Department of Public Health and Human Services

Home » Montana HELP Plan Participants

Montana HELP Plan Participants

Apply for quality healthcare coverage

Montana's New Healthcare Plan

HELP Participants

   Blue Cross Blue Shield HELP Plan id card

HELP Plan

HELP Plan participants will receive health coverage from Blue Cross Blue Shield of Montana.

What are the benefits?

All the essentials are covered, including:

  • Ambulatory Patient Services
  • Emergency Services
  • Hospitalization Services
  • Laboratory and X-Ray Services
  • Maternity and Newborn Services
  • Mental Health and Substance Use Disorder Services
  • Pediatric Services
  • Prescription Drug Services
  • Preventive Services
  • Rehabilitative and Habilitative Services and Devices
  • Wellness Programs

Services Processed by BCBSMT

  • Behavioral Health (Mental Health and Substance Use Disorder)
  • Convalescent Home (excludes Custodial Care)
  • Durable Medical Equipment/Supplies
  • Early and Periodic Screening, Diagnostic, and Treatment (EPSDT)
  • Emergency
  • Hospital
  • Lab and X-Ray (Medical)
  • Medical Vision and Exams
  • Mid-Level
  • Physician
  • Rehabilitative and Habilitative
  • Surgical
  • Therapies (OT, PT, ST)
  • Urgent Care

See the Participant Guide for additional information regarding your benefits.

Find a HELP Plan provider

Participant Services or call (877) 233-7055

Services Processed by DPHHS (Xerox)

  • Audiology
  • Community Health Center
  • Dental and Dentures
  • Diabetes Prevention Program
  • Eyeglasses
  • Federally Qualified Health Center
  • Hearing Aids
  • Home Infusion
  • Indian Health Services/Tribal Health Services
  • Pharmacy
  • Rural Health Clinic
  • Transportation

See the Member Guide for additional information regarding your benefits.

Find a Montana Medicaid provider

Member Services or call (800) 362-8312


HELP Healthy Behavior Plan

Blue Cross and Blue Shield of Montana (BCBSMT) has implemented a comprehensive health and wellness program for participants in the Montana Health and Economic Livelihood Partnership (HELP) Plan, with a focus on engaging participants and providers. This program is called the BCBSMT HELP Healthy Behavior Plan. The components of this program have been designed to facilitate the following:

  • Improve participant’s knowledge of lifestyles that are healthy and promote wellness;
  • Improve participant’s understanding of chronic health conditions;
  • Design programs to augment a participant’s understanding of lifestyle behaviors that negatively impact their health;
  • Ensure continuity of health care;
  • Provide easy access to validated, accurate health information;
  • Inform participant of health and self-care and how to access plan benefits, provider services, Department of Public Health and Human Services (DPHHS) programs and other community resources to assist them in engaging in healthy lifestyle behaviors;
  • Improve the participant-provider relationship;
  • Improve health plan-provider communication; and
  • Engage existing provider and community health education programs in providing participant wellness information and in offering participant support for chronic conditions.

 

Wellness Programs in the HELP Healthy Behavior Plan

There are several DPHHS approved wellness programs under the HELP Healthy Behavior Plan available throughout the state of Montana. Wellness programs will also be created to meet the specific needs of a participant. Frequently used programs are listed in this document, however, any wellness programs available through BCBSMT or DPHHS are approved. Participants are informed of these programs by:

  1. HELP Plan Participant Guide and welcome packet sent to participant by BCBSMT when they enroll.
  2. Care coordinators, customer service, and case managers at BCBSMT provide information to the participant both verbally and written regarding available wellness programs.
  3. When participants are discharged from the hospital they are informed of these programs by mail from BCBSMT.<
  4. Participant portal, Blue Access for MT Members (BAM).
  5. Wellness programs listed on BCBSMT website.
  6. Community based wellness programs.
  7. Community based information.

 

Community Based Wellness Programs (DPHHS)

  • Montana Living Life Well Program
  • Diabetes Self-Management Education
  • Asthma Self-Management Education
  • Arthritis Foundation Exercise Program
  • Walk with Ease Program
  • Diabetes Prevention Program
  • Montana Tobacco Quit Line

BCBSMT Wellness Programs

  • Asthma Management Program
  • Diabetes Prevention and Management
  • Hypertension
  • Tobacco/Smoking Cessation
  • Weight Loss and Healthy Lifestyle

What do I need to pay?

Premiums

As a participant of the HELP Plan you pay a monthly premium. Your premium helps cover the cost of your health insurance. The HELP Plan premium cannot exceed two (2%) of your yearly individual income. This total amount will be broken into monthly payments. BCBSMT will mail premium notices within the month prior to the due date. Premiums are due by the first of each month. Return the invoice stub and a check payment to the mailing address indicated on the invoice.

For participants at or below one hundred (100%) percent of the Federal Poverty Level (FPL), which equals approximately $1005 per month for an individual, or $2,050 per month for a family of four, failure to pay premiums will not result in disenrollment. Unpaid premiums for all participants become a debt to the State and will be collected against future tax refunds. You can call Participant Services at 1-877-233-7055 to ask about your premium status.

Copayments

A copayment is a payment owed by you to your health care provider for health care services that you receive. You will be responsible to pay the provider after the claim has been processed. All participants will receive a credit toward copayments equal to the total owed premium amount for the quarter. Copayments will not be charged until the credit is met. You can call Participant Services at 1-877-233-7055 to ask about your copayment credit amount or other copayment questions.

If your income is at or above 100% of the FPL, and you have an outstanding copayment balance, a provider does not have to provide services for you again.

You may be charged for more than one copayment for a visit to your doctor. For example, your visit may result in the following copayments: X-rays, lab work, doctor visit, and for a facility fee (depending on the place of service). Ask your doctor’s office if you have copayment questions.

Individuals Exempt from Copayment

  • Persons under 21 years of age
  • Pregnant women
  • American Indians/Alaska Natives who are eligible for, currently receiving, or have ever received an item or service furnished by
    • an Indian Health Service (IHS) provider
    • a Tribal 638 provider
    • an IHS Tribal or Urban Indian Health provider
    • through referral under contract health services
  • Persons who are terminally ill receiving hospice services
  • Persons who are receiving services under the Medicaid breast and cervical cancer treatment category
  • Institutionalized persons who are inpatients in a skilled nursing facility, intermediate care facility, or other medical institution if the person is required to spend for the cost of care all but their personal needs allowance, as defined in ARM 37.82.1320

Populations Exempt from Copayment

  • Emergency Services
  • Preventive Services (including primary, secondary, and tertiary)
  • Family Planning Services
  • Pregnancy Related Services
  • Generic Drugs
  • Immunizations
  • Medically Necessary Health Screenings Orders by a Health Care Provider

Copayment based on Federal Poverty Level

Provider Type 51-100%
(effective 1/1/16)
101-138%
(effective 1/1/16)
Behavioral Health – Inpatient Hospital $75 10% of the payment the State makes for the service
Behavioral Health - Outpatient $4 10% of the payment the State makes for the service
Behavioral Health - Professional $4 10% of the payment the State makes for the service
Durable Medical Equipment $4 10% of the payment the State makes for the service
Lab and Radiology $4 10% of the payment the State makes for the service
Inpatient Hospital $75 10% of the payment the State makes for the service
Other Medical Professionals $4 10% of the payment the State makes for the service
Outpatient Facility $4 10% of the payment the State makes for the service
Primary Care Physician $4 10% of the payment the State makes for the service
Specialty Physician $4 10% of the payment the State makes for the service
Pharmacy –preferred brands $4 $4
Pharmacy- non-preferred/specialty brands $8 $8
Other $4 10% of the payment the State makes for the service
Non-Emergency use of the ER $8 $8

HELP Plan Participants - Premium Rights and Obligations

As a participant of the HELP Plan, you are required to pay a monthly premium. The monthly premium will total 2% of your yearly income billed monthly. BCBSMT will send you a monthly bill for your premium. Submit your payment with the payment stub included in your monthly bill. Premiums are due on the 1st of each month.

WHAT IF I CANNOT PAY MY PREMIUM?

Even if you cannot pay your premium, you may still be able to keep HELP Plan coverage. You will remain in the HELP Plan if:

  1. If your income is under 100% of the federal poverty level (approximately $1005 a month for an individual, or $2,050 a month for a family of four you will be able to remain in the HELP Plan.
  2. If your income is above 100% of the federal poverty level, you may lose your coverage if you fail to pay your premiums. You are still responsible for the payment of your premiums. The unpaid premium balance will be transferred to the State of Montana for collection from your state income tax refund.

WHAT IF I HAVE SPECIAL CIRCUMSTANCES AND CANNOT PAY MY PREMIUM?

Even if you cannot pay your premiums, you may be able to keep HELP Plan coverage under certain circumstances including:

  • You have been discharged from the United States military service within the previous 12 months;
  • You are enrolled for credit in any Montana University System unit, a tribal college, or any other accredited college within Montana offering at least an associate degree;
  • You see a primary care provider who is part of a patient-centered medical home;
  • You are in a substance use treatment program; or
  • You are in a DPHHS approved health behavior activity program administered by DPHHS or BCBSMT.

The list of approved programs is located at HELPPlan.mt.gov or call 1-855-324-6259.

If Montana DPHHS determines that you meet two or more of these conditions, you will continue to have access to the health care services covered by the HELP Plan. You will still be responsible for payment of your premiums.

If two of the following describe you, call 888-706-1535:

You have been discharged from the United States military service within the past 12 months or: To let us know you were in college or in the military go to apply.mt.gov, or call (888) 706-1535 or visit any local Office of Public Assistance.
You are enrolled for credits in a Montana university, tribal college, or any other accredited college in Montana that offers at least a two-year degree: or

You are in an approved HELP Healthy Behavior Plan wellness program:

or

You are in a substance use treatment program; or

You see a primary care provider who is part of a patient-centered medical home. You can find out by asking your doctor's office.

To find our more about the Healthy Behavior programs or to sign up please go to HELPPlan.mt.gov or call BCBSMT Participant Services at 1-877-233-7055.

You can find out by asking your doctor's office. To let us know, go to apply.mt.gov, or call 1-888-706-1535 or visit any local Office of Public Assistance.

CAN I REENROLL IN THE HELP PLAN IF I HAVE UNPAID PREMIUMS?

Yes, you may reenroll after

  1. You have paid your unpaid (delinquent) premium balance in full, or
  2. You have received notice from the State of Montana that they have assessed your unpaid premium balance against your future state income tax. This assessment occurs once per calendar quarter.

Participants that would like to reenroll should contact the Montana Public Assistance Help Line at (844)-792-2460 or apply.mt.gov.

Participant Materials

HELP-link Workforce Program logo

 

Contact your local Job Service Office to enroll in HELP-Link, the HELP Plan Medicaid workforce program