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Blue - Blue Focus Bronze POS? 205 - Two $40 PCP Visits
Montana, 2018
Plan Type
HMO
Metal Tier
Bronze
Out of Pocket Maximum
$7,350
Deductible
$4,000
Emergency Room Care: $1000 Copay after deductible + 50% Coinsurance after deductible
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) | $4,000 |
|---|---|
| Deductible (Family) | $8,000 |
| Coinsurance | Not applicable |
| Out of Pocket Maximum (Individual) | $7,350 |
| Out of Pocket Maximum (Family) | $14,700 |
Doctor Visits
| Primary Care Visit | 50% Coinsurance after deductible |
|---|---|
| Specialist Visit | 50% Coinsurance after deductible |
| Inpatient Facility | $850 Copay per stay after deductible + 50% Coinsurance after deductible |
| Inpatient Physician | 50% Coinsurance after deductible |
| Emergency Room Services | $1000 Copay after deductible + 50% Coinsurance after deductible |
Tests and Imaging
| Imaging (CT/PET Scans, MRIs) | 50% Coinsurance after deductible |
|---|---|
| Laboratory Outpatient and Professional Services | 50% Coinsurance after deductible |
| X-Ray and Diagnostic Imaging | 50% 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 | Available |
| Pregnancy | Available |
| Weight Loss | Not available |
Other
| Mental / Behavioral Health Inpatient | $850 Copay per stay after deductible + 50% Coinsurance after deductible |
|---|---|
| Mental / Behavioral Health Outpatient | 50% Coinsurance after deductible |
| Rehabilitative Speech Therapy | 50% Coinsurance after deductible |
| Rehabilitative Occupational & Physical Therapy | 50% Coinsurance after deductible |
| Outpatient Facility | $600 Copay after deductible + 50% Coinsurance after deductible |
| Outpatient Surgery | $600 Copay after deductible + 50% Coinsurance after deductible |
Prescription Drugs
| Generic Rx | No charge after deductible |
|---|---|
| Preferred Brand Rx | 20% Coinsurance after deductible |
| Non Preferred Brand Rx | 35% Coinsurance after deductible |
| Specialty Drugs | 45% Coinsurance after deductible |
Other Plans in Montana
| Plan | Deductible | Coinsurance | Out of Pocket |
|---|---|---|---|
| Plan Blue Preferred Gold PPO? 204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Gold PPO? 204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Silver POS? 206 - Two $25 PCP Visits | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Gold PPO? 204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 202 | Deductible $2,700 | Coinsurance Not applicable | Out of Pocket $6,550 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Gold PPO?204 - Two $10 PCP Visits | Deductible $450 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Bronze POS? 205 - Two $40 PCP Visits | Deductible $4,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Security PPO? 200 | Deductible $7,350 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Gold POS? 207 | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Bronze PPO? 201 - Two $25 PCP Visits | Deductible $2,850 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Silver POS? 206 - Two $25 PCP Visits | Deductible $3,500 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Focus Gold POS? 207 | Deductible $0 | Coinsurance Not applicable | Out of Pocket $7,350 |
| Plan Blue Preferred Silver PPO? 203 | Deductible $1,000 | Coinsurance Not applicable | Out of Pocket $7,350 |