2019 Montana QHP Small Group Actual Policy Documents

elow is a list of actual policy documents for QHP small group coverage. These policies describe how the plans generally work and include eligible expenses, claim filing and appeals procedures, and coverage limitations and exceptions, among other things.

If you have questions, contact a customer service representative at 1-855-258-8471 for more information.

Return to Sample Policy Documents

Platinum Plans

Blue Preferred Platinum PPO Plans
Off Exchange

Blue Preferred Platinum PPO 101
Blue Preferred Platinum PPO 102

Gold Plans

Blue Preferred Gold PPO Plans
Off Exchange

SBC - Blue Preferred Gold PPO 105 
SBC - Blue Preferred Gold PPO 107
SBC - Blue Preferred Gold PPO 110
SBC - Blue Preferred Gold PPO 111
SBC - Blue Preferred Gold PPO 123
SBC - Blue Preferred Gold PPO 126

Silver Plans

Blue Preferred Silver PPO Plans
Off Exchange

Blue Preferred Silver PPO 117
Blue Preferred Silver PPO 120
Blue Preferred Silver PPO 122
Blue Preferred Silver PPO 127
Blue Preferred Silver PPO 129
Blue Preferred Standard Silver PPO 131

Bronze Plans

Blue Preferred Bronze PPO Plans
Off Exchange

Blue Preferred Bronze PPO 116
Blue Preferred Bronze PPO 118
Blue Preferred Bronze PPO 119