Signature Benefits

Put these plan perks to work.

welcome Members

Group and Individual plans* include these signature benefits to save you money.

Get them cleaned
or check for cavities.

$100 Dental Exam Reimbursement

** This is an annual reimbursement program so we pay you back after you send us proof of services received.

1. Choose a dentist then check their prices
There are no restrictions on who you see since this is a reimbursement program.

We pay you, not the provider, after you cover the initial costs.

You will receive up to $100 reimbursed towards the total cost of the visit.

Save the most money by checking the dentist’s fees before committing.

Example
If the service costs $120, you’ll be reimbursed $100. The visit will have cost you $20.

If the service costs $85, you’ll be reimbursed $85. Your visit will essentially be $0.

2. Get Proof of Services
The document we need is not a receipt.

Proof of Services is a line item statement specifically saying what service was performed not just the cost.

3. Send & Receive

Reimbursement will be mailed to you within 15 business days of receiving your Proof of Services Received.

Submit your Proof of Services Received for reimbursement by emailing it to [email protected].  

Eyes are a key indicator
of overall health

$60 Eye Exam Reimbursement

** This is an annual reimbursement program so we pay you back after you send us proof of services received.

1. Choose an optometrist then check their prices
There are no restrictions on who you see since this is a reimbursement program.

We pay you, not the provider, after you cover the initial costs.

You will receive up to $60 reimbursed towards the total cost of the visit.

Save the most money by checking the optometrist’s fees before committing.

Example
If the service costs $80, you’ll be reimbursed $60. The visit will have cost you $20.

If the service costs $50, you’ll be reimbursed $50. Your visit will essentially be $0.

2. Get Proof of Services
The document we need is not a receipt.

Proof of Services is a line item statement specifically saying what service was performed not just the cost.

3. Send & Receive

Reimbursement will be mailed to you within 15 business days of receiving your Proof of Services Received.

Submit your Proof of Services Received for reimbursement by emailing it to [email protected].    

Virtual visit
or in-home.

$50 In-home Health Assessment

Complete a free health assessment right at home and earn $50.

1. Request to schedule your free health assessment visit
Complete the form or call 1-800-367-5319 to set up your appointment.

2. Within 72 Hours
Someone from Advantmed** (406-559-2066) will reach out to you to complete scheduling your in-home** or telehealth visit. 

3.You will not receive an invoice or bill for this screening.
It’s completely free! The CO-OP pays for the assessment and any in-home testing performed.

The Nurse Practitioner shares all data and test results with your doctor.

4. Your $50 check is mailed
No later than 90 days after your appointment.

GET STARTED

Dental & Vision Questions

All Group and Individual members members are entitled to dental and vision reimbursements up to $100 for dental services or $60 for vision services per calendar year.

Reimbursement will be mailed to you within 15 business days once we receive your Proof of Services.

To expedite your reimbursement:
Make sure your Member ID is included on your Proof of Services — a line item statement specifically saying what service was performed not just the cost. 

No. This program is only for vision exams. We don’t reimburse purchases of eyewear or contacts. 

No. This program is only for dental exams — such as routine cavity check — or dental cleanings.  

Yes. The reimbursement is not dependent on location or network. You may visit any licensed dental or vision provider.

You’re allowed 365 days from the date of service to claim your reimbursement. 

Call your dentist or optometrist to provide “Proof of Services Received” and submit via email to [email protected] within 365 days from the date of service.

You’re allowed one vision exam (up to $60) reimbursement and one dental exam or cleaning (up to $100) reimbursement per plan year.

Check your Summary of Benefits and Coverage to view exact coverage dates. 

Fine print

*  All Signature Benefits are only available for individual and group plans. Exclusions apply to Medicare Supplement plans.

** Vision and dental benefits are reimbursement programs. You pay the cost directly, we pay you back up to the allocated amount. Available in Idaho, Wyoming, and Montana for members with Group of Individual plans only.  These benefits do not apply to Medicare Supplement Insurance Plans.

100% coverage for many preventive care services and prescriptions.

Our plans offer 100% coverage for preventive services when completed through an in-network provider.

Catch health changes before they become complications without paying a copayment or coinsurance, even if you haven’t met your yearly deductible.

Many insulins, select medications for depression, asthma, and more are available for $0 out-of-pocket.

Respiratory screenings and
medicine are 100% covered.

Cholesterol tests and
treatment are 100% covered.

What counts as preventive?

Abdominal aortic aneurysm one-time screening for men of specified ages who have ever smoked

Alcohol misuse screening and counseling

Aspirin use to prevent cardiovascular disease and colorectal cancer for adults 50 to 59 years with a high cardiovascular risk

Blood pressure screening

Cholesterol screening for adults of certain ages or at higher risk. Statin medications.

Colorectal cancer screening for adults 45 to 75

Depression screening

Diabetes (Type 2) screening for adults 40 to 70 years who are overweight or obese

Hepatitis B screening for people at high risk, including people from countries with 2% or more Hepatitis B prevalence, and U.S.-born people not vaccinated as infants and with at least one parent born in a region with 8% or more Hepatitis B prevalence.

Hepatitis C screening for adults age 18 to 79 years

HIV screening for everyone age 15 to 65, and other ages at increased risk

PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adults at high risk for getting HIV through sex or injection drug use

Lung cancer screening for adults 50 to 80 at high risk for lung cancer because they’re heavy smokers or have quit in the past 15 years

Obesity screening and counseling

Sexually transmitted infection (STI) prevention counseling for adults at higher risk

Syphilis screening for adults at higher risk

Tobacco use screening for all adults and cessation interventions for tobacco users

Tuberculosis screening for certain adults without symptoms at high risk

Bone density screening for all women over age 65 or women age 64 and younger that have gone through menopause

Breast cancer genetic test counseling (BRCA) for women at higher risk

Breast cancer mammography screenings

Every 2 years for women 50 and over

As recommended by a provider for women 40 to 49 or women at higher risk for breast cancer

Breast cancer chemoprevention counseling for women at higher risk

Cervical cancer screening

Pap test (also called a Pap smear) for women age 21 to 65

Chlamydia infection screening for younger women and other women at higher risk

Diabetes screening for women with a history of gestational diabetes who aren’t currently pregnant and who haven’t been diagnosed with type 2 diabetes before

Domestic and interpersonal violence screening and counseling for all women

Gonorrhea screening for all women at higher risk

HIV screening and counseling for everyone age 15 to 65, and other ages at increased risk

PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative women at high risk for getting HIV through sex or injection drug use

Sexually transmitted infections counseling for sexually active women

Tobacco use screening and interventions

Urinary incontinence screening for women yearly

Well-woman visits to get recommended services for all women

Pregnancy & Planning
Breastfeeding support and counseling from trained providers, and access to breastfeeding supplies, for pregnant and nursing women

Birth control: Food and Drug Administration-approved contraceptive methods, sterilization procedures, and patient education and counseling, as prescribed by a health care provider for women with reproductive capacity (not including abortifacient drugs). This does not apply to health plans sponsored by certain exempt “religious employers.” Learn more about contraceptive coverage.

Folic acid supplements for women who may become pregnant

Gestational diabetes screening for women 24 weeks pregnant (or later) and those at high risk of developing gestational diabetes

Gonorrhea screening for all women at higher risk

Hepatitis B screening for pregnant women at their first prenatal visit

Maternal depression screening for mothers at well-baby visits (PDF, 1.5 MB)

Preeclampsia prevention and screening for pregnant women with high blood pressure

Rh incompatibility screening for all pregnant women and follow-up testing for women at higher risk

Syphilis screening

Expanded tobacco intervention and counseling for pregnant tobacco users

Urinary tract or other infection screening

Alcohol, tobacco, and drug use assessments for adolescents

Autism screening for children at 18 and 24 months

Behavioral assessments for children: Age 0 to 11 months1 to 4 years5 to 10 years11 to 14 years15 to 17 years

Bilirubin concentration screening (PDF, 609 KB) for newborns

Blood pressure screening for children: Age 0 to 11 months1 to 4 years 5 to 10 years11 to 14 years15 to 17 years

Blood screening for newborns

Depression screening for adolescents routinely, beginning at age 12

Developmental screening for children under age 3

Dyslipidemia screening (PDF, 609 MB) for all children once between 9 and 11 years and once between 17 and 21 years, and for children at higher risk of lipid disorders

Fluoride supplements for children without fluoride in their water source

Fluoride varnish for all infants and children as soon as teeth are present

Gonorrhea preventive medication for the eyes of all newborns

Hearing screening for all newborns; and regular screenings (PDF, 609 KB) for children and adolescents as recommended by their provider

Height, weight and body mass index (BMI) measurements (PDF, 609 KB) taken regularly for all children

Hematocrit or hemoglobin screening for all children

Hemoglobinopathies or sickle cell screening for newborns

Hepatitis B screening for adolescents at higher risk

HIV screening for adolescents at higher risk

Hypothyroidism screening for newborns

PrEP (pre-exposure prophylaxis) HIV prevention medication for HIV-negative adolescents at high risk for getting HIV through sex or injection drug use

Many insulins are available for $0
along with supplies
and glucose monitoring.

$0 out-of-pocket drugs & supplies

No need to ration prescriptions and supplies or choose between medicine or gas refills.

These drugs are $0 out-of-pocket for Members.

Do you take medications in one of the categories listed below?

Our $0 out-of-pocket Prescription List provides coverage for specific drugs in these categories even if you haven’t met your deductible or annual out-of-pocket expense.

This means that CO-OP members will not have any cost-share for medications listed this preventive drug list.

$0 Drug Categories:

  • Anticoagulant Medications
  • Antidepressant Medications
  • Blood Glucose Meter
  • Bone Medications
  • Cardiovascular Medications
  • Cholesterol Medications
  • Continuous Glucose Monitor
  • Diabetic Medications
  • Diabetic Supplies
  • Diabetic Test Strips
  • Respiratory Medications

See Complete $0 List

or search all drugs.

Get prescription drugs delivered to your home.

Visit Birdi to set up your profile.

Set up a profile on Birdi using the Rx information off your member benefits card.

Pharmacy Mail Order – Instructions

*NoviXus is now known as Birdi

Text or call a mental health
specialist anytime
via Doctor on Demand.

Mental Health & Lifestyle Counseling

24/7 access to Behavioral Healthcare

All mental health services are available via a virtual doctor at anytime.

Depression screening

Depression screening for adolescents beginning routinely at age 12

Many medications for depression and mood regulation.

Diet counseling for adults at higher risk for chronic disease

Falls prevention (with exercise or physical therapy and vitamin D use) for adults 65 years and over, living in a community setting

Fine print

*Preventive Health Care services are covered at 100%, with no out of pocket costs when contracting provider networks are used. Any services performed with an Out of Network Provider will result in copayments, deductibles, and cost-sharing and may result in balance billing. Your doctor must write a prescription for preventive medication services to be covered by your plan, even if they are listed as over the counter. Frequency limitations may apply to to preventive care services such as screenings. Diagnostic tests (blood work, imaging) are not considered preventive. Networks may vary by plan. Please use the Provider Finder to find the providers for your network.

MHC complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age disability, or sex.

Travel support to see specialists at our Centers of Excellence.

Not everyone lives near a major medical hub. We help cover the cost of traveling to a specialist for unique care.*

We created the Centers of Excellence** (COE), giving you access to care at high-quality facilities with provisions to reduce your out-of-pocket costs.
Your deductible may be waived during these treatments.

How to Qualify

• You must receive prior authorization by calling 801-587-2851

• Services must be from Mountain Health CO-OP’s approved Centers of Excellence (COE)

• Services must be out of state or more than 60 miles from the patient’s residence.

Centers of Excellence Program
provide specialty care that require travel.

Travel Expenses 

Reimbursement
All travel-related reimbursement requires prior authorization, which can be obtained by calling 801-587-2851.

Travel Expense Reimbursement
Limited to $10,000 per calendar year per member.  Center of Excellence must be out of state or more than 60 miles from the patient’s residence.
 

Ground Transportation
Transportation provisions cover the member and one caregiver.

Travel by personal vehicle will be reimbursed at the IRS standard mileage rate, round trip, from your home zip code to the zip code of the provider location.

Air Transportation
Arranged by and billed to Mountain Health CO-OP.

Waived Deductible
Member deductible may be waived for services provided at a Center of Excellence.

Lodging

Lodging will be arranged by you, but then billed directly to us.

Daily Per Diem
Member and caregiver will be given a daily per diem equal to the current federal meals and incidental daily rate for the location in which the member will receive treatment.

What’s considered unique care?

Work with a customer service representative to discover if your situation is qualified for this benefit: 855-447-2900

Fine print

*Pre-approval required.
**LINK and Access Care Idaho plans do not have access to the Centers of Excellence Program.

Care is always available 24/7 anywhere you are.

No long drives or waiting weeks for an appointment. No more wasted hours in waiting rooms or waiting until 9 a.m. Monday for common medical help.

Video chat with an in-network doctor in minutes — 24/7 — to treat many common conditions via the mobile app or from any web browser. 

All records are shared with your primary care provider to seamlessly track your health.

All plans include 24/7 access
to online doctors.

Treatable Common Conditions via Telehealth

Virtual care doctors can treat most common health conditions:

Behavioral Health

Personalized counseling in either 25 or 50 minute sessions. Our team consists of US-based therapists, rated 4.9 out of 5 stars by patients.

Your online therapy visit could be $0 depending on your plan. Register to find out your cost before your visit.

Clinical experts in a variety of different specialties, such as anxiety, depression, relationship issues, LGBTQ+, PTSD, trauma, stress, and more.

Plus, chat-based coaching:

  • Healthy habits
  • Trouble sleeping
  • Work stress
  • Motivation to change

How much will it cost?

Calculate Cost:

  1. Sign in online or Download the Doctor on Demand app
  2. Register and create your account
  3. Add your insurance information
  4. Your cost will show before your visit

Remember

Your primary care provider might offer select telehealth services during business hours such as phone appointments. Check with your provider to see what virtual options they may have.

using your coverage

Maximize your plan to save money while getting the best care.