Blue Preferred Gold PPO℠ 204 - Two $10 PCP Visits Plan Details for 2020- HealthPocket

Blue Preferred Gold PPO℠ 204 - Two $10 PCP Visits

$447.38/mo

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Zip Code59102
Applicant1/23/1985 Male
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Benefits & Coverage

Insurance TypeACA (Obamacare)
Plan NameBlue Preferred Gold PPO℠ 204 - Two $10 PCP Visits
Plan IDqhp-30751MT0550045
Plan Year2020
Insurance ProviderBlueCross BlueShield of Montana
Metal LevelGold
Plan TypePPO
Deductible$750
Out-of-Pocket Maximum$8,150
Plan Highlights

Costs for Medical Care

Primary Care Visit to Treat an Injury or Illness30% Coinsurance after deductible
Specialist Visit30% Coinsurance after deductible
Laboratory Outpatient and Professional Services30.00% Coinsurance after deductible
X-rays and Diagnostic Imaging30.00% Coinsurance after deductible
Deductible - Family$1500
Out-of-Pocket Maximum - Family$16300

Prescription drug coverage

Generic Drugs$5 Copay
Preferred Brand Drugs$50 Copay
Non-Preferred Brand Drugs$100 Copay
Specialty Drugs$250 Copay

Access to doctors and hospitals

Provider directory URLhttps://public.hcsc.net/providerfinder/search.do?corpEntCd=MT1&residencestate=MT&product=PPO&entryPt=MKT

Hospital services

Emergency Room Services30% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)30% Coinsurance after deductible
Inpatient Physician and Surgical Services30% Coinsurance after deductible

Maternity

Prenatal and Postnatal Care30.00% Coinsurance after deductible

Mental Health

Mental/Behavioral Health Outpatient Services30.00% Coinsurance after deductible
Mental/Behavioral Health Inpatient Services30.00% Coinsurance after deductible

Vision Coverage

Routine Eye Exam for ChildrenNot Applicable
Eye Glasses for Children30.00% Coinsurance after deductible

Exclusions and Limitations

More Included BenefitsHabilitation Services
Chiropractic Care
Durable Medical Equipment
Imaging (CT/PET Scans, MRIs)
Preventive Care/Screening/Immunization
Acupuncture
Rehabilitative Speech Therapy
Rehabilitative Occupational and Rehabilitative Physical Therapy
Well Baby Visits and Care
Transplant
Accidental Dental
Dialysis
Allergy Testing
Chemotherapy
Radiation
Diabetes Education
Prosthetic Devices
Infusion Therapy
Nutritional Counseling
Reconstructive Surgery
Prescription Drugs Other
Other Practitioner Office Visit (Nurse, Physician Assistant)
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)
Outpatient Surgery Physician/Surgical Services
Hospice Services
Infertility Treatment
Urgent Care Centers or Facilities
Home Health Care Services
Inpatient Physician and Surgical Services
Cosmetic Surgery
Skilled Nursing Facility
Outpatient Rehabilitation Services
More Excluded BenefitsHearing Aids
Routine Foot Care
Weight Loss Programs
Dental Check-Up for Children
Abortion for Which Public Funding is Prohibited
Treatment for Temporomandibular Joint Disorders
Long-Term/Custodial Nursing Home Care
Private-Duty Nursing
Bariatric Surgery
PremiumPlan NameDeductible
from $382
Co-op Plus Gold
$750.00Select
from $385
Connected Care Gold
$750.00Select
from $410
Blue Preferred Silver PPO℠ 203
$650.00Select
from $429
Blue Preferred Gold PPO℠ 204 - Two $10 PCP Visits
$750.00Select
from $531
Blue Preferred Silver PPO 203
$650.00Select
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  • Phone Number
    (406) 969-6310
  • Office Locations
    2110 Overland Ave Ste 102
    Billings, MT 59102
2110 Overland Ave Ste 102 Billings MT, 59102
  • What is the Gold Plan?

    ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.

  • How are Gold Plans different than other Obamacare health plans?

    The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.

  • How much does a Gold Plan cost?

    The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.

  • When Can I Enroll in a Gold Plan?

    The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is part of the Health Insurance Innovations, Inc. family of companies (NASDAQ: HIIQ).