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
• Basic Vision coverage
  • 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
• Use of all Montana Health Centers  and virtual telehealth services at no cost for State Plan members over 2 years old. (Not available for Medicare retirees.) 
• No cost annual health screening  provided by Montana Health Centers (operated by Premise Health)

find an in-network provider and/or facility

1. Go to bcbsmt.com
2. Click “Find Care” in the top bar and select “Find a Doctor or Hospital”
3. Click “Search as a Guest”
4. Choose "Blue Preferred PPO" as the plan/network type

If you have BCBSMT specific questions call (888) 901-4989 or visitbcbsmt.com.

24/7 nurse line 

• Asthma or chronic health issues
• Dizziness or severe headaches
• 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 (877) 213-2565 for assistance.

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 completed a pre-authorization for services with Allegiance and that service will be taking place after December 31, 2022, those prior authorizations have been loaded into the BCBSMT system. Contact BCBSMT at (855) 313-8914 to verify your pre-authorization has been transferred.

If you have questions about medical claims before January 1, 2023, you may contact Allegiance at (855) 999-1057 orinquire@askallegiance.com. 

Hearing Aid Discount 

TruHearing makes hearing aids affordable by providing exclusive savings to Sate 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 (877) 396-7194.

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:

1. 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.
2. 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.
3. 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.