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

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) $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 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
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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) $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 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