How to Apply
A completed, signed, and dated application form is required for enrollment in the plans. Proof of residency is required for all plans. When applying for Traditional Plan coverage, you must include proof of the qualifying medical condition. Your doctor can provide this proof. For the Premium Assistance Program, you must supply documentation to support your annual income as outlined on the application form. Proof of your prior coverage is required for the Portability Plans. Please click on the application form below for the plan that you are interested in for further information.
(You must have Adobe Acrobat to download the applications.)
Please note: for the Premium Assistance Program you must complete both the Traditional and Premium Assistance Program applications.
LICENSED AGENTS - IMPORTANT - PLEASE NOTE: Due to HIPAA regulations, a business associate agreement (BA) must be on file so that MCHA can share information with you. Please go to the home (main) page of this website and download this important agreement. Then, complete the agreement and mail or fax to our office. If a BA is not on file, MCHA will not be able to provide any information about an applicant or application status. For more information, please see the home page.
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
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