MACO - MONTANA ASSOCIATION OF COUNTIES HEALTH CARE TRUST

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QUESTIONS & ANSWERS

	This information is intended to provide general guidance for members’ common questions about MACoHCT. The Summary Plan Description document, related amendments, and Schedule of Medical Benefits may supersede this general information for specific eligibility and benefit questions.
	Select a topic - Eligibility and Enrollment Health Savings Accounts / HSA-Qualifying High Deductible Health Plans Pharmacy Benefits Claims & Providers - or browse the list of questions below.
Eligibility and Enrollment
	What is the deadline for enrolling? I am a new employee. When does my coverage begin? What should I do if I need to see a doctor and haven’t yet received my MACoHCT identification card? I lost my ID card. Can I get a new one? Can my children who are away at college get their own ID cards? My employer offers more than one MACoHCT health plan. Can I switch to a different plan? What is a “special enrollment” period? When do my deductible and maximum out-of-pocket amounts start accumulating? I am currently enrolled in MACoHCT and will soon take a job with a different county that also offers MACoHCT health benefits. Will I get credit for deductible and out-of-pocket expenses I had already satisfied in my old county? I have a pre-existing medical condition. Will the MACoHCT plan impose any restrictions because of this? What is creditable coverage? Is pregnancy considered a pre-existing condition? Can my spouse stay on my insurance if we get divorced or legally separated? Is my newborn automatically eligible under my coverage? What are the eligibility rules for children under 19? What are the eligibility rules for children 19 and older? If I drop my dental or vision coverage, can I re-enroll later? Does the vision plan pay for both glasses and contacts in the same year? Are retirees eligible for MACoHCT coverage? I am a retiree turning 65. How will my claims be paid if I choose not to enroll in Medicare Part B? Back to Top
Health Savings Accounts / HSA-Qualifying High-Deductible Health Plans
	What is a Health Savings Account (HSA)? Who can have an HSA? How does the HSA-qualifying High Deductible Health Plan (HDHP) compare to other MACoHCT plans? Does MACoHCT control the Health Savings Account (HSA)? Who funds the HSA? What is the employer's role in this? How much money can be put into the HSA? How do HSA account holders access their money? Back to Top
Pharmacy Benefits
	Do all MACoHCT plans have a pharmacy benefit? Is there a separate ID card for the pharmacy benefit? What should I do if I need to fill a prescription and haven’t yet received my MACoHCT card? Can I really save money by filling a 90-day prescription? Do I have to use a mail-order service to get a 90-day supply? What should I do if my pharmacist doesn’t bill insurance? I have dual pharmacy benefits under both my own policy and my spouse’s policy. How does that work? Can I drop only the prescription drug part of my MACoHCT benefits? Back to Top
Claims and Providers
	Who processes my claims? Do I have to submit my own medical claims? Can I view my claims information online? What number should I call if I have a question about a claim? I called the Claims Administration office, but I need additional help understanding how my claim was processed. What should I do? How do I appeal a claim determination? Can I see any doctor I want? Can I see providers outside the U.S.? What does UCR stand for? My claim for a preventive visit was not processed correctly. Why? Does MACoHCT reimburse for mileage to my health care provider? I have other coverage in addition to MACoHCT. How does MACoHCT determine which plan pays first? Back to Top


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