2024
Montana
Plus Standard 87
Silver
Deductible
$700
Includes Signature Benefits
Max out-of-pocket
$3,000
Coinsurance (you pay)
30%
Tier 1-Preferred Generic Drug
$10 No Deductible
Primary Care Visit
$20 No Deductible
Specialist Visit
$40 No Deductible
Mental Health Visit
$20 No Deductible
*Based on in-network rates.
See plan documents for most accurate and up to date details. Telehealth provider costs may vary.
The amount you must pay out-of-pocket before your insurance coverage starts. The percentage of cost covered is determined by coinsurance.Â
A percentage of the cost you share with the insurer after meeting the deductible.
The most you’ll pay for covered services in a plan year.Â
Fixed fees you pay for specific services (e.g., $20 for a doctor’s visit).
Low-cost, generic medications that are considered the most affordable option for treating a particular medical condition.Â
Confirm coverage for procedures or services ahead of time to save money. Review your plan documents or follow these steps:
Step 1Â
Request the CPT code (Current Procedural Terminology) from your provider.
These unique 5-digit codes identify the procedure anywhere in the United States.
Step 2
Search for your code to see if it requires preauthorization.*
If so, your provider will take the next steps to request authorization.
* The search tool doesn’t include pharmacy services and products. For pharmacy prior authorization: Pharmacy Services and Products requiring Prior Authorization
Check coverage by phone.
Still wondering if a service is covered? Get your CPT code and call Member Services to confirm: 855-447-2900