Tattory Insurance Blue Cross/Blue Shield - Health Plans

$3000 Deductible $3000/$4000 Deductible $3000/$5000 Deductible $5950 Deductible	Premiums
Age	Rate	Spouse rate
Under 25	$113.30	$113.30
25-29	$128.75	$117.42
30-34	$143.17	$132.87
35-39	$164.80	$155.53
40-44	$185.40	$177.16
45-49	$227.63	$215.27
50-54	$265.74	$249.26
55-59	$309.00	$288.40
60 plus	$361.53	$336.81
1 Child	$54.59
2 Children +	$109.18

$3000 Deductible $3000/$4000 Deductible $3000/$5000 Deductible $5950 Deductible	Premiums
Age	Rate	Spouse rate
Under 25	$95.79	$95.79
25-29	$103.00	$91.67
30-34	$110.21	$99.91
35-39	$124.63	$115.36
40-44	$138.02	$129.78
45-49	$166.86	$154.50
50-54	$191.58	$175.10
55-59	$220.42	$199.82
60 plus	$255.44	$230.72
1 Child	$41.20
2 Children +	$82.40

$3000 Deductible $3000/$4000 Deductible $3000/$5000 Deductible $5950 Deductible	Premiums
Age	Rate	Spouse rate
Under 25	$90.64	$90.64
25-29	$97.85	$86.52
30-34	$104.03	$93.73
35-39	$117.42	$108.15
40-44	$129.78	$121.54
45-49	$156.56	$144.20
50-54	$179.22	$162.74
55-59	$206.00	$185.40
60 plus	$238.96	$214.24
1 Child	$38.11
2 Children +	$76.22

$3000 Deductible $3000/$4000 Deductible $3000/$5000 Deductible $5950 Deductible	Premiums
Age	Rate	Spouse rate
Under 25	$85.49	$85.49
25-29	$91.67	$80.34
30-34	$97.85	$87.55
35-39	$109.18	$99.91
40-44	$120.51	$112.27
45-49	$144.20	$131.84
50-54	$164.80	$148.32
55-59	$189.52	$168.92
60 plus	$218.36	$193.64
1 Child	$36.05
2 Children +	$72.10

50% coinsurance
$250 Preventive Benefit Rates

• Preventative Health Care
• $3,000,000 Lifetime Coverage
• Low Premiums
• 4 Plans to Choose From
• Health Savings Account (HSA)

HDHP Montana Option 1 HDHP Montana Option 2
Age	Premiums
Under 25	$160.29
25-29	$172.29
30-34	$182.79
35-39	$215.78
40-44	$262.28
45-49	$326.78
50-54	$392.76
55-59	$472.17
60 plus	$554.97
1 Child	$46.41
2 Children +	$93.22

HDHP Montana Option 1 HDHP Montana Option 2
Age	Premiums
Under 25	$117.70
25-29	$126.50
30-34	$134.21
35-39	$158.43
40-44	$192.58
45-49	$239.94
50-54	$288.39
55-59	$339.95
60 plus	$399.70
1 Child	$34.22
2 Children +	$68.44

HDHP Montana

Option 1:

$2,500 Individual
$5,000 Family Deductible
100% Coinsurance

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

• Saves Premiums
• Reduces Taxes
• Build's Tax-favored Savings

Take a look at Blue Cross Blue Shield's High Deductible Health Plan and take control of your Health Care Dollars.

Individual Policies are subject to medical underwriting unless otherwise noted (included in application).

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

Age	Monthly Premium per Pers
3 m- 5 years	$151.04
6-14	$117.88
15-18	$171.92

A comprehensive low premium health insurance plan that includes hospitalization, surgery, emergency medical care, outpatient services, and a $400 Primary Care Benefit that covers the first $400 in covered services with BCBS Participating Providers at 100% for the following:

• Routine physical exams
• Gynecological exams including pap smears
• Office visits
• Vision exams
• Accident services
• Diagnostic, Lab, and X-ray services
• Immunizations & Vaccinations

Other covered services paid at 75/25 after $1000 deductible up until MML of $2500.

Other benefits include:

• Hospitalization and surgery
• Emergency care and outpatient services
• Pharmacy benefit with $100 deductible, then paid at 75%
• A health plan just for children from 3 months to 19 years of age

Individual Policies are subject to medical underwriting unless otherwise noted (included in application).

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