Montana Risk Pool - Health Insurance for the Uninsurable

Risk Pool Name / Acronym
Montana Comprehensive Health Association / MCHA

Insurance Regulation Establishing Risk Pool
MCHA was established by Montana Legislature in 1985 and was later amended in 1997 to meet federal HIPAA regulations.

Montana Comprehensive Health Association (MCHA)

The Montana Comprehensive Health Association (MCHA) was established in 1985 to offer health coverage to eligible Montana residents who are otherwise considered uninsurable due to medical conditions. To qualify, eligible individual should have been rejected or offered a restrictive rider by two insurers within last 6 months; or have a medical illness; or his recent coverage was under a group health plan, o r church plan and had 18 months of continuous health coverage. In addition, the individual should not have any other health insurance coverage including employer group coverage or individual health insurance.

Funding
MCHA is funded partially by the premiums that collected from insured members. Additional funds to help cover operating costs and pay medical claims come from tax assessments to insurance companies operating in the state of Montana.

Plans Offered

There are two medical insurance plans available through the MCHA program that offer various benefits options. There are four traditional plans offered: Option 1000, Option 2500, Option 5000 and Option Medicare Carve-Out Plan. In addition to the traditional plans, there are three plans available for federally eligible person under HIPAA regulations: Option 1000 Portability, Option 2500 Portability, Option 5000 Portability, Option 7500 Portability and Option 7500 Portability.

Plan Benefits

All Traditional MCHA plans require that you pay a 20% coinsurance for most covered services after you meet your plan deductible. Option 1000 has an annual deductible of $1,000 and an annual maximum out-of-pocket limit of $5,000. Option 2500 has an annual deductible of $2,500 and an annual maximum out-of-pocket limit of $6,000. Option 5000 has an annual deductible of $5,000 and an annual maximum out-of-pocket limit of $7,500. Option 7500 has an annual deductible of $7,500 and an annual maximum out-of-pocket limit of $10,500. Option 10000 has an annual deductible of $10,000 and an annual maximum out-of-pocket limit of $13,500.The Option Medicare Carve-Out has annual deductible of $1,000 and an annual maximum out-of-pocket limit of $5,000.
The MCHA Portability Plans require that you pay a 30% coinsurance for most covered services after you meet the plan deductible. Option 1000 has an annual deductible of $1,000 and an annual maximum out-of-pocket limit of $3,000. Option 2500 has an annual deductible of $2,500 and an annual maximum out-of-pocket limit of $5,000. Option 5000 has an annual deductible of $5,000 and an annual maximum out-of-pocket limit of $8,000. Option 7500 has an annual deductible of $7,500 and an annual maximum out-of-pocket limit of $11,250. Option 10000 has an annual deductible of $10,000 and an annual maximum out-of-pocket limit of $14,500.

MCHA Traditional Plan Brochure
MCHA Portability Plan Brochure

Maximum Benefit Limits

All MCHA medical insurance plans have a lifetime maximum benefit of $2,000,000.00.

Eligibility

Traditional Plan Eligibility Requirements

• You have been a resident of the state of Montana for at least 30 days
• You have been rejected or offered a restrictive rider by two insurers within the last six months or have an illness as listed in the eligibility section of the plan brochure
• And, you are not eligible for any other health insurance coverage, as more particularly described in the eligibility section of the plan brochure, or, you are paying or have received a notice of a premium rate on other health insurance that is more than 150% of the average premium rate for MCHA

Federally Eligible Requirements

• You are a resident of the state of Montana
• Your most recent prior creditable coverage was under a group health plan, governmental plan, or church plan and you had 18 months of continuous coverage
• You do not have other health insurance coverage
• You were eligible for continuation coverage under a COBRA continuation and you elected and exhausted that coverage
• You apply for MCHA coverage within 63 days of the last date of your previous coverage

Enrollment Periods

You may apply for traditional MCHA coverage at anytime and your coverage will be made effective on the first day of the month following approval of your application. Portability plans must be applied for within 30 days of the termination date of your previous coverage.

Premium Payments

Premiums for the MCHA plans are based on your plan selection and age.

Premium Calculations

Premiums for MCHA plans are based on comparing the rates of standard risk rates available to residents of Montana for similar type benefit plans. MCHA rates are higher than standard risk rates, but are capped at no more than 200% of these rates.

Pre-Existing Condition Waiting Periods

Traditional MCHA plans have a pre-existing condition waiting period of 12 months. No benefits will be paid for treatment of pre-existing conditions during this waiting period. You may be eligible for a waiver of this waiting period if you had qualifying creditable coverage and submit your MCHA application within 30 days of losing that coverage. Other restrictions apply, so review the plan brochure for more details.

Montana Comprehensive Health Association Contact Information

Montana Comprehensive Health Association
P.O. Box 4309
560 North Park Avenue
Helena, MT 59604
Phone: 1-800-447-7828

MCHA Website

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