Medical Benefits
The State of Montana is a self-funded group that contracts with administrators to process claims and provide customer service for each benefit. The administrators can assist members with their claim issues as well as general benefit clarification. The State of Montana offers a benefit health plan and two managed care plans to choose from:
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Eligibility
Employees, legislators, retirees, COBRA members, and eligible dependents (spouse, domestic partner, and children) are eligible for the medical plan. Employees are required to be enrolled in medical coverage unless they waive the entire benefit package.
Right to Waive Benefits
Any employee can waive their right to participate in the State’s health care plan and forego state contribution. If you waive the state plan coverage, you do not give up your rights as an eligible state employee to automatic enrollment in core benefits at a later date. This automatic enrollment does not apply to dependents. The waiting period for coverage of a pre-existing medical condition may apply.
2012 Payment for Benefits
| Monthly Payment for Benefits/Per Paycheck Contributions | ||||
| New West | Blue Choice | Traditional | ||
| Employee | $682/$341 | $682/$341 | $696/$348 | |
| Employee & Spouse | $856/$428 | $856/$428 | $870/$435 | |
| Employee & Children | $769/$385 | $769/$385 | $783/$392 | |
| Employee & Family | $908/$454 | $908/$454 | $922/$461 | |
| Joint Core | $771/$359 | $771/$359 | $730/$365 | |
| Monthly Payment for Benefits | ||||
| New West | Blue Choice | Traditional | ||
| Retiree | $691 | $691 | $705 | |
| Retiree & Spouse | $944 | $944 | $958 | |
| Retiree & Children | $830 | $830 | $844 | |
| Retiree & Family | $967 | $967 | $982 | |
| Retiree & Medicare spouse | $795 | $795 | $810 | |
| Retiree & Medicare spouse and child | $845 | $845 | $859 | |
| Monthly Payment for Benefits | ||||
| New West | Blue Choice | Traditional | ||
| Medicare Retiree | $285 | $285 | $291 | |
| Medicare Retiree & Spouse | $566 | $566 | $578 | |
| Medicare Retiree & Children | $466 | $466 | $475 | |
| Medicare Retiree & Family | $592 | $592 | $604 | |
| Medicare Retiree & Medicare spouse | $496 | $496 | $506 | |
| Medicare Retiree & Medicare spouse and child | $507 | $507 | $518 | |
The Internal Revenue Service requires the State of Montana to apply the proper tax treatment (before or after tax) to payments for benefits paid for a spouse or domestic partner enrolled in medical benefits. The portion of your payment for benefits that is deducted on a before or after tax basis depends on whether your spouse or domestic partner is qualified or non-qualified for tax purposes. To help you determine your spouse or domestic partner's tax status, we have made several reference materials available.
Medical Plan Cost Comparison
This cost comparison shows how each medical plan would process the same services and what costs the plan member would be responsible for paying. The example is cumulative with respect to deductibles and coinsurance. The first line of each example shows the total costs to the member. The next three lines show how that cost is divided between copays, costs applied to the deductible, and coinsurance costs. It does not include payment for benefits or contribution costs. These examples assume the services were for one member. This is simply an example for ease of plan comparison and is not a guarantee that similar services will process identically.
Traditional Plan
The Traditional indemnity plan is administered by Blue Cross and Blue Shield of Montana (BCBSMT), which processes claims and payments, provides customer service, and sends notices to members in the form of an Explanation of Benefits (EOB). BCBSMT also contracts with health care providers to offer plan members a provider network – providers who have agreed to accept certain plan allowances. A description of the traditional plan benefits is availalbe in the Summary Plan Document, within the Indemnity Medical Plan Benefits section.
How the Plan Works
Plan members obtain medical services from a covered health care provider. If the provider is a BCBS provider, they will submit a claim for the plan member. BCBS will then process the claim and send an EOB to the plan member, indicating their payment responsibilities (deductible and/ or coinsurance costs) to the provider. The plan then pays the remaining allowable charges, which the provider accepts as full payment. Verify a provider is currently participating by calling BCBS or checking their website. If the provider is not a BCBS provider, you may be required to pay the entire fee and file a claim for reimbursement. There may also be charges above the allowable fee that you will have to pay.
Preferred Facility Services
Plan members may obtain covered medical services from any covered hospital. However, certain hospitals and surgical centers offer services for members on the Traditional Plan that are subject to lower coinsurance rates. Refer to the Participating Facilities for a list of these facilities. For your protection, it is strongly recommended that you pre-certify all inpatient hospital services by calling your plan’s customer service phone number, listed at the bottom of this page.
Out-of-State Services
The Blue Card Program lets plan members tap into BCBS plan networks in other states. If the out-of-state provider is a member of the BCBS network, the member will receive in-network benefits.
Managed Care Plans
Blue Choice and New West Health Plan are managed care plans offered through the Montana Association of Health Care Purchasers. The plans generally provide the same package of benefits, but there are differences in contribution costs, providers, and requirements for receiving services. Each managed care plan releases a supplement to describe the benefits offered.
How they Work
The benefits of managed care plans depend on the health care provider that the member uses. When a network provider is used, the in-network benefits apply. When an out-of-network provider is used, out-of-network benefits apply (unless a required plan authorization is obtained).
In-Network Benefits
Anytime a network provider is used, the in-network (highest level of benefit) is applied. For a complete listing of all in-network providers including specialists, check the plan administrator’s website or call their customer service number. An authorization is not required for the plan member to see an in-network specialist. Plan authorizations are required to see an out-of-network specialist and receive the plan’s in-network benefits.
BCBS has expanded its in-network providers to include all BCBS PPO providers throughout the U.S. and the world, so any BCBS provider is now considered in-network. In the past, SOM health plan members only received in-network benefits with the much smaller group of providers who are members of the BCBS HMO Montana network. Out-of-network benefits will not apply for Blue Choice members unless the provider is not a BCBS provider.
Out-of-Network Benefits
When plan members obtain services from providers who are not part of the plan’s network, without a required authorization, costs will be more because a separate and higher deductible, a higher coinsurance rate, and a separate out-of-pocket maximum apply.
To obtain an authorization to see an out-of-network provider from New West, the member must contact the plan administrator directly.
Major Plan Differences
The major difference in the managed care plans are the participating providers. Refer to the plan administrator for a listing of the most current participating providers.
Out-of-State Services
Plan members may receive in-network benefits for medical services in other states for a medical emergency for New West. For Blue Choice members, even out of state providers are in-network if they are in the BCBS PPO network. For non-emergency services out-of-state, please contact your plan administrator for specific provider network information.
Service Areas
Traditional Plan and
The Traditional Plan and Blue Choice are available to members living anywhere in Montana or throughout the world. The plans include services of any covered providers. However, providers who are not BCBS member providers may charge more for a service than the plan allows, leaving you responsible for paying the difference.
New West Health Plan
The managed care plan New West Health Plan is available to members living in certain areas in Montana.
This plan is available in most of Western Montana and many other towns including Bozeman, Billings, Great Falls, Havre, Libby, Miles City, and Lewistown.
Contact the Administrators
Blue Cross and Blue Shield Customer Service
(800) 423-0805 or (406) 444-8315
New West Health Plans
(800) 290-3657 or (406) 457-2200
