Blue - Blue Preferred Gold PPO? 204 - Two $10 PCP Visits

Montana, 2018

  • Plan Type

    PPO

  • Metal Tier

    Gold

  • Out of Pocket Maximum

    $7,350

  • Deductible

    $450

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) $450
Deductible (Family) $900
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility $850 Copay per stay after deductible + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $1000 Copay after deductible + 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 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 Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $850 Copay per stay after deductible + 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

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 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 Focus Bronze POS? 205 - Two $40 PCP Visits Deductible $4,000 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 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) $450
Deductible (Family) $900
Coinsurance Not applicable
Out of Pocket Maximum (Individual) $7,350
Out of Pocket Maximum (Family) $14,700

Doctor Visits

Primary Care Visit 30% Coinsurance after deductible
Specialist Visit 30% Coinsurance after deductible
Inpatient Facility $850 Copay per stay after deductible + 30% Coinsurance after deductible
Inpatient Physician 30% Coinsurance after deductible
Emergency Room Services $1000 Copay after deductible + 30% Coinsurance after deductible

Tests and Imaging

Imaging (CT/PET Scans, MRIs) 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 Available
Pregnancy Available
Weight Loss Not available

Other

Mental / Behavioral Health Inpatient $850 Copay per stay after deductible + 30% Coinsurance after deductible
Mental / Behavioral Health Outpatient 30% Coinsurance after deductible
Rehabilitative Speech Therapy 30% Coinsurance after deductible
Rehabilitative Occupational & Physical Therapy 30% Coinsurance after deductible
Outpatient Facility 30% Coinsurance after deductible
Outpatient Surgery 30% Coinsurance after deductible

Prescription Drugs

Generic Rx Data Not Available
Preferred Brand Rx Data Not Available
Non Preferred Brand Rx Data Not Available
Specialty Drugs

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 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 Focus Bronze POS? 205 - Two $40 PCP Visits Deductible $4,000 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 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