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What is the discount program?
The discount program has two parts. The first involves a discount on monthly coverage payments. The second is reductions in deductibles and out-of-pocket expenses.
Who qualifies for the discount program?
Enrollees with household incomes under 300% of the federal poverty level and who meet asset criteria may qualify for a discount.
What are the three plan options?
There are three plan options upon which monthly payment rates are based.
Out-of-pocket maximums will vary by plan.
Plan 1 has a higher monthly payment (on average) than Plan 2, and Plan 2 has higher monthly payments (on average) than Plan 3. Plan 1 has lower deductible and lower out-of-pocket maximums than Plan 2, and Plan 2 has lower deductible and lower out-of-pocket maximums than Plan 3.
How do I decide which plan to take?
Small businesses may choose from the Plan 1, Plan 2, or Plan 3 option. The employer makes the choice, not the employees. The employer makes this choice based on their monthly costs to cover their employees as well as the deductible levels and out-of-pocket maximums. Individuals and self-employed may enroll in Plan 2 or Plan 3.
What are the employee discounts?
The monthly payment discount applies to the employee's share and is calculated after the employer's contribution. The discounts range from 10% to 80%.
What is the employee's share?
The employee's share is the difference between the total monthly cost for coverage and the employer's contribution.
What is the employer's contribution?
Employers have to decide how much they are going to pay toward the monthly cost of coverage for their employees. The employer may contribute up to 100% of coverage cost for his/her employees and their dependents. However, at a minimum, employers are required to contribute 60% of the employee-only cost.
Is a Self-employed person considered an employer?
Yes, for purposes of the discount program, a Self-employed person must contribute 60% of the monthly employee-only cost. In the case of a Self-employed person, the monthly payment discount would apply to the remaining 40% as well as to the coverage costs for his/her dependents.
What determines my discount group?
Your household income, household size, and assets.
As an employee, how does the contribution and discount piece work?
Your employer will deduct your share from your monthly wages. The Dirigo Health Agency will deposit your discount to a Pine Tree EBT (Electronic Benefits Transfer) debit card in your name on the 1st of each month. This card works like any other debit card. You can use it at any store or ATM where you see the QUEST symbol.
How does the discount work for Individuals and the Self-employed?
Harvard Pilgrim Health Care will invoice you your reduced amount monthly.
How does the reduction in deductible levels and out-of-pocket maximums work?
Based on an enrollee's discount group, the deductible levels and out-of-pocket costs are lowered. For instance, if an employee-only enrollee is found eligible for a 55% discount, his/her deductible level (in Plan 1 option) would be lowered to $750 (from $1,500); his/her annual out-of-pocket maximum would be lowered to $1,850 (from $4,250). For Plan 2, the deductible would be lowered to $1,050 (from $2,000); the out-of-pocket maximums would be lowered to $2,850 (from $5,850).
How do I find out if I'm eligible for the subsidy program?
I don't have a Pine Tree EBT card but think I should. What do I do?
Call a DirigoChoice Customer Service Representative at 1-877-892-8391 in Maine or 1-207-287-9900. (TTY: 1-207-287-4344)
I have my Pine Tree EBT card. How do I get started?
Before you can use the card you will need a Personal Identification Number (PIN). To get a PIN call 1-800-477-7428 and follow the instructions.
How does money get to my Pine Tree EBT card? Is it automatic or do I have to do something?
You don't have to do anything. The Dirigo Health Agency deposits discount dollars to your Pine Tree EBT card. Once you have a Pine Tree EBT card and PIN, you will be able to access those discount dollars.
When will I get my money?
You will be able to withdraw cash or make purchases with your EBT card any time after 11:59 PM on the 1st of each month.
What should I do if I didn't get the amount of discount dollars I expected?
Call a DirigoChoice Customer Service Representative at 1-877-892-8391 in Maine or 1-207-287-9900. (TTY: 1-207-287-4344).
How can I find out how many discount dollars are on my Pine Tree EBT card?
You can call EBT Customer Service at 1-800-477-7428 24 hours a day, 7 days a week to find out your cash account balance. Also, your receipts will show you how much money is in your account.
What are other examples of times I should call EBT Customer Service at 1-800-477-7428?
You can call if:
If I'm hearing impaired, how do I contact the Pine Tree EBT card Customer Service?
You dial Maine's telecommunication relay service at 711 to access TTY service. You give the relay agent the 1-800-477-7428 number for the Pine Tree EBT card Customer Service. The relay agent will direct you with the prompts provided from the Customer Service line.
What can I use my EBT card for?
You can use your Pine Tree EBT to get cash and buy food and non-food items.
Where can I use my EBT card?
You can use your card where you see the Quest® sign. Look for the Quest® sign on the door or window of stores or banks as well as on ATMs.
Are there fees if I use my Pine Tree EBT card to make purchases?
No. You can use your Pine Tree EBT card at any store where you see the Quest® sign. At some stores you can get cash back above the cost of your purchase, or make cash withdrawals without a purchase. You should check with individual stores about their rules.
Are there fees for using my Pine Tree EBT card at an ATM to withdraw cash?
Yes, there are two possible fees. First, there is a $0.65 fee after the first two withdrawals each month. Second, the bank or credit union where you are using your Pine Tree EBT card may charge a fee for each withdrawal. These fees may be between $1.00 and $2.00 per ATM withdrawal. These fees are deducted from your available discount balance.
How can I find out what banks and credit unions accept the Pine Tree EBT card?
You can call 1-877-892-8391in Maine or 1-207-287-9900 (TTY: 1-207-287-4344) and ask a DirigoChoice Customer Service Representative to mail you a list.
Many ATM's only allow withdrawals in multiples of $20.00. How do I get my discount when it is not an even $20.00?
There are a number of ways to get your discount dollars.
My card doesn’t seem to work when I try to buy groceries at Hannaford or Shaws, but I can withdraw funds at an ATM. I know I have money available. What is wrong?
Make sure you select the “Checking” option when prompted at card swipe machine, not “EBT.” If you keep having the problem, call Pine Tree EBT Customer Service at 1-800-477-7428 (TTY 207-474-4891).
Can I get my discount by direct deposit into my checking or savings account?
Yes. DirigoChoice members with three months of timely payment history are eligible for Electronic Funds Transfer (EFT) direct deposit into a savings or checking account. To apply for your discount by EFT, please contact the Dirigo Health Agency at 1-877-892-8391in Maine or 1-207-287-9900 (TTY: 1-207-287-4344).
