Generally Asked

Mountain Health CO-OP offers coverage for individuals, families, businesses of all sizes, and even those who are 65+ years of age through our Medicare Supplement Insurance plans.   

Our Member Service team is here to ensure you always have the information you need about your plan.  You can send the team an email through memberservice@mhc.coop or call 855-447-2900.  You can even message the team through the MyChart portal for CO-OP members.  

Every hospital in Montana, Idaho, and Wyoming is covered under the CO-OP’s networks*.  We also work with a number of facilities and providers to give our members access to specialists of all kinds.  

Employer groups also receive access to a network of national providers, so if you have locations outside of the CO-OP’s primary states (Montana, Idaho and Wyoming), your employees will have coverage through our national network.    

*Networks may vary by plan.  Please use the Provider Finder to find the providers for your network.

First of all, welcome to the CO-OP!  We’re happy you’re here.

When you’re ready to make your first premium payment, please send your check (payable to Mountain Health CO-OP) to the following mailing address:

LB 410035
Mountain Health Cooperative
PO Box 35145
Seattle, WA 98124-5145

Express Mail payments:
Lockbox Services-#410035
18035 Sperry Dr
Tukwila, WA 98188-4750

If you prefer to make a payment online, please contact our Member Services team by calling 844-262-1560 to retrieve your member ID information and log onto our online portal to complete your transaction.  

Your member welcome booklet and ID card will be mailed 7-10 days after you make your first payment. Please contact our Member Services team by calling 855-447-2900 or email memberservice@mhc.coop if yours does not arrive within three weeks of your first premium payment.

If you need services before your member ID card arrives, please call Member Services to access your member ID information and use the MyChart portal to navigate your plan and benefits.

Welcome to the CO-OP – we’re happy you’re here!  

For individual members, coverage typically goes into effect the first day of the month following your purchase of the plan you selected.  

Group policies also typically go into effect at the start of the month following the purchase of the plan.  Please contact your employer’s plan administrator for more information.

Your health is the bottom line for the CO-OP.  We design insurance plans with benefits we know our members will value and use.

We are accredited by the National Committee for Quality Assurance (NCQA), which works to improve the quality of healthcare across the country.  The CO-OP has a dedicated team that completes a rigorous procedure to earn this accreditation, always using the feedback received from the process to find opportunities to improve our operations and service for members – all so we serve you better.   

You can order a replacement by filling out this form.  You can also contact our Member Services team at 855-447-2900 or memberservice@mhc.coop.  These team members can ensure you receive a replacement card and share the information you need so your information is easy to access. 

Business

Absolutely.  The CO-OP currently works with groups of all sizes across a variety of industries.  Our sales team will work closely with you to make sure the health insurance you offer your team will meet your budget and their needs. 

At Mountain Health CO-OP, your health is our bottom line. Our board of directors includes members from Montana, Idaho, and Wyoming, which means your best interests are being protected.  

Thanks to members like you and our board, the CO-OP offers a number of special benefits in addition to a wide range of coverage options.  These special benefits* include…

  • an annual $60 vision exam reimbursement**,
  • an annual $100 dental exam reimbursement**,
  • hundreds of medications available with no out-of-pocket cost (including many insulins),
  • 24/7 access to a doctor through Doctor on Demand,
  • a travel benefit to access specialized care when you need it,
  • and more.

We also offer high-quality customer service for members, because we want you to know you’re in good hands.  

*Does not apply to Medicare Supplement Insurance Plans.

**Some exclusions may apply, please review your outline of coverage.

Yes!  Groups don’t just have access to providers in Montana, Idaho and Wyoming – they have access to a network of providers across the country.  This makes it easy for your remote employees to get the care they need without breaking the bank or needing to travel. 

In addition to having a great Member Service team to answer your employees’ questions, your plan administrator will have a dedicated account service representative.  Our representatives are knowledgeable and can help your company’s administrator navigate your group’s coverage and needs with ease.  

Individual & Family

Individual insurance is when a person (and/or family) purchases their own insurance policy instead of being covered through an employer or a group.  

The CO-OP offers a variety of plans to provide individuals and families with the coverage they need.  We work with you (and insurance agents and brokers) to make sure you can choose from quality plans at affordable prices.

Many of our members qualify for an Advance Premium Tax Credit (APTC).  This credit reduces your out-of-pocket expenses by reducing your monthly premiums – which can make a significant difference. 

See how the APTC might impact your monthly premium by clicking here.

At Mountain Health CO-OP, your health is our bottom line. Our board of directors includes members from Montana, Idaho, and Wyoming, which means your best interests are being protected.  

Thanks to members like you and our board, the CO-OP offers a number of special benefits in addition to a wide range of coverage options.  These special benefits* include…

  • an annual $60 vision exam reimbursement**,
  • an annual $100 dental exam reimbursement**,
  • hundreds of medications available with no out-of-pocket cost (including many insulins),
  • 24/7 access to a doctor through Doctor on Demand,
  • a travel benefit to access specialized care when you need it,
  • and more.

We also offer high-quality customer service for members, because we want you to know you’re in good hands.  

*Does not apply to Medicare Supplement Insurance Plans.

**Some exclusions may apply, please review your outline of coverage.

Whether you need basic coverage or a more comprehensive plan, we have a variety of options for you to consider. We will work with you (and even connect you with an agent in your area) to understand your needs and see if one of our plans would be a good fit for you. 

 You can view plan options by visiting our pages for Individual, Business, and Medicare Supplement Insurance Plans by selecting the tabs at the top of our website.  

In-network providers are healthcare professionals or facilities that have contracts with the CO-OP.  They are our partners in providing care and will have negotiated terms for the cost of care for our members.  In-network providers are more affordable to receive care from because the contract will set a cost of care for our members.

Out-of-network providers are healthcare professionals or facilities the CO-OP has not contracted with.  These providers will not have an agreed-upon cost of care for our members and will be more expensive to receive care from.  Out-of-network providers are not held to contracted rates.  This means they balance bill. 

Balance Billing occurs when a provider bills you for the difference between the provider’s charge and the allowed amount (which is set by your insurance company). For example, if the provider’s charge is $100 and the allowed amount is $70, the provider may bill you for the remaining $30. An in-network provider cannot balance bill you for covered services.

Terms to Know

Allowable Fee/Allowable Amount means the maximum amount on which payment is based for covered health services for both In-Network and Out-of-Network Providers.

Ancillary Charge (in relation to the pharmacy) means a charge which the Covered Person is required to pay to a Preferred Pharmacy for a covered Brand-Name Prescription Drug Product for which a Generic substitute is available. The Ancillary Charge is determined by subtracting the contracted price of the Generic drug from the contracted price of the Brand-Name drug. Any Copayment amounts are in addition to the Ancillary Charge.

Annual Out-of-Pocket Maximum: The most you have to pay for covered services in a plan year. After you spend this amount on deductibles, copayments, and coinsurance, your health plan pays 100% of the costs of Covered Benefits. The Out-of-Pocket limit doesn’t include your monthly premiums.

The Annual Out-of-Pocket Maximum includes the following:

1. Plan Year Deductible

2. Copayments; and

3. Coinsurance

Family Limit for the Annual Out-of-Pocket Maximum: The Family Annual Out-of-Pocket Maximum is reached when two or more Family members, who are insured under this Policy, have incurred and paid deductibles, copays, and coinsurance equal to the amount listed in the Schedule of Benefits for that specific plan. When the total out-of-pocket expense is reached within the Plan Year of the effective policy, We then will pay 100% of Covered Medical Expenses incurred by all Family members for the remainder of the Plan Year. The total of out-of-pocket medical expenses returns to zero at the end of the plan year, and the accumulation would begin again for the new plan year.

Coinsurance means a percentage amount a member is responsible to pay out-of-pocket for health care services after satisfaction of the applicable deductibles or copayments, or both. The Coinsurance is applied to the Allowable Fee for Covered Medical Expenses incurred for Covered Benefits. The Coinsurance amount is shown in the Schedule of Benefits and applies to the Out-of-Pocket Maximum. No further co-insurance is assessed when the Out-of-Pocket Maximum is met.

Copay or Copayment means a fixed dollar amount the Covered Person is required to pay for specifically listed Covered Benefits as shown in the Schedule of Benefits. Copayments are generally paid to the Provider at the time of service. Copayments apply towards the satisfaction of the Out-of-Pocket Maximum.

Covered Benefits means all Medically Necessary services, supplies, medications and devices covered under this Policy as provided under Section 5, Covered Benefits. Covered Benefits are payable as shown in the Schedule of Benefits.

Covered Dependent means Your spouse or domestic partner, and any of Your dependent children (as defined in this Policy) who are insured under this Policy. A Covered Dependent must be listed as Your Dependent in Your Application for this Policy and approved by Us. The required premium for the Covered Dependent’s coverage under this Policy must be paid.

Covered Medical Expense means expenses incurred for Medically Necessary Covered Benefits that are based on the Allowable Fee and:

1. Covered under this Policy;

2. Provided to the Covered Person by and/or prescribed by a Covered Provider for the diagnosis or treatment of an active Illness or Injury or maternity care.

The Covered Person must be charged for such services, supplies, and medications. Covered Person means the Policy-owner and/or the Policy-owner’s Covered Dependents.

Deductible means the amount you pay for covered health care services before your insurance plan starts to pay. With a $2,000 deductible, for example, you pay the first $2,000 of covered services yourself. After you pay your deductible, you usually pay only a copayment or coinsurance for covered services.

The Deductible is shown in the Schedule of Benefits. The following do not apply towards satisfaction of the Deducible:

1) Services, treatments or supplies that are not covered under this Policy;

2) Co-pay amounts paid by the Insured;

3) The premium payments paid by the Insured; and

4) Amounts billed by Out-of-Network provider above the Allowable Fee.

 

Family Deductible: The Family Deductible is an aggregate Deductible as is shown in the Schedule of Benefits.

The Family Deductible must be satisfied by two of more family members, who are insured under this Policy, during the Calendar Year the policy is in force.

Once the Family deductible is met for the Calendar Year, no further payments toward the Family Deductible from Family members will be required for the remainder of that Calendar Year.

Dependent means Your: 1. Spouse or domestic partner; and 2. Dependent Child as defined in this Policy.

Dependent Child or Dependent Children means Your children who are: 1. Under age 26, regardless of their place of residence, marital status or student status; including: (a) newborn children; (b) stepchildren; (c) legally adopted children; (d)children placed for adoption with the Policy owner in accordance with applicable state or federal law;(e)foster children; and (f) children for whom You are a legal guardian substantiated by a court or administrative order; and 2. Unmarried dependent Handicap Children age 26 and over. Refer to the definition of Handicapped Child. A Dependent Child does not include a child who is enrolled for Medicare or Medicaid.

Emergency Medical Condition means a medical condition manifesting itself by acute symptoms of sufficient severity (including severe pain) so that a prudent layperson, who possesses an average knowledge of health and medicine, could reasonably expect the absence of immediate medical attention to result in a condition that places the health of the individual in serious jeopardy, would result in serious impairment to bodily functions, or serious dysfunction of any bodily organ or part; or with respect to a pregnant woman having contractions, that there is inadequate time to safely transfer the woman to another hospital for delivery or that a transfer may pose a threat to the health or safety of the woman or the fetus.

Exchange means the Health Insurance Marketplace through which qualified consumers can compare and purchase insurance from insurance companies. The state may operate a State- based Exchange, a Federally-Facilitated Exchange, or an Exchange in partnership with the federal Department of Health and Human Services. Exchanges are required by the Affordable Care Act.

Holistic Medicine means a form of alternative and complementary medicine. Practitioners apparently receive some level of training at holistic schools or courses. Accredited and licensed Medical Doctors occasionally will practice “Holistic medicine”. This approach to treatment uses a variety of herbal, spiritual, meditative, and other “natural” remedies and does not usually incorporate standard medical therapy in treatment of disease.

Home Health Services means a professional nursing service provided to a homebound Covered Person that can only be rendered by a licensed registered nurse (RN) or licensed practical nurse (LPN) provided such nurse does not ordinarily reside in the Covered Person’s household or is not related to the Covered Person by blood or marriage.

In-Network Provider means a Covered Provider who has a participation contract in effect with Mountain Health CO-OP’s Network to provide services to Covered Persons under this Policy. The In-Network Provider’s participation contract must be in effect at the time services are provided for Covered Benefits in order for Covered Medical Expenses to be eligible for In-Network benefits.

Out-of-Network Provider means a Covered Provider who does not have a participation contract in effect with the Mountain Health CO-OP In-Network Organization to provide services to Covered Persons under this Policy. When services are provided by an Out-of-Network Provider, the services provided are Out-of-Network and an Out-of-Network Provider Differential will be applied. Covered Person will be subject to reduced benefits under the plan and will be subject to Balance Billing by the Out-of-Network Provider.

To maximize your plan’s benefits, always make sure your healthcare provider is a Mountain Health CO-OP InNetwork Provider and do not assume all services at an In-Network facility are performed by an in-network provider.

Policy Effective Date or Effective Date means the date on which this Policy becomes effective. The PolicyEffectiveDate is shown in the Schedule of Benefits.

Policyholder means the person to whom this Policy is issued and is named as the Policy-owner in the Schedule of Benefits. The Policy-owner is the owner of this Policy, which means the Policy-owner may exercise the rights set forth in this Policy. On the Policy Effective Date, the Policy owner is as designated in the application for this Policy. The Policy-owner is also referred to as “You” or “Your”.