Montana Health Insurance Guide
Montana Health Insurance Information, Health Organizations and Resources and access to online health insurance quotes
As a resident of Montana you can choose from a variety of private health insurance plans including individuals and group plans provided by an employer. Depending on your income or employment status, you may also be eligible for Montana State-funded affordable health insurance for individuals and families, and federal programs such as Medicaid and COBRA.
Montana is not a guarantee issue state. That means private insurance companies are not required to sell you an individual health insurance policy if do not meet their underwriting criteria. You can be turned down for any number of reasons including your past or current health. If you are accepted, there are 12-month exclusionary and 36-month look-back periods for pre-existing conditions. However, Montana law requires that your prior creditable coverage be recognized and applied to the exclusionary period. Montana also allows elimination riders, which can temporarily or permanently result in denial of benefits for a specific medical condition. Although it places no premium caps on companies selling individual policies, Montana requires that they offer one standardized policy. By law, this basic policy must offer 50% coinsurance, $1,000 annual deductible and $5,000 maximum out-of-pocket.
Montana is a guarantee issue state for group health plans issued to small businesses, providing minimum participation requirements are met. If your Montana health insurance is provided through your employer, your coverage cannot be denied because of your past or current health. However, a maximum 12-month exclusionary period and 6-month look-back period for pre-existing conditions can be applied if you don’t have proof of prior creditable coverage. HMOs in Montana can place a two-month waiting period on new hires seeking enrollment. Your employer has the option of imposing waiting periods for new hires, but employees must enroll in the group plan within 30 days of becoming eligible. Newborn and adopted children can be added to a group plan outside of the enrollment period but no later than 31 days after birth or final adoption. Montana allows group health insurance issuers to medically underwrite policies to determine the premium they will charge the entire group, although the highest premium cannot be more than 25% of the standard rate. Rates can be adjusted based on the nature of a business, its location and the size of the group.
Montana is a guaranteed renewal state, with the exception of some disease-specific policies. Regardless of your health, your insurer must renew your individual health insurance policy as long as you’ve paid your premiums on time and haven’t defrauded the company, or in the case of some HMOs, as long as you haven’t moved out of the service area. However, your premiums can be increased to reflect your current health status and there are no caps on what you can be charged.
Montana Mandated Health Benefits
Montana laws require private health insurance policies to cover several state-mandated benefits. These currently include:
- Alcoholism and Drug Abuse Treatment
- Breast Reconstruction
- Diabetic Supplies
- Emergency Services
- Home Health Care
- In Vitro Fertilization and Other Infertility Services
- Mammography
- Mastectomy and Mastectomy Stays
- Maternity and Maternity Stays
- General and Parity Mental Health
- Newborn Hearing Screening
- Off-Label Drug Use
- PKU/Formula
- Well-Child Care
- Coverage for newborns under parent's policy
- Coverage for adopted children under parent's policy
- Coverage for handicapped dependents under parent's policy
- Coverage for continuation/dependents under parents policy
- Coverage for non-custodial children under their parents’ policy
- Coverage for continuation/employees
- Coverage for conversion to non-group
Plans Available in Montana
The following major medical health insurance plans are generally available in Montana. Major medical plans cover illness and injury, hospitalization, prescription drugs and office visits, as well as the mandated services stated above.
Indemnity plans - Typically the most flexible and therefore highest priced choice, an indemnity plan lets you select your health providers and facilities. Depending on your plan, you will have to pay a deductible or co-insurance.
Preferred provider organization plans (PPOs) - You select from a network of preferred health care providers and facilities, and receive services at an agreed-upon discounted rate. You also have the option of going outside the network, but typically at a higher cost. You do not need a referral from a primary care physician to see a specialist. Premiums may be less than an indemnity plan but more than an HMO. You will have to pay a deductible or co-insurance.
Health maintenance organizations (HMOs) - HMOs plans require you to select a primary care physician from a prescribed network of providers, who must issue a referral before you can see a specialist. Services and covered costs are typically more comprehensive than those provided by a PPO. HMOs offer the advantage of affordable premiums and low out-of-pocket costs, with an emphasis on preventive care. Non-emergency services out of network are usually not reimbursed.
Point of Service plans (POS) - Similar to a PPO in that you will receive reimbursement for out-of-network care, but with an HMO’s requirement for a primary care physician who must provide referrals to specialists. Premiums, co-pays and co-insurance are typically higher than what you’d pay with an HMO.
Alternative Health Programs in Montana
Montana Comprehensive Health Association
MCHA provides health coverage to Montana residents who are unable to obtain private health insurance. A variety of eligibility requirements apply including a minimum of 30 days’ residency. You can choose from two medical insurance plans offered through MCHA and four traditional plans. Coinsurance, deductibles and out-of-pocket maximum vary by plan. Enrollment is open. Premiums are based on the plan you choose and your age, but cannot exceed 200% of the standard risk rates of a similar plan. Pre-existing conditions will involve a 12-month waiting period before benefits are payable, but waivers are available. Lifetime maximum benefits on all MHIP plans is $2million.
Montana Children’s Health Insurance Program
Montana CHIP provides comprehensive health coverage to resident uninsured children up to age 19, whose family household income meets the plan requirements. Some waiting periods may apply and acceptance is on a first-come, first-served basis for available openings. If co-pays are required, they cannot exceed $215 per covered child. There are no co-pays for well-baby and well-child care. Enrollment is open, but families must reapply every 12 months to maintain coverage.
Regulating Agency
The Montana State Auditor’s Office is responsible for regulating Montana’s health insurance industry.
Get access to Montana health insurance quotes from http://www.einsurance.com/health-insurance.
MT Commissioner of Securities and Insurance
840 Helena Ave.
Helena, MT 59601
(406) 444-2040 or (800) 332-6148
http://www.sao.state.mt.us
Montana Comprehensive Health Association
PO Box 4309
560 North Park Ave
Helena, MT 59604
(800) 447-7828, ext. 2128
http://www.mthealth.org
Montana Children’s Health Insurance Program
Healthy Montana Kids Plan
PO Box 202951
Helena, MT 59620
(877) 543-7669
http://hmk.mt.gov
(NAIC) National Association of Insurance Commissioners
The National Association of Insurance Commissioners (NAIC) is the organization of insurance regulators from the 50 states, the District of Columbia and the five U.S. territories. The NAIC provides a forum for the development of uniform policy when uniformity is appropriate. NAIC members are the elected or appointed state government officials who along with their departments and staff regulate the conduct of insurance companies and agents in their respective state or territory.
http://www.naic.org/
Insurance Information Institute (I.I.I)
The mission of the Insurance Information Institute (I.I.I.) is to improve public understanding of insurance -- what it does and how it works.
Contact info:
110 William Street
New York, NY 10038
212-346-5500
http://www.iii.org/