Managed Care Plan

PacificSource, Blue Cross Blue Shield, and Allegiance are the Managed Care choices. The plans provide the same basic benefits but have differences in providers and plan requirements.

How The Plan Works:
The benefits of these plans depend on the health care provider the member uses. When a network provider is used, in-network benefits apply. When an out-of-network provider is used, out-of-network benefits apply.

Major Plan Differences
The major differences in the managed care plans are the participating providers. Check which providers participate on the medical plan administrator’s website. See Resources.

Details:

  • PacificSource Managed Care Plan (www.PacificSource.com/MUS).
  • Blue Cross Managed Care Plan (www.bcbsmt.com).
  • Allegiance Managed Care Plan (www.abpmtpa.com/mus).
  • Emergency services are covered everywhere. However, out-of-network providers may balance bill the difference between allowance and charge.

Note: The Managed Care Plans cover the same services and have:

Network Providers – Providers who have contracted with the managed care plan to manage and deliver care at agreed upon prices. Members may self-refer to in-network providers and specialists.

Better benefits for services received In-Network than for services Out-of-Network – You pay a $15 copayment for most visits to In-Network providers (no deductible) and 25% (after deductible) for most In-Network hospital/facility services. You pay 35% of allowable fees (after a separate deductible) for most services received Out-of-Network.

Out-of-network providers may balance bill the difference between their charge and the allowable charge.


Important 2014-15 Benefit Information

 

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