Plan Documents
- Amendment reminder - Located at the end of documents (PDF)
- Medical - City of Bozeman (PDF)
- Medical - City of Great Falls (PDF)
- Medical - City of Kalispell (PDF)
- Medical - City of Whitefish (PDF)
- Medical - High Deductible Health Plan (HDHP) (PDF)
- Medical - Standard Plans - Bridger, Madison, Mission (PDF)
- Dental Plan (PDF)
- Dental Plan - Ortho Benefit (PDF)
- Vision Plan (PDF)
- Basic Life and AD&D Summary (PDF)
- Basic Life and AD&D Policy (PDF)
- Form - Basic Life Beneficiary Designation (PDF)
- Voluntary Term Life and AD&D Summary (PDF)
- Voluntary Term Life and AD&D Policy (PDF)
- Form - Voluntary Term Life Enrollment (PDF)
Summary of Benefits and Coverage
- City of Bozeman (PDF)
- City of Great Falls (PDF)
- City of Kalispell (PDF)
- City of Whitefish (PDF)
- HDHP (PDF)
- Bridger with Prescription Drug Copay (PDF)
- Bridger with Prescription Drug Percentage (PDF)
- Madison with Prescription Drug Copay (PDF)
- Madison with Prescription Drug Percentage (PDF)
- Mission with Prescription Drug Copay (PDF)
- Mission with Prescription Drug Percentage (PDF)
Notices
- COBRA (PDF)
- EEOC Notice Regarding Wellness Program (PDF)
- HIPAA Portability Rights (PDF)
- Language Access Services
- Medicare Part D (PDF)
- Newborns (PDF)
- Notice of Privacy Practices
- Women's Health & Cancer Rights Act (PDF)
Forms
The following forms may be used to enroll in or make changes to your coverage during qualifying enrollment periods. Please submit ALL forms to your city or town representative. For questions, contact your city or town representative or the MMIA Employee Benefits staff at 1-800-635-3089 option 4
Enrollments and Change Forms
- Benefit Enrollment, Termination or Change Form (PDF)
- Voluntary Term Life Enrollment (PDF)
- Basic Life Beneficiary Form (PDF)
Claim and Mail Order Prescription Forms
Use the following forms to manually request claim reimbursement or visit the vendor’s website to do it online.
- Medical Claim Reimbursement PDF Form Vendor: www.Askallegiance.com
- Vision Out-of-Network Claim Reimbursement PDF Form Vendor: www.vsp.com
- Proact Prescription Reimbursement PDF Form Vendor: https://secure.proactrx.com/
- Ridgeway Mail Order Prescription PDF FormVendor: https://ridgeway.pharmacy/
- MMIA Scripts Enrollment Packet PDF Form Vendor: www.mmiascripts.com
- Authorization for Release of Information Form (PDF)
Medical Claims and Billing
www.askallegiance.com | 1-866-339-4308
Allegiance Benefit Plan Management process your medical claims. Call them if you have a medical claim or billing question. Go to their website to print a temporary benefit card, see your explanations of benefits, and more.
Low to no-cost primary care
www.healthcenter.mt.gov | 1-855-200-6822
No cost or low-cost primary care for physicals, lab work, flu shots, cold and flu, same-day services and much more. First time registration code: MMNA3. To make an appintment at a Montana Health Care Center near you, visit www.carehere.com.
No-cost telemedicine
www.Teladoc.com | 1-800-835-2362
Teladoc gives you no cost 24/7/365 access to board-certified doctors who can treat many of your medical issues by phone or video. It is an added medical benefit that gives you an affordable alternative to costly urgent care or ER visits. There is no cost to the participant for this service. Simply set up an account, request a consult, and a doctor will call you within an hour.
Employee Assistance Program
www.MyRBH.com (Access code: MMIA) | 1-866-750-1327
No cost life-balance and counseling services. You (and anyone in your household) can receive up to six in-person counseling sessions per issue per year. Other services include financial, mediation, and identity theft services and standard legal forms.
Disease Management
www.takecontrolmt.comTake Control is a Montana-based healthcare company that provides health coaching services to reduce risks associated with:
- Diabetes
- High blood pressure
- High cholesterol
- Being overweight
Case Management
StarPoint offers Case Management which can be used during a medically challenging time. A case manager will assist you in navigating the medical waters to ensure that appropriate and cost-effective care is obtained.
Maternity Management Program
www.askallegiance.com | 1-877-792-7827, Option 1
A registered nurse case manager will work with you throughout your pregnancy by phone and/or email to provide you with information and resources for a healthy pregnancy. Register in your first trimester to get a $50 incentive after your baby is born.
SAMA Air Ambulance Prior Authorization
You and your provider should use this service any time an air ambulance is called. The number for SAMA is also on your benefit card.
Price Finding Tool
Healthcare Bluebook is an online tool that enables you to find the best prices for healthcare services you may need. With Healthcare Bluebook, you can shop for care so that you get the most affordable care available in your area, from high-quality providers. Checkout price comparisons on Healthcare Bluebook by:
- Visit www.askallegiance.com.
- Click, “Cost Transparency.”
- Log in using your Group ID and Participant ID found on your benefit ID card.
You can look on Healthcare Bluebook's generic website, but logging in through Allegiance will give you more precise and accurate information about our health plan.
Watch this quick video to learn more about how you can save on your healthcare costs.
Medical Documents
- Medical - City of Bozeman (PDF)
- Medical - City of Great Falls (PDF)
- Medical - City of Kalispell (PDF)
- Medical - City of Whitefish (PDF)
- Medical - High Deductible Health Plan (HDHP) (PDF)
- Medical - Standard Plans - Bridger, Madison, Mission (PDF)
Pharmacy Claims and Questions
ProAct is our pharmacy benefit manager. Call this number is you have a pharmacy billing or claim question.
ProAct Customer Service – Pharmacy benefit and coverage questions
1-877-635-9545 | www.proactrx.com
Mail Order Pharmacy
ProAct Mail Order Pharmacy
1-866-287-9885 | | www.proactrx.com/mail-order
1-800-630-3214 | www.ridgewayrx.com
Specialty Medication Pharmacy
1-888-843-2040 | www.noblehealthservices.com
Noble Specialty Pharmacy – In order to get the best price on specialty medications, please contact Noble Pharmacy. Specialty medications include temperature sensitive drugs, infusions, etc.
No-copay International Mail Order Prescription Program
www.mmiascripts.com | 1-866-488-7874
Get certain brand-named medications for a $0 copay! Visit www.mmiascripts.com or call 1-866-488-7874 for a list of qualifying medications and information on how to enroll and take advantage of the cost savings today!
Dental Claims and Billing
1-800-521-2651 | www.deltadentalins.com
Delta Dental Customer Service – Delta processes your dental claims. Please call them if you have a dental claim or billing question. They can also perform a pre-treatment review to let you know what you’ll pay for your dental work.
Dental Plan Documents
- Dental Plan (PDF)
- Dental Plan with Orthodontics (PDF)
- Dental Benefit Summary (PDF)
Vision Claims and Billing
VSP processes your vision claims. Please contact them if you have questions about your vision coverage. Their website is also full of great information and product discounts for things like vision hardware and even laser eye surgery
Vision Plan Documents
- Vision Summary (PDF)
- Detailed Vision Benefit Summary (PDF)
Having trouble with the Engage Wellness Portal? Call 1-832-201-8500 (option 4) or email info@dhsgroup.com.
Get Wellthy Program Details, Screening Dates, and More
Disease Management
Take Control is a Montana-based healthcare company that provides health coaching services to reduce risks associated with:
- Diabetes
- High blood pressure
- High cholesterol
- Being overweight
Life Insurance through the MMIA Employee Benefit Program is through Unum, but managed by MMIA. Please call 1-800-635-3089 option 4 if you have a Life Insurance question.
Who processes medical claims?
Allegiance Benefit Plan Management based in Missoula, MT has entered into a contract with the MMIA EB Program to process claims for our membership. Most healthcare providers will submit claims on our members’ behalf, but if you need to file a claim manually, you can do it online at https://www.askallegiance.com/Submissions/Health/Claim or mail it to Allegiance at to PO Box 5066, Missoula, MT 59806-5006.
How can I find a participating or in-network provider?
- Medical Providers: www.askallegiance.com/ProviderSearch or call Allegiance customer service at 800-877-1122
- Dental Providers: www.deltadentalins.com/individuals/ and use the ‘Find a Dentist’ feature on the right side of the screen or contact Delta customer service at 800-521-2651
- Vision Providers: www.vsp.com/find-eye-doctors.html or call 800-877-7195
- Air Ambulance Providers: Call SAMA 877-542-8828
How can I get help with a medical claim?
Allegiance Customer Service personnel are available at 800-877-1122 to answer questions regarding benefits and claims processing. Claims inquiries can also be made securely online at www.askallegiance.com/Home/Contact.
How can I get a replacement I.D. Card?
You can request a replacement benefit I.D. card by calling Allegiance at 800-877-1122. You can also get a temporary ID card by following these instructions:
- Log into www.askallegiance.com
- Select your Health Account
- Under the “Resources” tab, select, “ID Card Image”
- Click the “Submit” button on the far right of the screen. It may take a moment to load the image.
- Print or download your card image.
When should a new employee enroll?
A new employee is eligible to enroll in the Program after the employee has met the City or Town’s waiting or probation period as determined by the City or Town’s personnel policy. Application must be made within 31 days of the eligibility date; otherwise, the employee would be considered a late enrollee and would not be able to apply for benefits until the next annual open enrollment period, which is May 15 through June 15.
How do I obtain proof of Creditable Coverage?
A Certificate of Creditable Coverage is presented to the group health or individual plan with enrollment application. When a covered member of the MMIA loses health benefits, a Certificate of Creditable coverage is generated within 30 days of the loss of coverage. If the employee requests a Certificate of Creditable Coverage, it will be generated within 24 hours of the request.
What is a special enrollment period?
Employees and eligible dependents may enroll or make certain changes to their benefits if certain qualifying events occur. Written application must be made within 31 days of the event. Such events include marriage, birth or adoption of a child, change in employment status or involuntary loss of coverage.
How do I enroll my newborn?
Babies are NOT automatically added to your coverage. You must submit an enrollment form (PDF) to your City or Town representative within 31 days of your baby’s birth. The baby’s coverage will be retroactive to its date of birth.
What is the maximum age for dependents to remain on the plan?
In compliance with federal health requirements, eligible dependents can remain on the plan through age 26 regardless of student or marital status. Refer to the Summary Plan Description (SPD) in the Plan Documents on this site for complete eligibility guidelines.
What is Reference Based Pricing?
Reference Based Pricing is a method of paying hospitals and other medical facilities based on a standard reference point, in this case, Medicare. Reference based pricing closes the gap in how much different hospitals in Montana charge for the same services and saves MMIA and our participants’ money.
Employee Benefits Newsletters
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