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Individual & Family

Important Policy Change

Thank you for your membership with Blue Cross and Blue Shield of Montana. We value your trust in us and the health care coverage we provide.

We’d like to highlight an important change to your policy.

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 will not be 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 will 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 will 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 will not be 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.

Woman working in a call center.

How to Request a Waiver

To request a waiver, call Customer Service at 1-800-447-7828. An agent 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 (if your service date isn't on or after 1/1/2025, the waiver will not be considered)

What Is Not Changing?

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Benefits

You will receive benefits similar to the benefits that are part of your plan today. 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 will still be able to get emergency and urgent care nationwide without the need for a waiver.

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Finding care

You can still find in-network providers through Blue Access for Members℠ under Find Care.

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Freedom to choose

You continue to be free to visit a range of in-network providers, specialists, and hospitals throughout Montana and its border counties.

In What Areas Won't I Need a Waiver for Non-Emergency or Non-Urgent Care?

If you're a Blue Preferred PPO℠ member:

Review a map of included counties if you have a Blue Preferred PPO plan.  

You won’t need a waiver for providers in Montana or for providers who are in network with a Blue Cross Blue Shield Plan in the border counties below.

  • Idaho: Bonner, Boundary, Clark, Clearwater, Fremont, Idaho, Lemhi, Shoshone
  • North Dakota: Bowman, Divide, Golden Valley, McKenzie, Slope, Williams
  • South Dakota: Butte, Harding
  • Wyoming: Big Horn, Campbell, Crook, Park, Sheridan, Teton

If you're a Blue Focus POS℠ member:

Review a map of included counties if you have a Blue Focus POS plan.  

You won’t need a waiver for providers in Montana or for providers who are in network with a Blue Cross Blue Shield Plan in the border counties below.

  • Idaho: Bonner, Boundary, Clark, Clearwater, Fremont. Idaho, Lemhi, Shoshone
  • North Dakota: Bowman, Divide, Golden Valley, McKenzie, Slope, Williams
  • South Dakota: Butte, Harding
  • Wyoming: Big Horn, Campbell, Crook, Park, Sheridan, Teton

Answers to Questions You May Have