• $5950 Deductible

  100% coinsurance

• $3000/$5000 Deductible

  50% coinsurance

• $3000/$4000 Deductible

  70% coinsurance

• $3000 Deductible

  100% coinsurance

• Age	Applicant	Spouse	Dependent
  0-5	$61.72	$101.65	$61.72
  6-10	$49.37	$101.65	$49.37
  11-14	$52.33	$101.65	$52.33
  15-18	$58.62	$101.65	$58.62
  19-24	$107.01	$107.01	$107.01
  25-29	$114.75	$107.55	$114.75
  30-34	$122.48	$109.59	$122.48
  35-39	$136.66	$125.06	$136.66
  40-44	$150.86	$140.54	$150.86
  45-49	$180.50	$165.04	$180.50
  50-54	$206.29	$185.67	$206.29
  55-59	$237.24	$211.46	$237.24
  60-120	$273.34	$242.42	$273.34

• Age	Applicant	Spouse	Dependent
  0-5	$65.44	$107.78	$65.44
  6-10	$52.35	$107.78	$52.35
  11-14	$55.49	$107.78	$55.49
  15-18	$62.15	$107.78	$62.15
  19-24	$113.46	$113.46	$113.46
  25-29	$122.48	$114.27	$122.48
  30-34	$130.22	$117.33	$130.32
  35-39	$146.98	$135.38	$146.98
  40-44	$162.46	$152.15	$162.46
  45-49	$195.98	$180.51	$195.98
  50-54	$224.34	$203.71	$224.34
  55-59	$257.88	$232.10	$257.88
  60-120	$299.14	$268.19	$299.14

• Age	Applicant	Spouse	Dependent
  0-5	$69.16	$113.92	$69.16
  6-10	$55.33	$113.92	$55.33
  11-14	$58.65	$113.92	$58.65
  15-18	$65.69	$113.92	$65.69
  19-24	$119.92	$119.92	$119.92
  25-29	$128.95	$121.00	$128.95
  30-34	$137.97	$125.07	$137.97
  35-39	$156.02	$144.41	$156.02
  40-44	$172.79	$162.48	$172.79
  45-49	$208.89	$193.43	$208.89
  50-54	$239.84	$219.22	$239.84
  55-59	$275.95	$250.16	$275.95
  60-120	$319.79	$288.85	$319.79

• Age	Applicant	Spouse	Dependent
  0-5	$81.81	$134.75	$81.81
  6-10	$65.45	$134.75	$65.45
  11-14	$69.38	$134.75	$69.38
  15-18	$77.70	$134.75	$77.70
  19-24	$141.85	$141.85	$141.85
  25-29	$161.20	$147.00	$161.20
  30-34	$179.24	$166.35	$179.24
  35-39	$206.32	$194.72	$206.32
  40-44	$232.12	$221.81	$232.12
  45-49	$284.99	$269.53	$284.99
  50-54	$332.70	$312.09	$332.70
  55-59	$386.87	$361.09	$386.87
  60-120	$452.65	$421.70	$452.65

These are preferred non-tobacco rates

Unlimited Lifetime Coverage
Unlimited Preventive Benefits: PPACA Info - Medical Policy

A HSA (Health Savings Account) qualified High Deductible Health plan that:

• Preventative Health Care
• Low Premiums
• 4 Plans to Choose From
• Health Savings Account (HSA)

Customize the plan that is right for you.

View list of BCBS participating providers. Select "Blue Cross and Blue Shield of Montana" from the "Choose a Plan" drop-down menu.