Montana health plan · 2025

Blue Preferred Silver PPO℠ 308 · 30751MT0550061

Blue Cross Blue Shield of Montana offers this marketplace health insurance plan (Plan ID 30751MT0550061) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: PPO CSR: Zero Cost Sharing Plan Variation Issuer: Blue Cross Blue Shield of Montana
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

CMS AV Calculator output: 100.00% (0.00% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$387 – $1519

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care $0.00, 0.00%
Specialist $0.00, 0.00%
HSA Not eligible

Drug tiers

Generic $0.00, 0.00%
Preferred brand $0.00, 0.00%

View formulary tiers

$531 / mo before subsidies

≈ $6368 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1682 / mo before subsidies

≈ $20180 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$2037 / mo before subsidies

≈ $24440 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1294 / mo before subsidies

≈ $15532 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Montana). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Zero Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

$0.00, 0.00%

Emergency Room Services

$0.00, 0.00%

Durable Medical Equipment

$0.00, 0.00%

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 30751MT0550061
Coverage year 2025
State Montana
Issuer Blue Cross Blue Shield of Montana
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 30751MT0550061-02
Available variants

Standard Off Exchange Plan · 30751MT0550061-00

Standard On Exchange Plan · 30751MT0550061-01

Open to Indians below 300% FPL · 30751MT0550061-02

Open to Indians above 300% FPL · 30751MT0550061-03

73% AV Silver Plan · 30751MT0550061-04

87% AV Silver Plan · 30751MT0550061-05

94% AV Silver Plan · 30751MT0550061-06
Last plan update Tue, 22 Oct 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Montana 11471
PCPs in Montana 1152
Telehealth support Data pending
Nationwide providers 15382
11,471 doctors statewide 1,152 PCPs 48 OB/GYN

Provider network(s)

Providers Montana All US states
All 11471 15382
PCP 1152 1564
Allergy 2 3
OB/GYN 48 70
Dentists 62 280

Drug coverage overview

3,942 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC 2,303
NON-PREFERRED-SPECIALTY 900
NON-PREFERRED-BRAND 739
Prior authorization Drugs
Required 946
Not Required 2,996
Step therapy Drugs
Required 28
Not Required 3,914
Quantity limits Drugs
Has Limit 1,667
No Limit 2,275

Customer highlights

What stands out for members

  • Issuer: Blue Cross Blue Shield of Montana · Plan ID 30751MT0550061 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 30751MT0550061-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 10.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Diabetes Education

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

[Non-HDHP plans] First $250 at 100% of allowable fee, then deductible, copayment, or coinsurance apply. [HDHP plans] After the plan deductible is satisfied, the first $250 will be paid at 100%. Then, standard benefits apply.

Exclusions: nan

Home Health Care Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 180.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Laboratory Outpatient and Professional Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Preventive Care/Screening/Immunization

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Primary Care Visit to Treat an Injury or Illness

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When services are provided via telehealth, cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Rehabilitative Speech Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Specialist Visit

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Urgent Care Centers or Facilities

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

X-rays and Diagnostic Imaging

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Childbirth/delivery professional services are subject to your Medical EHB Deductible/Maximum Out of Pocket for Medical EHB benefits, if applicable.

Exclusions: nan

Dialysis

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Durable Medical Equipment

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Emergency Room Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Emergency Transportation/Ambulance

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Emergency Transportation/Ambulance is covered when your condition is such that an ambulance is necessary. Benefits will not be provided for long distance trips or for use of an ambulance because it is more convenient than other transportation when rendered in connection with a covered Inpatient admission or covered Emergency Accident Care or covered Emergency Medical Care or if it does not meet the definition of Medically Necessary for non-emergency medical situations. Benefits will not be provided for long distance trips. See benefit book for details.

Exclusions: nan

Hospice Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Inpatient Hospital Services (e.g., Hospital Stay)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Inpatient Physician and Surgical Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Mental/Behavioral Health Inpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office. When services are provided via telehealth or in an outpatient facility setting , cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office. When services are provided via telehealth or in an outpatient facility setting , cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Outpatient Rehabilitation Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Radiation

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Skilled Nursing Facility

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 60.0 Days per Benefit Period

nan

Exclusions: nan

Substance Abuse Disorder Inpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office. When services are provided via telehealth or in an outpatient facility setting , cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a setting other than office. When services are provided via telehealth or in an outpatient facility setting , cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Transplant

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 1.0 Item(s) per 3 Years

1 hearing device every 3 years for dependents age 18 & younger. Medically Necessary cochlear implants may be covered per Medical Policy.

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

First prenatal visit is subject to the Office Visit charge. All subsequent prenatal care is covered under delivery for maternity care.

Exclusions: nan

Routine Eye Exam for Children

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 1.0 Visit(s) per Benefit Period

nan

Exclusions: nan

Well Baby Visits and Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Certain generic drugs may have a higher cost share amount than is listed on this page. When prescription drugs are bought from an out of network pharmacy additional charges may apply. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Non-Preferred Brand Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When prescription drugs are bought from an out of network pharmacy additional charges may apply. You may be responsible for paying the difference between the cost of a brand name drug and generic drug, if a generic was also available. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Preferred Brand Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When prescription drugs are bought from an out of network pharmacy additional charges may apply. You may be responsible for paying the difference between the cost of a brand name drug and generic drug, if a generic was also available. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Specialty Drugs

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Certain specialty drugs may have a higher cost share amount than is listed on this page. If prescription drugs are bought from an out of network pharmacy additional charges may apply. You may be responsible for paying the difference between the cost of a brand name drug and generic drug, if a generic was also available. See benefit book for details.

Exclusions: Coverage for certain agents or medication categories may also be excluded. These include, but are not limited to: Weight Loss, Sexual Dysfunction, OTC Equivalents, Fertility and Compounds. Any drug not found on the drug list is not covered. See benefit book for further details.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Member cost share may increase when using a Hospital-based facility for these services. See benefit booklet for details.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Also covered under preventive health care.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

Coverage details pending

Covered for Preventive services only.

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 12.0 Visit(s) per Benefit Period

Member cost share may increase when using a setting other than office. Please see Member Booklet for details.

Exclusions: nan

Allergy Testing

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

When services are provided in an office setting, cost shares may vary. Please see benefit booklet for details.

Exclusions: nan

Bariatric Surgery

Coverage details pending

nan

Exclusions: nan

Cosmetic Surgery

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Only covered when medically necessary.

Exclusions: nan

Eye Glasses for Children

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Limit: 1.0 Item(s) per Benefit Period

One pair of glasses (frames and lenses) or one pair of contacts per Benefit Period.

Exclusions: nan

Gender Affirming Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Habilitation Services

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Infertility Treatment

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Covered for the diagnosis of infertility and artificial insemination.

Exclusions: Excludes invitro and prescription drugs for the treatment of infertility.

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

nan

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

$0.00, 0.00%
Tier 1 in-network $0.00, 0.00%
Tier 2 in-network $0.00, 0.00%
Out-of-network $0.00, 0.00%

Covered when medically necessary

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

Coverage details pending

Surgical treatment is covered as any other surgery.

Exclusions: nan

Variant attributes

Blue Preferred Silver PPO℠ 308 · Variant 30751MT0550061-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

30751MT055

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

30751MT0550061-02

Plan Marketing Name

Blue Preferred Silver PPO℠ 308

Plan Variant Marketing Name

Blue Preferred Silver PPO℠ 308

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

30751

Issuer Marketplace Marketing Name

Blue Cross and Blue Shield of Montana

Market Coverage

Individual

Multiple In Network Tiers

Yes

National Network

No

Network ID

MTN009

Out of Country Coverage

Yes

Out of Country Coverage Description

This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Emergency and Urgent Care services. Non-emergency services received outside the service area may be covered with an approved waiver from the Plan.

Service Area ID

MTS019

State Code

MT

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

1.0

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Drug EHB Deductible, In Network (Tier 2), Default Coinsurance

0.00%

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

No

Medical Drug Maximum Out of Pocket Integrated

Yes

Medical EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Medical EHB Deductible, In Network (Tier 2), Default Coinsurance

0.00%

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 2), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

$0

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MTF014

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 1), Individual

$0

Drug EHB Deductible, In Network (Tier 2), Family Per Group

$0 per group

Drug EHB Deductible, In Network (Tier 2), Family Per Person

$0 per person

Drug EHB Deductible, In Network (Tier 2), Individual

$0

Drug EHB Deductible, Out of Network, Family Per Group

$0 per group

Drug EHB Deductible, Out of Network, Family Per Person

$0 per person

Drug EHB Deductible, Out of Network, Individual

$0

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

85%

Import Date

2024-10-22 20:01:41

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Medical EHB Deductible, Combined In/Out of Network, Individual

$0

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$0

Medical EHB Deductible, In Network (Tier 2), Family Per Group

$0 per group

Medical EHB Deductible, In Network (Tier 2), Family Per Person

$0 per person

Medical EHB Deductible, In Network (Tier 2), Individual

$0

Medical EHB Deductible, Out of Network, Family Per Group

$0 per group

Medical EHB Deductible, Out of Network, Family Per Person

$0 per person

Medical EHB Deductible, Out of Network, Individual

$0

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

PPO

QHP/Non QHP

Both

Second Tier Utilization

15%

Source Name

SERFF

Plan ID

30751MT0550061

Unique Plan Design

No

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Montana?

Blue Preferred Silver PPO℠ 308 (30751MT0550061) is a Silver PPO from Blue Cross Blue Shield of Montana in Montana for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Preferred Silver PPO℠ 308 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Preferred Silver PPO℠ 308 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Preferred Silver PPO℠ 308 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Preferred Silver PPO℠ 308?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Blue Preferred Silver PPO℠ 308?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: This plan does not cover any services and/or supplies provided to a member outside of the United States, if the member traveled to the location for the purposes of receiving medical services, supplies, or drugs.

Does Blue Preferred Silver PPO℠ 308 cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Emergency and Urgent Care services. Non-emergency services received outside the service area may be covered with an approved waiver from the Plan.

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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