MACo HCT Forms – This page under construction! Call our office if you can’t find what you need.
County Admin Forms
Enrollment and Change Form
Enrollment and Change Form County Paid Life
Enrollment and Change Form Dependent Paid Life
Enrollment and Change Form Dependent Paid Life
This notice is provided to participants upon initial enrollment describing their right to continue coverage under COBRA if they lose eligibility for group coverage.
Foreign Travel Letter (sample)
If you plan to travel outside the U.S., call the Claims Administration office (888-883-3233) for guidance on seeking health care from foreign providers. The Claims office will mail you a letter that explains the requirements.
HIPAA Notice
This notice is provided to newly enrolled participants to describe the privacy protections provided under HIPAA laws. It is also distributed to plan participants at least every three years.
Medicaid and the Children’s Health Insurance Program (CHIP) Notice
This notice describes special enrollment rights for eligible employees to enroll themselves and their children under the MACoHCT plan, if they lose coverage under Medicaid or a state-sponsored child health insurance program (CHIP). It is distributed to plan participants annually.
Women’s Health & Cancer Rights Notice
This notice describes certain benefits that are guaranteed under HIPAA laws. It is distributed to plan participants annually.
Credible Coverage Letter
Important Notice from Montana Association of Counties Health Care Trust About Your Prescription Drug Coverage and Medicare
This notice describes certain benefits that are guaranteed under HIPAA laws. It is distributed to plan participants annually.
Language Translation Information
This notice describes non-discrimination.