Medical - Benefits Division

• Medical Coverage from Blue Cross 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 Vision Service Plan (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 Blue Cross 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

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.

1. Go to bcbsmt.com (members may either sign into their BCBSMT account or search as a guest)
2. Click “Find Care” tab
3. Select “Find a Doctor or Hospital”
4. 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 (888) 901-4989.

State Plan members have access to BCBSMT's nurse hotline to answer your health questions and give general health tips 24 hours a day, seven days a week. The toll-free Nurse Line can help you or a covered family member get answers to health problem questions, such as:

• 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.

Ovia Health Apps

Ovia Health Apps offer support for reproductive health, starting a family, having a healthy pregnancy, balancing life as a parent, and managing menopause. The three Ovia Health apps are included as part of your State Plan medical benefit and available in the Apple or Google Play store.

• Ovia Fertility, Cycle, & Health App: Choose your goal: cycle tracking, trying to conceive, or managing menopause and the Ovia app will customize your experience to deliver personalized insights, tips, and content.

• Ovia Pregnancy App: Find answers to all your prenatal questions - read weekly updates, find symptom relief, learn what’s safe to eat, share bump pictures, and try the baby name feature. Ovia Pregnancy is your pocket companion for each trimester (and beyond).

• Ovia Parenting & Baby Tracker App: Track baby’s day with Ovia Parenting so you always know when the next feeding, nap, or diaper change is coming. Record important developmental milestones and family pictures securely in the app.

Get Started with Ovia

1. Download the app that’s right for you
2. Select “I have Ovia Health as a benefit” during signup
3. Enter “BCBSMT” as your health plan
4. Enter “State of Montana” as your employer name (optional)

Prenatal Health Benefits -- THIS LINK NEEDS TO BE UPDATED WHEN THE CONTENT IS MIGRATED including vitamins, labs, and breastfeeding support are also available.

Details on reproductive health services covered by the State Plan are in the Wrap Plan Document -- THIS LINK NEEDS TO BE UPDATED WHEN THE CONTENT IS MIGRATED.

• 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 (877) 396-7194.
• Dental Dental also offers State Plan members access to preferred pricing on hearing aids through Amplifon Hearing Services.Amplifon Hearing Services.

If you have been diagnosed with a serious illness, long-term health condition, or are recovering from a severe injury, BCBSMT's Care Management team can help you to find treatment and support that is right for you based on your health needs. In certain situations, members may be eligible to work one-on-one with a case manager. A case manager is a specially trained professional, generally a registered nurse or social worker.

• Navigating the health care system
• Assistance identifying, implementing, and monitoring health care needs
• Education on health condition and medication(s)
• Minimize barriers to receiving medical care
• Finding community resources
• Coordination of services such as home health, skilled nursing facilities, inpatient rehabilitation, hospice, durable medical equipment, and more
• Assistance with care plans and questions

Examples of qualifying conditions include oncology, high risk pregnancy, transplant management, palliative care, HIV and aids, chronic kidney disease, Alzheimer’s, behavioral health, and more. You can engage with care managers in two ways. The first one is to simply answer the phone - care managers work to identify members who may qualify and reach out to them directly. The second way is to call BCBSMT and ask to be referred to a case manager.

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.

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.

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 BlueCross BlueShield Montana'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.

• 2025 Medical Summary of Benefits and Coverage (SBC)
• 2026 Medical Summary of Benefits and Coverage (SBC)
• Behavioral Health Resources
• Employee Assistance Program (available to all members)
• Flu Shots (see below on this page)
• Wrap Plan Document
• Montana Health Centers
• One Health Clinics

The FDA recommendations for COVID vaccines changed starting in fall 2025.

Montana Health Centers and Off-Site Events

Montana Health Centers appointment information and instructions

Anaconda, Billings, Butte, Helena, Missoula

• Flu vaccine is available for State Plan members 4 years of age and older including Medicare Retirees.
• COVID vaccines are available to eligible State Plan members (except Medicare Retirees) after completing an appointment with a Health Center provider.
  • Your personal health needs will determine your eligibility for the COVID vaccine. You can schedule a COVID-19 visit using the directions in the next bullet.

One Health Clinics

One Health Clinics information

Ashland, Chinook, Glendive, Hardin, Harlem, Lewistown, Miles City

• Flu and/or COVID vaccines are available for eligible State Plan members as recommended by the FDA including Medicare Retirees. Vaccine availability varies based on location, high-dose, egg free, etc.
  • Call your One Health Clinic for availability.
• If you only need a flu and/or COVID vaccine and no other services, please call the One Health Clinic of your choice for details.
• If you are an established patient, you may ask to add a flu and/or COVID vaccine when checking in for another scheduled One Health Clinic appointment.

Vaccination Timing

It is most effective to get the flu and/or COVID shot in early fall as recommended by your medical provider. If you have a special circumstance that requires you to get your vaccinations earlier, please contact the Montana Health Center or a One Health Clinic of your choice for details. You may also reach out to an in-network pharmacy or a provider.

High Dose Flu Vaccine:

The high-dose flu vaccine is not available at the Montana Health Center or at Montana Health Center off-site vaccination clinics. If you need a high dose flu vaccine, you will need to get it from a participating pharmacy. The State Plan's pharmacy administrator Navitus can assist you with finding an in-network pharmacy for the high dose flu vaccine.

Can I Get the Flu and COVID Vaccine at the Same Appointment?

Possibly, but you'll need to have an appointment with a health center provider to discuss your vaccine needs. Medicare retirees may only receive a flu vaccine at the Montana Health Centers.

Where Should I Get My Vaccination?

Where you get your flu and COVID vaccine affects your out-of-pocket cost and the cost to the State Plan. The options listed below are in order from least expensive to most expensive.

Least Expensive: Montana Health Centers, Montana Health Center off-site events or One Health Clinics - no cost to you, best value for the State Plan. See above for age restrictions.

The best option for those who can't attend the Montana Health Center or the One Health Clinics: In-network pharmacy. No additional cost to you but more expensive for the State Plan. To find an in-network pharmacy in your area, please contact Navitus, our pharmacy plan administrator.

An In-Network provider: You pay a $25 office visit copay, this is most expensive for the State Plan. The State Plan pays for your visit and the vaccine.

Out-of-Network Pharmacy or Provider: You pay the full cost of the vaccine(s). Most expensive for you.

Accommodations

HCBD will make reasonable accommodations for any known disability that may interfere with a person's ability to participate in wellness events, programs, or public meetings. Please contact HCBD at least three days prior to the event, program, or meeting to allow adequate time for us to make appropriate accommodations.

Contact Information

Phone: (888) 901-4989

Preauthorization for Services: (855) 313-8914

24/7 Nurse Line: (877) 213-2565

Website: bcbsmt.com

App: BCBSMT

Mailing Address:

BlueCross BlueShield of Montana

P.O. Box 660255

Dallas, TX 75266-0255