Employer Plan Summaries Montana2017 Montana Small Group Plans

The information on this page is for small group plans beginning January 1 and April 1, 2017. Small groups in Montana are employers with one to 50 employees.

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 chart below. All network plans are available direct with PacificSource and through HealthCare.gov, unless noted.

Medical handbook samples:


Plan

Deductible

Out-of-pocket limit

Co-pay for office visits
Services performed during an office visit may be billed separately.

Co-insurance
after     deductible    

SBCs effective January 1
by Network
SBCs
effective April 1

by Network
Summaries
by Network
Bronze HSA 6550 $6,550 $6,550  No charge No charge PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Bronze 7150 $7,150 $7,150  $20 co-pay^+, then no charge No charge PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver HSA 3600 $3,600 $3,600  No charge No charge PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 2500 $2,500 $7,150 $20 co-pay^ 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 2500 VH $2,500 $7,150 $20 co-pay^ 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 3000 $3,000 $7,150  $20 co-pay^  30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 3000 VH $3,000 $7,150  $20 co-pay^  30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 4000 $4,000 $7,150 $20 co-pay^ 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 4000 VH $4,000 $7,150 $20 co-pay^ 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 5000  $5,000 $7,150 $20 co-pay^ 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Silver 5000 VH $5,000 $7,150 $20 co-pay^ 30% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Gold 1000 $1,000 $4,000 $20 co-pay^ 20% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth
Gold 1000 VH $1,000 $4,000 $20 co-pay^ 20% PacificSource / SmartHealth PacificSource / SmartHealth PacificSource / SmartHealth

^Not subject to annual deductible.

+The first five office visits combined are paid at 100 percent after any applicable co-pay. After that, office visits are subject to deductible and co-insurance.

 

Dental Plans


Dental handbook samples:


Dental Choice Core  
Dental Choice 0/20/50 50-750    
Dental Choice 0/20/50 50-1000 Dental Choice 0/20/50 50-1500
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
Kids Dental Choice 0/20/50 Kids Dental Choice 20/40/50
Ortho 1000 WP*  

*Available direct from PacificSource only.

 

Choose a Medical Plan in One of Two Networks


Access more providers with our PacificSource Network.

The PacificSource Network (PSN) includes the broadest access to in-network providers and facilities, such as hospitals and urgent care centers. Plans on the PacificSource Network will typically cost more because your employees will
have more providers to choose from.

PacificSource Network Availability

All Montana businesses can choose health plans on the PacificSource Network, regardless of location.

 

Lower your costs with our SmartHealth Network.

The SmartHealth Network is designed to give your employees a coordinatedcare experience through select provider groups and facilities. This level of provider collaboration means great care for your employees at a lower cost.

SmartHealth Network Availability

If your business is in one of the following counties, you can choose plans on the SmartHealth Network:

  • Carbon
  • Missoula
  • Musselshell
  • Park
  • Stillwater
  • Sweet Grass
  • Yellowstone