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Individual & Family

Important Benefits Change

We’d like to highlight some important benefits information for Blue Choice Preferred PPO℠ and Blue Focus Point of Service (POS)℠.

Woman getting her blood pressure checked.

What Is Changing?

As of January 1, 2025, non-emergency, non-urgent care out of state beyond the counties that border Montana is not a covered benefit under your plan.

Coverage for non-emergency or non-urgent care outside your plan’s service area or border counties will be available only if adequate care is not available in your plan’s service area. You can find in-network care by logging into Blue Access for Members℠.

If a service you need is not available in your plan’s service area, coverage may be available if you request a waiver in advance, and it is approved. To ask for a waiver for services beginning January 1, 2025, call Customer Service at the number on your member ID card.

You need an approved out-of-service-area waiver from BCBSMT prior to receiving non-emergency or non-urgent care from any providers, whether in network or out of network, outside Montana or the counties that border Montana (also known as “contiguous counties”). Additionally, you need an approved out-of-service-area waiver from BCBSMT prior to receiving non-emergency or non-urgent care from out-of-network providers in counties that border Montana.

Please refer to this page's Answers to Questions You May Have section to find what counties border (are contiguous to) Montana and for additional information on out-of-service-area waivers and how to obtain a waiver. Once you receive your member contract for 2025, you may also refer to the “Out of State Services” section for further details on this benefit change.

Remember:

Out-of-state care beyond the border counties is not covered, unless you obtain an out-of-service area waiver. A waiver for otherwise covered services will be approved only if the services are not available in the plan’s service area. A waiver will be denied if adequate care is available in Montana or its border counties. You may be redirected to available, local in-network services.

If you do not receive the appropriate waiver in advance, Blue Cross and Blue Shield of Montana will not pay the claim.

As always, if you are facing a medical emergency call 911 or proceed to the nearest emergency room.

What Is Not Changing?

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Benefits

You can choose to go to an out-of-network provider or facility within Montana without a waiver. If you do, however, you may pay more for your care than if you were to stay in network.

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Access to emergency & urgent care

You are able to get emergency and urgent care nationwide without the need for a waiver.

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Finding care

You can find in-network providers through your member account under Find Care.

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Freedom to choose

You can visit a range of in-network providers, specialists, and hospitals throughout Montana and its border counties.

How to Request a Waiver

To request a waiver, call Customer Service at 1-800-447-7828. A Customer Advocate will need the following information, so it may be helpful to speak with your doctor ahead of calling:

  • Provider name, address and phone number
  • Provider type
  • Provider number/NPI (10-digits)
  • Provider tax ID (9-digits with a hyphen after the 2nd digit)
  • Diagnosis code
  • Estimated number of visits
  • First date of service

Answers to Questions You May Have

This information is only applicable to members of the identified Individual and Family plans.