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 Montana Health CO-OP?

Montana Health CO-OP is one of the initial seven 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 Montana. Today, we are focused on providing affordable health insurance plans for individuals and families throughout the state. As a local CO-OP, we are a member-controlled and -operated organization. Enrollment for our 2016 plans begins November 1, 2015 and coverage starts on January 1, 2016.


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 Montana Health CO-OP help the state’s uninsured population?

About 20 percent of Montana’s population does not have insurance. As the Health Insurance Marketplace (the online tool to help individuals choose a health insurance plan) becomes more widely used, we will be there as a viable, affordable option for this group.

At the same time, we will not focus solely on the state’s uninsured population. We are also a competitive option for small businesses and others who currently have insurance.


Individuals & Families


Why is Montana Health CO-OP more affordable?

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


What plans does Montana Health CO-OP offer?

Montana Health CO-OP offers a choice of the Bronze, Silver, and Gold coverage levels. We also have choices between coverage through two different networks, that both offer excellent coverage. We negotiate discounts with the doctors, hospitals and other providers in both networks, so you will save money with either plan. If you want to know if your doctor is in our networks, view our lists of participating providers. To learn more about our products, explore our plans 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 Montana?

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


Why should I choose Montana Health CO-OP?

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

 

 

If you qualify for a tax credit from the federal government to help with insurance costs, the only way to get this tax credit is to apply for this credit through the Health Insurance Marketplace at Healthcare.gov. Your insurance agent can help you sign up and help you figure out which coverage is best for you.


What is the health insurance marketplace/exchange?

Healthcare.gov is the online 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.

You can 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 individuals and families. The only way to get and use a tax credit is through the health insurance marketplace/exchange at Healthcare.gov.


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

You can find out if you qualify for a tax credit with our Tax Credit Calculator here, call us at 1-855-447-2900 or talk to your insurance agent. We’re 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,  Montana Health CO-OP offers many online services for Montana 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
  • A search tool to find a doctor or pharmacy
  • 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 through Friday, at 1-855-447-2900.

 


Are the Silver Cost Share Reduction plans available off of the Health Insurance Marketplace?

No, the special Silver Cost Share variance plans are only available for those that purchase insurance through the Individual Marketplace or Exchange. This is also true of the special Native American 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, and budget for large cost increases.

2. Cancel your group plan and direct your employees to the Health Insurance Marketplace. The Marketplace compares competing plans on a level playing field, allowing individuals to make well-informed decisions about which plan is best for them. The Marketplace will also help your employees determine their eligibility for federal tax credits to reduce the cost of monthly premiums.


How will Montana 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, Montana Health CO-OP offers many online services for Montana 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
  • 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 through 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


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

The Affordable Care Act established CO-OPs to help 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 Marketplace (also known as an exchange), and provide choice in markets dominated by a few insurance companies.

Montana Health CO-OP is one of the initial seven co-ops funded on February 21, 2012, as a result of the Affordable Care Act. The Department of Health and Human Services gave us a loan to establish a consumer-oriented and -operated (CO-OP) health insurance program in Montana.


What is the Health Insurance Marketplace or exchange?

The online Health Insurance Marketplace offers a single website for visitors to compare competing health insurance plans on a level playing field. Since October 2013, your employees have been able to 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 the Health Insurance Marketplace affect my employees?

If you do not offer health insurance to your employees, they will have access to quality plans in the Health Insurance Marketplace. 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 tax credit to millions of individuals and families. The only way your employees can get a tax credit is by purchasing their insurance through the Health Insurance Marketplace.


How soon can my employees receive coverage?

If you are purchasing group coverage, we can begin the first of any month. For individual coverage, enrollment begins November 1, 2015 and coverage starts January 1, 2016.


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 Montana Health CO-OP network?

Montana 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 Montanans that is uninsured will finally be able to get coverage—and you’ll get reimbursed for the care you provide to them. Learn more here.


What are your networks?

At Montana Health CO-OP, we offer two networks based on our coverage plans:

  • Connected Care, a POS (Point of Service) network emphasizing preventive healthcare to maintain affordability.  (Limited provider choices in Billings and Missoula).
  • Access Care, a PPO (Preferred Provider Organization) network. Our widest network.


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 Montana Health CO-OP plans begins November 1, 2015 and coverage starts January 1, 2016.


How can I learn more?

Call us at 855-447-2900 or fill out this quick form and we’ll call you. You may also learn more here.