Claims & Benefits

New Members

After signing up please watch your mail for a letter containing a My-Chart Activation code. You will need this activation code to create an account.

If you have not received this letter please call customer service at  844-262-1560.

Viewing your claims

Claims information and benefit usage are available to view online through My-Chart.

Looking for your card?

Looking for a way to access your ID card?  You can get your ID card on your phone or other mobile device through our partner, the University of Utah Health Plans, who will be processing our claims in 2020.

Just search for the University of Utah Health Plans in your app store.  The login is your ID number.  The pin is the last four digits of your ID number.

 

Pay my bill

You choose! Online, Phone, Or Mail

Send it by mail

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

For overnight service:

Wells Fargo Bank

260 North Charles Lindbergh DriveLockbox Services – U1240-02C Box 410035 Salt Lake City, UT 84116

 

Provider Finder

Montana Health CO-OP offers two provider networks—Connected Care and Access Care—that correspond with our insurance plans of the same names. Check to see if your preferred providers are “in-network” based on which type of plan you are considering or have purchased already. In-network doctors and hospitals will save you more money.

Connected Care

Network Provider Finder for all types of providers

Includes doctors and hospitals

across the state

Employer Group Network

Providers Outside of Montana, Idaho, and Utah

Includes doctors and hospitals across the state

Report Changes to Your Plan

Life moves quickly—make sure your insurance is keeping up. Examples of life event changes include marriage, divorce, birth, adoption, a change in salary or a change of address.

Healthcare.gov

Email Portal

If you signed up through healthcare.gov please call

1-800-318-2596 or log in at www.healthcare.gov to make changes to your plan.

If you enrolled directly through MHC

Use the email portal to securely return the change form.  If you haven’t used the Email Portal before, you will need to register your email address in order to send encrypted emails to Montana Health CO-OP. Click on the “Email Portal” button to begin.

You can log into your online account to process changes: https://marketplace.mhc.coop/ehpportal/eapp/login

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Download the change form and email, mail or fax in.

 

Pharmacy 

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Find a

Pharmacy 

Prescription

Drug List

Prescription

Mail Order

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Need a pharmacy prior authorization?

 
 

Vision Exam Reimbursement

Did you know that your eyes can be a key indicator of your overall health? 
 
This is why MHC has added an adult vision exam reimbursement to
 your 2020 medical plan and we have worked to keep it as simple as possible. 

 

Here’s how it works….

 

  • You pick your provider

    • Helpful hint: Please check with your provider regarding the cost of the exam ahead of time to make the most of the $60 reimbursement

  • Go to your appointment and pay direct – make sure you get a copy of your receipt

    • Helpful hint: The receipt should include one of the following standard vision exam codes: 92002, 92004, 92012, 92014, 92015, Z13.5, Z00.00, Z00.01

 

  • Submit your receipt along with the claim form, located at www.mhc.coop, to MHC. For your convenience, we provide three ways for you to submit:

 

  • Mail to University of Utah Health Plans, PO Box 45180, Salt Lake City, UR 84145-0180;

  • Fax to 801-281-6121 Attn: Member Reimbursement; or

  • Email to uuhp@hsc.utah.edu

 

  • MHC will reimburse you up to $60 for the eye exam – reimbursement will be mailed to you within 15 business days of receipt

 

Vision Coverage

Vision coverage is included without additional charge for all enrolled children under 18.

Adult vision coverage is available as a stand-alone plan administered by VSP.  VSP is a national leader in vision and eye-care benefits offering vision insurance with plans designed to save you money on doctor visits and eyewear.

If you need assistance with your pharmacy benefits please contact Pharmacy Customer Service at 1-866-236-5936. They are available 24 hours, seven days a week, 365 days a year.

Pharmacy Network

 Prescription Drug List

Need to obtain prior authorization or request a drug coverage exception?

Specialty Pharmacy Program

What is a specialty drug?

Specialty medications are generally prescribed to treat complex and/or chronic conditions, such as multiple sclerosis, hepatitis C and rheumatoid arthritis.

 

These medications may be taken by mouth, injection or infusion and have special handling or storage requirements and may not be stocked by retail pharmacies.

 

Specialty medications that require professional services for administration are usually covered under your medical benefit plan.

 

Coverage for self-administered specialty medications is provided through your pharmacy benefit plan.  

 

How to access

Your plan may require you to get self-administered specialty drugs through MHC's preferred specialty pharmacy or another in-network specialty pharmacy.

 

Specialty medications are designated as Tier 4 medications in MHC'S list of covered drugs (formulary). Certain Tier 4 specialty medications require prior authorization, and your provider may submit a coverage request by using our existing medication prior authorization form or by calling UUHP Pharmacy Customer Service at 866-236-5936.

Prescription Mail Order Services 

Did you know you could have your medications delivered to your home and save money? Instead of driving to the pharmacy and standing in line, consider having your prescriptions delivered right to your door.

If interested here are your next steps:

Step 1: Go to Novixus.com

Step 2: Set up a profile using the Rx information off your member benefits card

Step 3: Once your web profile is set up, call Novixus at 1-877-668-4987. Novixus will gather your doctor’s information and contact your doctor for you. Novixus will then set up your prescription on 90-day mail order.

It’s just that easy.

Drug List Abbreviations and Terms 
 

For each drug on our lists, find additional information and requirements including: 

Tier: The numbers refer to drug copay tiers. Tier 0 drug copays are waived under the Affordable Care Act. Tier 1 drugs have the lowest copay and are typically generics. For Tier 2 drugs you will have a mid-range copay. For Tier 3 drugs you will have a high copay. Tier 4 drugs are specialty drugs.

PA, Preauthorization: Pre-authorization helps encourage safe, cost-effective use of prescription drugs by requiring a "prior authorization" request from your physician before the drug will be covered. If PA appears in the Requirements column, the drug requires pre-authorization from your physician before the drug will be covered. 

QL, Quantity Limits: QL stands for quantity limits. If QL appears in the requirements column, the drug may be covered by your plan, but only up to a certain quantity or limit. If you need quantities higher than the limit shown, have your provider fax a preauthorization request to us.

SP, Specialty Drug: SP stands for specialty or biotech drug. In most cases, specialty drugs are required to be filled at a designated specialty pharmacy. Check your member handbook or Summary of Benefits to find the specialty drug copay amount or deductible amount. 

ST, Step Therapy: SP stands for Step Therapy, a program that requires you to try a lower-cost alternative medication ("Step 1 Drugs") before using the more expensive ("Step 2") medication. If it is medically necessary for you to use a Step 2 medication as initial therapy, your provider can submit an exception request to us. 

 

Doctor on Demand

We have partnered with Doctors on Demand to bring you virtual visits. This means, we can deliver urgent and behavioral health care services on demand, at a low cost to you.

 
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Montana Health CO-OP does not discriminate on the basis of race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

 

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