2021 Policy Documents

Actual Policy Documents

In some cases, your actual policy document may be available through the links below. In order to help make it easier to locate your policy, they are divided into categories, including individual, small group, and large group market policies.

Tips to help locate your policy:

  • If you have coverage through your employer, then your policy would be in the group market.
  • If you have coverage other than through your employer (such as through an Exchange), then your policy would be in the individual market.
  • Depending on the size of your employer (i.e., how many employees it has), your policy may be in either the "small group market" or "large group market."
  • Each of these categories may be further divided based on certain information, such as whether your policy is a qualified health plan (QHP) or grandfathered plan, or whether the group health plan has a standard benefit design or a custom benefit design.
  • If you have any questions or need assistance locating your actual policy, you can contact a customer service representative at 1-855-258-8471.

It is important to note that while BCBSMT is posting every actual insurance policy as soon as it becomes available, including policies that contain customized benefit designs; your policy may not yet be available. If you are unable to locate your policy through the links below, you may find it helpful to view one of the sample policies above, and you can contact a customer service representative at 1-855-258-8471.

Qualified Health Plans

Small Group Actual Policy Documents

Standard Insured Plans – Policy Categories

MT Blue Choice HSA
MT Blue Choice PPO

Sample Policy Documents

Below is a list of sample policy documents for individual, small group and large group market 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.

The information in these policies is representative and is subject to change; it is not your actual policy. The sample policies are for coverage with a PPO network (including a high deductible health plan, which may be paired with a health savings account) and an HMO network, as applicable.

Qualified Health Plans (QHP)
On and Off Exchange

Blue Preferred Gold PPO 001 Individual Sample
Blue Preferred Gold PPO 005 Small Group Sample
Blue Premier 1 Multi-State Plan Sample
BlueCare Dental 1A Sample

Standard Insured Plans / Pre-Affordable Care Act Plans

MT Blue Preferred PPO

Custom Group Plans

BlueEdge HCA - Sample (Large Group)
Blue Dimensions - Sample (Large Group)