Purchasing Pool - Insure Montana
Purchasing Pool – Premium Assistance Program

About
Eligibility Requirements
Insure Montana Purchasing Pool Health Plans
Qualified Association Health Plans
Application process
Renewals

About the Insure Montana Purchasing Pool Program

If your small business is interested in offering your employees health insurance, the single largest barrier may be cost.  The Insure Montana Premium Assistance program may help make costs more affordable to you and your employees by providing upfront monthly payments before your premiums are due.

This program assists both the employer and employees with their portion of the health insurance premium each month. 

Premium Incentive payments are issued monthly to the employer for their contribution toward the employees premium (Employers must contribute a minimum of 50% of the Employee Only premium).

Premium Assistance payments are issued to each eligible employee to help pay a portion of their health insurance premium costs; the amount of assistance is based on the employee’s household income and composition.

Funding for this program is provided in part by a $1.00 increase to the price of cigarettes, passed in 2004 by Montana voters. Other funding sources include insurance fees and general fund. Funding and sustainability of the Small Business Health Insurance Pool is determined on an annual basis.

Employer/Employee Eligibility Requirements

  1. The small employer/business must employ between 2-9 "eligible employees"**;
  2. The small employer/business purchases a group health insurance policy through the State Health Insurance Purchasing Pool or another Qualified Association Plan;
  3. The business or any related business may not have any delinquent state tax liability owing the Montana Department of Revenue.
  4. Employees with gross household income exceeding 400% of the Federal Poverty Level are not eligible for a premium assistance payment.
  5. Employees participating in the subsidy program may not have dual coverage as defined by MCA 33-22-2001 (4) (a), It is the intent of the legislature that the board: establish criteria that will allow the greatest number of employees possible to be eligible for premium assistance payments by not permitting eligibility for premium assistance payments under this part to employees who continue other comprehensive health insurance coverage through a spouse, parent, or other person.

*(20) "Small employer" means a person, firm, corporation, partnership, or bona fide association that is actively engaged in business and that, with respect to a calendar year and a plan year, employed at least two but not more than 50 eligible employees during the preceding calendar year and employed at least two employees on the first day of the plan year. In the case of an employer that was not in existence throughout the preceding calendar year, the determination of whether the employer is a small or large employer must be based on the average number of employees reasonably expected to be employed by the employer in the current calendar year. In determining the number of eligible employees, companies are considered one employer if they:
     (a) are affiliated companies;
     (b) are eligible to file a combined tax return for purposes of state taxation; or
     (c) are members of a bona fide association

**(12) (a) "Eligible employee" means an employee who works on a full-time basis with a normal workweek of 30 hours or more, except that at the sole discretion of the employer, the term may include an employee who works on a full-time basis with a normal workweek of between 20 and 40 hours as long as this eligibility criteria is applied uniformly among all of the employer's employees. The term includes a sole proprietor, a partner of a partnership, and an independent contractor if the sole proprietor, partner, or independent contractor is included as an employee under a health benefit plan of a small employer. The term also includes those persons eligible for coverage under 2-18-704.
     (b) The term does not include an employee who works on a part-time, temporary, or substitute basis.

***MCA 33-22-2002 - (11) “Related Employers” (a) affiliates or affiliated entities or persons who directly or indirectly, through one or more intermediaries, control, are controlled by, or are under common control with a specified entity or person; and (b) entities or persons that are eligible to file a combined or joint tax return for purposes of state taxation.

The Insure Montana Plans (Administered by Blue Cross Blue Shield of Montana)

Platinum Blue Preferred PPO 002
In Network Deductible $250
Out of Network Deductible $500
Co-Insurance In Network 20%
Co-Insurance Out of Network 40%
Co-Payments $25/PC
Out of Pocket Limit In Network $1,250
Out of Pocket Limit Out of Network $2,500
 
Gold Blue Preferred PPO 007
In Network Deductible $1,000
Out of Network Deductible $2,000
Co-Insurance In Network 20%
Co-Insurance Out of Network 40%
Co-Payments $30/PC
Out of Pocket Limit In Network $3,000
Out of Pocket Limit Out of Network $6,000
 
Gold Blue Preferred PPO 010
In Network Deductible $1,250
Out of Network Deductible $2,500
Co-Insurance In Network 20%
Co-Insurance Out of Network 40%
Co-Payments $30/PC
Out of Pocket Limit In Network $3,500
Out of Pocket Limit Out of Network $7,000
 
Gold Blue Preferred PPO 011
In Network Deductible $2,000
Out of Network Deductible $4,000
Co-Insurance In Network None
Co-Insurance Out of Network 20%
Co-Payments None
Out of Pocket Limit In Network $2,000
Out of Pocket Limit Out of Network $4,000
 
Silver Blue Preferred PPO 017
In Network Deductible $2,000
Out of Network Deductible $4,000
Co-Insurance In Network 20%
Co-Insurance Out of Network 40%
Co-Payments None
Out of Pocket Limit In Network $5,000
Out of Pocket Limit Out of Network $10,000
 
Bronze Blue Preferred PPO 018
In Network Deductible $5,000
Out of Network Deductible $10,000
Co-Insurance In Network 20%
Co-Insurance Out of Network 40%
Co-Payments None
Out of Pocket Limit In Network $6,250
Out of Pocket Limit Out of Network $12,500


Qualified Association Health Plan Information
Insure Montana program also allows Qualified Association Plans to participate in the program. For a list of the Qualified Associations that offer group health plans and have been determined eligible to participate with Insure Montana click here.

Insure Montana Purchasing Pool Application Process

  1. Employers/Business Owners must submit a Business Application to the Insure Montana office for a determination of eligibility and placement on the program’s waiting list.  (NOTE:  Businesses on the waiting list must complete a renewal application in the month of May each year. See ‘Renewals’.)
  2. Businesses will receive a notice confirming or denying eligibility for program participation. (NOTE: Quotes of premium costs or premium incentive/assistance payments cannot be made until the business begins the enrollment process.)
  3. Enrollment Process - Once funding becomes available, Insure Montana staff will send an enrollment packet containing a Business Enrollment Application, Employee Assistance Applications, and instructions for businesses to complete the enrollment process (60 days) and begin participation in the program. When all completed forms and health insurance quotes have been received, Insure Montana staff will provide incentive/assistance estimates. The group will select and purchase their group health insurance plan through the Insure Montana Purchasing Pool options or a health plan offered by one of the Qualified Association’s, and will also start receiving their monthly subsidy payments.

To apply complete a Business Application.  Click here.

Annual Online Renewals – Eligible Businesses and Employee's 

Montana Code (MCA 33-22-2008) requires businesses and employees participating in the Insure Montana program to complete an annual renewal application. Eligible businesses and employees are required to complete an online electronic renewal process that will coordinate with the business annual health insurance policy renewal period. Online renewal letters containing unique log in codes and passwords will be mailed and each eligible business and employee and they will have a 60 day period in which they must complete their online renewal application to maintain eligibility in the Insure Montana premium incentive and premium assistance program. If additional information is required to determine ongoing eligibility, Insure Montana will notify the business or employee and they will have 10 days to respond to the additional information request.


Business Online Renewal – Each business will receive a letter with a unique log in code and password that will be used to complete the required renewal process. Failure to complete this online renewal by the date specified would result in the closure of the business’ premium incentive payments and any eligible employees’ premium assistance payments regardless if they have completed their online renewal process or not. The business would then be required to reapply for the program and would be subject to the eligibility requirements as a new applicant.


IMPORTANT: Business owners who are also eligible employees participating in the program must complete the business online renewal as well as an individual employee renewal. Two separate notices will be sent, and will have different unique log in and passwords.


Employee Online Renewal – Each eligible participating employee will receive a letter with a unique log in code and password that will be used to complete the required renewal process. This online renewal application will be used to update the employee’s annual gross household income which is used to determine the amount of premium assistance subsidy that the employee is eligible to receive. Failure to complete the online renewal process by eligible employees will result in suspension from the Insure Montana subsidy program until a completed application is submitted. Future payments will be re-instated with the next scheduled payment; therefore, if a premium assistance payment is not issued due to failure to submit an online renewal application, that payment is forfeited by the employee and they will be eligible for the next scheduled payment once a complete application is received. NOTE: Once the 60 day period has expired, an employee will no longer be able to log in and complete the online renewal process, they will need to complete a whole new employee premium assistance application and submit it by fax or mail to the Insure Montana office.


IMPORTANT: As mentioned, the Insure Montana annual online renewal process will be coordinated with the group health insurance policy renewal. It is important to recognize that these are two separate renewals, and Insure Montana requires information from both processes to be submitted to the office. If a business fails to renew their group health insurance policy, that will result in loss of both group health coverage and Insure Montana subsidy benefits. If the employer fails to complete the business Insure Montana online renewal application, but does complete the group health insurance renewal then there is no loss to the group health coverage, but the business and any participating employees would no longer be eligible for Insure Montana incentive and assistance subsidy payments. Insure Montana does not maintain or renew any group health insurance policies, those renewals need to be handled with the group health insurance agent and/or the group health insurance carrier.


Terms to know:
Group Election form / Member participation form – This is the annual contract between the business and the group health insurance carrier. This form provides all the necessary information regarding the health insurance policy to be administered by the carrier. It displays information such as business demographic information, business contribution, and which health insurance plan the group is opting for in the current year.


Group Census/ Group Listing – This is a complete list of all employees and how they are enrolled in the group health insurance. Each employee that is participating should be listed as well as their enrollment level of coverage (Employee Only, Employee/Spouse, Employee/Child, Employee/Children, Family/Child or Family/Children).

Renewals – Business on the Waiting List  
Montana Code (MCA 33-22-2008) requires businesses participating in the Insure Montana program to complete a renewal application process in the month of May.  Renewal applications will be sent to participating businesses toward the end of April.  Businesses must submit a completed renewal application by May 31st.  Businesses will receive a warning notice on or about May 20th if a completed application has not been received.  If additional information is required to complete a determination of continued eligibility, the business will be required to provide the information by May 31st or within 10 days, whichever is longer. 

Failure to provide a completed application or required information by the due date will result in removal of the business’ position on the waiting list
The business would then be required to reapply for the program and it would be placed at the bottom of the waiting list.

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