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Insurance

Full-time permanent employees, permanent part-time employees (those regularly scheduled to work twenty (20) hours or more per week and seasonal employees scheduled to work more than six (6) months in any twelve (12) month period) and temporary employees scheduled to work twenty (20) hours or more per week for six (6) months or more are eligible for coverage under the Montana University System Group Benefits Plan.

All eligible employees are required to complete a “Choices” benefits enrollment form and return it with their elected coverage within 30 days of hire or date of eligibility even if coverage is waived.

Note - Student employees who occupy positions designated as student positions by a campus are not eligible to join the Plan.

If you are eligible, you may also enroll your family for certain benefits under Choices, including medical, dental, vision, life insurance and AD&D coverage. Eligible family members include:

Legal spouse, as defined under Montana law, or one other unrelated adult dependent as defined in the Summary Plan Description. To enroll an adult dependent other than a spouse, you will need to obtain criteria from your campus Human Resources Office and complete a Declaration of Adult Dependent form, also available there.

Unmarried dependent children under age 26 which include your natural children, stepchildren, and children placed in your home for adoption before age 18 or for whom you have court-ordered custody or you are the legal guardian.

MEDICAL PLANS

Allegiance Managed Care
Traditional Plan: #95000-05 & 
Managed Care: #95008-05
2806 S. Garfield St.
PO Box 4786
Missoula MT 59806-3018
1-877-778-8600
Telephone Service 7am-6pm MST
Walk-in Service 8am-5pm MST
Allegiance Change of Address


Blue Cross Blue Shield of Montana
Group#: X58005 131-2
PO BOX 7982
Helena, MT 59604
1.800.820.1674


Pacific Source Managed Care
Group #: GSO 01302
PO Box 7068
Springfield, OR 97475
Toll Free: 866.999.5583, Ext. 2203
Fax: 541.225.3673


DENTAL PLANS

Delta Dental Insurance
Group #: 7500-0000
PO Box 1809
Alpharetta GA 30023-1809
Automated Information Line: 1-866-579-5717


PHARMACY

URx
Customer Service: 1-877-501-1064
Ask-a-Pharmacist: 1-888-527-5879 or 1-888-ASK-URX
Group#: 36430, Bin# 003585, PCN# 36430


MedVantx Pharmacy Services (MedVantx)
PO Box 5736
Sioux Falls, SD 57117
1-877-870-6668


Ridgeway Pharmacy
2824 US Highway 93 N
Victor, MT 59875
1.800.630.3214
FAX: 1.406.652.6050


REIMBURSEMENT ACCOUNTS

Allegiance
2806 Garfield Street
P.O. Box 4346
Missoula, MT& 59806
1-877-778-8600
Fax 1-877-424-3539
Claim Forms
Submit Claims Online


VISION PLAN

Vision Hardware
Group #: V58005
1-800-820-1674
406-447-8747


ACCIDENTAL DEATH & DISMEMBERMENT

The Hartford
PO Box 946790
Maitland FL 32794-6790
1-800-303-9744


LIFE & LONG-TERM DISABILITY

Standard Life Insurance Company
Group #:  643129
PO Box 2800
Portland, OR 97208-2800
1.800.628.8600


See Also:
Life Insurance Booklet
Long Term Disability