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Member Forms

Click on buttons below to download the forms you need.

Prescription Claim Form

A form to request reimbursement for out of pocket payment of prescription drugs

Mail Order Prescription Form

Medical Claim Form

For group changes, please talk to your HR department.

Anti-Discrimination Policy

Incapacitation Review 

Direct Application - ID

Direct Application - MT

Direct Application - WY

Direct application only, NOT marketplace applications

Preauthorization

  • Montana Health CO-OP Facebook
  • Montana Health CO-OP Instagram
  • YouTube

Mountain Health CO-OP does not discriminate based on race, color, national origin, disability, age, sex, gender, sexual orientation, or health status in the administration of the plan, including enrollment and benefit determinations.

 

Compliance and Privacy

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Contact Us with Questions About Coverage
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