reglab/housing_qa huggingface dataset:
MT Code § 33-22-1315 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1315. Calculation of reinsurance payments

  33-22-1315. Calculation of reinsurance payments. (1) Each reinsurance payment must be calculated with respect to an eligible health insurer's incurred claims costs for an individual enrollee's covered benefits in the applicable benefit year. If the claims costs do not exceed the attachment point, the reinsurance payment is $0. If the claims costs exceed the attachment point, the reinsurance payment must be calculated as the product of the coinsurance rate and the less of:   (a) the claims costs minus the attachment point; or   (b) the reinsurance cap minus the attachment point.   (2) The board shall ensure that the reinsurance payments made to the eligible health insurer do not exceed the total amount paid by the eligible health insurer for any eligible claim.   (3) For purposes of this section, "total amount paid" means the amount paid by the eligible health insurer based on the allowed amount less any deductible, coinsurance, or copayment.   History: En. Sec. 10, Ch. 210, L. 2019.
MT Code § 33-22-1316 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1316. Administration of reinsurance payments

  33-22-1316. Administration of reinsurance payments. (1) Claims that are incurred during a benefit year and are submitted for reimbursement in the following benefit year by the date established by the board in the plan of operation will be allocated to the benefit year in which they are incurred. Claims submitted after the date established by the board following the benefit year in which they were incurred will be allocated to the next benefit year in accordance with the board's operating rules, policies, and procedures.  (2) If funds accumulated in the reinsurance program account in the state special revenue fund with respect to a benefit year are expected to be insufficient to pay all program expenses, claims for reimbursement, and other disbursements allocable to that benefit year, all claims for reimbursement allocable to that benefit year must be reduced proportionately to the extent necessary to prevent a deficiency in the funds for that benefit year. Any reduction in claims for reimbursement with respect to a benefit year must apply to all claims that are allocated to that benefit year without regard to when those claims were submitted for reimbursement, and any reduction must be applied to each claim in the same proportion.   (3) If funds accumulated in the reinsurance program account in the state special revenue fund exceed the actual claims for reimbursement and program expenses of the association in a given benefit year, the board shall use such excess funds to pay reinsurance claims in successive benefit years and may recommend to the commissioner a reduction in the assessment amount for the following year.   (4) For each applicable benefit year, the board shall notify eligible health insurers of reinsurance payments to be made for the applicable benefit year by the date established by the board in the plan of operation in the year following the applicable benefit year.   (5) By December 31 of the year following the applicable benefit year, the board shall disburse all applicable reinsurance payments payable to an eligible health insurer.   History: En. Sec. 11, Ch. 210, L. 2019; amd. Sec. 7, Ch. 471, L. 2021.
MT Code § 33-22-1317 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1317. Eligible health insurer requests for reinsurance payments

  33-22-1317. Eligible health insurer requests for reinsurance payments. (1) An eligible health insurer shall:   (a) make requests for reinsurance payment in accordance with any requirements established by the board;   (b) provide the association with access to data according to the rules and timeline established by the board in the plan of operation or by the commissioner in the administrative rules. The data environment utilized must be compatible with the federal risk adjustment program.   (c) maintain documents and records sufficient to substantiate the requests for reinsurance payments made pursuant to this part for a period of at least 6 years;   (d) apply all managed care, utilization review, case management, preferred provider arrangements, claims processing, and other methods of operation as appropriate to each claim without regard to whether that claim is eligible for or may be paid by reinsurance;   (e) make records available upon request from the commissioner or the board for purposes of verification, investigation, audit, or other review of reinsurance payment requests; and   (f) repay to the reinsurance program account in the state special revenue fund any reinsurance overpayments as determined by the commissioner as a result of an investigation, audit, or other review.   (2) Data collected from eligible health insurers under this section is confidential and not subject to public inspection.   History: En. Sec. 12, Ch. 210, L. 2019.
MT Code § 33-22-1318 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1318. and 33-22-1319 reserved

  33-22-1318 and 33-22-1319 reserved.
MT Code § 33-22-1320 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1320. Liability of association members

  33-22-1320. Liability of association members. An association member may not be held liable for the acts or omissions of the association board or the association membership.   History: En. Sec. 13, Ch. 210, L. 2019.
MT Code § 33-22-1321 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1321. State and federal special revenue accounts -- reinsurance program

  33-22-1321. State and federal special revenue accounts -- reinsurance program. (1) (a) There is a reinsurance program account in the state special revenue fund established by 17-2-102. The account must be administered by the commissioner for the benefit of the program.   (b) There must be deposited in the account:   (i) all assessments collected under 33-22-1313;   (ii) any interest and income earned on the account; and   (iii) any other money from any other source accepted for the benefit of the account.   (c) The account may be used only to provide funding for the administration, operation, and claims expenses incurred by the program created in 33-22-1302.   (2) There is an account in the federal special revenue fund to the credit of the board and administered by the commissioner for the benefit of the program. There must be deposited in the account:   (a) federal funding allocated as a result of a section 1332 waiver application;   (b) any federal or grant funding; and   (c) any interest and income earned on the account.   History: En. Sec. 14, Ch. 210, L. 2019.
MT Code § 33-22-1322 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1322. State innovation waiver

  33-22-1322. State innovation waiver. The commissioner, the governor, and the board shall jointly apply, no later than July 1, 2019, to the U.S. secretary of health and human services under 42 U.S.C. 18052 for a state innovation waiver and federal pass-through funding to implement this part for benefit years beginning January 1, 2020, and future years to maximize federal funding.   History: En. Sec. 15, Ch. 210, L. 2019.
MT Code § 33-22-1501 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1501. Repealed

  33-22-1501. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 1, Ch. 595, L. 1985; amd. Sec. 15, Ch. 798, L. 1991; amd. Sec. 5, Ch. 357, L. 1995; amd. Sec. 17, Ch. 416, L. 1997; amd. Sec. 1, Ch. 173, L. 1999; amd. Sec. 1, Ch. 453, L. 2003; amd. Sec. 29, Ch. 469, L. 2005; amd. Sec. 1, Ch. 133, L. 2011; amd. Sec. 1, Ch. 404, L. 2013; amd. Sec. 23, Ch. 63, L. 2015.
MT Code § 33-22-1502 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1502. Repealed

  33-22-1502. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 2, Ch. 595, L. 1985; amd. Sec. 2, Ch. 367, L. 2001; amd. Sec. 2, Ch. 453, L. 2003; amd. Sec. 30, Ch. 469, L. 2005; amd. Sec. 2, Ch. 404, L. 2013; amd. Sec. 24, Ch. 63, L. 2015.
MT Code § 33-22-1503 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1503. Repealed

  33-22-1503. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 3, Ch. 595, L. 1985; amd. Sec. 6, Ch. 357, L. 1995; amd. Sec. 2, Ch. 173, L. 1999; amd. Sec. 2, Ch. 528, L. 1999.
MT Code § 33-22-1504 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1504. Repealed

  33-22-1504. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 4, Ch. 595, L. 1985; amd. Sec. 16, Ch. 798, L. 1991; amd. Sec. 7, Ch. 357, L. 1995; amd. Sec. 3, Ch. 173, L. 1999; amd. Sec. 3, Ch. 528, L. 1999; amd. Sec. 2, Ch. 133, L. 2011; amd. Sec. 3, Ch. 404, L. 2013; amd. Sec. 25, Ch. 63, L. 2015.
MT Code § 33-22-1505 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1505. Repealed

  33-22-1505. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 13, Ch. 595, L. 1985.
MT Code § 33-22-1506 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1506. through 33-22-1510 reserved

  33-22-1506 through 33-22-1510 reserved.
MT Code § 33-22-1511 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1511. Repealed

  33-22-1511. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 5, Ch. 595, L. 1985; amd. Sec. 26, Ch. 798, L. 1991.
MT Code § 33-22-1512 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1512. Repealed

  33-22-1512. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 8, Ch. 595, L. 1985; amd. Sec. 27, Ch. 798, L. 1991; amd. Sec. 8, Ch. 357, L. 1995; amd. Sec. 18, Ch. 416, L. 1997; amd. Sec. 1, Ch. 475, L. 2001; amd. Sec. 41, Ch. 380, L. 2003; amd. Sec. 3, Ch. 133, L. 2011.
MT Code § 33-22-1513 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1513. Repealed

  33-22-1513. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 9, Ch. 595, L. 1985; amd. Sec. 31, Ch. 112, L. 1991; amd. Sec. 17, Ch. 798, L. 1991; amd. Sec. 29, Ch. 349, L. 1993; amd. Sec. 19, Ch. 416, L. 1997; amd. Sec. 4, Ch. 528, L. 1999; amd. Sec. 3, Ch. 367, L. 2001; amd. Sec. 2, Ch. 475, L. 2001; amd. Sec. 42, Ch. 380, L. 2003; amd. Sec. 3, Ch. 453, L. 2003; amd. Sec. 31, Ch. 469, L. 2005; amd. Sec. 26, Ch. 63, L. 2015.
MT Code § 33-22-1514 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1514. Repealed

  33-22-1514. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 10, Ch. 595, L. 1985; amd. Sec. 28, Ch. 798, L. 1991; amd. Sec. 5, Ch. 528, L. 1999; amd. Sec. 32, Ch. 469, L. 2005; amd. Sec. 11, Ch. 120, L. 2013.
MT Code § 33-22-1515 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1515. Repealed

  33-22-1515. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 11, Ch. 595, L. 1985; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 29, Ch. 798, L. 1991; amd. Sec. 9, Ch. 357, L. 1995; amd. Sec. 5, Ch. 173, L. 1999; amd. Sec. 33, Ch. 469, L. 2005.
MT Code § 33-22-1516 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1516. Repealed

  33-22-1516. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 12, Ch. 595, L. 1985; amd. Sec. 30, Ch. 798, L. 1991; amd. Sec. 10, Ch. 357, L. 1995; amd. Sec. 20, Ch. 416, L. 1997; amd. Sec. 6, Ch. 173, L. 1999; amd. Sec. 4, Ch. 453, L. 2003; amd. Sec. 34, Ch. 469, L. 2005.
MT Code § 33-22-1517 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1517. Repealed

  33-22-1517. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 1, Ch. 357, L. 1995; amd. Sec. 35, Ch. 469, L. 2005; amd. Sec. 16, Ch. 399, L. 2007.
MT Code § 33-22-1518 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1518. Repealed

  33-22-1518. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 2, Ch. 357, L. 1995.
MT Code § 33-22-1519 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1519. and 33-22-1520 reserved

  33-22-1519 and 33-22-1520 reserved.
MT Code § 33-22-1521 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1521. Repealed

  33-22-1521. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 6, Ch. 595, L. 1985; amd. Sec. 31, Ch. 798, L. 1991; amd. Sec. 11, Ch. 357, L. 1995; amd. Sec. 152, Ch. 42, L. 1997; amd. Sec. 7, Ch. 173, L. 1999; amd. Sec. 4, Ch. 367, L. 2001; amd. Sec. 4, Ch. 133, L. 2011.
MT Code § 33-22-1522 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1522. Repealed

  33-22-1522. Repealed. Sec. 34, Ch. 798, L. 1991.   History: En. Sec. 7, Ch. 595, L. 1985.
MT Code § 33-22-1523 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1523. Repealed

  33-22-1523. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 41, Ch. 416, L. 1997.
MT Code § 33-22-1524 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 15. Comprehensive Health Association and Plan (Repealed)|33-22-1524. Repealed

  33-22-1524. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 1, Ch. 528, L. 1999; amd. Sec. 5, Ch. 453, L. 2003.
MT Code § 33-22-1601 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 16. Subrogation -- Notice|33-22-1601. Subrogation rights

  33-22-1601. Subrogation rights. A disability insurance policy subject to this chapter may contain a provision providing that, to the extent necessary for reimbursement of benefits paid to or on behalf of the insured, the insurer is entitled to subrogation, as provided for in 33-22-1602, against a judgment or recovery received by the insured from a third party found liable for a wrongful act or omission that caused the injury necessitating benefit payments.   History: En. Sec. 1, Ch. 365, L. 1987.
MT Code § 33-22-1602 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 16. Subrogation -- Notice|33-22-1602. Notice -- shared costs of third-party action -- limitation

  33-22-1602. Notice -- shared costs of third-party action -- limitation. (1) If an insured intends to institute an action for damages against a third party, the insured shall give the insurer reasonable notice of the intention to institute the action.   (2) The insured may request that the insurer pay a proportionate share of the reasonable costs of the third-party action, including attorney fees.   (3) An insurer may elect not to participate in the cost of the action. If an election is made, the insurer waives 50% of any subrogation rights granted to it by 33-22-1601.   (4) The insurer's right of subrogation granted in 33-22-1601 may not be enforced until the injured insured has been fully compensated for the insured's injuries.   History: En. Sec. 3, Ch. 365, L. 1987; amd. Sec. 1232, Ch. 56, L. 2009.
MT Code § 33-22-1701 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1701. Short title

  33-22-1701. Short title. This part may be cited as the "Preferred Provider Agreements Act".   History: En. Sec. 1, Ch. 638, L. 1987.
MT Code § 33-22-1702 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1702. Purpose

  33-22-1702. Purpose. The purpose of this part is to allow a health care insurer providing disability insurance benefits to negotiate and contract with health care providers to:   (1) provide health care services to its insureds or subscribers at a reduction in the fees customarily charged by the provider; or   (2) enter into agreements in which the participating providers accept negotiated fees as payment in full for health care services the health care insurer is obligated to provide or pay for under the health benefit plan.   History: En. Sec. 2, Ch. 638, L. 1987.
MT Code § 33-22-1703 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1703. Definitions

  33-22-1703. Definitions. As used in this part, the following definitions apply:   (1) "Emergency medical condition" means a condition manifesting itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in any of the following:   (a) the covered person's health would be in serious jeopardy;   (b) the covered person's bodily functions would be seriously impaired; or   (c) a bodily organ or part would be seriously damaged.   (2) "Emergency services" means health care items or services furnished or required to evaluate and treat an emergency medical condition.   (3) "Health benefit plan" means the health insurance policy or subscriber arrangement between the insured or subscriber and the health care insurer that defines the covered services and benefit levels available.   (4) "Health care insurer" means:   (a) an insurer that provides disability insurance as defined in 33-1-207;   (b) a health service corporation as defined in 33-30-101;   (c) a fraternal benefit society as described in 33-7-105; or   (d) any other entity regulated by the commissioner that provides health coverage except a health maintenance organization.   (5) "Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's license or legal authorization or services provided under Title 33, chapter 22, part 7.   (6) "Insured" means an individual entitled to reimbursement for expenses of health care services under a policy or subscriber contract issued or administered by an insurer.   (7) "Preferred provider" means a provider or group of providers who have contracted to provide specified health care services.   (8) "Preferred provider agreement" means a contract between or on behalf of a health care insurer and a preferred provider.   (9) "Provider" means an individual or entity licensed or legally authorized to provide health care services or services covered within Title 33, chapter 22, part 7.   (10) "Subscriber" means a certificate holder or other person on whose behalf the health care insurer is providing or paying for health care coverage.   History: En. Sec. 3, Ch. 638, L. 1987; amd. Sec. 67, Ch. 713, L. 1989; amd. Sec. 40, Ch. 586, L. 1991; amd. Sec. 32, Ch. 451, L. 1993; amd. Sec. 1, Ch. 413, L. 1997.
MT Code § 33-22-1704 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1704. Preferred provider agreements authorized

  33-22-1704. Preferred provider agreements authorized. (1) Notwithstanding any other provision of law to the contrary, a health care insurer may:   (a) enter into agreements with providers relating to health care services that may be rendered to insureds or subscribers on whose behalf the health care insurer is providing health care coverage, including preferred provider agreements relating to:   (i) the amounts an insured may be charged for services rendered; and   (ii) the amount and manner of payment to the provider; and   (b) issue or administer policies or subscriber contracts in this state that include incentives for the insured to use the services of a provider that has entered into an agreement with the insurer pursuant to subsection (1)(a).   (2) A preferred provider agreement issued or delivered in this state may not unfairly deny health benefits for health care services covered.   (3) A preferred provider agreement entered into or renewed after March 26, 1993, must provide each health care provider with the opportunity to participate on the basis of a competitive bid or offer. For each health care service that an insurer proposes to obtain for its insureds from a preferred provider in the geographic area covered by the proposal, the insurer shall provide all known providers of the health care service in that area with an equal opportunity to submit a competitive bid or offer to become a preferred provider. Except as provided in subsection (5), the insurer shall issue a request for proposals and shall select the lowest cost bid or offer. If only one bid or offer is received, the insurer may enter into a preferred provider agreement with the health care provider.   (4) If a bid or an offer is not received in response to a request for proposals under subsection (3), the insurer may not establish a preferred provider agreement for that service in the geographic area except pursuant to a new request for proposals.   (5) An insurer may reserve the right in its request for proposals to reject bids or offers submitted in response to the request, including the lowest cost bid or offer. A bid or offer must be rejected in the manner established in the request for proposals. An insurer may not enter into a preferred provider agreement for a health care service except pursuant to a request for proposals.   History: En. Sec. 4, Ch. 638, L. 1987; amd. Sec. 1, Ch. 714, L. 1991; amd. Sec. 1, Ch. 202, L. 1993.