Sold outside the marketplace. This plan is bought directly from the insurer, so it is not eligible for a premium tax credit. If your income qualifies you for savings, a marketplace plan at the same price will usually cost you less.

Blue Focus Bronze POS℠ - Champion HSA

Blue Cross and Blue Shield of Montana · 2027 plan year

Expanded BronzeHSA eligible
Ind. deductible
$5,000
Family deductible
$10,000
Ind. OOP max
$11,100
Family OOP max
$22,200

Monthly premiums by age

Rating Area 2

AgeIndividualIndividual + tobacco
Under 15$409$409
21$535$535
30$607$688
40$683$881
50$955$1,262
60$1,451$1,864
64 and over$1,604$2,060

Live premium estimate

$

Benefits & cost sharing

Primary Care

BenefitIn-network
Preventive Care/Screening/ImmunizationNo charge
Primary Care Visit to Treat an Injury or Illness$45.00

Specialist

BenefitIn-network
Specialist Visit50.00% Coinsurance after deductible

Hospital

BenefitIn-network
Emergency Room Services50.00% Coinsurance after deductible
Inpatient Hospital Services (e.g., Hospital Stay)50.00% Coinsurance after deductible
Outpatient Surgery Physician/Surgical Services50.00% Coinsurance after deductible
Urgent Care Centers or Facilities$65.00

Pharmacy

BenefitIn-network
Generic Drugs$5.00
Non-Preferred Brand Drugs45.00% Coinsurance after deductible
Preferred Brand Drugs35.00% Coinsurance after deductible
Specialty Drugs50.00% Coinsurance after deductible

Mental Health

BenefitIn-network
Mental/Behavioral Health Inpatient Services50.00% Coinsurance after deductible
Mental/Behavioral Health Outpatient Services50.00% Coinsurance after deductible

Other

BenefitIn-network
Abortion for Which Public Funding is ProhibitedNot covered
Accidental Dental50.00% Coinsurance after deductible
Acupuncture50.00% Coinsurance after deductible
Allergy Testing50.00% Coinsurance after deductible
Bariatric SurgeryNot covered
Basic Dental Care - AdultNot covered
Basic Dental Care - ChildNot covered
Chemotherapy50.00% Coinsurance after deductible
Chiropractic Care50.00% Coinsurance after deductible
Cosmetic Surgery50.00% Coinsurance after deductible
Delivery and All Inpatient Services for Maternity Care50.00% Coinsurance after deductible
Dental Check-Up for ChildrenNot covered
Diabetes Education50.00% Coinsurance after deductible
Dialysis50.00% Coinsurance after deductible
Durable Medical Equipment50.00% Coinsurance after deductible
Emergency Transportation/Ambulance50.00% Coinsurance after deductible
Eye Glasses for Children50.00% Coinsurance after deductible
Habilitation Services50.00% Coinsurance after deductible
Hearing Aids50.00% Coinsurance after deductible
Home Health Care Services50.00% Coinsurance after deductible
Hospice ServicesNo charge
Imaging (CT/PET Scans, MRIs)50.00% Coinsurance after deductible
Infertility Treatment50.00% Coinsurance after deductible
Infusion Therapy50.00% Coinsurance after deductible
Inpatient Physician and Surgical Services50.00% Coinsurance after deductible
Laboratory Outpatient and Professional Services50.00% Coinsurance after deductible
Long-Term/Custodial Nursing Home CareNot covered
Major Dental Care - AdultNot covered
Major Dental Care - ChildNot covered
Nutritional Counseling50.00% Coinsurance after deductible
Orthodontia - AdultNot covered
Orthodontia - ChildNot covered
Other Practitioner Office Visit (Nurse, Physician Assistant)50.00% Coinsurance after deductible
Outpatient Facility Fee (e.g., Ambulatory Surgery Center)50.00% Coinsurance after deductible
Outpatient Rehabilitation Services50.00% Coinsurance after deductible
Prenatal and Postnatal Care$45.00
Private-Duty NursingNot covered
Prosthetic Devices50.00% Coinsurance after deductible
Radiation50.00% Coinsurance after deductible
Reconstructive Surgery50.00% Coinsurance after deductible
Rehabilitative Occupational and Rehabilitative Physical Therapy50.00% Coinsurance after deductible
Rehabilitative Speech Therapy50.00% Coinsurance after deductible
Routine Dental Services (Adult)Not covered
Routine Eye Exam (Adult)Not covered
Routine Eye Exam for ChildrenNo charge
Routine Foot Care50.00% Coinsurance after deductible
Skilled Nursing Facility50.00% Coinsurance after deductible
Substance Abuse Disorder Inpatient Services50.00% Coinsurance after deductible
Substance Abuse Disorder Outpatient Services50.00% Coinsurance after deductible
Transplant50.00% Coinsurance after deductible
Treatment for Temporomandibular Joint DisordersNot covered
Weight Loss ProgramsNot covered
Well Baby Visits and CareNo charge
X-rays and Diagnostic Imaging50.00% Coinsurance after deductible

Service area

This plan covers 3 geographic areas.

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