Gold Connected Care

Connected Care plans offer our lowest premiums and a provider network that emphasizes preventive care to maintain affordability.  These health insurance plans are accepted by doctors and hospitals across the state (provider choices are limited in Billings and Missoula).  Have questions?  Just call us at 855-447-2900.

Gold Connected Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $750
Family: $1,500
Individual: $2,250
Family: $4,500
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $5,750
Family: $11,500
Individual: $17,250
Family: $34,500
Co-insurance
(What’s this?)
You pay 30% You pay 50%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $35 copay per visit  You pay 50% after deductible
Specialist Office Visits You pay $40 copay per visit You pay 50% after deductible
Emergency Room Visits You pay 30% after deductible You pay 30% after deductible
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 25% per drug
Tier 3 Non-Preferred: You pay 35% per drug
Tier 4 Specialty: You pay 45% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 50% after deductible
Tier 2 Preferred Brand: You pay 50% after deductible
Tier 3 Non-Preferred: You pay 50% after deductible
Tier 4 Specialty: You pay 50% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 50% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $40 copay per visit You pay 50% after deductible
Diagnostic X-Ray & Lab Services You pay 30% after deductible You pay 50% after deductible
Inpatient Hospital Services You pay 30% after deductible You pay 50% after deductible
Maternity You pay 30% after deductible You pay 50% after deductible
Physician, Surgical & Medical Services You pay 30% after deductible You pay 50% after deductible
Physical, Occupational & Speech Therapy You pay 30% after deductible You pay 50% after deductible

Get PricingDownload a comparison chart

Gold Connected Care

In Network Out of Network
Deductible
(What’s this?)
Individual: $750
Family: $1,500
Individual: $2,250
Family: $4,500
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $5,000
Family: $10,000
Individual: $15,000
Family: $30,000
Co-insurance
(What’s this?)
You pay 30% You pay 50%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
You pay $35 copay per visit  You pay 50% after deductible
Specialist Office Visits You pay $40 copay per visit You pay 50% after deductible
Emergency Room Visits You pay $200 copay per visit You pay $200 copay per visit
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 10% per drug
Tier 2 Preferred Brand: You pay 25% per drug
Tier 3 Non-Preferred: You pay 35% per drug
Tier 4 Specialty: You pay 45% per drug
Tier 0: You pay $0
Tier 1 Generic: You pay 50% after deductible
Tier 2 Preferred Brand: You pay 50% after deductible
Tier 3 Non-Preferred: You pay 50% after deductible
Tier 4 Specialty: You pay 50% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 50% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $40 copay per visit You pay 50% after deductible
Diagnostic X-Ray & Lab Services You pay 30% after deductible You pay 50% after deductible
Inpatient Hospital Services You pay 30% after deductible You pay 50% after deductible
Maternity You pay 30% after deductible You pay 50% after deductible
Physician, Surgical & Medical Services You pay 30% after deductible You pay 50% after deductible
Physical, Occupational & Speech Therapy You pay 30% after deductible You pay 50% after deductible

Get PricingDownload a comparison chart

Gold Connected Care

In Network Out of Network
Deductible
(What’s This?)
Individual: $750
Family: $1,500
Individual: $2,250
Family: $4,500
Annual Out-of-Pocket Maximum
(What’s this?)
Individual: $5,750
Family: $11,500
Individual: $17,250
Family: $34,500
Co-insurance
(What’s this?)
You pay 30% You pay 50%
Primary Care Provider & Non-specialist Office Visits
(Find a Provider)
$25 copay per visit You pay 50% after deductible
Specialist Office Visits $40 copay per visit You pay 50% after deductible
Emergency Room Visits $200 copay per visit $200 copay per visit
Prescription Drugs
(View Drug List)
Tier 0: You pay $0
Tier 1 Generic: You pay 20% per drug
Tier 2 Preferred Brand: You pay 25% per drug
Tier 3 Non-Preferred: You pay 45% per drug
Tier 4 Specialty: You pay 45% per drug
Tier 5 Non-preferred Specialty: You pay 45% per drug
You pay 50% after deductible
Preventive Care Services, Immunizations You pay nothing for preventive services in-network–deductible does not apply You pay 50% after deductible
Chiropractic Care
(Covered up to 20 visits per year)
You pay $40 copay per visit You pay 50% after deductible
Diagnostic X-Ray & Lab Services You pay 30% after deductible You pay 50% after deductible
Inpatient Hospital Services You pay 30% after deductible You pay 50% after deductible
Maternity You pay 30% after deductible You pay 50% after deductible
Physician, Surgical & Medical Services You pay 30% after deductible You pay 50% after deductible
Physical, Occupational, & Speech Therapy
You pay $40 copay per visit You pay 50% after deductible

Get PricingDownload a comparison chart