| |
BLUE CROSS PLANS
HDHP Premier HealthLink »
HDHP Montana Individual Plan »
Blue Evolution »
Montana Youthcare »
(Effective 1st Quarter rates for 2010)
HDHP Premier HealthLink
- Designed to meet the Federal requirements to be offered in conjunction with
Health Savings Account (HSAs).
- Allows you to design your own plan.
- Preventive Services covered at 100% up to $250 per person per year.
- Prescription Drugs covered up to $2,500 per person per year.
- Four healthcare options to choose from:
- Option 1: $3,000 individual deductible with $3,000 maximum out of pocket. Coinsurance at 100% after deductible
- Option 2: $3,000 individual deductible with $4,000 maximum out of pocket. Coinsurance at 70% after deductible
- Option 3: $3,000 individual deductible with $5,000 maximum out of pocket. Coinsurance at 50% after deductible.
- Option 4: $5,950 individual deductible with $5,950 maximum out of pocket. Coinsurance at 100% after deductible
For details, phone 406-541-8080
HDHP Premier HealthLink Details (PDF 252KB)
Individual Application (PDF 332KB)
|
| |
Premiums: |
Age |
Option I |
Option II |
Option III |
Option IV |
0-24 |
110.00 |
93.00 |
88.00 |
83.00 |
25-29 |
125.00 |
100.00 |
95.00 |
89.00 |
30-34 |
139.00 |
107.00 |
101.00 |
95.00 |
35-39 |
160.00 |
121.00 |
114.00 |
106.00 |
40-44 |
180.00 |
134.00 |
126.00 |
117.00 |
45-49 |
221.00 |
162.00 |
152.00 |
140.00 |
50-54 |
258.00 |
186.00 |
174.00 |
160.00 |
55-59 |
300.00 |
214.00 |
200.00 |
184.00 |
60 plus |
351.00 |
248.00 |
232.00 |
212.00 |
1 Child |
53.00 |
40.00 |
37.00 |
35.00 |
2 Children + |
106.00 |
80.00 |
74.00 |
70.00 |
|
HDHP Montana Individual Plan
- Designed to meet the Federal requirements to be offered in conjunction with
Health Savings Account (HSAs).
- Two healthcare options to choose from:
- Option 1: $2,500 individual deductible/$5,000 family deductible
- Option 2: $5,000 individual deductible/$10,000 family deductible
No co-payments
For details, phone 406-541-8080
HDHP Montana Individual Details (PDF 305KB)
Individual Application (PDF 332KB)
|
| |
Premiums: |
Age |
Option I |
Option II |
0-24 |
142.67 |
110.95 |
25-29 |
153.35 |
119.25 |
30-34 |
162.69 |
126.52 |
35-39 |
192.05 |
149.35 |
40-44 |
233.44 |
181.54 |
45-49 |
290.85 |
226.19 |
50-54 |
349.58 |
271.86 |
55-59 |
420.26 |
320.47 |
60 plus |
493.95 |
376.79 |
1 Child |
41.48 |
32.26 |
2 Children + |
82.96 |
64.52 |
|
Blue Evolution
|
Benefits of the Blue Evolution Plan include:
- Low Premiums
- Up to $750 in Primary Care Benefit
- Hospitalization and surgery
- Emergency care and outpatient services
- Office visits, lab tests, physician charges
- Allows you to create your own plan and choose your own deductible, coinsurance, and out-of-pocket amount
- Includes prescription drug coverage
For details, phone 406-541-8080
Blue Evolution Plan Details (PDF
143KB)
Individual Application (PDF 332KB)
|
There are many different plan combinations, so please download the PDF to view rates. |
Montana YouthCare
|
Benefits of the Montana YouthCare plan include:
- Low Premiums
- $400 for primary care
- Hospitalization and surgery
- Emergency care and outpatient services
- Pharmacy benefit
- A health plan just for children from 3 months to 19 years of age
For details, phone 406-541-8080
Montana YouthCare Details (PDF
136KB)
Montana YouthCare Application (PDF 926KB)
|
Age |
Monthly Premium
per Person |
0-5 years |
141.01 |
6-14 |
110.05 |
15-18 |
160.51 |
|
|
|
 |
|
 |
| © Gagliardi Insurance Services, LLC | Disclaimer
& Privacy Policy