reglab/housing_qa huggingface dataset:
MT Code § 33-22-1705 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1705. Incentives in health benefit plans

  33-22-1705. Incentives in health benefit plans. (1) A health care insurer may issue a policy or a health benefit plan that provides for incentives for covered persons to use the health care services of preferred providers. The policy or health benefit plan must contain at least:   (a) a provision that if a covered person receives emergency care for services specified in the preferred provider agreement and cannot reasonably reach a preferred provider, the care rendered during the course of the emergency will be reimbursed as though the covered person had been treated by a preferred provider; and   (b) a provision that clearly identifies the difference in benefit levels for health care services of a preferred provider and benefit levels for the same health care services of a nonpreferred provider.   (2) A health care insurer may not require hospital staff privileges as criteria for designation as a preferred provider in a preferred provider agreement.   History: En. Sec. 5, Ch. 638, L. 1987.
MT Code § 33-22-1706 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1706. Permissible and mandatory provisions in provider agreements, insurance policies, and subscriber contracts

  33-22-1706. Permissible and mandatory provisions in provider agreements, insurance policies, and subscriber contracts. (1) A provider agreement, insurance policy, or subscriber contract issued or delivered in this state may contain components designed to control the cost and improve the quality of health care for insureds and subscribers as provided in this part.   (2) All terms or conditions of an insurance policy or subscriber contract, except those already approved by the commissioner, are subject to the prior approval of the commissioner.   (3) Provisions designed to control cost and improve the quality of health care under this section include but are not limited to those that set a payment difference for reimbursement of a nonpreferred provider as compared to a preferred provider and those designed to give policyholders or subscribers an incentive to choose a particular provider consistent with the other provisions of this part.   (4) (a) A health benefit plan that contains a payment difference provision and that the commissioner has determined to have an adequate provider network is not subject to subsection (4)(b).   (b) A health benefit plan that contains a payment difference provision and has not been determined to have an adequate provider network may not exceed a 25% payment difference in the reimbursement level for a preferred provider, and the commissioner shall review differences between copayments, deductibles, and other cost-sharing arrangements under this subsection (4)(b).   (c) For the purposes of this subsection (4), a provider network is adequate if:   (i) the network includes at least 80% of the licensed individual physicians actively practicing in the state of Montana;   (ii) the network includes at least 80% of the licensed individual nonphysician health care providers actively practicing in the state of Montana; and   (iii) the network includes at least 90% of those facilities licensed and operating as hospitals in the state of Montana.   (5) A health benefit plan or other plan offering prepaid dental services under this part shall offer its insureds the right to obtain dental care from any licensed dental care provider of their choice subject to the same terms and conditions imposed under this section.   History: En. Sec. 6, Ch. 638, L. 1987; amd. Sec. 1, Ch. 265, L. 1989; amd. Sec. 1, Ch. 306, L. 2013.
MT Code § 33-22-1707 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 17. Preferred Provider Agreements|33-22-1707. Rules

  33-22-1707. Rules. The commissioner may adopt rules necessary to implement the provisions of this part.   History: En. Sec. 7, Ch. 638, L. 1987; amd. Sec. 2, Ch. 413, L. 1997.
MT Code § 33-22-1801 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1801. Short title

  33-22-1801. Short title. This part may be cited as the "Small Employer Health Insurance Availability Act".   History: En. Sec. 22, Ch. 606, L. 1993.
MT Code § 33-22-1802 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1802. Purpose

  33-22-1802. Purpose. (1) This part must be interpreted and construed to effectuate the following express legislative purposes:   (a) to promote the availability of health insurance coverage to small employers regardless of health status or claims experience;   (b) to prevent abusive rating practices;   (c) to require disclosure of rating practices to purchasers;   (d) to establish rules regarding renewability of coverage;   (e) to establish limitations on the use of preexisting condition exclusions;   (f) to provide for the development of basic and standard health benefit plans to be offered to all small employers;   (g) to provide for the establishment of a reinsurance program; and   (h) to improve the overall fairness and efficiency of the small employer health insurance market.   (2) This part is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.   History: En. Sec. 23, Ch. 606, L. 1993.
MT Code § 33-22-1804 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1804. Applicability and scope

  33-22-1804. Applicability and scope. (1) This part applies to a health benefit plan marketed through a small employer that provides coverage to the employees of a small employer in this state if any of the following conditions are met:   (a) a portion of the premium or benefits is paid by or on behalf of the small employer;   (b) an eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium;   (c) the health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of section 106, 125, or 162 of the Internal Revenue Code, except a plan or program that is funded entirely by contributions from the employees; or   (d) all of the premium is paid by the employee who obtains coverage through the employer's group health benefit plan.   (2) This part does not apply to an individual health benefit plan for which the entire premium is paid by an employee through payroll deduction or other means.   (3) Unless prohibited by a written opinion from a federal agency, by final regulations implementing Public Law 104-191, or by a ruling by a court of competent jurisdiction, this part does not apply to an individual health benefit plan if the eligible employee or dependent is directly or indirectly reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium. However, this part does apply to an individual health benefit plan if the employer making the direct or indirect reimbursement for any portion of the premium has had in place an employer-sponsored group health benefit plan in the 12 months preceding the reimbursement.   History: En. Sec. 25, Ch. 606, L. 1993; amd. Sec. 2, Ch. 377, L. 1995; amd. Sec. 22, Ch. 416, L. 1997; amd. Sec. 1, Ch. 403, L. 1999; amd. Sec. 3, Ch. 349, L. 2013; amd. Sec. 27, Ch. 63, L. 2015.
MT Code § 33-22-1805 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1805. through 33-22-1807 reserved

  33-22-1805 through 33-22-1807 reserved.
MT Code § 33-22-1808 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1808. Establishment of classes of business

  33-22-1808. Establishment of classes of business. (1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs that are related to the following reasons:   (a) The small employer carrier uses more than one type of system for the marketing and sale of health benefit plans to small employers.   (b) The small employer carrier has acquired a class of business from another small employer carrier.   (c) The small employer carrier provides coverage to one or more association groups that meet the requirements of 33-22-501(2).   (2) A small employer carrier may establish up to nine separate classes of business under subsection (1).   (3) The commissioner shall adopt rules to provide for a period of transition in order for a small employer carrier to come into compliance with subsection (2) in the case of acquisition of an additional class of business from another small employer carrier.   (4) The commissioner may approve the establishment of additional classes of business upon application to the commissioner and a finding by the commissioner that the action would enhance the fairness and efficiency of the small employer health insurance market.   History: En. Sec. 26, Ch. 606, L. 1993.
MT Code § 33-22-1810 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1810. Renewability of coverage

  33-22-1810. Renewability of coverage. (1) A health benefit plan subject to the provisions of this part is renewable with respect to all eligible employees or their dependents, at the option of the small employer, except in any of the following cases:   (a) nonpayment of the required premium;   (b) fraud or misrepresentation of the small employer or with respect to coverage of individual insureds or their representatives;   (c) noncompliance with the carrier's minimum participation requirements;   (d) noncompliance with the carrier's employer contribution requirements;   (e) repeated misuse of a restricted network provision;   (f) election by the small employer carrier to not renew all of its health benefit plans delivered or issued for delivery to small employers in this state, in which case the small employer carrier shall:   (i) provide advance notice of this decision under this subsection (1)(f) to the commissioner in each state in which it is licensed; and   (ii) at least 180 days prior to the nonrenewal of all small employer health benefit plans by the carrier, provide notice of the decision not to renew coverage to all affected small employers and to the commissioner in each state in which an affected insured individual is known to reside. Notice to the commissioner under this subsection (1)(f) must be provided at least 3 working days prior to the notice to the affected small employers.   (g) the commissioner finds that the continuation of the coverage would:   (i) not be in the best interests of the policyholders or certificate holders; or   (ii) impair the carrier's ability to meet its contractual obligations.   (2) If the commissioner makes a finding under subsection (1)(g), the commissioner shall assist affected small employers in finding replacement coverage.   (3) (a) A small employer carrier that elects not to renew all of its health benefit plans under subsection (1)(f) is prohibited from writing new business in the small employer market in this state for a period of 5 years from the date of notice to the commissioner.   (b) The provisions of 33-22-524(3) apply to a small employer carrier that elects to renew only a portion, but not all, of its small employer health benefit plans.   (4) In the case of a small employer carrier doing business in one established geographic service area of the state, the rules set forth in this section apply only to the carrier's operations in that service area.   History: En. Sec. 28, Ch. 606, L. 1993; amd. Sec. 61, Ch. 227, L. 2001.
MT Code § 33-22-1812 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1812. Repealed

  33-22-1812. Repealed. Sec. 13, Ch. 377, L. 1995.   History: En. Sec. 31, Ch. 606, L. 1993.
MT Code § 33-22-1814 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1814. Restoration of terminated coverage

  33-22-1814. Restoration of terminated coverage. The commissioner may promulgate rules to require small employer carriers, as a condition of transacting business with small employers in this state after January 1, 1994, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after July 1, 1993. The commissioner may prescribe the terms for the reissuance of coverage that the commissioner finds are reasonable and necessary to provide continuity of coverage to small employers.   History: En. Sec. 36, Ch. 606, L. 1993.
MT Code § 33-22-1815 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1815. Qualifications for voluntary purchasing pool

  33-22-1815. Qualifications for voluntary purchasing pool. A voluntary purchasing pool of disability insurance purchasers may be formed solely for the purpose of obtaining disability insurance upon compliance with the following provisions:   (1) It contains at least 51 eligible employees.   (2) It establishes requirements for membership. The voluntary purchasing pool shall accept for membership any small employers and may accept for membership any employers with at least 51 eligible employees that otherwise meet the requirements for membership. However, the voluntary purchasing pool may not exclude any small employers that otherwise meet the requirements for membership on the basis of claim experience, occupation, or health status.   (3) It holds an open enrollment period at least once a year during which new members can join the voluntary purchasing pool.   (4) It offers coverage to eligible employees of member employers and to the employees' dependents. Coverage may not be limited to certain employees of member small employers except as provided in 33-22-1811(3)(c).   (5) It does not assume any risk or form self-insurance plans among its members.   (6) (a) Disability insurance policies, certificates, or contracts offered through the voluntary purchasing pool must rate the entire purchasing pool group as a whole and charge each insured person based on a community rate within the common group, adjusted for case characteristics as permitted by the laws governing group disability insurance.   (b) Rates for voluntary purchasing pool groups must be set pursuant to the provisions of 33-22-1809.   (c) At its discretion, premiums may be paid to the disability insurance policies, certificates, or contracts by the voluntary purchasing pool or by member employers.   (7) A person marketing disability insurance policies, certificates, or contracts for a voluntary purchasing pool must be licensed as an insurance producer.   History: En. Sec. 2, Ch. 375, L. 1995; amd. Sec. 51, Ch. 472, L. 1999; amd. Sec. 1, Ch. 376, L. 2003; amd. Sec. 16, Ch. 595, L. 2005; amd. Sec. 27, Ch. 151, L. 2017.
MT Code § 33-22-1816 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1816. Commissioner powers and duties -- application for registration -- reporting insolvency

  33-22-1816. Commissioner powers and duties -- application for registration -- reporting insolvency. (1) The commissioner shall develop forms for registration of an organization as a voluntary purchasing pool.   (2) An organization seeking to be registered as a voluntary purchasing pool shall make application to the commissioner. The commissioner shall register an organization as a voluntary purchasing pool upon proof of fulfillment of the qualifications provided in 33-22-1815.   (3) Except as provided in subsection (5), on March 1 of each year, the voluntary purchasing pool shall provide a report and financial statement for the previous calendar year to the commissioner so that the commissioner may determine:   (a) whether the operation of the voluntary purchasing pool is fiscally sound;   (b) whether the voluntary purchasing pool is bearing any risk; and   (c) the number of individuals covered.   (4) The annual report of the voluntary purchasing pool must disclose its total administrative cost.   (5) A voluntary purchasing pool may choose to operate on a fiscal year other than on the calendar year. A voluntary purchasing pool that establishes a fiscal year that is other than the calendar year shall provide the report required in subsection (3) to the commissioner within 60 days of the voluntary purchasing pool's fiscal yearend.   History: En. Sec. 3, Ch. 375, L. 1995; amd. Sec. 52, Ch. 472, L. 1999; amd. Sec. 1, Ch. 87, L. 2009; amd. Sec. 28, Ch. 151, L. 2017.
MT Code § 33-22-1817 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1817. Collection of charges and premiums

  33-22-1817. Collection of charges and premiums. (1) All insurance or premiums collected by a voluntary purchasing pool on behalf of or for an insurer and all return premiums received from the insurer are held by the voluntary purchasing pool in a fiduciary capacity. These funds must be remitted immediately to the person entitled to them or must be deposited promptly in a fiduciary bank account established and maintained by the administrator of the voluntary purchasing pool. If deposited charges or premiums are collected on behalf of or for more than one insurer, the voluntary purchasing pool shall either keep or require the bank in which the fiduciary account is maintained to keep records clearly recording the deposits to and withdrawals from the account on behalf of each insurer. The voluntary purchasing pool shall promptly obtain and keep copies of all these records and shall, upon request of an insurer, furnish the insurer with copies of the records pertaining to deposits and withdrawals on behalf of or for the insurer.   (2) The voluntary purchasing pool may not pay a claim by withdrawals from the fiduciary account. Withdrawals from the fiduciary account must be made, as provided in the written agreement between the voluntary purchasing pool and the insurer, for:   (a) remittance to an insurer entitled to the remittance;   (b) deposit in an account maintained in the name of the insurer;   (c) payment to a group policyholder for remittance to the insurer entitled to the payment; or   (d) remittance of return premiums to the person entitled to the premium.   History: En. Sec. 4, Ch. 375, L. 1995.
MT Code § 33-22-1818 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1818. Repealed

  33-22-1818. Repealed. Sec. 3, Ch. 103, L. 1999.   History: En. Sec. 30(1)-(3), Ch. 606, L. 1993; amd. Sec. 7, Ch. 377, L. 1995; amd. Sec. 1, Ch. 15, L. 1997.
MT Code § 33-22-1819 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1819. Repealed

  33-22-1819. Repealed. Sec. 3, Ch. 103, L. 1999.   History: En. Sec. 30(4)-(15), Ch. 606, L. 1993; amd. Sec. 8, Ch. 377, L. 1995; amd. Sec. 66, Ch. 379, L. 1995; amd. Sec. 2, Ch. 15, L. 1997; amd. Sec. 25, Ch. 416, L. 1997; amd. Sec. 35, Ch. 531, L. 1997; amd. Sec. 2, Ch. 103, L. 1999.
MT Code § 33-22-1820 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1820. Periodic market evaluation -- report

  33-22-1820. Periodic market evaluation -- report. The commissioner may study and report at least every 3 years to the governor or other interested persons on the effectiveness of this part. The report must analyze the effectiveness of this part in promoting rate stability, product availability, and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency, and fairness of the small employer health insurance markets. The report must address whether carriers and producers are fairly and actively marketing or issuing health benefit plans to small employers in fulfillment of the purposes of this part. The report may contain recommendations for market conduct or other regulatory standards or action.   History: En. Sec. 32, Ch. 606, L. 1993; amd. Sec. 9, Ch. 377, L. 1995; amd. Sec. 36, Ch. 531, L. 1997.
MT Code § 33-22-1821 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1821. Waiver of certain laws

  33-22-1821. Waiver of certain laws. A small employer carrier may exclude any category of licensed health care practitioner and any benefit or coverage for health care services otherwise required by law or rule from a basic health benefit plan delivered or issued for delivery in this state.   History: En. Sec. 33, Ch. 606, L. 1993; amd. Sec. 10, Ch. 377, L. 1995; amd. Sec. 15, Ch. 227, L. 2011.
MT Code § 33-22-1822 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1822. Administrative procedure

  33-22-1822. Administrative procedure. The commissioner shall adopt rules in accordance with the Montana Administrative Procedure Act to implement and administer this part.   History: En. Sec. 34, Ch. 606, L. 1993.
MT Code § 33-22-1823 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1823. through 33-22-1826 reserved

  33-22-1823 through 33-22-1826 reserved.
MT Code § 33-22-1827 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1827. Repealed

  33-22-1827. Repealed. Sec. 24, Ch. 227, L. 2011.   History: En. Sec. 5, Ch. 377, L. 1995; amd. Sec. 5, Ch. 410, L. 1997; amd. Sec. 26, Ch. 416, L. 1997.
MT Code § 33-22-1828 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 18. Small Employer Health Insurance Availability Act|33-22-1828. Repealed

  33-22-1828. Repealed. Sec. 24, Ch. 227, L. 2011.   History: En. Sec. 6, Ch. 377, L. 1995; amd. Sec. 27, Ch. 416, L. 1997; amd. Sec. 37, Ch. 531, L. 1997.