Purchasing Pool

About

Insure Montana Plan of Operations
Requirements
Health Plans

Healthy Wonders Program

Employee Assistance Program
Application process

Application

Qualified Association Health Plans

Renewals

All available slots for the Purchasing Pool program are currently filled due to limited funding. 

Applications continue to be accepted and businesses are placed on a waiting list in the order that they are received.  Additional funding has been requested and will be decided by state legislators at the 2009 legislative session beginning January 2009.

About the Insure Montana Purchasing Pool

If your small business is interested in offering your employees health insurance, the single largest barrier is probably the cost—your business and employees can afford to pay something, but are not able to pay for coverage at current market rates. Insure Montana will help you and your employees bridge the gap by providing upfront monthly payments before your bills are due and are also offering excellent new health plans.

Insure Montana is a joint initiative of Governor Brian Schweitzer and State Auditor John Morrison that is administered by the State Auditor’s Office.  This is two part program that is designed to assist small businesses with the cost of health insurance, whether they have provided health insurance previously, or not.

For businesses that were previously unable to afford health insurance for their employees, Insure Montana provides a monthly assistance payment for both the employer and the employee’s portion of the health insurance premium.  This assistance will pay a portion of the cost of an employee’s health insurance when the employer has not offered insurance in the past, but begins to do so by selecting of one of two Blue Cross Blue Shield of Montana plans through the Insure Montana Purchasing Pool, or through a Qualified Association Plan.  About 60% of the available funding is designated to make these Employee Assistance Payments and Employer Premium Incentives.  The funds are distributed on a first come, first served basis.  The size of each employee’s Premium Assistance Payment will be determined by Insure Montana staff and based on a formula approved by Insure Montana Board of Directors.

Top of Page

Description:

Employer/Employee Eligibility Requirements: To qualify for Premium Incentive and Assistance Payments employers and employees must meet the following criteria:

1. The employer does not currently provide employee health insurance;
2. The employer has a number of employees that meets the eligibility criteria established by the State Auditor’s Office (between 2 – 9 employees);
3. The employer begins to provide health insurance through the new State Health Insurance Purchasing Pool or another Qualified Association Plan;
4. No employee is paid more than $75,000 per year (owner excluded);

Insure Montana will contribute to both the employer’s and employees’ portion of the monthly premium.

• After premium incentive, the net of employer payment is 25 percent of the employee premium.  The employer will receive a monthly Premium Incentive Payment for each employee covered.
• Each employee will receive a monthly Premium Assistance Payment; amounts will range from 20%-90% depending on family annual income.

Below is an example based on an average rate tier 5 and average age of 45 – 49 with a business contribution of 50% of the employee-only premium:

This is a business with 3 employees, with varying types of coverage and varying employee family income levels.    

*Amounts are capped at the 2007 levels.

Total group premium cost:  $2,165.04

Total business contribution:  $598.35

Total business premium incentive:  $256.20

Total employee responsibility:  $1,566.68

Total employee premium assistance:  $851.30

Top of Page

The Insure Montana Plans:

The Insure Montana Insurance provider is Blue Cross Blue Shield of Montana

Standard Healthlink

• $1500/$3000 deductible

• 60/40% co pay

• Preventative services covered at 60/40% - no deductible

• 2 professional office visits per year covered at 100%

• Dental Plan included (not optional)

• Vision not available

• Rx $200 deductible

Premier Healthlink

• $750/$1500 deductible

• 75/25% co pay

• Preventative Services covered at 75/25% - no deductible

• 2 professional office visits per year covered at 100%

• Dental Plan included (not optional)

• Vision not available

• Rx $100 deductible

**Plans also available using Blue Cross Blue Shield’s traditional network of providers.

• Premier Plan 2008

• Premier Plan Healthlink 2008

• Standard Plan 2008

• Standard Plan Healthlink 2008

• Dental 2008

Top of Page

Healthy Wonders Program

Insure Montana is offering a new benefit to its members called Healthy Wonders. Healthy Wonders is a maternity management program offered in conjunction with case management through Blue Cross/Blue Shield. Healthy Wonders provides education, support and early identification of risks to help expectant mothers achieve a full-term pregnancy. This program is voluntary and is available at no additional cost to Insure Montana members and their dependents.   

Each expectant mother covered by this service is assigned a personal Maternity Case Manager who is an OB-GYN registered nurse. The Maternity Case Manager works with the expectant mother and her health care provider to:

• provide support to maximize medical care;
• help in understanding and complying with treatment plans;
• arranging for special services, when required;
• answering questions about pregnancy; and,
• provide postpartum follow up.

Incentives to enroll in the Healthy Wonders program include:

• prenatal vitamins;
• an informational book regarding pregnancy;
• one free ultrasound; and,
• a $100 gift card.

For more information regarding enrollment in this program, please call Blue Cross/Blue Shield's Maternity Case Manager at 1-800-447-7828.

Top of Page

Employee Assistance Program

Insure Montana provides a free program called Employee Assistance Program (EAP) to participating members and their families.  The program provides professional support services including:

• Addiction
• Adult Care
• Anger
• Child Care
• Depression
• Financial Concerns
• Grief
• Intimate Relationships
• Legal concerns
• Relationships that hurt
• Sexuality
• Stress/Anxiety
• Parenting
• Workplace Issues

Members and/or their families can explore these issues in an anonymous, confidential and secure manner 24 hours a day by contacting APS Healthcare at either 1-800-999-1077 or www.APSHealthLink.com with the company code of MONTANA.

Top of Page

Insure Montana Purchasing Pool Application Process

 1. Employers submit an 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 a business will begin participation in the program)  

3.  Once funding becomes available, Insure Montana staff will send an enrollment packet with directions for businesses to complete the application process and begin participation in the program.

Click here to apply.

Click here to email questions to Insure Montana staff.

Funding is provided by a $1.00 increase to the price of cigarettes, passed in 2004 by Montana voters. Number of applicants admitted to the program, is dependent upon cigarette sales. Funding and sustainability of the Small Business Health Insurance Pool is determined on an annual basis.

Top of Page

Renewals – Participating Businesses  

Montana Code (MCA 33-22-2008) requires businesses participating in the Insure Montana program to complete a renewal application process in the month of October.  Renewal applications will be sent to participating businesses toward the end of September.  Businesses must submit a completed renewal application by October 31^st.  Businesses will receive a warning notice on or about October 20^th 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 October 31^st or within 10 days, whichever is longer.  Failure to provide a completed application or required information by the due date will result in closure of the business’ participation in the program effective December 31^st.  The business would then be required to reapply for the program and it would be placed at the bottom of the waiting list. Businesses participating in the Tax Credit program would also lose eligibility for the current year’s tax credit.  

Employees of a business participating in the Purchasing Pool program are required to complete and submit an Employee Renewal Application by October 31^st.  The Employee Renewal Application will be used to update the employee’s annual gross income which is used to determine the percentage of the Insure Montana premium assistance subsidy.  Employees who fail to submit a renewal application will be suspended from the program until an application is submitted effective with the next scheduled payment.  

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 31^st.  Businesses will receive a warning notice on or about May 20^th 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 31^st 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.

Top of Page