Benefit Plans

MCHA is not accepting applications for effective dates of coverage on, or after, January 1, 2014.

For applicant who have applied for effective dates of coverage of December 31, 2013 or before, MCHA has many plan options with different deductibles.  In addition, MCHA has a federally qualified High Deductible Health Plan option and a Basic Medicare Supplement Plan option.

Please be advised that MCHA plans are only available though December 31, 2014, when MCHA will close its doors and terminate all enrollee coverage.

For each of the deductible plan options (except the $3,000 high deductible health plan option), the annual calendar year deductible is split between medical and pharmacy costs.

Once payment of the deductible is met, coverage is provided at 80% of the allowed amount for eligible services received from in-network providers. Payment of the remaining 20% charges is a coinsurance and the responsibility of the insured. Once $3,000 of eligible out-of-pocket expenses has been satisfied in a calendar year (for the $5,000 and $10,000 deductible plans, the deductible amount serves as the out-of-pocket maximum), MCHA pays 100% of the allowed amount for eligible services to the end of the calendar year, to a lifetime maximum benefit of $5,000,000.

You have the option to utilize out-of-network providers; however, the benefit and payment percentage will generally be less than in-network providers.

Benefits generally include charges for eligible services when ordered by a physician. Eligible services include:

  • Professional service
  • Prescription drugs and pharmacy services
  • Mail service prescription drug program
  • Hospital services
  • Ambulance services
  • Home health care
  • Outpatient rehabilitation
  • Mental health
  • Substance abuse
  • Durable medical equipment and prosthetics
  • Miscellaneous medical supplies
  • Organ and bone marrow transplant services
  • Reconstructive and restorative surgery
  • Skilled nursing facility services
  • Hospice services
  • Temporomandibular Joint Disorder (TMJ)
  • Medical-related dental services
  • Emergency services

This is only a summary of eligible services. For questions about whether a specific service is covered, please contact Customer Service at the telephone numbers listed on the back of your MCHA ID card.

High Deductible Health Plan (HDHP)

The $3,000 deductible plan option is a federally qualified high deductible health plan that allows you to open a health savings account (HSA) if certain HSA eligibility requirements are met. The HDHP requires a $3,000 individual deductible and out-of-pocket maximum /$6,000 family deductible and out-of-pocket maximum – the same deductible amounts apply to both medical and prescription drugs (no split deductibles).

Once the annual deductible has been met, coverage is provided at 100% of the allowed amount for eligible services as described above.

Differences

The following information outlines the major differences in coverage and benefits between the MCHA deductible plans and the HDHP:

Deductible Plans HDHP
Deductible is split between pharmacy and medical services Total deductible must be met before coverage is available
Individual only deductible Individual and family deductible
Coverage for both formulary and non-formulary drugs Coverage only for formulary drugs

 

Basic Medicare Supplement (no Rx coverage, optional riders available) Medicare Supplement Plan

For the Basic Medicare Supplement plan (providing the care is Medicare eligible and the member has met his/her Medicare deductibles) MCHA pays the 20% not covered by Medicare up to the allowed amount. The insured is responsible for any amount in excess of the allowed amount and for any ineligible service. Optional additional riders are available.

This is only a summary of eligible services. If you have specific questions about whether a specific service is covered, please contact Customer Service at the telephone numbers listed on the back of your MCHA ID card.

Important Information on Pre-existing Conditions

For all MCHA policies, no benefits are payable during the first six months of coverage for expenses for any preexisting condition, injury, illness or other physical or mental condition that was diagnosed, treated or evaluated during the 90 days preceding the effective date of coverage. However, Minnesota State law does provide some exceptions to the preexisting condition limitation. In order to determine if you may be eligible for a waiver, you must requests a waiver of the preexisting condition limitation by completing the applicable section of the MCHA application.

MCHA to Close 12/31/14 Insurance companies can no longer deny you or charge you more because of your pre-existing health condition. As a result, the Minnesota Comprehensive Health Association is no longer accepting new enrollees (for a Jan. 1, 2014 effective date or later) and will close on December 31, 2014. We encourage you to look for a plan on MNsure, Minnesota's online insurance marketplace, or visit myMCHAagent.com to find an agent.