Plan Descriptions & Description of Benefits

Plan Descriptions

The brochure that is linked below provides a very brief description of the important features and coverage provided by the MCHA plans. The insurance contract itself sets forth in detail the rights and obligations for both you and the MCHA. It is very important that you READ YOUR CONTRACT CAREFULLY! KNOW YOUR BENEFITS!

There are several different comprehensive plans offered by the MCHA. MCHA offers indemnity and PPO (Preferred Provider Organization) options.  The primary differences between the plans (other than indemnity or PPO) are the annual deductible and the associated maximum annual liability limitations. The annual deductible is the amount that you must pay each calendar year for covered medical expenses before the plan pays benefits. The maximum annual liability is the out-of-pocket amount, including the annual deductible and co-payments, which you must pay in any calendar year. The maximum annual liability is listed in the brochures for each plan.

MCHA's Indemnity options utilize the BCBSMT Participating Provider Network and offer the same coverage as the MCHA plans that have been in existence for many years. 

MCHA's PPO options utilize the BCBSMT (Blue Cross Blue Shield of Montana) Healthlink PPO network and the BCSBMT Participating Provider Networks.  When you receive services from a BCBSMT Participating Professional or Facility Provider (other than Hospitals or surgery centers) or a Healthlink PPO Network hospital or surgery center, you receive the most value from your health care benefits while limiting your out-of-pocket expenses.  In return, you receive lower MCHA premium rates than those for the MCHA indemnity options.

If you use a non-PPO hospital or surgery center or a nonparticipating provider, a higher copayment will apply to those services and you may be billed for charges above the allowable fee in addition to deductible and coinsurance. 

Participating Providers accept the allowable fee as their full reimbursement, so Plan payment, deductible, and copayment is the full reimbursement.  Participating Providers will NOT bill you for charges in excess of the allowable fee for covered services. 

Locate Participating Providers, e.g., physicians, durable medical equipment providers, skilled nursing facilities, and Healthlink PPO hospitals and surgery centers by visiting the BCBSMT website at www.bcbsmt.com or call Customer Service at 1-800-447-7828, ext. 7828,.

Nationwide networks are at your fingertips.  With BlueCard, you have access to PPO and Participating providers across the country.  Visist the Blue Cross Blue Shield Association at www.bcbs.com/healthtravel or call 1-800-810-BLUE. 

Preexisting Condition Exclusion
A preexisting condition is a sickness or condition:

• that was diagnosed or treated during the three years immediately preceding the date that your coverage begins.

Waiting Period
No payment will be made for treatment of any preexisting condition, including pregnancy, until you have been continuously covered under MCHA coverage for 12 months. This waiting period does not apply to:

• Newborn children or children placed for adoption; or
• Creditable coverage may be given if:
  • coverage was not voluntarily canceled by the applicant, and;
  • application for this plan is made within 30 days of the last day of your previous coverage, and;
  • all other options for health insurance, including COBRA or state continuation coverage, have been exhausted.

If you are eligible for coverage under the federal rules, no preexisting condition exclusion will be applied.

MCHA Traditional Plan
(For persons with medical conditions who have been denied coverage or offered a significant rider on a medical condition)

The MCHA Traditional Plan has five options for coverage:

• Traditional Indemnity 1000: $1,000 deductible, 80/20 copayment with a $5,000 annual maximum member liability.
• Traditional PPO 1000:  $1,000 deductible, 80/20 (in-network) 60/40 (out-of-network) copayment with a $5,000 annual maximum member liability.
• Traditional PPO 2500: $2,500 deductible, 80/20 (in-network) 60/40 (out-of-network) copayment with a $6,000 annual maximum member liability.
• Traditional PPO 5000: $5,000 deductible, 80/20 (in-network) 60/40 (out-of-network)copayment with a $7,500 annual maximum member liability.
• Traditional PPO 7500: $7,500 deductible, 80/20 (in-network) 60/40 (out-of-network)copayment with a $10,500 annual maximum member liability.
• Traditional PPO 10000: $10,000 deductible, 80/20 (in-network) 60/40 (out-of-network)copayment with a $13,500 annual maximum member liability.
• Traditional Medicare Carve-out PPO 1000: $1,000 deductible, 80/20 (in-network) 60/40 (out-of-network) copayment with a $5,000 annual maximum member liability. 

All options except the Medicare Carve-out Plan contain a pharmacy benefit. Coverage is provided up to a lifetime maximum of $2,000,000.

This plan is also available to individuals with Medicare coverage, with Medicare paying primary and this plan paying secondary for services and supplies covered by the plan. For additional information please click to view the brochure for all MCHA Plans.

MCHA Premium Assistance Plan
(For persons with medical conditions who have been denied coverage or offered a significant rider on a medical condition and who meet certain income guidelines)

The MCHA Premium Assistance Plan offers the same coverage as outlined in the Traditional Plan section above, except that the preexisting condition waiting period is reduced to four months (if applicable) and premiums are subsidized 45%. This plan is also available to individuals with Medicare coverage, with Medicare paying primary and this plan paying secondary for services and supplies covered by the plan.

The MCHA Premium Assistance Plan is offered as a PPO plan.  The plan is also offered as a Medicare Carve-out Plan.  The following options of coverage are offered:

MCHA Portability Plans
(For persons who are federally-eligible:)

The MCHA Portability Plan has four options for coverage:

• Portability Indemnity 1000: $1,000 deductible, 70/30 copayment with a $3,000 annual maximum member liability.
• Portability PPO 1000:  $1,000 deductible, 70/30 (in-network) 50/50 (out-of-network) copayment with a $3,000 annual maximum member liability.
• Portability PPO 2500: $2,500 deductible, 70/30 (in-network) 50/50 (out-of-network) copayment with a $5,000 annual maximum member liability.
• Portability PPO 5000: $5,000 deductible, 70/30 (in-network) 50/50 (out-of-network) copayment with a $8,000 annual maximum member liability.
• Portability PPO 7500: $7,500 deductible, 70/30 (in-network) 50/50 (out-of-network) copayment with a 11,250 annual maximum member liability.
• Portability PPO 10000: $10,000 deductible, 70/30 (in-network) 50/50 (out-of-network) copayment with a $14,500 annual maximum member liability.

Both options contain a pharmacy benefit. Coverage is provided up to a lifetime maximum of $2,000,000.

Please click to view the brochure for all MCHA plans.

Plan Rates

The MCHA programs are funded through premiums paid by participants in the program and through assessments paid by insurance carriers operating in Montana. The rates shown in the documents attached below are current as of January 1, 2009.

• Traditional Plan Rates
• Premium Assistance Program Rates
• Portability Plans Rates

Outlines of Coverage for each plan are attached below: 

• Portability 1000 Plan
• Traditional 1000 Plan
• Portability PPO 1000 Plan
• Portability PPO 2500 Plan
• Portability PPO 5000 Plan
• Portability PPO 7500 Plan
• Portability PPO 10000 Plan
• Traditional PPO 1000 Plan
• Traditional PPO 2500 Plan
• Traditional PPO 5000 Plan
• Traditional PPO 7500 Plan
• Traditional PPO 10000 Plan
• Medicare Carve Out PPO 1000 Plan
• Premium Assistance PPO 1000 Plan
• Premium Assistance Medicare Carve Out PPO 1000 Plan

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