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Montana Risk Pool - Health Insurance Provided for the Uninsurable

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Acronym or name of the risk pool: Montana Comprehensive Health Association or MCHA.

Regulation establishing risk pool: It was established by Montana legislature in 1985 and was amended in 1997 to meet regulations under HIPAA.

Funding: The programme receives funds from premium payments by members. It is also received from assessments on health plans. Licensed companies are assessed according to the business they’re receiving in the state.

Plans offered: Two medical plans are offered through the MCHA programme. Four traditional plans are offered. These are options 1000, 2500, 5000 and option Medicare Carve out Plan. Additionally, three other plans are available for people with HIPAA eligibility. These are option 1000 portability, option 2500 portability and option 5000 portability.

Plan benefit: For the traditional plans, you have to pay a coinsurance of20% after the deductibles are paid for covered services. Option 1000 has a deductible of $1000 annually and the out of pocket for this plan is $5000. For plan 2500, the deductible is $2500 and the out of pocket limit is $6000. For option 5000, the deductible is $5000 annually and the out of pocket limit is $7500. The Medicare carve out option has a deductible of $1000 and the out of pocket limit is $5000.

The portability plans requires you to pay 30% coinsurance for most covered services after the plan deductibles are met. Option 1000 has annual deductibles of $1000 and the out of pocket limit is $3000. Option 2500 requires you to pay a deductible of $2500 annually and the out of pocket is $5000. Option 5000 has annual deductibles of $5000 and the out of pocket limit is $8000.

MCHA traditional plan summary: http://www.mthealth.org/pdf/

MCHA portability plan summary: http://www.mthealth.org/pdf/

Maximum benefit limits: The lifetime maximum benefits for all MCHA plans are $1000000.

Eligibility: Traditional plan - (1) The person must be a resident of Montana for at least 30 days. (2) The person must have received a notice rejecting his application for insurance from an admitted company in the state within the last 6 months. (3) You are not receiving benefits from any other plans, state or federal. (4) No other health coverage is being provided to the individual. (5) You are paying premiums at a rate that is more than 150% the rate for MCHA.

Federally eligible requirements: (a) The person must be a resident of Montana for at least 6 months. (b) The person may not be eligible for Medicare or Medicaid. (c) The person must have at least 18 months of insurance coverage, most recently for a group insurance. (d) The last payment should not have been terminated because of non -payment of premium. (e) You have exhausted your last coverage under COBRA. (f) You have applied for MCHA within 63 days of termination of the last cover.

Enrollment periods: Applications for traditional plans can be made at any time. The covers become effective on the first day of the next month. If you want to apply for portability plans, you have to do so within 30 days of the end of your last cover.

Premium payments: Premiums are dependent on the health plan you select. It is also determined by your age, sex and whether you are a smoker.

Premium calculations: The rates for MCHA coverage vary according to the standard rate charged by five of the largest health insurers in Montana. The rates are higher than those charged by other companies but they are capped at a certain percentage.

Pre existing condition waiting period: For all policies under MCHA, benefits are not payable for the first 12 months of coverage under a preexisting condition. Exceptions apply under waivers. You can apply for a waiver in the waiting period if you apply for cover before 30 days of the end of the last cover. An MCHA representative can guide you on these clauses.

Contact information: Montana comprehensive health association. PO box- 4309.560, North Park Avenue. Helena, MT 59604. Ph- 18004477828. MCHA Website.

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