Health Care and Cafeteria Benefits

Welcome to the Helena School District Health Plan

The Helena School District #1 Health Plan is a Self-Funded Plan. Allegiance Benefit Plan Management is our third-party Administrator (TPA) to process claims and other administrative functions of our Plan. Our Pharmacy Benefit Manager is Express Scripts. As you scroll through this page, you will find more information about the Health Plan and options.  Welcome to our School District!

Health Benefits Office

The Health Benefits Office is located at 1325 Poplar St. in Helena, MT. The HR Benefits Manager is Richard Franco and you can contact him through email ( or phone (406-324-2008).

Health Benefit Committee

The Health Benefit Committee is created with employees of the District.  The Committee is designed to look into health premium costs, changes and other various impacts to our health benefits in the School District.  This Committee reports to the Board of Trustees and makes recommendations.  You can view a list of your Committee members Here.

Monthly Newsletter

Please view this month’s June 2024 Newsletter for valuable and helpful information.  You might even find a recipe or two to try!

Allegiance Plan Management, Inc. Website

Employee/Participants – If you have never logged into the Allegiance web site before, click Register New User to create a login Username (ID). You will then be e-mailed a temporary password. If you have already received your temporary password letter, enter the Username (ID) you created during the registration and the password you have received. Be careful to enter the password EXACTLY as it appears in your e-mail, as this site is case sensitive. If you have accessed this site with a login prior to November 2006, then your Username will be your SSN or Alt ID and your password will be the same, just be sure to type your password in ALL CAPS.

If you have any issues logging in, contact Allegiance at 855-999-8878.

All dependents over 18 years of age will need to register and use their own login. If you have not yet logged into our new website you will need to re-request your PIN by clicking on Register New User.

Secured and encrypted, the Allegiance website allows participants access to up-to-date health and flexible benefits plan information twenty-four hours a day.

  1. Go to:
  3. Click on “New User” and proceed accordingly if you do not have an account login setup already.
  4. If you already have a username and password, then enter: USERNAME and your PASSWORD (case sensitive). A menu of the available services will be displayed.
  • Please Note:  To update any of your personal or contact information, you must go through the HSD Benefits Manager.

Health Insurance Plan Description

For Plan Year 2023-24 each 12 month full-time employee receives $969.40 per month ($1,163.28/ for 10 months) in cafeteria dollars to apply to the election of a HSD1 health insurance plan that best meets their needs. Part-time employees receive a pro-rated cafeteria amount based on their full-time equivalency (FTE) (position hours). These cafeteria dollars are pre-taxed dollars that are to purchase a health plan through the District.  If an employee waives, they will lose the Single Premium amount in the cafeteria/benefit dollars as mandated by federal law.  A summary of health insurance plans available is attached below. The District’s Cafeteria Plan also allows pre-tax dollars to be set aside for items such as child and/or dependent care costs, other benefit premiums such as additional Life Insurance, Long-Term Disability Insurance and health care expenses not covered by the District’s health insurance. Please contact the Human Resources Benefits Manager with any questions.

**** Effective 4/25/2024 paycheck the Benefit Dollars will increase!  Please see documents below for more information.

Health Plan Document

We recommend that you read the plan document carefully, before incurring any medical expenses. If you have specific questions regarding coverage or benefits, you are urged to refer to the Plan Document.  We also have the Cafeteria Plan Agreement listed below.

As a result of the Federal government currently writing rules for the new health care reform laws, there maybe a need for required plan changes during the year. Therefore, the Health Benefit Plan Document will be sent to your district e- mail in pdf format if a change should arise mid-year. The most recent up-to-date Health Benefit Plan Document is available by clicking on the link below.

If you wish, you may contact Allegiance (1-855-999-8878 or P.O. Box 3018, Missoula, MT 59806) or the HSD#1 Insurance Office (406-324-2008 or 1325 Poplar St, Helena, MT 59601) regarding any detailed questions you may have concerning the Plan.

Making a Change During Open Enrollment or Mid Year

Open Enrollment starts August 15, 2024 this year. Information for Open Enrollment is mailed prior to school starting, and the Online enrollment needs to be completed Friday, September 13th. Open Enrollment is designed for employees to make changes for the upcoming Plan Year (October 1st 2024 – September 30th 2025).

To make change during Open Enrollment you will need to change your selection in the employee portal Benefits Enrollment. If you are adding or removing a dependent or spouse, you will need to fill out a Request for Enrollment Change form for that year (located above). Once open enrollment is closed all enrolled employees will not be able to make any changes.

“Special Enrollment Period” means a period of time allowed under this Plan, other than the eligible person’s initial enrollment period or late enrollment, during which an eligible person can request coverage under this Plan as a result of certain qualifying events.

Coverage will become effective on the date of the event if the Employee makes a Special Enrollment request, verbally or in writing, within sixty (60) days of any special enrollment qualifying event and application for such coverage is made on the Plan’s “Request for Enrollment Change” form within ninety (90) days of the event.

Employees are able to add/delete dependents during the plan year only if they experience a “qualifying event”. The following are considered qualifying events and are allowed a Special Enrollment Period:

      • Marriage
      • Birth of a child
      • Adoption/Pre-Adoption placement
      • Loss of other coverage
      • Court Order
      • Qualified Medical Child Support Order
      • Divorce
      • Legal Separation
      • Death

You must print the Request For Enrollment Change, complete, sign, and return to the Personnel Benefit Office at the May Butler Center as soon as you are aware of the change but no later than ninety (90) days after the qualifying event. If the Request for Enrollment Change is not completed and submitted to the Human Resources Benefits Office within the time frame allowed, the dependent will not qualify for a Special Enrollment Period. If you are enrolling/adding a dependent and they had prior insurance coverage, you will need to request and submit a Certificate of Credible Coverage from the enrollees prior insurance carrier within thirty (30) days of the date of change noted on the Request for Enrollment Change Form. If the change to your coverage is due to a birth, you will need to complete the Request for Enrollment Change without the Social Security number. At such time that you receive the child’s social security number, you will need to submit it to the Human Resources Benefits Office at (406) 324-2008 as required by law.

As a reminder: the Mid-Year enrollment can affect your cafeteria payroll withholding (Example: adding your spouse would change your payroll withholding from Single to Single + Spouse) you could possibly see a difference of pay in your paychecks. Contact your Insurance Manager (406-324-2008) if you have any other questions.


Here is the link for the TiC pricing information for compliance


Whether you lost your ID Card or haven’t received a new one, you can request one through the Allegiance Website by clicking on Request an ID Card under the “Forms” link.  If you want to print out a Temporary ID Card, you can also do that through the Allegiance Website by logging in, clicking on your “Health Account”, then click on “Resources” and from there you can select ID Card Image for your Temporary ID Card.

HSD1 Health Plan Changes for PY 23-24

The document below explains what the differences for this upcoming Plan Year Benefits are in comparison to last Plan Year.

Summary of Benefits and Coverage

As required by Affordable Care Act (ACA), we provide a Summary of Benefits and coverage for the Premium and Standard Plans. The Summary explains what the the Plan covers, what it costs, examples, and other Questions and Answers.


The Helena School District has an Appeal Process that each member can follow if they are unsatisfied with their initial claims determination by the Third Party Administrator (TPA). Please click HERE to view the processes. If you should have any questions please contact Rich Franco at (406) 324-2008.


As required by ACA law, the HSD1 provides notice to inform employees of possible assistance through Medicaid, CHIP, etc.

The Health Insurance Marketplace Notice is to inform employees of possible other coverage options through the Health Insurance Marketplace.

The Medicare Part D Creditable & Non-Creditable Coverage Letter is to determine whether your current Pharmacy Benefit is creditable or not.

Family Medical Leave Act (FMLA)

Below is information for FMLA in accordance to Board and Federal Policy.  As for health insurance, if an employee wishes to continue insurance with the District they can either self-pay or they must have at least 10 paid days in each pay period to continue to receive their Benefit dollar/Cafeteria contribution.  If you have any questions, please contact the Insurance Manager.

Women’s Health & Cancer Rights Act Notice

As required by ACA law, the HSD1 provides this notice to our employees

Air Ambulatory Services

Air ambulatory services can leave balance bills towards members from $10,000 up to $50,000 (and even more). As a member you must be diligent in your communication with Allegiance and the hospital. As of right now, there is only 1 in Network provider with Allegiance and that is Montana Medical Transport. Please note the coverage of Air Ambulatory Services on the HSD1 Health Plan:

      • A contracted amount as established by a preferred provider or other discounting contract;
      • 250% of the allowable charge established by application of the Medicare Ambulance Fee Schedule; or
      • The billed charge if less than 1 or 2 above

Senate Bill 44 (SB 44)

The Montana Legislature passed Senate Bill 44 which pertains to emergent flights provided by non-participating air ambulance transport companies not controlled by a Montana hospital. Emergency care for SB 44 means care that is necessary to stabilize a patient for transfer to another hospital or medical unit within a hospital. Transferring a patient between hospitals on a fixed wing flight would not typically be considered “emergent” care under SB 44. The bill requires the HSD1 Health Plan to make payment based on billed charges, a negotiated amount, or the participating provider contracted amount. If either party (HSD1 Health Plan or Air Transport Company) does not like the required payment amount, either party can take the other party to dispute resolution. The HSD1 Health Plan pays any emergent transport in accordance with the Plan Document (see above). In this case, a member is held harmless except for their deductible, etc. In the event a member receives a non-emergent transport by a non-participating air ambulance transport company, the member may still be balance billed. Contact Allegiance (800) 877-1122 with any questions about air ambulance transportation coverage or participation air transport companies.

Primary Care Provider/Preferred Providers

As a member of the HSD1 Health Plan, it is the member’s job to keep their cost down. Seeing a Preferred Provider is a good way to keep your cost down and the Health Plans’ costs. You can find a list of Preferred Providers on the Allegiance WEBSITE or a quick list of Primary Care Providers by clicking HERE.

St. Peter’s Narrow Network Plan (NNP)

The HSD has come into an agreement with St. Peter’s for a program that will allow co-pays and lower rates than any other hospital in Montana.  Please visit the link below for more information on what the co-pays and benefits are.  PAGE 2 – begins the Premium Plan benefits.  PAGE 12 – begins the Standard Plan benefits.

Helena School District NNP St Peter’s


Each member of the HSD can access the EAP for help with many life issues.  To find out more, please click on the link below:


Each member of the HSD can access the Hinge Health Program for help with pain to various body parts such as knee, elbow, ankle, neck and so forth.  To sign up, please click on this link:

Accident/Injury Benefit

Each member on the HSD1 Health Plan may be eligible for this benefit. Please see the link below (Accident Injury Benefit) to see if your claim may qualify or contact Allegiance Customer Service at 1-855-999-8878. You can also fill out the form electronically online through the Allegiance website. Please note that only services within 90 days of the injury date are payable. Charges for Physical Therapy, Occupational Therapy, Speech Therapy, and Chiropractic Care services are specifically excluded under this benefit.

Chiropractic Benefits

Take a look at our new Chiropractic benefits HERE!

There is also a membership option to Align Chiropractic in Helena.  To use your Flex dollars, you must pay out of pocket first and then when you receive your Chiropractic services, you would submit for reimbursement each month.  If you do not use any service during the month, then it is not reimbursable.  Please see below for pricing.

Align Chiropractic Memberships Helena

Dental Schedule

Click below for the Dental Schedule. The Dental Schedule is designed to show you, the Member, the benefit dollars paid for each Dental Code/Description. If you aren’t sure how much will be covered, you can always have your Dental Office submit a pre-approval for any procedures done or contact Allegiance Customer Service at 1-855-999-8878.  *Side Note:  Orthodontics are not covered, however you may use Flex to pay for it.  Please visit the Flex section below for more information


Click below for the Vision Benefits. If you aren’t sure how much will be covered, you can always have your Vision Office submit a pre-approval for any procedures done or contact Allegiance Customer Service at 1-855-999-8878.


Our Pharmacy Benefit Manager (PBM) is called Express Scripts (ESI). Click HERE to view your Pharmacy Benefits.

      • If you have a mail order, please request your prescriptions from your doctor for mail order through Express Scripts. You will need to give them your new Pharmacy/Rx numbers on your new ID cards when you get them in September. You can setup automatic payments through the Express Scripts program by calling 1-800-948-8779 or enrolling online. You will want to update your payment information with Express Scripts when you call or enroll online. Please have your prescription number available when calling.
      • If you have any Pharmacy/Rx questions, please call ESI (Express Scripts) at: 1-800-247-9579
      • If your medication is not covered under the formulary, you will need to discuss this with your Doctor and change to an alternative. If your Doctor feels you should stay on the current medication your Doctor can initiate a prior authorization review by calling 1-800-753-2851 and then Express Scripts will notify you and your Doctor of the coverage decision.
      • Here you can find the ACA guidelines list of Preventative covered Vaccines from for Adults and for Children.  Here is also a list of vaccines covered through Express Scripts:  ACA Druglist – HSD – 9071

FLEX Benefits (125 Plan)

The final date for incurring expenses for the 2023-2024 FLEX Medical Spending Account is December 15, 2024. All participants of this plan have until March 15, 2025 to submit their valid claims to Allegiance for reimbursement. Under the “use-it-or-lose-it” rule, any money remaining in your account after this date will be forfeited! We encourage you to not wait until the final day for reimbursement due to possible tech/website complications. To find out more about Flex please visit the Allegiance website below. To file a flex claim online, click HERE.

Below are the Medical Expense Reimbursement Form and Dependent Care Reimbursement Form. You may print these forms, complete them and fax them to Allegiance along with legible copies of the medical receipts and/or Dependent Care receipts. All forms relating to FLEX can also be found at the above link.

Wellness Health Screening & Skin Education Clinic Information

To make a Fall or Spring appointment for the Wellness Health Screenings please view the HSD Appointment Scheduling PDF below . Make sure to schedule your screening appointment a minimum of 3 days before the screening you wish to attend. You will receive your confirmation email with the date and time of your screening once signed up.

Quick Notes:

      • For those who qualified for the 2023-24 Plan Year Wellness Incentive during the 2022-23 Plan Year Fall and Spring Wellness Screenings, the incentive will be paid out in full on the September paycheck (effective 09/25/23). Retirees will see the Incentive reflected in their Premiums.  If you qualified for the incentive and do not return the for the 2023-24 year, or if you waive the Health Insurance, then you forfeit any Wellness Incentive you may have qualified for, NO exceptions.
      • For those who qualify for the 2024-25 Plan Year Wellness Incentive during the 2023-24 PY Fall and Spring Wellness Screenings, the incentive will be paid out in full on the September paycheck (effective 09/25/24). Retirees will see the Incentive reflected in their Premiums.  If you qualified for the incentive and do not return the for the 2024-25 year, or if you waive the Health Insurance, then you forfeit any Wellness Incentive you may have qualified for, NO exceptions.
      • You can qualify for $200 of the $400 Wellness Incentive by attending a Wellness Screening.  The incentives are payed out in full in the following Plan Year and are taxed.
      • If you do not pass all criteria, take your results to your Primary Physician to review. Have your Primary Physician complete the PCP Follow-up Form (below) and fax to St. Peter’s WellNow! staff. You automatically will qualify for the $100!
      • You will have until 6/30/24 to pass all criteria for the Wellness Incentive for the 23-24 PY. All passing incentives for the Fall and Spring screenings are paid out in the following school year.
      • To Check your Screening resultsplease visit your MyChart through St. Peter’s.  You can also call the WellNow! team at 444-2128
      • You MUST attend a Wellness Screening for incentive purposes, you cannot do one through your Doctor to bypass and qualify.
      • The Stepping Out Program is a four to six-week course usually held on Tuesdays. Those who do not pass the Waist Measurement portion of the Incentive are eligible to take the course. Once you complete all six weeks, you will be qualified for the Waist portion of the Incentive. You will also have the opportunity to purchase a Fitbit for $40 and get reimbursed at the end of the class if you attend all six weeks. Once all the qualified participants go through the class, we will be able to allow everyone else through the class. Please contact Rich Franco ( for more details.

Remember, this Wellness website is a secure website through St. Peter’s Hospital that will keep your information confidential.

Useful documents:

Life Insurance

As an employee, you are required to choose a Life Insurance Plan through the HSD1 group policy. You will only need to fill out the Enrollment form if you are applying for Optional (Additional) Life Insurance. For those who are not New Hires, you will have to complete the Evidence of Insurability form as well.

Please take time to review your Policy to understand all the terms and age reduction limits.

Please contact Rich Franco ( if you should have any questions.

Useful Documents

Voluntary Long Term Disability (LTD)

Each year during Open Enrollment, eligible employees may elect Voluntary LTD.  New Hires and those wanting to continue to opt for this optional election must make their selection through their enrollment through the Employee Portal.  LTD covers 60% of your monthly income if you’re out of work for an extended period of time, the waiting period is 6 months.  To view more information about LTD, please see documents below.  Should you have any questions please contact Rich Franco (

Useful documents:


The Helena Public School District has very low Discount Rates through AFLAC for multiple “Optional” Benefits such as; Short-Term Disability, Life Insurance, Dental, Vision, Accident, Hospital Confinement Indemnity, and much more! To find out more, contact Loren Sampson:  (978) 828-9585 /


As a retiree, you should be able to find any information needed in the links provided in the sections above and below. However, if you do not find what you are looking for, please contact Rich Franco ( or by Phone (406-324-2008).  *As a reminder, a Retiree can stay on the District’s Health Plan until they’re 65 and then can only have the District as a Secondary/Supplemental to Medicare, without the Prescription/Rx.

Useful forms:

Retirement Plans

As a subsidiary of the State of Montana all of our employees are required to belong to either the Montana Public Employees Retirement System (MPERS) or the Montana Teachers Retirement System (MTRS). More information about these retirement systems is available through the personnel office or you can access the following websites.

For a 403b Option, please visit the OMNI website HERE

For 457b, please contact:  Empower Retirement – Email Julie Lucas at:

Empower 457b

Urgent Care

St. Peter’s North Urgent Care is located on Ptarmigan Lane located west of Bob Wards Sporting Goods.  St. Peter’s South Urgent Care is located at the hospital by the ER.

      • The $25 co-pay only applies to the office visit and does not pertain to any testing, x-rays or additional treatments
      • Due to COVID and various other Viruses, some restrictions may be in place.  Please call ahead!

St Peters Urgent Care

Urgent Care Summary Use

Employee Discounts

Please Check Back Soon!  We are currently working on developing a list of all discounts employees receive from multiple vendors.