Insure Montana
Frequently Asked Questions
 
Purchasing Pool FAQ
 
Q: What is Insure Montana, and how does it work?

A: Insure Montana is a two-part program that has been designed to make health insurance more affordable to small businesses, regardless if they currently offering  health insurance to their employees or not.
Tax Credit Program - Small businesses with 2-9 eligible employees that are currently providing group health insurance to their employees are eligible to apply for a refundable tax credit. (see Tax Credit program)
Purchasing Pool - Small businesses can apply for coverage through the Insure Montana Purchasing Pool or one of the Qualified Association Plans. Once eligible to participate they may receive a monthly subsidy payment to help cover the cost of their insurance premiums. Insure Montana is a program designed to subsidize Group health insurance policies. It does not provide assistance or tax credits for Individual policies.
Q: What are the eligibility requirements for the Purchasing Pool program?

A: Insure Montana Purchasing Pool Program is available to small businesses that have a minimum of 2 eligible employees but may not exceed 9 eligible employees. The employer may not have delinquent state taxes.
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; the amount of assistance is based on the employee’s gross household income.
Q: What portion of the employee premiums does the employer have to contribute to be considered eligible to participate in Insure Montana and to obtain group health coverage?

A: The employer must contribute a minimum of 50% of the employee only premium. The employer can choose to contribute more toward employee premiums but are not required to contribute toward employee’s spouse/dependents premium costs. For more information regarding employer contribution contact your health insurance agent.
Q: What is an eligible employee? Do part-time and seasonal employees count in the 2-9 employee count?

A: "Eligible Employee," means any 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. Owners are eligible employees if they work 20 hours or more a week at the business. Part-time and seasonal employees are generally not eligible, unless their annual hours average 20 hours per week or more. For more information on setting your eligibility requirements contact your health insurance agent.
Q: Once my small group is eligible to participate who receives the subsidy payments?

A: 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). The incentive payment is generally 25% of the employee only portion of the premium. If the employer contributes more than the required 50% of employee only premium the premium incentive payment increases depending on the employer contribution. **The incentive payment is always calculated based off the employee only premium.

Premium Assistance payments are issued to each eligible employee to help pay a portion of their health insurance premium, the amount of assistance is based on the employee’s household composition and income that is submitted on their Employee Assistance application. For accurate assistance payments it is important to report your household composition and income correctly.

OPT IN: An employee may decide to elect to “opt in” by signing an “opt in” form; this allows all subsidy payments for that employee to be sent to the employer.
Q: Do I report changes to Insure Montana when adding/removing employees, address changes, and other changes my group may experience?

A: YES! It is important for you to report changes that your group may experience as soon as you are aware of the change. Many changes need to be reported to both Insure Montana and your group health insurance carrier. It is important to note that Insure Montana is a different entity than your health insurance carrier, and both organizations may need to be notified of the change. All changes must be reported within 30 days of the event, failure to do so can result in loss of subsidy benefits. If overpayments of a subsidy occur as a result of a change, those funds must be repaid to Insure Montana.
To help streamline the changes, contact your health insurance agent and report the change, they can submit the appropriate documents to both Insure Montana and your health insurance carrier.
TAX Credit Program FAQ
Q: What are the eligibility requirements for the Tax Credit program?

A: Eligibility requires your business to have a minimum of 2 eligible employees but not exceed 9 eligible employees. The employer may not have delinquent state taxes, and there can be no employee earning over 75K gross wages from this business annually (excluding owners). You must also have a current group health policy, with at least two eligible employees participating.
Q: How much of a Tax Credit am I entitled to for providing a group health policy for my employees?

A: The business may be eligible to receive a refundable tax credit in the amount of up to $100 per employee per month, up to $100 per spouse per month, and up to $40 per dependent per month (up to two dependents) through Insure Montana Tax Credit program based on the contribution the business makes toward the employees monthly premiums. (If the average age of the employees are 45 or older the tax credit for the employee increases up to $125 for the employee and their spouse if applicable). This credit may not exceed 50% of the total premiums paid by the employer.
Q: Does a group have to be on a Blue Cross Blue Shield group plan in order to qualify for the Tax Credit program?

A: NO, the group health insurance policy can be from any health insurance carrier.
Q: Does Insure Montana provide a Tax Credit for Individual Policies?

A: NO, Insure Montana does not provide a Tax Credit for Individual policies. If you are unsure if your policy is a group or individual policy, contact your health insurance agent.
Q: We do not have a group health plan, but we do contribute toward our employees’ individual health insurance plans, are we eligible for the Tax Credit program?

A: NO, in order to participate in the Tax Credit program, you must have purchased and have an active GROUP health policy.
Q: If I have a change to my health insurance, add or drop an employee throughout the year, when do I report the change to Insure Montana?

A: Insure Montana must be notified of all changes to your policy within 30 days of the event.  Complete a TAX CREDIT CHANGE form and submit it either by mail or fax.
Q: I am the owner of the business, what income should I report when answering the question regarding earning over $75,000 in wages?

A: As a business owner, it would be the gross income that you have received from the business participating in Insure Montana or any related or affiliated business.
MCA 33-22-2006 (2) An owner, partner, or shareholder of a business who received more than $75,000 in wages, as defined in 39-71-123, and those individuals' spouses who are employees are not eligible under this chapter for:
     (a) any premium assistance payment. However, a premium incentive payment may be made for the premium share paid by the business for group health insurance coverage for:
     (i) the owner, partner, or shareholder;
     (ii) a spouse of those listed in subsection (2)(a)(i) who is also an employee of the business; or
     (iii) dependents of those listed in subsection (2)(a)(i).
     (b) a tax credit for group health insurance premiums paid by the business or the owner, partner, or shareholder for group health insurance coverage for the individual or the individual's dependents.
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