The Montana Insurance Exchange (Marketplace) is the Federally-Facilitated Marketplace. The Federally-facilitated Marketplace is administered by the federal government, under the Department of Health and Human Services (HHS).
General information about the Federally-facilitated Marketplace can be found at: https://www.healthcare.gov/marketplace/individual/#state=montana.
PATIENTS
The Federally-facilitated Marketplace is essentially a marketplace for individuals to shop for health insurance if they do not already have insurance coverage from another source. If individuals have insurance from another source such as employment, retirement benefits, or spousal benefits, they do not need to obtain it from the Marketplace.
HIV PROVIDERS
Providers must contract with each of the plans in the marketplace individually in order to fully participate in the Alabama Health Benefit Exchange.
This process is similar to enrolling in insurance or managed care organization provider networks. See below for a list of insurers participating in the state marketplace, and information on contacting them.
As an HIV provider, you may qualify for designation as an “Essential Community Provider (ECP).” The Qualified Health Plans participating in the Insurance Exchange (Marketplace) are required to contract with a minimum number of ECPs and Specialists to ensure network adequacy.
Visit our Provider Resources Section for more specific instructions to assist you in contacting health plans.
REPORTING PROBLEMS
The state office of insurance is primarily responsible for examining and addressing issues with the plans offered within the state Exchange (Marketplace), and the companies that offer them.
If you are experiencing problems as a medical provider with the plans or companies in the state exchange, or if your patients are experiencing problems with the plans or companies in the state exchange, including trouble with access to medications, access to preferred providers, navigating the appeals process, excessive costs, or possible discriminatory policies, or any otherproblems related to the Affordable Care Act, please report these problems to the state office of insurance:
Office of the Commissioner of Securities and Insurance
840 Helena Ave
Helena, Montana 59601
800- 332-6148
www.csi.mt.gov/
Complaints: http://www.sao.mt.gov/complaint/index.asp
Additionally, if you are experiencing these or other problems, please report these problems to AAHIVM, so that we may track issues affecting our members, and seek additional policies remedies.
QUALIFIED HEALH PLANS PARTICIPATING IN THE EXCHANGE
Below is a list of the Qualified Health Plans that have publicly announced that they will offer plans in the Alabama Health Benefit Exchange.
Alabama has established Blue Cross Blue Shield of AL as the “benchmark” plan.
This list is being routinely updated, and may change as insurers join or drop out of the exchange. Please check back for updates
Assurant Health
Plan Website: http://www.assuranthealth.com/corp/ah/AHHome.htm
Provider Enrollment: http://www.assuranthealth.com/corp/ah/Providers/health-care-provider.htm
Plan types offered: Individual
BlueCross and BlueShield of Montana
Plan Website: https://www.bcbsmt.com/Pages/globalhome.aspx
Provider Enrollment: https://www.bcbsmt.com/Pages/provcred.aspx
Plan types offered: Individual, SHOP
Montana Health Co-Op
Plan Website: http://www.mhc.coop/
Provider Enrollment: http://www.mhc.coop/what-is-mhc/providers/
Plan types offered: Individual, SHOP
Montana Health Cooperative
Plan Website: http://www.mhc.coop/index.php
Provider Enrollment: http://www.mhc.coop/providers/overview/
Plan types offered: SHOP
PacificSource Health Plans
Plan Website: http://www.pacificsource.com/reform-information-current-members.aspx
Provider Enrollment: http://www.pacificsource.com/provider/forms-and-materials.aspx
Plan types offered: Individual, SHOP