· Insurance companies that sell small group health plans in Montana must offer a standard plan and a basic plan. Insurers can offer other health plans as well.
· The standard plan must meet coverage requirements set by law. A standard plan deductible cannot exceed $500 per person ($1,000 per family). Copayments cannot exceed 25%. The out-of-pocket limit on covered expenses cannot exceed $2,000 per person annually ($4,000 per family). The lifetime maximum benefit cannot be less than $1 million.
· Coverage under basic plans must be less than under standard plans. Basic plans must cover at least the benefits covered under MCHA traditional coverage, plus coverage for mammograms and treatment for chemical dependency and mental health. The insurance company will vary deductibles, copayments, out-of-pocket expenses, lifetime benefits, and other cost-sharing arrangements to give the basic plan benefits a lower value than the standard plan.
