FAQ

General Questions


What is a health insurance CO-OP? How does it differ from a traditional insurance company?

CO-OP stands for Consumer Oriented and Operated Plan. It’s a nonprofit insurance company operated by the people it serves. CO-OP members must be a majority of the board of directors, ensuring that it will always meet the needs of the members at large.


How did CO-OPs begin?

The Affordable Care Act established CO-OPs to foster competition among health plans by providing a nonprofit alternative to current health insurance companies. Ultimately, the goal of a CO-OP is to help lower health insurance costs for individuals and families, create more competition in each state-based health insurance exchange, and expand insurance choices in markets dominated by a few insurance companies.


What is Mountain Health CO-OP?

Mountain Health CO-OP is an expansion of Montana Health CO-OP, one of the original CO-OPs funded on February 21, 2012, as a result of the Affordable Care Act. Through a loan from the Department of Health and Human Services, we established a consumer-oriented and  operated (CO-OP) health insurance company in Idaho. Today, we are focused on providing affordable health insurance plans for individuals and families throughout the state. Open Enrollment for our 2018 plans begins in November 1,  2017 and coverage starts on January 1, 2018.  Open Enrollment ends on December 15, 2017.


How will CO-OPs address the rising cost of healthcare?

CO-OPs will help manage increasing healthcare costs in three main ways:

  • Cost savings through prevention, disease management, screening, appropriate pharmacy benefits and use of high-value providers
  • Enhance competition in the state health insurance exchange, which is especially important in areas currently dominated by a few insurance companies
  • Greater primary care access and care coordination for members


How will Mountain Health CO-OP help the state’s uninsured population?

About 15 percent of Idaho’s population does not have insurance – around 240,000 people. We are working hard to provide options that are more affordable. But we will not focus solely on the state’s uninsured population. We are a more affordable option for any small business, individual or family that currently has insurance in Idaho.


Individuals & Families


Why is Mountain Health CO-OP more affordable?

We can have lower prices because we are a nonprofit, required by federal law to return our profits to our members in the form of lower prices, better benefits or programs to improve health. And we keep our administrative costs low.


What plans does Mountain Health CO-OP offer?

Mountain Health CO-OP offers a choice of the Bronze, Silver, Gold, and Catastrophic coverage levels. We also have choices between coverage through three different networks, that each offer excellent coverage. We negotiate discounts with the doctors, hospitals and other providers in each network, so you will save money with either plan. If you want to know if your doctor is in our networks, use our online Provider Finder. To learn more about our products, check out the products page or talk to your insurance agent.


How much do the plans cost?

The premiums are lowest for the Bronze plans, and highest for our Gold plans, but you may get help with your monthly premium from the federal government. Depending on your income and family size, you may also qualify for a reduction in your deductible and other out of pocket expenses. Check out our tax credit estimator that can show you whether you qualify, and how much your monthly premium would be.


Am I covered when I'm traveling outside of Idaho?

Yes. When traveling outside of Idaho, you’re covered throughout the United States for emergency services.


Why should I choose Mountain Health CO-OP?

Choose us because we offer quality healthcare coverage at affordable prices – from a company that returns the profits to you. Mountain Health CO-OP is a homegrown, nonprofit company, and we are here to stay.

 

 


What is the health insurance marketplace/exchange?

Your Health Idaho is the online state health insurance marketplace—also called the exchange—where you can make apples-to-apples comparisons of competing health insurance plans. The Affordable Care Act created these exchanges to help residents of each state find a health insurance plan that fits their needs and budget.

Beginning November 1, 2015, you’ll be able to fill out one application on the health insurance exchange and find out if you’re eligible for a $0 or low-cost health insurance premium (the amount you pay for insurance each month). You can also find out what your premium, deductibles and out-of-pocket costs will be before you sign up.


What is a tax credit and how can it help me save money?

A tax credit is financial assistance from the government to help with insurance costs. Since 2014, the government has been providing tax credits to millions of lower-income individuals and families. The only way to get and use this tax credit is through the health insurance marketplace/exchange at www.yourhealthidaho.org.


How do I know if I qualify for a tax credit?

You can find out if you qualify for tax credits at the Your Health Idaho Tax Credit Calculator here, call us at 855-447-2900 or talk to your insurance agent. We’re all here to help.


What is the University of Utah Health Plans?

We selected the University of Utah Health Plans, a proven and reliable claims administrator, as our third party administrator (TPA) to process our claims, handle your monthly premium, and issue your contract and ID cards.


Do you have online claims information?

Through the University of Utah Health Plans, Mountain Health CO-OP offers many online services for Mountain Health CO-OP members through our secure member web portal. This portal puts you in control of your personal health benefits information 24/7, so you never need to call to find out answers to claims questions. An easy-to-use dashboard gives you fast and easy access to:

  • Recent claims
  • Summary of current drugs
  • Links to useful tools for health risk assessments
  • Drug and health information

If our online services don’t provide the information you need, we also have live customer service representatives who are available 9 a.m. – 5 p.m., Monday thru Friday, at 855-447-2900.


What do I do since Idaho isn’t expanding Medicaid? Will I have to pay a fee?

Since Idaho is not expanding Medicaid and you don’t qualify for Medicaid under the current rules, one of three situations applies to you:

  • If your income is more than about $11,770 a year as a single person (about $24,250 for a family of four, or 100% of the federal poverty level), you will be able to buy health insurance in the state heath insurance exchange and get lower costs based on your household size and income.
  • If you make less than about $11,770 a year as a single person you may buy insurance in the state health insurance marketplace/exchange (Your Health Idaho) or directly from Mountain Health CO-OP—but you won’t be able to get lower costs based on your income. Visit this page on the federal website to learn more.
  • Families with children may find that certain members of the family may be eligible for CHIP or Medicaid. Check out the Idaho Department of Health and Welfare to learn more.


Are the Silver Cost Share Reduction plans available off of the state health insurance marketplace/exchange, Your Health Idaho?

No, the special Silver Cost Share Reduction plans are only available through Idaho’s heath insurance exchange. This is also true of the special Native American Zero Cost and Limited Cost Sharing options.


Small Business Owners


What are my choices?

Companies with fewer than 50 employees have two penalty-free options:

  1. Continue to sponsor your current group plan.
  2. Cancel your group plan and direct your employees to Your Health Idaho. Your Health Idaho allows Idahoans to compare competing plans on a level playing field, allowing individuals to make well-informed decisions about which plan is best for them. It will also help your employees determine their eligibility for federal tax credits to reduce the cost of monthly premiums.


How will Mountain Health CO-OP save me time and money?

We offer wonderful options for your group plan, with excellent service. Talk to your insurance agent about how our competitive rates can save you money or call us at 855-447-2900.


What is Altius/Conventry?

We selected Altius, a proven and reliable claims administrator, as our third party administrator (TPA) to process our claims, handle your monthly premium, and issue your contract and ID cards.


Do you have online claims information?

Through Altius, Mountain Health CO-OP offers many online services for Mountain Health CO-OP members through our our secure member web portal. This portal puts you in control of your personal health benefits information 24/7, so you never need to call to find out answers to claims questions. An easy-to-use dashboard gives you fast and easy access to:

  • Recent claims
  • Summary of current drugs
  • A search tool to find a doctor or pharmacy
  • Links to useful tools for health risk assessments
  • Hospital and physician quality scores
  • Drug and health information
  • Personalized wellness coaching
  • A library of children’s health information

If our online services don’t provide the information you need, we also have live customer service representatives who are available 9 a.m. – 5 p.m., Monday thru Friday, at 855-447-2900.


What is the Affordable Care Act?

On March 23, 2010, President Obama signed the Affordable Care Act (ACA), often called Obamacare. This law calls for health insurance reforms designed to:

  • Expand coverage
  • Lower health costs
  • Improve the quality of care
  • Make insurance companies more accountable
  • Increase healthcare choices
  • Through some of these initiatives, Idaho established  Your Health Idaho—a state-based program to help you make informed decisions about insurance.


What does the Affordable Care Act have to do with CO-OPs?

The Affordable Care Act established CO-OPs as a way to create new consumer-governed nonprofit health plans. Ultimately, the goal of a CO-OP is to help individuals and families save money on health insurance, enhance competition in each state-based health insurance exchange and provide choice in markets dominated by a few insurance companies.


What is the health insurance exchange – Your Health Idaho?

Your Health Idaho (www.yourhealthidaho.org) offers a place for visitors to compare competing health insurance plans on a level playing field. Idahoans can fill out one application and find out if they’re eligible for a $0 or low-cost health insurance premium. They can also find out what their premium, deductibles and out-of-pocket costs will be before they sign up.


How will Your Health Idaho affect my employees?

If you do not offer health insurance to your employees, they will have access to quality plans at Your Health Idaho. Depending on their income, employees may be eligible for federal tax credits, making monthly premiums more affordable.


What is a tax credit?

A tax credit is financial assistance from the federal government to help with insurance costs. The government provides these tax credits to millions of lower-income individuals and families. The only way your employees can get this tax credit is by purchasing their insurance through Your Health Idaho.


How soon can my employees receive coverage?

If you are purchasing group coverage, we can begin the first of any month. For individual coverage, Open Enrollment for 2018 begins November 1, 2017 and coverage starts January 1, 2018.  Open Enrollment ends on December 15, 2017.


Who can I contact for more information?

Contact your insurance agent, or call us at 855-447-2900 or fill out this quick form and we’ll call you. We’re here to answer your questions!


Providers


Why should I join the Mountain Health CO-OP network?

Mountain Health CO-OP embraces an innovative health insurance model that keeps healthcare local and affordable. Because our insurance is affordable and available, the large group of Idahoans that is uninsured will finally be able to get coverage—and you’ll get reimbursed for the care you provide to them.


What are your networks?

At Mountain Health CO-OP, we offer three networks based on our coverage plans:

  • Access, a PPO (Preferred Provider Organization) network: Our widest network.
  • LINK, a POS (Point of Service) network: Our narrower network connected to St. Luke’s Healthcare System.
  • Engage, with two tiers of in-network providers in northern Idaho.


How do I submit a claim?

We have selected Altius, a proven and reliable claims administrator, as our third party administrator (TPA). Altius’ wide range of online services simplifies claims processing and data flow, making information readily available to busy providers. Altius is dedicated to meeting provider needs for ease and convenience through:

  • Prompt and accurate claims payment
  • Electronic funds transfer
  • Live customer service representatives, available 9 a.m. – 5 p.m., Monday through Friday


When does coverage begin?

Enrollment for all Mountain Health CO-OP plans begins November 15, 2014 and coverage starts January 1, 2015.


How can I learn more?

Call us at 855-447-2900 or fill out this quick form and we’ll call you.