus Silver POS Deductible $3,850 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Basic Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Focus Bronze POS Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Focus Silver POS Deductible $3,850 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Focus Silver POS Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Focus Gold POS Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Cross Blue Shield Basic Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Focus Gold POS Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350

Health Insurance Tools

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Health Exchange Guides

{"onCurrent":true,"type":"guides"}

Cost Sharing Benefits (In Network)

Policyholders are generally responsible for 100% of costs until the deductible amount is met. After the deductible has been met the policyholder is responsible for the coinsurance / copay until the out of pocket maximum is reached at which point the insurance company assumes 100% of all costs.

Deductible (Individual) $6,100
Deductible (Family) $12,200
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,150
Out of Pocket Maximum (Family) $14,300

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility $750 Copay per stay before deductible + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $1000 Copay before deductible + 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) $500 Copay before deductible + 30% Coinsurance after deductible
Laboratory Outpatient and Professional Services 30% Coinsurance after deductible
X-Ray and Diagnostic Imaging 30% Coinsurance after deductible

Health Management Programs

Asthma Available
Depression Available
Diabetes Available
Heart Disease Available
High Blood Pressure / High Cholesterol Available
Lower Back Pain Available
Pain Management Not available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $750 Copay per stay before deductible + 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient No charge
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility $400 Copay before deductible + 30% Coinsurance after deductible
Outpatient Surgery $400 Copay before deductible + 30% Coinsurance after deductible

Prescription Drugs

Generic Rx 20% Coinsurance after deductible
Preferred Brand Rx 30% Coinsurance after deductible
Non Preferred Brand Rx 40% Coinsurance after deductible
Specialty Drugs 50% Coinsurance after deductible

Other Plans in Montana

Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Focus Silver POS Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Basic Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Focus Bronze POS Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Focus Silver POS Deductible $3,850 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Basic Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $4,500
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Focus Bronze POS Deductible $6,000 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Focus Silver POS Deductible $3,850 Coinsurance Not applicable Out of Pocket $6,850
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Cross Blue Shield Premier Deductible $1,650 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Security PPO Deductible $7,150 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Focus Silver POS Deductible $2,500 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Cross Blue Shield Solution Deductible $3,350 Coinsurance Not applicable Out of Pocket $5,600
Plan Blue Focus Gold POS Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Cross Blue Shield Basic Deductible $6,100 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Bronze PPO Deductible $5,000 Coinsurance Not applicable Out of Pocket $6,550
Plan Blue Preferred Silver PPO Deductible $3,000 Coinsurance Not applicable Out of Pocket $6,600
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350
Plan Blue Preferred Bronze PPO Deductible $6,500 Coinsurance Not applicable Out of Pocket $6,500
Plan Blue Focus Gold POS Deductible $500 Coinsurance Not applicable Out of Pocket $5,250
Plan Blue Preferred Bronze PPO Deductible $6,350 Coinsurance Not applicable Out of Pocket $7,150
Plan Blue Preferred Gold PPO Deductible $1,400 Coinsurance Not applicable Out of Pocket $3,350