Insure Montana began in 2005 as an initiative of the Insurance Commissioner and the Governor, and is administered by office of the Commissioner of Securities and Insurance. The program is funded by the State Tobacco Tax, insurance fees, and general funds. It is a two-part program designed to help make small group health insurance more affordable to small businesses, regardless of whether they are currently offering health insurance or not.
Small businesses with 2-9 eligible employees that are currently providing group health insurance to their employees may be eligible to apply for a refundable State Tax Credit, through the Tax Credit Program.
Small businesses can apply for the Purchasing Pool Program which offers premium assistance and incentive subsidy payments monthly to qualified groups to help make the cost of health insurance premiums more affordable.
The program eligibility requirements are as follows:
- A business or "small employer"* must have at least 2 and no more than 9 "eligible employees"**. (An eligible employee is defined by MCA 33-22-1803, as 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 normal workweek of between 20 and 40 hours as long as the eligibility criteria is applied uniformly among all the employer’s employees.)
- For the Tax Credit Program - The business/employer may not have any employee (excluding owner) who receives more than $75,000 in wages, as defined by MCA 39-71-123, from the small employer or related employer in the prior year tax year.
- Employees with gross household income exceeding 400% of the Federal Poverty Level are not eligible for a premium assistance payment.
- The business/employer may not have any delinquent state taxes owing to the Montana State Department of Revenue.
- To be eligible for a Tax Credit, the business/employer must currently be offering a group health insurance policy to the eligible employees.
*(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.