Blue Cross and Blue Shield of Montana
Blue Preferred Gold PPO℠ 204
Plan Overview
Combined Medical and Drug Deductible |
|
Combined Medical and Drug Out of Pocket Maximum |
|
Office Visit
Primary Doctor |
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Specialist |
|
Prescription Drug Information
Preferred Brand Drugs |
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Non Preferred Brand Drugs |
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Generic Drugs |
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Specialty Drugs |
|
Inpatient Coverage
Hospital Services |
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Inpatient Services |
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Emergency and Urgent Care
Emergency Room |
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Urgent Care Facility |
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Maternity
Labor and Delivery Hospital Stay |
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Pre and Postnatal Office Visit |
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Vision
Routine Eye Exams For Children |
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Major Dental Care
Routine Dental Checkups for Children |
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Routine Dental Checkups for Adults |
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Basic Dental Care - Adult |
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Basic Dental Care - Child |
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Major Dental Care - Adult |
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Major Dental Care - Child |
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- HealthMarkets Insurance Agency d/b/a Insphere Insurance Solutions, Inc is an independent, authorized agent for Blue Cross and Blue Shield of Montana.
- Blue Cross and Blue Shield of Montana: A Division of Health Care Service Corporation, a Mutual Legal Reserve Company, an Independent Licensee of the Blue Cross and Blue Shield Association.
- Effective dates are available on the first of the month only, unless otherwise required by law. Applications must be received by Blue Cross and Blue Shield of Montana within the defined enrollment period to be accepted.
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