Newsletter

Stay informed! Here’s the latest edition of our newsletter – online so you can always find your copy. Click each topic below to read the article. Beneath this month’s stories is an encyclopedia of our newsletter content arranged by topic. Feel free to browse the topics when you need to learn more about health insurance and your coverage.

See our June 2018 Newsletter on how to earn a $25 gift card, just for sending in childhood immunization records!

September 2018 Newsletter

Health Risk Assessments – Get your Annual Wellness Visit scheduled right away!

MHC is encouraging all of our members to schedule an annual wellness visit. Having an annual wellness visit is the best way to identify and treat health issues.

Schedule your wellness visit today with your primary care provider. If you do not have a primary care provider, go to www.mhc.coop to access the Provider Finder, or contact Member Services and we’ll help you find the location on our website.

Open Enrollment begins November 1st

Montana Health CO-OP offers affordable health insurance for individuals and families, as well as businesses. Our plans are accepted by doctors and hospitals all across the state.

To make our coverage even more affordable, you may also qualify for tax credits from the federal government that could reduce your costs significantly. All our coverage plans offer preventive care services covered at 100%. With Open Enrollment around the corner (November 1st), go to www.mhc.coop and click on the Explore Plans link to get an Overview of current and upcoming plans.

Fire Prevention Week – Look. Listen. Learn.

The latest statistics from the National Fire Protection Association (NFPA) show that if you have a reported fire in your home, you are more likely to die today than you were a few decades ago.

Be aware – fire can happen anywhere. Fire Prevention Week is October 7-13, 2018. Look for places fire can start. Listen for the sound of the smoke alarm. Learn two ways out of each room. These skills are the them for this year’s Fire Prevention Week.

For more resources, please click here.

August 2018 Newsletter

Take Advantage of your Free Annual Wellness Exam!

MHC began our telephone calling effort to encourage members to schedule a visit with their provider in order to have a health risk assessment performed in conjunction with their annual wellness visit (AWV). Studies have demonstrated that staying up-to-date with AWVs has a direct effect on reducing future hospitalizations and improving member health. Schedule your wellness visit today with your primary care physician.

If you do not have one, go to the Provider Finder, or contact Member Services and we’ll help you find the location on our website.

September is National Cholesterol Education Month

September is National Cholesterol Education Month, a good time to get your blood cholesterol checked and take steps to lower it if it is high. National Cholesterol Education Month is also a good time to learn about lipid profiles and about food and lifestyle choices that help you reach personal cholesterol goals. Visit the website highlighted below to find a few fact sheets and publications about cholesterol.

Please review these information sources by clicking here.

School Safety!

Schools are back in session. Whether children walk, ride their bicycle or take the bus to school, it is vitally important that they – and the motorists around them – take proper safety precautions.  Click here for some tips for students and drivers to be safe!

June 2018 Newsletter

Finding Information on our Website

Need to find a doctor or hospital? Want to view drug lists available in our formulary? We’ve got you covered! MHC maintains member information right on our website – go to www.mhc.coop, go to your state and click on the Members > Overview drop-down to find links to the information you need. It’s easy to do and is designed to save our members time and money.

Earn a $25 gift card for sending in childhood immunization records

Vaccinations are an important tool to prevent disease, but sadly Idaho and Montana rank 39th and 40th in vaccination rates nationwide. MHC is working to improve these rates by providing information and incentives to our members who obtain needed vaccines. Our 2nd annual vaccination program begins in July and runs through November 2018. Read more on the topic by clicking here.

I’m Tired All the Time – Am I Normal?

For some women, waking up in the morning can be a real struggle, even if they think they had a good night’s rest. Majority of people sleep less than the amount they actually need and feeling tired the next day is normal. But just because it’s normal doesn’t mean it’s good for your health.  Read more here

For more information, read this article, “How Much Sleep Do We Really Need?”

Summer Safety Tips

Summer is a great time to be outdoors in Idaho and Montana. Yet, we need to be safe to have a really great time. Check out these summer safety tips – from beating the heat to bug safety, these tips have just what you need. See these National Safety Council tips by clicking here.

May 2018 Newsletter

Safety Tips – Weight Lifting

Weight lifting has multiple potential benefits – it may increase metabolism, reduce the risk of osteoporosis, and reduce stress. However, weight lifting can place increased stress on your shoulder and elbow, and injuries are common. Whether you are weight lifting for fitness or aiming for the perfect “beach body” when spring break comes, here are some tips to reduce the risk of shoulder or elbow injury while pumping iron: Pumping Iron: Safety Tips Weight Lifting

 

MIND What You Eat

The MIND diet is rich in green leafy vegetables, whole grains, nuts, berries (particularly blueberries), fish, poultry, olive oil and wine. Foods that should be limited include red meat, butter, cheese, fried foods and sweets. In a study involving more than 900 Chicago residents, people on the MIND diet lowered their risk for Alzheimer’s by 35% to 53%, depending on whether they followed it moderately well or rigorously. Read more here

Limit Your Alcohol Consumption

Alcohol affects every organ in the body. It is a central nervous system depressant that is rapidly absorbed from the stomach and small intestine into the bloodstream. Alcohol is metabolized in the liver by enzymes. However, the liver can only metabolize a small amount of alcohol at a time, leaving the excess alcohol to circulate throughout the body. The intensity of the effect of alcohol on the body is directly related to the amount consumed. Read more here: Know Your Limit

Home Safe Home!

Our homes are our sanctuary amidst the fast-paced lives we live. In order to keep our homes safe, consider these home safety tips

April 2018 Newsletter

Enrollee Experience Survey

You may receive a survey in the mail with questions about your satisfaction with your healthcare provider or your overall health. This is a tool MHC uses to monitor and improve the quality of our members’ care in our health plan.  If you receive this survey, please complete it – we would be very appreciative!

NCQA Accreditation

MHC underwent a triennial accreditation survey through the National Committee for Quality Assurance (NCQA) in January-February 2018. The results? MHC passed, scoring 97.1% (48.55 out of 50 points) on the over-300 quality standards established by NCQA for health plans. MHC’s commitment to quality begins with establishing processes that benefit our Members and engage our Providers. If you would like additional information on MHC’s Quality Program, contact our Quality Director, Robbie Roberts at 208-328-7003 or rroberts@mhc.coop.  Click here to see a copy of our 2018 NCQA Accreditation certificate.

2018 NCQA Patient Health Management Standards

As part of our ongoing commitment to quality, MHC is developing Patient Health Management (PHM) processes in conjunction with new NCQA standards. The PHM category is a shift from evaluation of a single-disease state towards a whole-person focus. Within the PHM category, health plans describe their strategy for addressing the needs of members, then demonstrate effective execution of that strategy.

The updated standards combine important components of population health management such as wellness and complex case management. These standards align with MHC’s vision where providers are engaged to improve population health, to improve individual healthcare, and control healthcare spending. The PHM category includes the following standards:

PHM 1: PHM Strategy (NEW)
Plans describe their comprehensive PHM strategy—targeted populations, programs, services and activities offered to members, in addition to demonstrating that they provide basic program information to members and instructions for using program services.

PHM 2: Population Identification (NEW)
Plans integrate data to identify and assess the needs of members and connect them with appropriate programs or services.

PHM 3: Delivery System Supports (NEW)
Plans demonstrate how they support providers or practitioners in their delivery system—providing data directly to ACOs or providing practice transformation support to budding PCMHs—and demonstrate that they engage providers and practitioners in value-based payment arrangements.

PHM 4: Wellness and Prevention
Plans identify members’ health risks and educate them about heathier lifestyles through evidence-based tools.

PHM 5: Complex Case Management
Plans offer case management services to their most complex, highest-risk members.

PHM 6: Population Health Management Impact (NEW)
Plans conduct a comprehensive analysis of their PHM efforts, to determine the effectiveness of their strategy. Analysis includes measures related to clinical processes or outcome, member experience and cost/utilization.

Contact our Quality Director, Robbie Roberts, with any questions regarding these new standards.

 

February 2018 Newsletter

Cardiovascular Disease

February is American Heart Month. Every year, 1 in 4 deaths are caused by heart disease and is the leading cause of death for men and women in the United States? Heart disease can lead to a heart attack or a stroke. If you have any of these symptoms, call 911 right away.

Some warning signs of a heart attack may be chest discomfort, discomfort in other areas of the upper body such as pain and discomfort in your arm(s), back, neck/jaw or stomach and shortness of breath, with or without chest discomfort. Heart attack symptoms in women may differ, which may include the above as well as nausea, vomiting, sweating, dizziness, lightheadedness or fainting and unusual fatigue.

Stroke symptoms can include; face drooping, arm weakness or numbness and difficulty with speech. If you are experiencing any of these symptoms, get emergency treatment immediately – it could save your life!

For more on Warning Signs of Heart Attack or Stroke, read information here

Healthy Living Begins with Healthy Choices

Here are some steps towards making healthy choices, lifestyle changes and managing your health conditions:

  • Annual check-ups or more frequently if required by your health care provider
  • Use spices to season your food rather than salt
  • Watch your weight
  • Quit smoking and stay away from second-hand smoke
  • Control your cholesterol and blood pressure
  • Take any prescribed medication as directed by your health care provider
  • Follow-up on any health condition monitoring as directed by your health care provider
  • If you drink alcohol, drink only in moderation
  • Get active and eat healthy

For more on healthy choices, read information here

MHC 101

MHC has dedicated a web page to inform Members on our quality efforts. Go to www.mhc.coop; once you reach the main page, hover your mouse over About Us and click on the drop-down menu link for Commitment to Quality. MHC develops a Work Plan each year to guide our efforts with improving the quality and safety of our clinical care, as well as our processes and service.

Please review MHC’s 2018 Quality Management Work Plan. Contact MHC’s Quality Director with any questions or recommendations regarding the plan – your engagement in the process will help us further our Vision to Improve Population Health and Individual Healthcare.

Robbie Roberts

Quality Director

(208) 328-7003

rroberts@mhc.coop

December 2017 Newsletter

Health Insurance Literacy

What is a health insurance premium? Can you describe what an annual health insurance deductible is? If you answered, “no,” you’re not alone. The language of health insurance can be complex and confusing, particularly for many long-time uninsured people enrolling in the new insurance marketplaces set up under the Affordable Care Act.

Take this 10-question quiz and learn how health insurance literate you are compared to a nationally representative survey of U.S. adults who were asked the same questions.

Take the Health Insurance quiz, here.

Find a Provider

MHC provides our members with resources to help them make informed health care decisions. Need to find a provider? Access our Provider Finder right on www.mhc.coop. Once you’ve chosen your State (Idaho or Montana), access the Provider Finder tab at the top of the page Follow the instructions on the main page and locate an in-network practitioner or facility.

Click here to go to our online Provider Finder.

Why in-network? In-network providers have contracts with MHC that save our Members money! Be a smart consumer and check-out your options.

Still need help? Call our Member Services team and we’ll help you find the practitioner or facility you need. Call 855-447-2900.

MHC Member Policy Documents

Need your MHC Policy, a Summary of Benefits or an Outline of your Coverage? We’ve got you covered!

 

MHC Members can find their policy information, benefits summary and outlines of coverage right on our website: www.mhc.coop. See the many tools we have available on the member drop-down menu located on the main page after you click on your State (Idaho or Montana).

For more information, go directly to your plan type located on MHC’s website:

September 2017 Newsletter

Substance Use and Mental Health Issues

The Substance Abuse and Mental Health Services Administration’s (SAMHSA) latest National Survey on Drug Use and Health (NSDUH) report provides the latest estimates on substance use and mental health in the nation, including the misuse of opioids across the nation. Opioids include heroin use and pain reliever misuse. In 2016, there were 11.8 million people aged 12 or older who misused opioids in the past year and the majority of that use is pain reliever misuse rather than heroin use—there were 11.5 million pain reliever misusers and 948,000 heroin users.

The complete findings for the NSDUH report issued are available, by clicking here.

Healthy Aging and Smoking

In recognition of Healthy Aging Month, FDA’s Center for Tobacco Products has created some social media content and shareable images highlighting the impact of tobacco use on health.

 

When it comes to understanding the health risks of smoking, most people think first about its impact on the lungs. The truth is that smoking can hurt almost any part of your body—including your heart. Available research proves that smoking hurts not only your heart, but also your entire cardiovascular system.

Read more “Did you know” information, by clicking here.

August 2017 Newsletter

Earn a $25 Gift Card for Childhood Immunization

Would you like to earn a $25 gift card and improve your child’s health at the same time?

You can earn that gift card by:

  1. Making sure your children are up to date on their vaccinations, and
  2. Sending MHC a copy of your child’s vaccination records

Your children can have all their recommended vaccines AT NO COST to you.  MHC covers childhood immunizations free of charge.  Recommended adult vaccinations, too!

A list of the vaccines recommended for every age of child is located below.  Take a look at your child’s health records and if your child has all the recommended vaccinations, send us a copy of that record.

If your child isn’t up to date on all recommended immunizations, make an appointment with your child’s pediatrician or primary care provider to get caught up and then send us the record.  Please send it the record to us by fax, email or postal mail.

Make sure you include your child’s name and MHC insurance ID number when you send in the record!

  • Scan and email to: QIS@mhc.coop
  • Send by postal mail to: MHC, PO Box 5358, Helena, MT 59604
  • Fax to: 406-447-5799

We will check the information and send you a gift card* in the mail.

*Only one gift card per qualified Child

Immunization Age (Years)
Hepatitis B (HepB) 0-2
Diptheria, Tetanus, Pertussis (DTaP) 0-2
H. influenzae (Hib) 0-2
Pneumococcal (PCV) 0-2
Polio (IPV) 0-2
Influenza (IIV) 0-2
Measles, Mumps, Rubella (MMR) 0-2
Chicken Pox (VZV) 0-2
Influenza (IIV) 3-15
Meningococcal 13-15
Tetanus, Diphtheria, Pertussis (Tdap) 13-15
Eating and Cooking Outdoors FDA Toolkit

During the summer and fall months, many Americans are cooking and eating outdoors. To promote and encourage safe food handling when eating and cooking outdoors, FDA’s Center for Food Safety and Applied Nutrition has drafted tweets and FB posts along with images. Use the tweets, FB posts and images below to provide helpful food safety information about cooking and eating outdoors to your followers on social media.

Read the article here: Eating Outdoors Toolkit

 

July 2017 Newsletter

Substance Abuse: A Focus on Youth

Did you know that daily marijuana use is now at a 30-year peak level among high school seniors? That 40 percent of youth have tried cigarettes by 12th grade, and 10 percent of 12th graders are daily smokers? That alcohol remains the most widely used drug by today’s teenagers?[i] That prescription medications are some of the most commonly misused drugs by teens, after tobacco, alcohol and marijuana.? [ii]

If you aren’t already, it’s time to open conversations with the young people in your community and help them before their lives and their futures are compromised by substance abuse or devastated by addiction.

Here are resources from National Institute of Drug Abuse (NIDA), Office of Adolescent Health (OAH), the Substance Abuse Mental Health Services Administration (SAMHSA) to help you get started or enhance your existing efforts to serve the youth and families in your community.

For more information, get this free resource: Growing Up Drug-Free: A Parent’s Guide to Prevention

[i] Drug Enforcement Administration and U.S. Department of Education, Growing up Drug-Free: A Parent’s Guide to Prevention, Washington, D.C., 2012.

[ii] The National Institute on Drug Abuse Blog Team. (). Prescription Pain Medications (Opioids). Retrieved from https://teens.drugabuse.gov/drug-facts/prescription-pain-medications-opioids on July 3, 2017.

 

 

 

 

 

National Institute of Drug Abuse (NIDA)

Addiction can happen at any age, but it usually starts when a person is young.  If a teen you know continues to use drugs despite harmful consequences, he or she may be addicted. According to the National Institute of Drug Abuse (NIDA), through scientific advances, we know more than ever before about how drugs work in the brain. We also know that addiction can be successfully treated to help young people stop abusing drugs and lead productive lives. Intervening early when you first spot signs of drug use in your teens is critical.

Learn about teen drug use and the brain- this site features videos, games, blog posts and more!

Get the resource: NIDA Teen Talk

Videos like “Anyone Can Become Addicted to Drugs” and “Why are Drugs so Hard to Quit” provide critical information in an easy-to-understand format.  The website also provides information on the different drugs (i.e. heroin, bath salts, prescription pain medications, MDMA, Meth etc.) circulating in our schools and communities.

Get the resource: Easy–to-Read Drug Facts

Helpful answers to timely questions about teens and substance abuse to share with families in your community.

Get the resource: What to Do If Your Teen or Young Adult Has a Problem with Drugs

June 2017 Newsletter

Prescription Opioid Awareness

Prescription opioids can be used to help relieve moderate-to-severe pain and are often prescribed following a surgery or injury, or for certain health conditions. These medications can be an important part of treatment but also come with serious risks. It is important to work with your health care provider to make sure you are getting the safest, most effective care.

Prescription opioids carry serious risks of addiction and overdose, especially with prolonged use. An opioid overdose, often marked by slowed breathing, can cause sudden death. The use of prescription opioids can have a number of side effects as well, even when taken as directed.

Get the Factsheet by clicking here: Prescription Opioids – What you Need to Know

Learn more: https://www.cdc.gov/drugoverdose/prescribing/patients.html

June is National Safety Month

Join the National Safety Council and thousands of organizations across the country as we work to raise awareness of what it takes to Keep Each Other Safe. Observed annually in June, National Safety Month focuses on reducing leading causes of injury and death at work, on the road and in our homes and communities.

 

For more information, click here: Personal Safety Check-up

 

Be Prepared – Extreme Heat Information and Tools

As we head into the summer months, this is just a reminder of getting the word out regarding planning for and responding to periods of extreme heat including potential power outages.  It is a time to prepare yourself.  Whether you provide programs and services for an older adult, an individual with a disability or family caregivers, you know that each person’s needs and abilities are unique.  Every individual can take important steps to prepare for periods of extreme heat including risk for potential power outages and put plans in place. By evaluating needs and making emergency plans, everyone can be better prepared for any situation.

 

A Commitment to planning today will help you prepare your consumers for extreme heat situations including risk for power outages.  The following are just a few examples of online information and tools that are available to help you prepare for and respond to extreme heat:

For more information, click here: https://www.cdc.gov/extremeheat/

May 2017 Newsletter

National Stroke Awareness Month and National High Blood Pressure Education Month - May 2017

May is National Stroke Awareness Month and National High Blood Pressure Education Month. MHC is promoting the Million Hearts® campaign in encouraging our members to understand the risk factors associated with stroke. The CDC provides resources to empower Americans to manage risk factors—like high blood pressure—that contribute to stroke and encourage people to learn the signs and symptoms of stroke.

Take the Quiz: Can You Spot the Signs and Symptoms of a Stroke?

For Member Resources, click here: Tips for Taking Blood Pressure Medicines as Directed

Improving Health Care Quality

You may not know it, but MHC is accredited by the National Committee for Quality Assurance (NCQA), the leading organization focused on improving health care in the U.S. NCQA understands the importance of aligning the Centers for Medicare & Medicaid (CMS) Marketplace requirements and NCQA Accreditation requirements. As a member, understanding your rights and responsibilities as a health plan member is important.

As a member of Mountain Health CO-OP, you have a right to:
• Receive information about the organization, its services, its practitioners and providers and member-owner rights and responsibilities
• Be treated with respect and recognition of your dignity and your right to privacy
• Participate with practitioners in making decisions about your health care
• A candid discussion of appropriate or medically necessary treatment options for your conditions, regardless of cost or benefit coverage
• Voice your complaints or file appeals about the CO-OP, CO-OP providers or the care you receive
• Make recommendations regarding the CO-OP’s member rights and responsibilities policy

As a member of Mountain Health CO-OP, you have a responsibility to:
• Supply information (to the extent possible) that the CO-OP and its practitioners and providers need to provide care to you
• Follow plans and instructions for care that you have agreed to with your practitioners
• Understand your health status and participate in developing mutually agreed-upon treatment goals, to the degree possible

No Tobacco Day – May 31st

The Centers for Disease Control (CDC) in conjunction with the World Health Organization (WHO) have designated Wednesday, May 31st as No Tobacco Day to promote health living and smoking cessation. Did you know:
• Smoking leads to disease and disability and harms nearly every organ of the body
• Smoking is the leading cause of preventable death
• The tobacco industry spends billions of dollars each year on cigarette advertising
• Smoking costs the United States billions of dollars each year
• 15.1% of all adults (36.5 million people): 16.7% of males, 13.6% of females were current cigarette smokers in 2015
• Thousands of young people start smoking cigarettes every day
• Many adult cigarette smokers want to quit smoking

For more information click here: Idaho Smoking Facts

October Newsletter

It's Flu Season! Your flu vaccine is FREE!

We encourage you to take advantage of your FREE FLU SHOT benefit!  The Centers of Disease Control and Prevention recommends everyone over the ages of 6 months should receive the seasonal influenza vaccine (flu shot).  It’s not possible to predict what the 2015-2016 flu season will be like because it changes from year to year, however the basic symptoms remain the same.  Some of these symptoms can include; fever, aches, chills, cough, runny nose and generally comes on suddenly.  The typical flu season can start as early as October and last into spring.  You can get your flu shot by your participating care provider, a participating pharmacy or your local health department, that provides the flu vaccine.

For additional information about the flu shot, go to; www.cdc.gov/flu/protect/keyfacts.htm

 Health Tips to help prevent the flu

Get vaccinated

Frequent handwashing or hand sanitizer, if no access to soap & water

Don’t share personal items (drinking glasses, towels, etc)

Stay home if you have a fever or have flu symptoms

Cover your mouth & nose when you cough or sneeze

Avoid crowds or others, if you may be ill

Back ache? A guide for seeking care

One of the most common reasons adults visit a care provider visit is for low back pain.  There are many reasons for low back pain, such as lifting heavy objects, twisting or sudden movements, to name a few.

Talking to your care provider and having an evaluation of your symptoms is important.  Many times the use of over-the-counter pain medicine, walking, stretching, physical therapy, rest and superficial heat can help with pain.

Most times low back pain feels better in about a month with this kind of treatment.  So, an  x-ray, MRI or CT scan may not be necessary.

However, there are times when symptoms may suggest nerve damage, infection of the spine or other conditions where imaging may be needed.  These symptoms can include but are not limited to progressive and severe pain, loss of control of your bowel and bladder, numbness, reflex problems or loss of strength in your legs, fever over 102 degrees or a history of cancer.  When you have these symptoms or health history, be sure to see your care provider for an evaluation.

Pregnant? Regular visits mean healthy baby, healthy mother

If you or your partner are expecting, congratulations!  Are you aware that regular check-ups during pregnancy are extremely important to the expectant mother and baby?   These visits are designed to improve the overall health and experience of both mother and baby.

Routine prenatal care and testing throughout the course of your pregnancy can prevent potential problems and help you live healthier in ways that benefit both you and your baby.  Regular prenatal visits also help detect any problems early, which is a key to having an easier pregnancy and healthier baby.

Prenatal visits include a complete physical exam and a discussion of your health history.  Here are some of the things your provider will talk about or check during your prenatal visits:

  • The date of your last menstrual period
  • When you think your baby is due
  • Any health problems in your family
  • Any previous pregnancy complications
  • Blood pressure, height, weight
  • Lab tests to screen for sexually transmitted disease
  • Abdomen measurements to check your baby’s growth
  • Your baby’s heart rate
  • Lab tests on your urine and blood

While you are at your prenatal visit, you should be sure to talk about any health problems you have had, or others in your family have had.  Here are some of the conditions you might want to talk about:

  • High blood pressure (hypertension)
  • Diabetes
  • Asthma
  • Depression
  • Bladder or kidney infections
  • Bleeding or clotting problems
  • Problems with anesthesia
  • Thyroid problems
  • Past surgeries
  • Allergies
  • Fatigue, tiredness, discomfort and any other medical history or concerns

Your provider will also talk with you about recommendations for a good diet, the right kind and amount of exercise, weight gain and what to expect during your pregnancy, delivery and following your delivery.

Taking home your new baby is one of the happiest times in a woman’s life, but it also presents with both physical and emotional changes.  So, you should plan on a visit after your delivery as well, between 21 and 56 days after delivery.

 

This postpartum visit and exam will give you an opportunity to address any issues, complications, concerns, warning signs.  Your provider will also provide more information on caring for yourself and your baby.

Immunizations and Preventive Care Cost You $0

Take advantage of your health plan immunization and preventive services benefits for both you and your child!

In general, we all try to protect ourselves and our children from harm by using seat belts, car seats, helmets, exercise and eating right. Immunizing and taking advantage of no-cost preventive testing for ourselves and our children, is just as important

Annual wellness exams are covered at no cost to you.  These visits can help keep you and your family well through prevention, screening and early detection of a health condition or disease.

Please contact your and your child’s healthcare provider for recommended immunization schedules and preventive services, as well as any questions or concerns you may have.

  • You pay nothing for immunizations and preventive services if provided by in-network providers.

For additional information on recommended immunization schedules for persons of all ages, go to the Centers for Disease Control and Prevention at:    http://www.cdc.gov/vaccines/schedules

Managing Long Term Medication Therapy

If your doctor prescribes medication that you need to take on a long term basis, we encourage you to take those medications.  Taking needed medications regularly can keep you healthy longer, prevent future problems and improve your quality of life.

Of course, always seek medical attention when you need care, and keep your regular appointments, because ongoing follow up with your healthcare provider is essential to maintaining your health.

If you are taking long-term medication, you should see your healthcare provider at least yearly, to monitor your condition.  Your visit could include some tests, to make sure your medications are working as your provider expects them to.

Here are some of the conditions you may have that require long term medication and regular check-ups with your health care provider:

  • High blood pressure
  • Diabetes
  • Asthma
  • Heart failure
  • Atrial fibrillation/flutter
  • Kidney disease

A short list of to-dos:

  • Be sure to take all medications as directed
  • Keep up with your refills
  • Bring a list of all medications, including vitamins and supplements, to review with your health care provider at your visit so you can determine possible side effects or drug interactions with other medications
  • Use one pharmacy for your prescribed medications to help avoid possible drug interactions

Claims

How to view your claims online

To get the latest information on your claims, you must register on our website. Once you do that, you can see all your claims, how much you have paid toward your deductible, a list of your prescription medication and a copy of your ID card. While you’re logged in, you can also order a new ID card or take a health risk assessment, among other things.

It takes only a few minutes to register, but you need to have your ID card handy. Use this link to go to the registration page

Commitment to Quality

CAHPS Survey

Did you receive a survey in the mail on behalf of MHC? If you did, please take a few minutes and fill it out and send it in. This survey is required by the federal government to measure our performance in our members’ eyes. It’s free for you to send back and completely confidential. MHC will only see all the answers compiled together, with no way to identify your specific responses.

Contact Info

Our partners

If you’ve called some of our member service telephone numbers, or gone online to our member services portal, you’ve probably noticed that there are other companies involved in providing our insurance services to you.

We contracted with these companies to create the most cost-efficient health insurance coverage we can. Having these outside vendors has helped us keep our premium costs low. Here’s a run-down of some of our partners and what they do for you:

Altius/Coventry: Altius/Coventry process our claims, sends out ID cards, manages our enrollment process, collects premiums for us, and provides our online member portal. Expect to see Coventry’s name on the back of your ID card, and online when you log into our member portal.

Aetna: Aetna, a large national insurance company, recently purchased the Altius/Coventry plans. Aetna oversees our pharmacy specialty services. Over time, you may see Aetna’s name replace Altius/Coventry’s name.

Express Scripts: Express Scripts is a large national pharmacy benefits management company. Express Scripts, sometimes referred to as ESI, processes claims for your prescription drugs, and maintains the list of drugs we cover at the four tier levels.

Health Plan Services – HPS: HPS provides the enrollment function for Altius/Coventry, taking the enrollment and tax credit information from federal and state marketplaces and enrolling members. They also accept premium payments for exchange-covered members, send out invoices and provide telephone customer service in their Florida offices.

Certifi: If you purchased your coverage directly from MHC, you would have received an email link to set up your account with another of our partners, Certifi. This company accepts payments for members enrolled directly with the CO-OP.

Contact information

There are many ways to reach us. You can call us at 855-488-0621, or send us an email inquiry at info@mhc.coop.

Doctor visits

How in-network doctors and hospitals save you money

One of the reasons to join Montana Health CO-OP is our affordable monthly premium. One of the ways we keep our prices low is our discount agreement with nearly 4,500 Montana doctors and hospitals — MHC “in network” providers. To get the most value out of your coverage, you need to visit these in-network doctors and hospitals!

When you use services from doctors and hospitals who don’t have this agreement with us — we call them “out of network” — you can lose out on our discount. Your service may still be covered, but only according to your MHC plan limits, with you picking up the difference between the MHC payment amount and the actual charge. Meaning you could have a very large medical bill to pay when you use services with out of network doctors and hospitals.

So, choose an in-network doctor, hospital or other healthcare provider to save money! Here’s a link to our Provider Finder to help you choose where to receive care next.

Annual checkups

Your MHC coverage includes preventive care at no cost to you, regardless of your coverage. Just be sure to use an in-network provider. Check your member contract and coverage overview for a complete list of covered preventive services, or call Customer Service at 855-488-0621 to learn more.

Glossary terms

Deductible

Aside from your monthly premium, your deductible is the next most important number to know. The deductible is the amount you must pay before MHC starts to pay its part. Some services are covered before the deductible, such as your annual wellness checkup and certain screening tests — you do not pay anything for these services. If you need help understanding your deductible, check My Online Services, through mhc.coop/members where you can read up on your coverage. Or, give us a call or send us an email. We’re here to help!

Insurance acronyms and definitions

Health insurance is confusing. We admit it! But, we’re trying to help make it as understandable as we can! Knowing the lingo of health insurance can help you make the best use of your coverage, and keep your costs as low as possible.

We will be including explanations of health insurance terms in every issue of our member newsletter, starting now. We’re adding a health insurance glossary to our website too.

Let’s start with the terms you will likely encounter when you first start to use your MHC coverage:

Deductible: This is the amount you must pay before coverage starts for many benefits, such as surgery or any hospital procedure.

Family Deductible: Our family deductible is twice the single deductible. When one member of the family has met half the family deductible, that person’s deductible has been met for the year. The remaining members of the family can combine their expenses to meet the second half of the deductible. Here’s an example: A family has a deductible of $3,500. One person must meet $1,750. Then, the other members of the family can combine amounts that contribute toward the deductible to total $1,750.

Non Specialist Doctor Office Visit Cost: Most of our plans have coverage for non-specialist (that is, primary care doctors) doctor office visits before the deductible starts – only the Plus (Bronze, Silver and Gold) coverage plans and Access Care Bronze do not have a before-deductible office visit co-payment. The cost of a doctor office visit is usually a co-payment.

Primary Care Doctors: In our LINK and Connected Care plans, members must choose a primary care doctor. You can receive services from other primary care doctors, and you can see specialists without a referral, but you must choose a primary care doctor for our files. Primary care doctors can be family physicians, internists, general practitioners, pediatricians for children or OB/GYNs for women.

Specialist Doctor Office Visit Cost: Your cost for a specialist office visit is different, generally higher, than a primary care, non-specialist visit. Specialists are cardiologists, orthopedists, dermatologists, etc.

Co-Payment: This is a flat amount you pay for a service, like a doctor visit, or an item, like a prescription drug. Co-payment amounts do not go toward your deductible. But, they do go toward your out of pocket maximum.

Out of Pocket Maximum: This the most you will pay for covered services in the year. After you have paid the amount of our out of pocket maximum, all your covered services will be paid at 100% — no further cost to you.

Drug Tiers and Generics: Our covered drug list (often called a formulary) includes thousands of drugs, intended to provide a full array of options for treatment. We have four levels, also called tiers, of costs for these drugs. As the drugs become more expensive, the cost to you increases. Tier 1 is the least expensive level, and includes many generic forms of drugs. Some generics are also Tier 3 drugs. Tier 4 is the most expensive.

Generic drugs: These drugs have the same active ingredients, as approved by the US Federal Drug Administration, as their brand-named equivalents. Generic drugs are almost always far less expensive than their brand name parent drugs, saving you money.

Pre-Authorization: To make sure our members receive the right care at the right time, we will only pay for some services and some drug treatments if we have approved them. Your doctor should call our pre-authorization line, 855-447-2900, to get preauthorization for any surgery, inpatient hospital stay, and any drug that requires pre-authorization. A full list is on our website in the Members: Overview page.

Drug Step Therapy: Because many different drugs can be used to treat the same condition, we want to be sure our members are using a drug that works for them, but also is the most cost-effective, which helps keep our premiums low. If the drug you wish to take requires that you try a different drug before we will allow coverage for it, that is called step therapy. If you have worked through step therapy with a previous health insurer, your doctor should submit the results of your previous treatment when requesting pre-authorization of your prescription.

Member Experience

MHC Member Survives, and Thrives, after Grizzly Bear Attack

It’s been a difficult year for MHC members David and Lisa Brzycki – one filled with challenges and angst and hard-lived lessons.

In June of 2014, while bear hunting with his father near Montana’s Centennial Valley, David was brutally mauled by a grizzly bear.  His survival and continuing recovery are a testament to personal fortitude, the support of family, friends and community, and the availability of excellent healthcare.

Due to the extent of his injuries, David was transported to Seattle where he and Lisa have spent much of the past year.  Medical decisions, financial concerns and hospital bills were overwhelming, said Lisa, “But the CO-OP was amazing.”

Barbara Kamerzel, who manages MHC Provider Services, said, “These were our members, and they were thrown into this horrible ordeal.”   With his life turned upside down, Barbara made sure that that David’s MHC policy worked as it should.  Amidst all the upheaval in the Brzyckis’ lives, “The last thing they needed to worry about was their insurance,” she explained.

Not an initial fan of the Affordable Care Act, and frustrated when the premiums from their previous insurer doubled, Lisa credits David for insisting they purchase policies from MHC.  As fitness trainers, both were incredibly healthy and rarely visited doctors — and because of the high cost to renew their old policies, Lisa was ready to go without health insurance.

“Then we heard about Montana Health CO-OP,” said Lisa.

One month after purchasing their policies, David was face-to-face with that grizzly bear.

Have Courage. Love Lots. Be Strong. 

Simple but poignant, these lessons are emblazoned on wristbands and shared with people who learn about David’s ordeal. “Have Courage.”

At MHC, proud to have the Brzyckis among our membership.

Money-saving tips

Generic drugs

Always check to see if your prescription drug is available in a generic form. You’ll save money, and get the same quality drug therapy, since all generics must have the same active ingredients as the brand name drug. To learn more about your prescription drug benefits, visit the Express Scripts website, register and log in.

In-network providers

Be sure to choose caregivers such as doctors and therapists, hospitals and outpatient centers that are in the MHC network. When you choose an in-network provider and reach your annual out of pocket maximum, MHC will pay 100% of the cost for covered services. Because we have contracts with our in-network providers, they must accept our allowed amount as the most they will receive for the service.

But, if you use out of network providers, not only is your annual out-of-pocket maximum much higher, healthcare providers can charge you the difference between what they charge, and what MHC pays them. Depending on the service, this difference can be thousands…this is called “balance billing.” So, stay in network and get the most out of your coverage. Use our online provider finder or call Customer Service at 855-447-2900 for help finding a provider near you.

Monthly Premiums

Payment options

We have different payment options, depending on whether you purchased through the state or federal marketplace, or directly from MHC. Members purchasing through Your Health Idaho or Healthcare.gov can only pay with a bank account, check or money order, starting with the second month of coverage. Members purchasing directly from MHC can use these methods as well as a debit or credit card for all payments – first and subsequent payments.

Here are your options:

  • Set up an automatic bank draft for your monthly premium using Member Online Services or by calling 855-488-0622. Money will be drafted the last day of the month and withdrawn from your account the first day of the month.
  • Pay online through Member Online Services
  • Pay over the phone, by calling 855-488-0622

Send a check or money order, being sure to put your case number on your check or money order, along with your full name and address. The case number is located on your paper invoice on the payment coupon portion. Include the coupon with your check or money order. Please allow at least 10 days from the time you mail the payment for us to receive and record your payment.

Make Your Premium Payment each Month – Automatically!

Rather than write out a check every month, why not just have your monthly premium deducted from your bank account automatically?  You’ll never be late and you’ll always be assured we received your payment timely!

Just call us at 1-855-447-2900 and we can get you set up with an automatic withdrawal from your checking or savings account.  Have your bank routing number and your account number when you call.  You can cancel the automatic payment at any time by calling us at 1-855-447-2900.

Make Sure Your Mailed Payment Reaches us on Time…Where to Send your Monthly Premium

If you are using mail to send us a check or money order, please be sure you send your payment to the correct address.  We have two different addresses for payments, and you can check your monthly statement for the correct address.

Do not use the address on your explanation of benefits form!  Sending your check to the wrong address will definitely delay your payment and could cause an disruption in your coverage.

If you purchased your coverage through Healthcare.gov/Your Health Idaho, send your check or money order to:

Montana Health CO-OP
P. O. Box 864750
Orlando, FL 32886-4750

If you purchased your coverage directly from Mountain Health CO-OP, send your check or money order to:

Montana Health CO-OP
P. O. Box 410035
Salt Lake City, UT 84141-0035

Always include your name, address and Billing ID on your monthly statement on your check or money order.  Do not use your member ID on your check or money order.

For MHC Members Receiving a Tax Credit: How the 90 Premium Payment Grace Period Works

Everyone who receives a tax credit to help with payment of their health insurance premium also gets the benefit of having a 90 day grace period to pay premiums before coverage is cancelled.

Here’s how that 90 grace period works:

  • Every month, your premium is due on the 1st day of that month. So, for July, your premium is due July 1.
  • Every month, you have until the last day of that month to make your full premium payment. So, for July, you must pay your premium by July 31.
    • You must pay the entire premium every month…to the penny!
  • If you do not pay your entire premium in that first month, the next month is the second month of your grace period.
    • Beginning in this second month, we put your coverage on hold.
    • We do not process your claims for service — we pend them and process them after your premium in paid in full.
    • You also do not have prescription drug coverage in this second month, because your coverage is on hold.
  • If you do not pay your premiums by the third month, your coverage is still on hold until the end of the third month.
  • If you still do not catch up your premium payments by the last day of that third month, in full, to the penny, your coverage will be cancelled and you will not be eligible for your tax credit, or to purchase coverage again until the next Open Enrollment period.
  • You can catch up your premiums, in full, by the end of the third month and your claims will be processed and your coverage restored.
    • Every member receiving a tax credit gets 90 days to catch up and pay the entire premium – in full, to the penny, and have full coverage restored for that period.

One way to be sure you don’t fall behind in your premiums is to use our automatic payment process.  Here’s a link to our article in this month’s member newsletter on how to set that up.

What is the Grace Period for Members Who Buy Directly from MHC?

For members who purchase coverage directly from MHC, the grace period is 30 days.  The due date for coverage is the 1st of the month, with 30 days during that month to make the premium payment in full.  If we do not receive payment within that 30 days, we will cancel your coverage.

Prescription Drugs

MHC’s Prescription Drug Policies: Our Goal is to Help our Members

For nearly every medical condition, there are a dozen or more drugs a person could take to help cure, treat or manage that condition.  Some drugs cost more, some cost less. Some are more effective, some less effective.  Some work better for one patient or another.

What we at MHC want is for our members to get the best possible care, while being the most cost effective.  That’s how we help keep our premiums down.

Our list of prescription drugs and our “step therapy” requirements are set up to do just that.  These decisions are made thoughtfully by committees of physicians and pharmacists who analyze the effectiveness of the drug first, and then the value, based on lowest cost for the best outcome.

We’re trying to help our members choose drugs wisely.  Often members find themselves on a very expensive drug regimen when a less expensive drug will work as well – sometimes even better.

To give you an idea of the effect drug prices can have on the cost of providing health care coverage, in May, MHC paid out $650,000 for 12,000 prescription drug claims.

But what is truly astounding is that 65 of those 12,000 claims – just 0.5% of the number of claims – cost $250,000, nearly 40% of the total amount.

Now, many of these drugs are life-saving and life-sustaining for our members, and we are honored to be able to provide the coverage that helps our members live full lives.

So, we ask our members to first try a less expensive drug —  our “step therapy” program —  before continuing to take a higher cost drug, to make sure that the drugs our members take help them the most and cost the least.  And that helps us hold our premium costs down.

That’s one of the reasons you signed up for the CO-OP’s coverage – because it all comes back to you.

Wellness

Colon cancer screening for those 50 and over

We at Mountain Health CO-OP strongly recommend that everyone consider being screened regularly for colon cancer, starting at the age of 50. Below is a discussion of what this means and recommended colon cancer screening tests which have the best value and are approved for payment by your plan. Be sure to talk with your doctor at your annual checkup about this.

The colon is the name of the lower part of a person’s intestine. This is the part of the intestine where cancer is most common. Colon cancer screening is a way to check the lower intestine for signs of cancer or growths (called polyps) that might become cancer. It is done in people who have no symptoms and no reason to think they have cancer or polyps. The goal is to find and remove any polyps before they become cancer, or to find cancer early, before it spreads.

Being screened for colon cancer lowers the chance of dying from colon cancer. Catching a problem like this early can prevent more serious problems later. These screening tests that have been shown to be useful for finding early problems.

Keep in mind that colon cancer screening with colonoscopy, sigmoidoscopy, or stool testing for blood are preventive tests paid at 100% by your insurance through the Montana/Mountain Health CO-OP. There are potentially other ways to screen for colon cancer, but some of these are newer and will not be covered by your insurance with us.

Colonoscopy – Colonoscopy allows a doctor to directly see the inside of the entire colon with a long flexible tube. This is done in a special setting, with medication given to help the person relax and not experience pain. Since the colon needs to be clean in order to see everything inside, the preparation involves taking a special liquid that causes watery diarrhea. Any abnormal growths can be sampled or even removed through the flexible tube (colonoscope) during this process.

  • Colonoscopy finds most small polyps and almost all large polyps and cancers. Most polyps can be removed right away.
  • Drawbacks to this test – Colonoscopy has more risks than the other screening tests. In 1 in 1,000 people, it can cause bleeding or tear the inside of the colon. Cleaning out the bowel beforehand can be unpleasant. People usually cannot work or even drive themselves home the day of the test, because of the medicine they are given during the test.
  • Insurance covers 100% of the cost of a screening colonoscopy. Not all colonoscopies are done for screening purposes. Many are done for people with problems or with a prior history of colon polyps or other diseases. If you have any questions about whether a colonoscopy you are scheduling is for screening purposes only, check with us or your doctor beforehand.

Stool test for blood – “Stool” is another word for bowel movements. Stool tests most commonly check for blood in samples of stool. Cancers and polyps can bleed, so blood can be detected in the stool. Other less serious conditions can also cause small amounts of blood in the stool which can cause this test to be positive. You will have to collect small samples from bowel movements, which you will put on a special card and mail to your doctor or to a lab.

  • Advantages of this test – This test does not involve cleaning out the colon or having any procedures.
  • Drawbacks to this test. Since polyps and cancers do not always bleed, stool tests for blood are less likely to find polyps or cancers than other screening tests. These tests also often come up abnormal even in people who do not have cancer. If a stool test shows something abnormal, a person should have a colonoscopy to look directly for polyps or cancer.

Sigmoidoscopy – is a way of looking at the bottom part of your lower intestine (sigmoid colon) with a shorter flexible tube. You need less bowel preparation and no medication during this test. This test is still used at times in special circumstances, but many medical providers recommend the full colonoscopy since the whole colon cannot be seen with just a sigmoidoscopy. This test would generally be combined with regular stool testing for blood which could come from abnormalities higher in the colon.

There are other potential tests that can screen for colon cancer, but be aware that they are not currently approved for payment by your health insurance for screening purposes. One is a special type of CAT (Computed Axial Tomography) scan known as virtual colonoscopy. There are also a variety of different stool tests which look for DNA markers of colon cancer. At this time we believe that there are some disadvantages to the CAT scan, and that the DNA testing is still in an early stage of development. So, these other colon cancer screening tests will not be paid for by your Montana/Mountain Health CO-OP insurance.

Which test(s) is right for you? This mostly depends on your own approach to your health and a conversation with your health care provider. The most important issue is probably not which test to have, but whether or not to start (and continue) regular colon cancer screening.

Who should be screened for colon cancer? Doctors recommend that most people begin having colon cancer screening at age 50. People who have an increased risk of getting colon cancer should begin screening at a younger age. African Americans have a higher likelihood of developing colon cancer and can consider starting screening at age 45. People with an immediate family history of colon cancer at a young age, and people with inflammatory diseases of the colon called “Crohn’s disease” and “ulcerative colitis” also are more likely to develop colon cancer. Talk with your doctor if you have one of these illnesses or if there is a history of colon cancer or polyps in your family, to decide when you should start with colon cancer screening.

How often screening should happen depends on your risk of colon cancer and which test you have. Most people can choose one of these schedules:

  • Colonoscopy every 10 years
  • Stool testing for blood once a year
  • Sigmoidoscopy every 5 years
  • Remember that people with a higher risk of colon cancer because of a family history, other illnesses, or a previous finding of colon polyps or cancers should have more frequent colon testing. Ask your doctor what schedule is right for you.

The content of this website is not intended or recommended as a substitute for medical advice, diagnosis or treatment. Always seek the advice of your own physician or other qualified health care professional regarding and medical questions or conditions.

Well Child & Adolescent Exams Covered at 100% -- No Cost to You!

Childhood & adolescence is a time of rapid growth and change and regular wellness exams are a time when you can focus on your child’s development and overall health.  And since regular wellness exams are covered at 100%, there’s no reason not to go!

Each wellness visit should include a complete physical examination, in which your healthcare provider will check your child’s growth and development to detect or prevent health problems.

Your healthcare provider will record your child’s height, weight, body mass index (BMI), vital signs and other important developmental markers such as hearing, vision. He or she may recommend other screening tests, and will administer any needed immunizations.

Physical, mental/behavioral health development, nutrition, sleep, safety and social or school performance (if applicable) are other topics you should discuss with your child’s health care provider during the wellness exam.

These visits are key times for communication with your child’s healthcare provider to talk about what is normal at each age, and to find ways to address any issues that may come up.

Here is a schedule of well child and adolescent exams from the American Academy of Pediatrics:

Infants:

2 weeks

2 months

4 months

6 months

9 months

12 months

15 months

18 months

24 months

30 months

Toddlers, young children and adolescents:

Beginning at age 3 years and then annually