reglab/housing_qa huggingface dataset:
MT Code § 33-31-221 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 2. Authorization of Health Maintenance Organizations|33-31-221. Powers of health maintenance organizations

  33-31-221. Powers of health maintenance organizations. (1) The powers of a health maintenance organization include but are not limited to the following:   (a) the purchase, lease, construction, renovation, operation, or maintenance of a hospital, a medical facility, or both, its ancillary equipment, and property that may reasonably be required for its principal office or for purposes that may be necessary in the transaction of the business of the organization;   (b) the making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation under its control for the purpose of acquiring or constructing a medical facility or hospital or in furtherance of a program providing health care services to enrollees;   (c) the furnishing of health care services through a provider who is under contract with or employed by the health maintenance organization;   (d) the contracting with a person for the performance on its behalf of certain functions, such as marketing, enrollment, and administration;   (e) the contracting with an insurer authorized to transact insurance in this state, or with a health service corporation authorized to do business in this state, for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization; and   (f) the offering of other health care services in addition to basic health care services.   (2) A health maintenance organization shall file notice, with adequate supporting information, with the commissioner before exercising a power granted in subsection (1)(a), (1)(b), or (1)(d). The commissioner may, after notice and hearing, within 60 days disapprove the exercise of a power under subsection (1)(a), (1)(b), or (1)(d) only if, in the commissioner's opinion, it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. The commissioner may make reasonable rules exempting from the filing requirement of this subsection those activities having a de minimis effect. The commissioner may exempt certain contracts from the filing requirement whenever exercise of the authority granted in this section would have little or no effect on the health maintenance organization's financial condition and ability to meet obligations.   (3) This section does not exempt the activities of a health maintenance organization from any applicable certificate of need requirements under Title 50, chapter 5, parts 1 and 3.   History: En. Sec. 5, Ch. 457, L. 1987; amd. Sec. 1250, Ch. 56, L. 2009.
MT Code § 33-31-222 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 2. Authorization of Health Maintenance Organizations|33-31-222. Governing body

  33-31-222. Governing body. (1) The governing body of a health maintenance organization may include providers or other individuals, or both.   (2) The governing body shall establish a mechanism to give the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.   History: En. Sec. 6, Ch. 457, L. 1987.
MT Code § 33-31-223 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 2. Authorization of Health Maintenance Organizations|33-31-223. Fiduciary responsibilities

  33-31-223. Fiduciary responsibilities. (1) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization is responsible for the funds in the manner of a fiduciary to the health maintenance organization.   (2) A health maintenance organization shall maintain in force a fidelity bond on employees and officers in an amount not less than $100,000 or such other sum as may be prescribed by the commissioner. Each bond must be written with at least a 1-year discovery period and, if written with less than a 3-year discovery period, must contain a provision that a cancellation or termination of the bond, whether by or at the request of the insured or by the underwriter, may not take effect prior to the expiration of 90 days after written notice of the cancellation or termination has been filed with the commissioner unless the commissioner approves an earlier cancellation or termination date.   History: En. Sec. 7, Ch. 457, L. 1987.
MT Code § 33-31-302 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-302. Information to enrollees

  33-31-302. Information to enrollees. Each authorized health maintenance organization shall provide to its enrollees 30 days' advance notice in writing of any material change in the operation of the health maintenance organization that will affect them directly.   History: En. Sec. 10, Ch. 457, L. 1987.
MT Code § 33-31-303 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-303. Complaint system

  33-31-303. Complaint system. (1) (a) Each authorized health maintenance organization shall establish and maintain a complaint system to provide reasonable procedures to resolve written complaints initiated by enrollees. A health maintenance organization may not use a complaint system:   (i) before the commissioner approves it; and   (ii) unless the health maintenance organization describes it in each evidence of coverage issued or delivered to an enrollee in this state.   (b) Each time the health maintenance organization denies a claim or initiates disenrollment, cancellation, or nonrenewal, it shall notify the affected enrollee of the right to file a complaint and the procedure for filing a complaint.   (c) Each health maintenance organization shall acknowledge a complaint within 10 days of receiving it.   (d) Each health maintenance organization shall retain records of all complaints for 3 years and shall develop a summary for each year that must include:   (i) a description of the procedures of the complaint system;   (ii) the total number of complaints handled through the complaint system, a compilation of causes underlying the complaints filed, the date on which each complaint was filed, the date on which each complaint was resolved, the disposition of each complaint filed, the time it took to process each complaint, and a summary of each administrative change made because of a complaint; and   (iii) the number, amount, and disposition of malpractice claims made by enrollees of the health maintenance organization that were settled during the year by the health maintenance organization.   (e) The health maintenance organization shall annually on or before March 1 file with the commissioner the summary described in subsection (1)(d) for the preceding year.   (2) The commissioner shall hold in confidence the information provided by the health maintenance organization pursuant to subsection (1)(d)(iii).   (3) The commissioner may examine a complaint system.   History: En. Sec. 11, Ch. 457, L. 1987.
MT Code § 33-31-304 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-304. Dual choice

  33-31-304. Dual choice. An employer in this state that offers its employees the option to enroll in a health maintenance organization and an employee benefit fund in this state that offers its members the option to enroll in a health maintenance organization may not be required to pay more for health benefits provided by the health maintenance organization than it would otherwise be required to provide by any prevailing collective bargaining agreement or other contract for the provision of health benefits to its employees, if the employer or benefits fund pays to the health maintenance organization chosen by each employee or member an amount equal to the lesser of:   (1) the amount paid on behalf of its other employees or members of health benefits; or   (2) the health maintenance organization's charge for coverage approved by the commissioner pursuant to 33-31-301.   History: En. Sec. 29, Ch. 457, L. 1987.
MT Code § 33-31-305 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-305. Dentist participation as provider

  33-31-305. Dentist participation as provider. A contract for dental care services through a health maintenance organization that is offered, delivered, or renewed under this chapter must allow a dentist to request participation as a provider on the same terms and conditions as those by which other dentists participate. This opportunity for participation must be offered for each contract or plan. Each contract or plan must provide at least one annual period during which a dentist may exercise this right.   History: En. Sec. 2, Ch. 265, L. 1989.
MT Code § 33-31-306 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-306. Point-of-service option

  33-31-306. Point-of-service option. (1) (a) A health maintenance organization that has at least 10,000 enrollees shall offer a point-of-service option benefit plan to each purchaser of a health care services agreement. The purchaser may accept or reject the addition of a point-of-service option to the health care services agreement.   (b) For the purposes of subsection (1)(a), an enrollee does not include an individual receiving medicaid services under the Montana medicaid program provided for in Title 53, chapter 6, or an individual participating in an approved medicare risk contract administered by a licensed health maintenance organization.   (2) Any difference in premium charged for the point-of-service option benefit plan compared to the premium for a standard health care services agreement may not exceed the expected cost to the insurer of benefits and expenses based on sound actuarial principles.   (3) This section may not be construed to permit a health maintenance organization to offer stand-alone indemnity insurance coverage.   History: En. Sec. 2, Ch. 165, L. 1997.
MT Code § 33-31-307 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-307. Affiliation periods

  33-31-307. Affiliation periods. (1) A health maintenance organization that offers health insurance coverage in connection with a group health plan and that does not impose a preexisting condition exclusion allowed by 33-22-246 or 33-22-514 with respect to any particular coverage option may impose an affiliation period for that coverage option if:   (a) the affiliation period is applied uniformly without regard to any health status-related factors; and   (b) the affiliation period does not exceed 2 months, or 3 months in the case of a late enrollee, as defined in 33-22-140.   (2) A health maintenance organization is not required to provide health care services or benefits during the affiliation period, and a premium may not be charged to the participant or beneficiary for any coverage during the affiliation period. An affiliation period begins on the enrollment date and runs concurrently with any waiting period under the plan.   (3) A health maintenance organization may use a method other than an affiliation period to address adverse selection if the method is approved by the commissioner.   (4) The definitions in 33-22-140 apply to this section.   History: En. Sec. 43, Ch. 416, L. 1997.
MT Code § 33-31-308 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-308. through 33-31-310 reserved

  33-31-308 through 33-31-310 reserved.
MT Code § 33-31-311 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-311. Insurance producer license required

  33-31-311. Insurance producer license required. An individual or business entity may not act as or represent to the public that the individual or business entity is an insurance producer for a health maintenance organization unless the individual or business entity is:   (1) licensed as a disability insurance producer by the commissioner pursuant to Title 33, chapter 17, parts 1, 2, 4, and 10 through 12, or licensed as an insurance producer as provided in 33-30-311; and   (2) appointed or authorized by the health maintenance organization or other health insurance issuer to sell, solicit, or negotiate health care service agreements on its behalf.   History: En. Sec. 15, Ch. 457, L. 1987; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 153, Ch. 42, L. 1997; amd. Sec. 68, Ch. 227, L. 2001; amd. Sec. 24, Ch. 399, L. 2007; amd. Sec. 35, Ch. 271, L. 2009.
MT Code § 33-31-313 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-313. Premium increase restriction -- exception

  33-31-313. Premium increase restriction -- exception. (1) A health maintenance organization may not increase a premium for an individual's or an individual's group health care services agreement more frequently than once during a 12-month period unless failure to increase the premium more frequently than once during the 12-month period would:   (a) place the health maintenance organization in violation of the laws of this state; or   (b) cause the financial impairment of the health maintenance organization to the extent that further transaction of insurance by the health maintenance organization would injure or be hazardous to its enrollees or to the public.   (2) Subsection (1) does not apply to a premium increase necessitated by a state or federal law, by a court decision, by a state rule, or by a federal regulation.   History: En. Sec. 7, Ch. 413, L. 1997.
MT Code § 33-31-314 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-314. through 33-31-320 reserved

  33-31-314 through 33-31-320 reserved.
MT Code § 33-31-321 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-321. Disclosure standards -- health maintenance organizations

  33-31-321. Disclosure standards -- health maintenance organizations. (1) In order to provide for full and fair disclosure in the sale of disability insurance, an enrollment form or evidence of coverage may not be delivered or issued for delivery in this state by a health maintenance organization unless an outline of coverage is delivered to the applicant at the time the application is made. The outline of coverage must be filed with the commissioner as required by 33-1-501.   (2) The outline of coverage must include:   (a) a general description of the principal benefits and coverages provided by the policy;   (b) a general description of the insureds financial responsibility under the policy, including, if applicable, the amount of the deductible, the amount or percentage of copayment, and the maximum annual out-of-pocket expenses to be paid by the insured;   (c) a statement of the maximum lifetime benefit available under the policy;   (d) a statement of the estimated periodic premium to be paid by the insured;   (e) a general description of the factors or case characteristics that the insurer may consider in establishing or changing the premiums and, if applicable, in determining the insurability of the applicant; and   (f) a general description of the trend of premium increases or decreases for comparable policies issued by the insurer during the preceding 5 years, if the trend data is available.   (3) The outline of coverage may include any other information that the insurer considers relevant to the applicant's selection of an appropriate health benefit plan.   (4) An insurer or producer shall provide to an individual, upon request, an outline of coverage for any health benefit product marketed to the general public. The outline of coverage provided under this subsection may exclude the statement of the estimated periodic premium to be paid by the insured.   History: En. Sec. 7, Ch. 527, L. 1995.
MT Code § 33-31-322 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 3. Operations|33-31-322. Repealed

  33-31-322. Repealed. Sec. 35, Ch. 63, L. 2015.   History: En. Sec. 10, Ch. 527, L. 1995; amd. Sec. 31, Ch. 416, L. 1997.
MT Code § 33-31-401 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 4. Supervision, Rehabilitation, and Liquidation|33-31-401. Examination

  33-31-401. Examination. (1) The commissioner may examine the affairs of a health maintenance organization as often as is reasonably necessary to protect the interests of the people of this state. The commissioner shall make an examination at least once every 5 years. Similarly, the commissioner shall examine a health maintenance organization operated by an insurer or health service corporation as a plan at least once every 5 years. The provisions of 33-1-408 and 33-1-409 apply to examinations under this section.   (2) Each authorized health maintenance organization and provider shall submit its relevant books and records for the examinations and in every way facilitate the examinations. For the purpose of examination, the commissioner may administer oaths to and examine the officers and insurance producers of the health maintenance organization and the principals of the providers concerning their business.   (3) (a) Upon presentation of a detailed account of the charges and expenses of examinations by the commissioner, the health maintenance organization being examined shall pay to the examiner as necessarily incurred on account of the examination the actual travel expenses, a reasonable living-expense allowance, and a per diem, all at reasonable rates customary therefor and as established or adopted by the commissioner. The commissioner may present an account periodically during the course of the examination or at the termination of the examination as the commissioner considers proper. A person may not pay and an examiner may not accept any additional emolument on account of any examination.   (b) If a health maintenance organization fails to pay the charges and expenses as referred to in subsection (3)(a), the commissioner shall pay them out of the funds of the commissioner in the same manner as other disbursements of funds. The amount paid is a lien upon all of the person's assets and property in this state and may be recovered by suit by the attorney general on behalf of the state and restored to the appropriate fund.   (4) In lieu of an examination, the commissioner may accept the report of an examination made by the commissioner of another state.   History: En. Sec. 17, Ch. 457, L. 1987; amd. Sec. 7, Ch. 628, L. 1989; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 6, Ch. 437, L. 1991; amd. Sec. 61, Ch. 472, L. 1999; amd. Sec. 69, Ch. 227, L. 2001; amd. Sec. 37, Ch. 151, L. 2017.
MT Code § 33-31-403 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 4. Supervision, Rehabilitation, and Liquidation|33-31-403. Supervision, rehabilitation, or liquidation of health maintenance organization

  33-31-403. Supervision, rehabilitation, or liquidation of health maintenance organization. (1) The supervision, rehabilitation, or liquidation of a health maintenance organization is considered to be the supervision, rehabilitation, or liquidation of an insurer and must be conducted under the supervision of the commissioner pursuant to chapter 2, part 13. The commissioner may apply for an order directing the commissioner to supervise, rehabilitate, or liquidate a health maintenance organization upon any one or more grounds set out in 33-2-1321, 33-2-1331, or 33-2-1341 or when in the commissioner's opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this state. Enrollees have the same priority in the event of liquidation or rehabilitation as the law provides to policyholders of an insurer.   (2) A claim by a health care provider for an uncovered expenditure has the same priority as a claim by an enrollee if the provider of services agrees not to assert the claim against any enrollee of the health maintenance organization.   History: En. Sec. 19, Ch. 457, L. 1987; amd. Sec. 1253, Ch. 56, L. 2009.
MT Code § 33-31-404 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 31. Health Maintenance Organizations|Part 4. Supervision, Rehabilitation, and Liquidation|33-31-404. Administrative procedures

  33-31-404. Administrative procedures. (1) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist or that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall give written notice to the health maintenance organization specifically stating the grounds for denial, suspension, or revocation and fixing a time of at least 30 days after the notice for a hearing on the matter.   (2) After the hearing or upon the failure of the health maintenance organization to appear at the hearing, the commissioner shall make written findings and act as the commissioner considers advisable. The commissioner shall mail the written findings to the health maintenance organization. The action of the commissioner is subject to review by the district court having jurisdiction. The court may, in disposing of the issue before it, modify, affirm, or reverse the order of the commissioner in whole or in part.   (3) When notice and hearing are required with regard to actions taken by the commissioner under this chapter, the requirements of 33-1-314 through 33-1-316 and Title 33, chapter 1, part 7, apply, except that the formal rules of pleading and evidence must be observed. To the extent that 33-1-314 through 33-1-316 and Title 33, chapter 1, part 7, do not address the notice and hearing requirements of this chapter, the provisions of Title 2, chapter 4, parts 6 and 7, apply.   History: En. Sec. 21, Ch. 457, L. 1987; amd. Sec. 8, Ch. 437, L. 1991; amd. Sec. 1254, Ch. 56, L. 2009.