Health Care and Cafeteria Benefits

Welcome to the Helena School District #1 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 benefits are through Cigna Insurance.  As you scroll through this page, you will find more information about the Health Plan and options.  Start by clicking HERE to view the welcome packet.  Welcome to our School District!

Health Benefits Office

The Health Benefits Office is located at 55 South Rodney St in Helena, MT.  The HR Benefits Manager is Richard Franco and you can contact him through email (rfranco@helenaschools.org) or phone (406-324-2008).

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 800-877-1122.

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: https://www.askallegiance.com/hsd1
  2. Click on “Health/Flex Login”
  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.
Health Insurance Plan Description

For PY 2019-20 each 12 month full-time employee receives $781.00 per month ($937.20/ for 10 months) in cafeteria dollars to apply to the election of a 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).  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 Life and Disability Insurance and health care expenses not covered by the District’s health insurance. Please contact the Human Resources Benefits Office with any questions.

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.

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.  You will receive electronic updates when revisions or amendments are added.  The most recent up-to-date Health Benefit Plan Document and Summary Plan Description are available by contacting the Human Resource Benefits Office (see below).

If you wish, you may contact Allegiance (1-800-877-1122 or P.O. Box 3018, Missoula, MT 59806( or the HSD#1 Human Resources Benefits Office (406-324-2008 or 55 S. Rodney, 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 mid-August each year.  Information for Open Enrollment is mailed prior to school starting, and the Online enrollment needs to be completed by the end of the first full week of September of each year.  Open Enrollment is designed for employees to make changes for the upcoming Plan Year (October 1st – September 30th).

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.

HSD1 Health Plan Changes for PY 19-20

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.

Appeals

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.

Notices

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.

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).  To prevent the balance bills, it is up to the members to request an Allegiance Participating Air Transport Provider.  In using a preferred provider, you will only owe the deductible and coinsurance up to the max out of pocket and not be stuck with balance billing due to a non-preferred provider charges.  As a member, if you are unsure, please contact Allegiance (800-877-1122) and they will be able to assist.  You can also lookup Preferred Providers on Allegiance website:  https://www.askallegiance.com/hsd1

The HSD1 Health Plan coverage of Air Ambulatory services is as follows:

  • 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.

Accident/Injury Benefit

Each employee 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 1-800-877-1122.  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.

Dental Schedule

Click HERE for the Dental Schedule for the 2018-2019 Plan Year.  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 1-800-877-1122.

Vision

Click HERE for the 2018-2019 Plan Document page for 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 1-800-877-1122.

Pharmacy

Beginning 10/1/2019 we will have a new Pharmacy Benefit Manager (PBM) called Express Scripts (ESI).  Click HERE to view your Pharmacy Benefits.

  • If you have a mail order, please request new 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 new formulary, you will have until 1/1/2020 to discuss 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.

Transitioning to Express Scripts_Helena School District_v2.1

Mobile App and Express-Scripts.com Solution Overview

FLEX Benefits (125 Plan)

The final date for incurring expenses for the 2018-2019 FLEX Medical Spending Account is December 15, 2019.  All participants of this plan have until March 15, 2020 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 log onto this WEBSITE.  Click the green link to Sign up for a Wellness Screening.  Please note: you must complete your Health Risk Assessment (HRA) before a screening to be counted towards your incentive . 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.  To make an appointment for the Skin Education Clinic, log on like you would for a Wellness Screening.   Skin Screenings are done every other year, the next Skin Screenings are scheduled for Plan Year 2019-2020.

Quick Notes:

  • The next Wellness Incentive will be paid out in full in the September paycheck (effective 09/25/19).  If you qualify for the incentive and do not return the next year, or if you waive the Health Insurance, then you forfeit any Wellness Incentive you may have qualified for, NO exceptions.
  • New!  You can qualify for $100 of the $400 Premium Health Incentive by attending a Wellness Screening.
  • 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 6/30/20 to pass all criteria for the Wellness Incentive for the 19-20 PY.  All passing incentives for the Fall and Spring screenings are paid out in the following school year.
  • The Stepping Out Program is a six-week course usually held on Tuesdays.  Those who do not pass the BMI/Waist Measurement portion of the Premium Incentive are eligible to take the course. Once you complete all six weeks, you will be qualified for the BMI/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 (rfranco@helenaschools.org) for more details.

Remember, this Wellness website is a secure website through St. Peter’s Hospital that will keep your information confidential.  You must complete the Wellness Health Risk Assessment (HRA) along with your Health Screening in order to qualify for the Premium Reduction Incentive.

Useful documents:

Life Insurance and Employee Assistance Program

As an employee, you are required to choose a Life Insurance Plan through the HSD1 group policy.  The rates are on the Enrollment sheet link provided below.  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.

We also have an Employee Assistance Program linked with our Life Insurance Group Policy.  Please see the attached PDF “Employee Connect EE Flier” or “Employee Connect Poster” below for more information.

Please contact Rich Franco (rfranco@helenaschools.org) if you should have any questions.

Useful Documents

Voluntary Long Term Disability (LTD)

Each year during Open Enrollment, eligible employees may elect Voluntary LTD. The Health Benefits Office will typically send out renewal letters to employees who are already enrolled, just before Open Enrollment begins.  However, New Hires who want to opt for this optional election must complete the form on the link provided below.  Should you have any questions please contact Rich Franco (rfranco@helenaschools.org)

Useful documents:

AFLAC

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, just click HERE for the AFLAC booklet link below.

Retirees

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 (rfranco@helenaschools.org) or by Phone (406-324-2008).

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.

*  To find out about 403b and 457b Vendors, please contact the Insurance Administrator

Riverwood Health

Riverwood Health walk-in clinic is located across from Burger King by Wal-Mart.  This walk-in clinic is a $10 co-pay and it applies to the office visit and Urgent Care needs. Their hours of operation:  Monday – Thursday from 8:00am – 6:00pm.  Phone #: 406-324-7003.

Urgent Care

St. Peter’s Urgent Care is located on Ptarmigan Lane located west of Bob Wards Sporting Goods.  This is the only Urgent Care the $10 co-pay applies to.  To schedule an appointment online please visit this WEBSITE.

  • Please Note:  Setting an appointment does NOT mean that you will get in at that time. Due to being an Urgent Care serving Helena, there could be long wait times, but St. Peter’s assures that they will do their best to get the HSD employees in as quickly as possible.

Useful forms:

Employee Gym Discounts

We have a few discounts eligible for employees through the Helena Public School District #1.  Currently we have discounts through Crossroads Gym, Fuel Fitness Gym (All Locations: Billings, Bozeman, Butte, Helena, and Missoula), Broadwater Hot Springs, and FireTower Crossfit.  We are working to try and get discounts at other facilities and will update when there’s a resolution.  If you have any questions please contact your Health Benefits Manager, Rich Franco, (406-324-2008).