reglab/housing_qa huggingface dataset:
MT Code § 33-32-406 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-406. through 33-32-409 reserved

  33-32-406 through 33-32-409 reserved.
MT Code § 33-32-413 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-413. and 33-32-414 reserved

  33-32-413 and 33-32-414 reserved.
MT Code § 33-32-415 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-415. Binding nature of external review decisions

  33-32-415. Binding nature of external review decisions. (1) An external review decision is binding on:   (a) the health insurance issuer; and   (b) the covered person except to the extent that the covered person has other remedies available under applicable federal or state law.   (2) A covered person or, if applicable, the covered person's authorized representative may not file a subsequent request for external review involving the same adverse determination or final adverse determination for which the covered person has already received an external review decision pursuant to this part.   History: En. Sec. 25, Ch. 428, L. 2015.
MT Code § 33-32-418 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-418. Liability limits for independent review organization

  33-32-418. Liability limits for independent review organization. (1) Except as provided in subsection (2), an independent review organization or clinical peer working on behalf of an independent review organization or an employee, agent, or contractor of an independent review organization is not liable to any person for any opinions rendered or acts or omissions performed within the scope of the organization's or person's duties under the law during or upon completion of an external review conducted pursuant to this part.   (2) The liability exemption under subsection (1) does not apply if the opinion was rendered or if the act or omission was performed in bad faith or involved gross negligence.   History: En. Sec. 28, Ch. 428, L. 2015.
MT Code § 33-32-419 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-419. Fees

  33-32-419. Fees. (1) An application for approval of an independent review organization under 33-32-416 must be accompanied by a fee of $250.   (2) An application for renewal as an approved independent review organization must be accompanied by a fee of $150.   History: En. Sec. 1, Ch. 31, L. 2019.
MT Code § 33-32-420 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-420. reserved

  33-32-420 reserved.
MT Code § 33-32-422 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-422. Funding of external review

  33-32-422. Funding of external review. The health insurance issuer against which a request for a standard external review or an expedited external review is filed shall pay the costs of the independent review organization for conducting the external review.   History: En. Sec. 30, Ch. 428, L. 2015.
MT Code § 33-32-423 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 32. Health Utilization Review|Part 4. External Review|33-32-423. Disclosure requirements

  33-32-423. Disclosure requirements. (1) Each health insurance issuer shall include a description of the external review procedures in or attached to the policy, certificate, membership booklet, outline of coverage, or other evidence of coverage provided to covered persons.   (2) The disclosure required under subsection (1) must:   (a) be in a format prescribed by the commissioner; and   (b) include a statement that informs the covered person of the right of the covered person or, if applicable, the covered person's authorized representative to file a request for an external review of an adverse determination or final adverse determination with the health insurance issuer. The statement may explain that external review is available when the adverse determination or final adverse determination involves an issue of medical necessity, appropriateness, health care setting, level of care, or level of effectiveness. The statement must include the telephone number and address of the commissioner.   (3) In addition to the requirements under subsection (2), the statement must inform the covered person that, when filing a request for an external review, the covered person or, if applicable, the covered person's authorized representative is required to authorize the release of any medical records of the covered person that may be required to be reviewed for the purpose of reaching a decision on the external review.   History: En. Sec. 31, Ch. 428, L. 2015; amd. Sec. 44, Ch. 151, L. 2017.
MT Code § 33-33-101 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 33. Property and Casualty Utilization Review|Part 1. General Provisions|33-33-101. Purpose

  33-33-101. Purpose. The legislature recognizes that property and casualty insurers providing coverage for medical expenses or liability coverage for bodily injury may need, with respect to some claims, to seek medical reviews from qualified utilization review organizations so that an insurer may use the reviews to determine its contractual obligations. This chapter establishes standards for organizations providing utilization reviews and for property and casualty insurers seeking reviews.   History: En. Sec. 1, Ch. 335, L. 2001.
MT Code § 33-33-102 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 33. Property and Casualty Utilization Review|Part 1. General Provisions|33-33-102. Scope -- rulemaking

  33-33-102. Scope -- rulemaking. (1) This chapter applies to property and casualty insurers seeking utilization review opinions and to utilization review organizations that provide opinions with respect to property and casualty insurance contracts issued in this state.   (2) The commissioner may adopt rules to implement the provisions of this chapter, including but not limited to registration procedures and medical privacy requirements.   History: En. Sec. 2, Ch. 335, L. 2001.
MT Code § 33-33-103 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 33. Property and Casualty Utilization Review|Part 1. General Provisions|33-33-103. Definitions

  33-33-103. Definitions. As used in this chapter, the following definitions apply:   (1) "Utilization review" has the meaning provided in 33-32-102.   (2) "Utilization review organization" means an entity that provides utilization review services.   History: En. Sec. 3, Ch. 335, L. 2001; amd. Sec. 39, Ch. 428, L. 2015.
MT Code § 33-33-201 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 33. Property and Casualty Utilization Review|Part 2. Standards|33-33-201. Standards for utilization review organizations

  33-33-201. Standards for utilization review organizations. (1) A utilization review organization that conducts utilization reviews in this state for property and casualty insurers shall register with the commissioner prior to performing utilization reviews. The commissioner shall place a utilization review organization on the register when the utilization review organization provides information that establishes that the utilization review organization meets the standards set forth in this section. The commissioner shall remove from the register a utilization review organization that fails to meet the standards set forth in this section.   (2) Utilization review organizations may use only licensed or certified health care professionals to conduct utilization reviews.   (3) Utilization reviews must be conducted by health care professionals who are licensed or certified in the same specialty as the provider whose treatment is being received by the insured or by a health care professional who is qualified to render the treatment being reviewed.   (4) Utilization review organizations shall comply with all applicable state or federal medical privacy laws.   (5) Utilization review evaluations must use generally accepted standards for treatment of the illness, injury, or condition that is being reviewed.   (6) Utilization review opinions must be signed by the health care professional performing the review.   (7) A utilization review organization may not base its fees or charges on any recommendation for a reduction in payment under an insurance contract or on a percentage of claim savings.   History: En. Sec. 4, Ch. 335, L. 2001.
MT Code § 33-33-202 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 33. Property and Casualty Utilization Review|Part 2. Standards|33-33-202. Standards for property and casualty insurers

  33-33-202. Standards for property and casualty insurers. (1) Property or casualty insurers seeking utilization reviews with respect to insurance contracts issued in this state may use only utilization review organizations that are registered under 33-33-201.   (2) A property or casualty insurer that denies, in whole or in part, a policyholder's claim after consideration of a utilization review shall provide the policyholder an opportunity to request reconsideration by the insurer and the opportunity to submit additional information relating to the claim.   History: En. Sec. 5, Ch. 335, L. 2001.
MT Code § 33-35-101 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 1. General Provisions|33-35-101. Short title

  33-35-101. Short title. This chapter may be cited as the "Self-Funded Multiple Employer Welfare Arrangement Regulation Act".   History: En. Sec. 1, Ch. 420, L. 1995.
MT Code § 33-35-102 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 1. General Provisions|33-35-102. Purpose

  33-35-102. Purpose. The purposes of this chapter are to:   (1) provide for the authorization and registration of self-funded multiple employer welfare arrangements;   (2) regulate self-funded multiple employer welfare arrangements in order to ensure the financial integrity of the arrangements;   (3) provide reporting requirements for self-funded multiple employer welfare arrangements; and   (4) provide for sanctions against self-funded multiple employer welfare arrangements organized and maintained in Montana that do not comply with this chapter.   History: En. Sec. 2, Ch. 420, L. 1995.
MT Code § 33-35-103 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 1. General Provisions|33-35-103. Definitions

  33-35-103. Definitions. As used in this chapter, unless the context requires otherwise, the following definitions apply:   (1) "Allowable benefit" means a benefit relating to medical, surgical, or hospital care in the event of sickness, accident, disability, or any combination of sickness, accident, or disability.   (2) (a) "Bona fide association" means an association of employers that has been in existence for a period of not less than 5 years prior to sponsoring a self-funded multiple employer welfare arrangement, during which time the association has engaged in substantial activities relating to the common interests of member employers, and that continues to engage in substantial activities in addition to sponsoring an arrangement.   (b) Notwithstanding subsection (2)(a), an association that was formed and began sponsoring an arrangement prior to October 1, 1995, is not subject to the requirement that the association be in existence for 5 years prior to sponsoring an arrangement.   (3) "Claims liability" means the total of all incurred and unpaid claims for allowable benefits under a self-funded multiple employer welfare arrangement that are not reimbursed or reimbursable by excess of loss insurance, subrogation, or other sources.   (4) (a) "Multiple employer welfare arrangement" means a multiple employer welfare arrangement as defined by 29 U.S.C. 1002.   (b) The term does not include an arrangement, plan, program, or interlocal agreement of or between political subdivisions of this state, including school districts, as provided in 33-1-102.   (5) "Reserves" means the excess of the assets of a self-funded multiple employer welfare arrangement minus the liabilities of the arrangement. The liabilities of a self-funded multiple employer welfare arrangement include the claims liability of the arrangement.   (6) "Self-funded multiple employer welfare arrangement" or "arrangement" means a multiple employer welfare arrangement that does not provide for payment of benefits under the arrangement solely through a policy or policies of insurance issued by one or more insurance companies with a certificate of authority under this title.   History: En. Sec. 3, Ch. 420, L. 1995; amd. Sec. 25, Ch. 399, L. 2007.
MT Code § 33-35-201 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-201. Certificate of authority

  33-35-201. Certificate of authority. (1) Except as provided in subsection (3), a person may not establish or maintain a self-funded multiple employer welfare arrangement in Montana unless the arrangement first obtains a certificate of authority from the commissioner.   (2) A self-funded multiple employer welfare arrangement is considered to be established or maintained in Montana if one or more of the employer members participating in the arrangement is either domiciled in or maintains its principal place of business in Montana.   (3) A self-funded multiple employer welfare arrangement established and maintained in Montana prior to January 1, 1995, has until April 1, 1996, to file an application for a certificate of authority. An arrangement that files an application for a certificate of authority by that date is considered to have been issued a certificate of authority unless the commissioner finally denies the arrangement's application for a certificate of authority.   History: En. Sec. 4, Ch. 420, L. 1995.
MT Code § 33-35-202 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-202. Eligibility for certificate of authority

  33-35-202. Eligibility for certificate of authority. The commissioner may not issue a certificate of authority to a self-funded multiple employer welfare arrangement unless the arrangement establishes to the reasonable satisfaction of the commissioner that the following requirements have been satisfied by the arrangement:   (1) the employers participating in the self-funded multiple employer welfare arrangement are either engaged in the same trade, profession, or industry or the employers participating in the arrangement are members of a bona fide association;   (2) the employers participating in the arrangement exercise control over the arrangement, as follows:   (a) Subject to subsection (2)(b), control exists if the employers participating in the arrangement have the right to elect at least 75% of the individuals designated in the arrangement's organizational documents as having control over the operations of the arrangement and the individuals designated in the arrangement's organizational documents in fact exercise control over the operation of the arrangement.   (b) The use of a third-party administrator to process claims and to assist in the administration of the arrangement is not evidence of the lack of exercise of control over the operation of the arrangement.   (3) the arrangement provides only allowable benefits. However, an arrangement may provide life insurance coverage to its participants if the coverage is provided pursuant to contracts of insurance that comply with Title 33, chapter 20, parts 10 through 12.   (4) the arrangement provides allowable benefits to not less than 2 employers and not less than 75 employees;   (5) the arrangement may not solicit participation in the arrangement from the general public. However, the arrangement may employ or independently contract with a licensed insurance producer who may be paid a commission or other remuneration to enroll employers in the arrangement, and employees of the arrangement, employees of the association sponsoring the arrangement, or employees of affiliates of the association, other than licensed insurance producers, may enroll employers in the arrangement if the employees do not receive a commission or other remuneration in addition to their customary compensation for enrolling employers.   (6) the arrangement is not organized or maintained solely as a conduit for the collection of premiums and the forwarding of premiums to an insurance company. However, it is permissible for a self-funded multiple employer welfare arrangement to act as a conduit for the collection and forwarding of premiums for life insurance coverage pursuant to subsection (3).   History: En. Sec. 5, Ch. 420, L. 1995.
MT Code § 33-35-204 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-204. reserved

  33-35-204 reserved.
MT Code § 33-35-205 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-205. Application for certificate of authority

  33-35-205. Application for certificate of authority. A self-funded multiple employer welfare arrangement shall apply for a certificate of authority on a form prescribed by the commissioner and shall submit the application, together with the following documents, to the commissioner:   (1) a copy of all articles, bylaws, agreements, trusts, or other documents or instruments describing the rights and obligations of the employers, employees, and beneficiaries of the arrangement;   (2) a copy of the summary plan description or summary plan descriptions of the arrangement filed or required to be filed with the United States department of labor, together with any amendments to the description;   (3) evidence of coverage of or letters of intent to participate executed by at least 2 employers providing allowable benefits to at least 75 employees;   (4) a copy of the arrangement's most recent year's financial statements or, if the arrangement has been in existence for less than 1 year, pro forma financial statements that must include, at a minimum, a balance sheet, an income statement, a statement of changes in financial position, and an actuarial opinion that the unpaid claim liability of the arrangement satisfies the standards of 33-2-514. The commissioner may, in the commissioner's discretion, waive the requirement of an actuarial opinion and require a report by an actuarial firm.   (5) proof that the arrangement maintains or will maintain fidelity bonds required by the United States department of labor pursuant to the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001, et seq.;   (6) a copy of any excess of loss insurance coverage policies maintained or proposed to be maintained by the arrangement;   (7) biographical reports on forms prescribed by the national association of insurance commissioners evidencing the general trustworthiness and competence of each individual who is serving or who will serve as an employee or fiduciary of the arrangement; and   (8) a statement executed by a representative of the arrangement certifying, to the best knowledge and belief of the representative, that:   (a) the arrangement is in compliance with requirements of 33-35-202;   (b) the arrangement is in compliance with the requirements of the Employee Retirement Income Security Act of 1974, 29 U.S.C. 1001, et seq., or a statement of any requirements with which the arrangement is not in compliance and a statement of proposed corrective actions; and   (c) the arrangement is in compliance with requirements of 33-35-209 and 33-35-210.   History: En. Sec. 7, Ch. 420, L. 1995.
MT Code § 33-35-206 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-206. through 33-35-208 reserved

  33-35-206 through 33-35-208 reserved.
MT Code § 33-35-209 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-209. Minimum reserve requirements

  33-35-209. Minimum reserve requirements. Self-funded multiple employer welfare arrangements shall establish by the end of the first year of operations of the arrangement and shall maintain as of the end of each year of operations reserves equal to at least 30% of the unpaid claims liability of the arrangement. The commissioner may adopt rules regarding the supervision, rehabilitation, and liquidation of self-funded multiple employer welfare arrangements that fail to maintain the level of reserves required by this section.   History: En. Sec. 8, Ch. 420, L. 1995.
MT Code § 33-35-210 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-210. Minimum funding levels

  33-35-210. Minimum funding levels. A self-funded multiple employer welfare arrangement shall establish and maintain contribution rates for participation under the arrangement that satisfy either of the following requirements:   (1) contribution rates must equal or exceed the sum of projected claims liability for the year, plus all projected costs of operation of the arrangement for the year, plus an amount equal to any deficiency in the reserves of the arrangement for the prior year, minus an amount equal to the reserves of the arrangement in excess of the minimum required level of reserves; or   (2) contribution rates must equal or exceed a funding level established by a report prepared by an actuarial firm.   History: En. Sec. 9, Ch. 420, L. 1995.
MT Code § 33-35-211 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 35. Multiple Employer Welfare Arrangements|Part 2. Certificate of Authority|33-35-211. Issuance of certificate of authority

  33-35-211. Issuance of certificate of authority. (1) The commissioner shall grant or deny an application for a certificate of authority within 180 days of the date that a completed application, together with the items designated in 33-35-205, is submitted to the commissioner.   (2) The commissioner shall grant the application of an arrangement that satisfies the applicable requirements of 33-35-202, 33-35-203, 33-35-205, 33-35-209, and 33-35-210.   (3) The commissioner shall deny the application of an arrangement that does not satisfy the applicable requirements of 33-35-202, 33-35-203, 33-35-205, 33-35-209, and 33-35-210. Denial of an application for a certificate of authority is considered a contested case under the Montana Administrative Procedure Act.   (4) A certificate of authority granted to an arrangement is effective unless revoked by the commissioner under 33-35-302.   History: En. Sec. 10, Ch. 420, L. 1995.