Montana Health Co-Op

PLUS IND SILVER MT

Prescription Drug Information

Inpatient Coverage

Emergency and Urgent Care

Major Dental Care

Links

Plan Overview

Combined Medical and Drug Deductible	Individual: $8,000.00 Family: $16,000 Per Person: $8,000
Combined Medical and Drug Out of Pocket Maximum	Individual: $8,550.00 Family: $17,100 Per Person: $8,550

Office Visit

Primary Doctor	CoPay: $10.00 CoInsurance: Not Applicable Covered: Covered
Specialist	CoPay: $80.00 Copay after deductible CoInsurance: Not Applicable Covered: Covered

Prescription Drug Information

Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 30.00% Covered: Covered
Non Preferred Brand Drugs	CoPay: Not Applicable CoInsurance: 40.00% Covered: Covered
Generic Drugs	CoPay: Not Applicable CoInsurance: 20.00% Covered: Covered
Specialty Drugs	CoPay: Not Applicable CoInsurance: 50.00% Covered: Covered

Inpatient Coverage

Hospital Services	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered
Inpatient Services	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered

Emergency and Urgent Care

Emergency Room	CoPay: Not Applicable CoInsurance: 50.00% Coinsurance after deductible Covered: Covered
Urgent Care Facility	CoPay: $120.00 CoInsurance: Not Applicable Covered: Covered

Maternity

Labor and Delivery Hospital Stay	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered
Pre and Postnatal Office Visit	CoPay: Not Applicable CoInsurance: 40.00% Coinsurance after deductible Covered: Covered

Vision

Routine Eye Exams For Children

CoPay: No Charge
CoInsurance: Not Applicable
Covered: Covered
Limit Quantity: 1
Limit Unit : Visit(s) per Benefit Period
Benefit Explanation: The following services only may be provided by a licensed ophthalmologist or optometrist operating within the scope of his or her license, or a dispensing optician to Members under 19 years of age: One Routine vision exam per Benefit Period.

Major Dental Care

Routine Dental Checkups for Children

Covered: Not Covered

Related Articles

You may be interested in these relevant articles from across the HealthMarkets.com network.

6 Dental Emergencies and How to Deal With Them

You wake up with a toothache. Your first thought: Ouch! Your next thought is:…Read More

Read More

Sick With a Cold, Flu, or Allergies? Symptoms + Tips to Get Well

Is it a cold, flu, or allergies? You’re feeling pretty lousy. You’ve got sniffles,…Read More

Read More

What Is a Qualifying Life Event, and How Might It Help You Get Health Benefits?

Have you recently had a qualifying life event? “A qualifying what?” you might ask.…Read More

Read More