2020 Montana Large Group Plans

The information on this page is for large group plans beginning January 1, 2020. 

Quicklinks

 

Learn what we have to offer

Download a brochure (PDFs):

 

At your service: plans and networks come with choice

PacificSource is excited to introduce Navigator and Voyager.

Navigator—for exceptional coordinated care

Navigator gives you a more integrated approach to care—helping members get the right care, at the right time, in the right place. It’s care that’s coordinated to simplify the member experience, improve access to care, and promote member engagement through shared decision-making within an accountable network of providers.

Navigator is available for purchase by employers located in the following counties:

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

Voyager gives you the broadest choice of networks

Voyager is our rebranded evolution of the PSN (PacificSource Network) product. As a preferred provider organization (PPO), Voyager means greater choice for members. For those who prefer a more self-guided experience, Voyager gives members expanded access to our broadest network of providers.

Voyager is available for purchase by businesses located throughout the state of Montana.

 

Review 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 table below.  

Medical handbook samples (PDFs): 

Non-HSA Qualified Medical Plans

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
500+20_20 $500 $2,000 Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
750+20_20 $750  $3,000 Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
1000+20_20  $1,000 $4,000 Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
1500+20_20 $1,500 $5,000 Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
2000+20_30  $2,000 $5,000 Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
2500+20_30 $2,500 $7,000  Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
3000+20 $3,000 $3,000  Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager
4000+20_30 $4,000 $8,000  Covered in Full Primary/Specialist: $20* Navigator / Voyager Navigator / Voyager

 * Not subject to deductible.

HSA Qualified Medical Plans

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
HSA 2800+Rx $2,800 $2,800 Covered in Full Covered in Full Navigator / Voyager Navigator / Voyager
HSA 3000_50+Rx $3,000 $6,900 Covered in Full 50% Navigator / Voyager Navigator / Voyager
HSA 3000+Rx $3,000 $3,000 Covered in Full Covered in Full Navigator / Voyager Navigator / Voyager
HSA 4000+Rx $4,000 $4,000 Covered in Full Covered in Full Navigator / Voyager Navigator / Voyager
HSA 5000+Rx $5,000 $5,000 Covered in Full Covered in Full Navigator / Voyager Navigator / Voyager
HSA 6900+Rx $6,900 $6,900 Covered in Full Covered in Full Navigator / Voyager Navigator / Voyager

 

Decide on dental plans 

Dental handbook sample (PDF): 

Summaries (PDFs):

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   
Dental Choice Plus 0-20-50 25-2000 Dental Choice Plus 0-20-50 50-2000
Dental Defined  
Orthodontia 1000* Orthodontia 1500*

* Additional eligibility requirements may apply.

Voluntary Dental Option Plans

Our Voluntary Dental option is available to businesses with ten or more enrolled employees. Summaries (PDFs):

Dental Choice 0-20-50 25-1500 Dental Choice 0-20-50 50-1500  
Dental Choice 0-20-50 50-1000   Dental Choice 0-20-50 50-2000

 

Pharmacy options

Summaries (PDFs): 

MT 10-35-60 MDL MT 2800D MDL MT 5000D MDL
MT 10-50P-50P MD MT 3000D MDL MT 6900D MDL
MT 50P 3000D MDL MT 4000D MDL  

  

Vision plans complete your package

Summaries (PDFs):

 

Brochures, enrollment forms, and more

Brochures (PDFs):

    Forms (PDFs):  

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

     

    For producers

    You can order sales kits for large group clients online!

    Order printed materials 

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