Medical Plan
BlueCross BlueShield of Montana (BCBSMT) is the State Plan's medical plan third party administrator. BCBSMT processes medical claims and payments, provides customer service, and sends Explanation of Benefits (EOB) to members showing what has been paid to medical providers and what the member's portion of the cost is. The State decides rates, out-of-pocket costs, and coverage because it is self-funded. The State Plan uses BCBSMT's large nationwide network of in-network providers. Using in-network providers is the best way to control how much you have to pay out-of-pocket for health care.
Medical Plan highlights
- Medical Coverage from BlueCross Blue Shield of Montana
- Basic Vision Coverage from VSP Vision Care
- All members covered on the medical plan are entitled to one routine vision and eye health evaluation each year for a $10 copay at an in network VSP Vision Care provider at no additional cost.
- This benefit is administered by VSP Vision Care, not BCBSMT. Note that if the provider bills as a medical visit, the $10 copay does not apply and normal medical benefits take effect.
- Prescription Drug Coverage from Navitus Health Solutions
- Basic Life Insurance from BlueCross Blue Shield of Montana
- Use of all Montana Health Centers and virtual telehealth services at no cost for State Plan members over 2 years old, operated by Premise Health. (Not available for Medicare retirees.)
- No cost annual health screening provided by Montana Health Centers
find a provider and/or facility and Compare Costs
The Provider Finder from Blue Cross and Blue Shield of Montana (BCBSMT) gives members access to in-network health care providers and helps manage out-of-pocket medical costs. Provider Finder allows members to check and compare costs before their appointment, find and compare doctors or facilities, understand benefits coverage, and learn more about providers.
Find an in-network provider, clinic, hospital and/or facility:
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Go to bcbsmt.com (members may either sign into their BCBSMT account or search as a guest)
- Click “Find Care” tab
- Select “Find a Doctor or Hospital”
- Choose "Blue Preferred PPO" as the plan/network type
Members may create a Blue Access for Members (BAM) account at bcbsmt.com. For assistance creating an account, contact BCBSMT at
24/7 nurse line
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Asthma or chronic health issues
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Dizziness or severe headaches
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High fever
- Cuts or burns
- Sore throat
Plus, when you call, you can access an audio library of more than 1,200 health topics — from allergies to women’s health — with more than 600 topics available in Spanish. Call
Medical Resources
- Behavioral Health Resources
- Employee Assistance Program (available to all members)
- Flu Shots
- Montana Health Center
- Medical Summary of Benefits and Coverage
- Wrap Plan Document
Phone: (888) 901-4989
Preauthorization for Services: (855) 313-8914
24/7 Nurse Line: (877) 213-2565
Helena, Montana 59604-8600
Website: bcbsmt.com
App: BCBSMT
REPRODUCTIVE HEALTH BENEFITS
Prenatal Health Benefits including vitamins, labs, and breastfeeding support.
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Ovia: Fertility, Cycle, Health
- Ovia offers fertility and cycle tracking for individuals and families.
- The menopause support program offers symptom tracking, education, and support for perimenopause and menopause.
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Ovia Pregnancy & Baby Tracker
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Ovia Parenting & Baby Tracker
- Downloaded an Ovia Health app from the Apple App Store or Google Play Store
- During sign-up, choose “I have Ovia Health as a benefit”
- Select "BlueCross and BlueShield of Montana" as your health plan and "State of Montana" as your employer name
- Enter your full name, date of birth, and zip code to verify eligibility
The State Plan provides benefits for reproductive health under the medical plan administered by BCBSMT. Complete information regarding State Plan coverage for reproductive health services can be found in the Wrap Plan Document. Questions regarding State Plan coverage should be directed to BCBSMT at
Hearing Aid Discount
TruHearing makes hearing aids affordable by providing exclusive savings to State Plan members. You can save up to 60% on a pair of hearing aids with TruHearing. What’s more, your dependents and even extended family members are eligible too. Learn more at vsp.com/offers/special-offers/hearing-aids or call
Medical Plan Administrator CHange
On January 1, 2023, BlueCross BlueShield of Montana (BCBSMT) began administering State Plan medical benefits. Previously, from January 1, 2016, through December 31, 2022, Allegiance Benefit Plan Management administered State Plan medical benefits.
If you have questions about medical claims before January 1, 2023, you may contact Allegiance at
No Surprises Act
Effective 1/1/2022, when you receive emergency care or get treated by an out-of-network provider at an in-network hospital or ambulatory surgical center, you are protected from surprise billing or balance billing.
When a covered service is rendered by an out-of-network provider, charges will be paid as if the service were rendered by an in-network provider under any of the following circumstances:
- Charges for an emergency, as defined by the State Plan, limited to only emergency medical procedures necessary to treat and stabilize an eligible injury or illness and then only to the extent that the same are necessary for the member to be transported, at the earliest medically appropriate time to an in-network hospital, clinic, or other facility, or discharged.
- Charges incurred as a result of and related to confinement in or use of an in-network hospital, clinic, or other facility only for out-of-network provider services and providers over whom or which the member does not have any choice in or ability to select.
- Charges for emergency use of an air ambulance.
machine readable files
Effective July 1, 2022, self-funded health plans, like the State Plan, must publicly disclose its in-network rates, and out-of-network allowed amounts and billed charges in a Machine-Readable File in accordance with the Transparency in Coverage Rule (TiC). TiC helps to provide consumers better insight into the cost of services before obtaining care and receiving a bill.
State Plan Machine Readable File
The Machine Readable File is intended to be processed by a computer system; it is not meant to be a generally accessible resource for a State Plan member. The nature of the files means its often over a Terabyte in size and unable to be processed by an internet browser or even the average computer. For further assistance with the Machine Readable File review BCBSMT's implementation guide.
Additional information is coming soon regarding the Transparency in Pricing Self Service tool that is intended to serve as a member-facing resource for accessing similar data.