Who is Eligible?
Benefits eligible employees, retirees, COBRA enrollees, and their eligible dependents.
Benefits eligible employees may choose to waive the Choices Medical Plan coverage. If medical coverage is waived, enrollment in all mandatory and optional benefits will also be waived, and the employer contribution will be forfeited.
During Annual Enrollment, benefits eligible employees may add eligible dependent children to the Medical Plan. Important Note: Annual Enrollment for the Plan year is Closed Enrollment for a legal spouse for medical coverage unless there is a qualifying event.
Retirees are offered continued enrollment in the Choices Medical Plan at retirement. If you do not make an election when you first retire, you will permanently forfeit you medical coverage eligibility.
Refer to the Summary Plan Description (SPD) on the Choices home page for complete Medical Plan benefits and Plan exclusions information.
How The Medical Plan Works:
The benefits of the Medical Plan will depend on the health care provider the member uses. When an In-Network provider is used, In-Network benefits apply. When an Out-of-Network provider is used, Out-of-Network benefits apply. To see if your provider is an In-Network BCBSMT provider, visit BCBSMT.
In-Network Providers (In and Out of State) – Providers who have contracted with the Medical Plan claims administrator to manage and deliver care for Plan members and who accept the allowed amount as payment in full. Members will pay less out of pocket expenses if they see an In-Network provider.
Out-of-Network Providers (In and Out of State) – Providers who have not contracted with the Medical Plan claims administrator and who may balance bill the difference between their billed charge and the allowed amount. Members will pay more out of pocket expenses if they see an Out-of-Network provider. Out-of-Network providers can balance bill the difference between their bill charge and the allowed amount. Members are responsible for the balance billed amount.