Eligibility Requirements

Are you eligible for MCHA coverage?

You may be eligible for coverage if you are a Montana resident and you meet the following medical or federal requirements. Coverage is available to eligible persons under the following rules:

For medical reasons, you may be eligible for Traditional or Premium Assistance Plan coverage if:

• You are a resident of the state of Montana and have been for at least 30 days; and,
• You have been rejected or offered a restrictive rider by two insurers within the last six months or have one of the listed specified illnesses (see below); and
• You are not eligible for any other health insurance coverage*; or,
• You have comparable coverage but are paying or have received a notice of a premium rate that is more than 150% of the average premium rate used to calculate MCHA premium rates. 

*Other coverage includes any other comprehensive health coverage, such as Medicare, employer group coverage and individual health coverage.  If you have any of these coverages, you are not eligible for the Traditional or Premium Assistance Plan.  The exception is that persons enrolled in Medicare (due to disability and under age 65) can be covered by the Traditional Plan Medicare Carve-out Plan that provides secondary coverage to Medicare up to the plan limits. 

**If you are eligible for Medicare (and are under age 65), you may qualify for the Medicare Carve-out Plan at a reduced rate. The Medicare Carve-out Plan does not provide coverage for prescription drugs. 

You may be eligible under the federal rules (federally eligible) for Portability Plan coverage if:

• You are a resident of the state of Montana; and,
• Your most recent prior creditable coverage was under a group health plan, governmental plan, or church plan and you had an aggregate of 18 months or more creditable prior health coverage; and,
• You do not have other health insurance coverage; and
• You were eligible for continuation coverage under a COBRA continuation provision or under a similar state program, you elected that coverage, and have now exhausted that continuation coverage; and,
• You make application for this plan within 63 days of the last date of your previous coverage.

*If you have been certified as eligible for federal Trade Adjustment Act assistance and a health insurance tax credit or for Pension Benefit Guarantee Corporation assistance, you may be eligible for the Portability Plan.  All other criteria apply, except that you must have a minimum of three months prior creditable coverage.  If you have less than three months creditable coverage or apply after 63 days, a 12-month preexisting waiting period may apply. 

Note: For children under 18 months of age who are otherwise eligible, as defined above, the requirement to have 18 months of previous creditable coverage is waived. Also, children born to persons on the Portability Plan can transfer to their own Portability Plan after 31 days coverage on the parent’s plan.

How do I apply?

It’s simple. Just call the MCHA at 1-800-447-7828 extension 8537 and ask for an information packet or download the materials from this website.

Read the brochure carefully. Complete the application. Be sure to sign and date your application. When you return your completed application make sure that you enclose the required eligibility information and documentation (such as proof of residency.)

You will be notified in writing of your acceptance into the program. In general, coverage is effective the first day of the month after we receive the completed and accepted application.

Montana Comprehensive Health Association
Phone: Toll Free 1-800-447-7828, extension 8537
8:00 AM to 5:00 PM (Montana time) Monday – Friday
PO Box 4309
560 North Park Avenue
Helena, MT 59604
Email: info@mthealth.org