reglab/housing_qa huggingface dataset:
MT Code § 33-22-1123 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 11. Long-Term Care Insurance Act|33-22-1123. Delivery of policy -- policy summary -- monthly reports

  33-22-1123. Delivery of policy -- policy summary -- monthly reports. (1) If an application for a long-term care insurance policy is approved, the issuer shall deliver the policy to the applicant or policyholder not later than 30 days after the date of approval.   (2) (a) At the time of delivery of an individual life insurance policy that provides long-term care benefits within the policy or by rider, a policy summary must be provided to the insured.   (b) In the case of direct response solicitations, the insurer shall deliver the policy summary upon the applicant's request, and whether or not a request is made, a policy summary must be delivered not later than at the time the policy is delivered.   (c) In addition to complying with any other applicable requirements, the summary must include:   (i) an explanation of how the long-term care benefit interacts with other components of the policy, including deductions from death benefits;   (ii) an illustration of the amount of benefit, the length of benefit, and the guaranteed lifetime benefit, if any, for each covered person;   (iii) any exclusions, reductions, and limitations on benefits of long-term care;   (iv) a statement that any long-term care inflation protection option required by the Administrative Rules of Montana is or is not available under this policy;   (d) If applicable to the policy type, the summary must also include:   (i) a disclosure of the effects of other exercising rights under the policy;   (ii) a disclosure of guarantees related to long-term care costs of insurance charges; and   (iii) current and projected maximum lifetime benefits.   (3) The required provisions of the policy summary may be incorporated into a basic illustration required to be delivered in accordance with administrative rules or into the life insurance policy summary.   (4) Any time a long-term care benefit funded through a life insurance vehicle by the acceleration of the death benefits is in benefit payment status, a monthly report must be provided to the policyholder. The report must include:   (a) any long-term care benefits paid out during the month;   (b) an explanation of any changes in the policy, such as to death benefits or cash values, due to long-term care benefits being paid out; and   (c) the amount of long-term care benefits existing or remaining.   History: En. Sec. 47, Ch. 416, L. 1997; amd. Sec. 10, Ch. 32, L. 2007.
MT Code § 33-22-1124 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 11. Long-Term Care Insurance Act|33-22-1124. Denial of claims

  33-22-1124. Denial of claims. If a claim under a long-term care insurance policy is denied, the issuer shall, not later than 60 days after the date of a written request by the policyholder, certificate holder, or the representative of either of them:   (1) provide a written explanation of the reasons for the denial; and   (2) provide all information possessed by the issuer relating to the denial.   History: En. Sec. 48, Ch. 416, L. 1997; amd. Sec. 11, Ch. 32, L. 2007.
MT Code § 33-22-1125 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 11. Long-Term Care Insurance Act|33-22-1125. Benefit triggers

  33-22-1125. Benefit triggers. (1) A long-term care insurance policy may not be delivered or issued for delivery in this state unless it complies with the requirements of this section and applicable rules for the triggering of mandatory provision of benefits.   (2) (a) A long-term care insurance policy must condition the payment of benefits on a determination of the insured's inability to perform activities of daily living or on cognitive impairment.   (b) Eligibility for the payment of benefits may not be more restrictive than requiring a deficiency in the ability to perform not more than three of the activities of daily living or requiring the presence of cognitive impairment.   (c) Insurers may use activities of daily living to trigger covered benefits that are in addition to those contained in the definition under 33-22-1107 or rules as long as they are defined in the policy.   (3) An insurer may use additional provisions for the determination of when benefits are payable under a policy. However, the provisions may not restrict or be in lieu of the requirements contained in subsections (1) and (2).   (4) For purposes of this section, the determination of a deficiency may not be more restrictive than:   (a) requiring the hands-on assistance of another person to perform the prescribed activities of daily living; or   (b) if the deficiency is due to the presence of a cognitive impairment, the need for supervision or verbal cueing by another person in order to protect the insured or others.   (5) Assessments of activities of daily living and cognitive impairment must be performed by licensed or certified professionals, such as physicians, nurses, or social workers.   (6) Long-term care insurance policies must include a clear description of the process of appealing and resolving benefit determinations.   History: En. Sec. 49, Ch. 416, L. 1997; amd. Sec. 12, Ch. 32, L. 2007.
MT Code § 33-22-1127 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 11. Long-Term Care Insurance Act|33-22-1127. Incontestability period

  33-22-1127. Incontestability period. (1) Upon a showing of misrepresentation that is material to the acceptance for coverage, a policy that has been in force for less than 6 months may be rescinded by the insurer or the insurer may deny an otherwise valid long-term care insurance claim.   (2) Upon a showing of misrepresentation that is both material to the acceptance for coverage and that pertains to the condition for which benefits are sought, a policy that has been in force for at least 6 months but less than 2 years may be rescinded by the insurer or the insurer may deny an otherwise valid long-term care insurance claim.   (3) After a policy has been in force for 2 years, it is not contestable upon the grounds of misrepresentation alone. The policy may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health.   (4) (a) A long-term care insurance policy may be field-issued if the compensation to the field issuer is not based on the number of policies sold.   (b) For purposes of subsection (4)(a), "field-issued" means a policy issued by a producer or a third-party administrator pursuant to the underwriting authority granted to the producer or third-party administrator by an insurer and using the insurer's underwriting guidelines.   (5) If an insurer has paid benefits under the long-term care insurance policy, the benefit payments may not be recovered by the insurer if the policy is rescinded.   (6) In the event of the death of the insured, this section may not be applied to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care. In that situation, the remaining death benefits under the policy must be governed by Title 33, chapter 20. In all other situations, this section applies to life insurance policies that accelerate benefits for long-term care.   History: En. Sec. 14, Ch. 32, L. 2007.
MT Code § 33-22-1129 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 11. Long-Term Care Insurance Act|33-22-1129. Penalties

  33-22-1129. Penalties. In addition to any other penalty provided for in Title 33, an insurer or an insurance producer found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of long-term care insurance is subject to a fine of up to three times the amount of any commissions paid for each policy involved in the violation or up to $10,000, whichever is greater.   History: En. Sec. 16, Ch. 32, L. 2007.
MT Code § 33-22-1201 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 12. Limited Benefit Disability Insurance (Repealed)|33-22-1201. Repealed

  33-22-1201. Repealed. Sec. 44, Ch. 531, L. 1997.   History: En. Sec. 1, Ch. 606, L. 1991.
MT Code § 33-22-1202 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 12. Limited Benefit Disability Insurance (Repealed)|33-22-1202. Repealed

  33-22-1202. Repealed. Sec. 44, Ch. 531, L. 1997.   History: En. Sec. 2, Ch. 606, L. 1991; amd. Sec. 26, Ch. 504, L. 1995; amd. Sec. 85, Ch. 546, L. 1995.
MT Code § 33-22-1203 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 12. Limited Benefit Disability Insurance (Repealed)|33-22-1203. Repealed

  33-22-1203. Repealed. Sec. 44, Ch. 531, L. 1997.   History: En. Sec. 3, Ch. 606, L. 1991.
MT Code § 33-22-1204 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 12. Limited Benefit Disability Insurance (Repealed)|33-22-1204. Repealed

  33-22-1204. Repealed. Sec. 44, Ch. 531, L. 1997.   History: En. Sec. 4, Ch. 606, L. 1991.
MT Code § 33-22-1205 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 12. Limited Benefit Disability Insurance (Repealed)|33-22-1205. Repealed

  33-22-1205. Repealed. Sec. 44, Ch. 531, L. 1997.   History: En. Sec. 5, Ch. 606, L. 1991.
MT Code § 33-22-1301 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1301. Short title -- purpose

  33-22-1301. Short title -- purpose. This part may be cited as the "Montana Reinsurance Association Act". The purpose of this act is to establish a Montana-based public reinsurance program in order to stabilize the individual health insurance market, maintain competition, and reduce premiums.   History: En. Sec. 1, Ch. 210, L. 2019.
MT Code § 33-22-1302 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1302. Reinsurance association -- mandatory membership -- exceptions

  33-22-1302. Reinsurance association -- mandatory membership -- exceptions. (1) The Montana reinsurance association is established as a nonprofit legal entity. As a condition of doing business, an insurer that has issued or renewed disability insurance, as defined in 33-1-207, regardless of license type, in this state in the past 12 months must be a member of the association.   (2) Disability insurers are exempt from the requirement to be association members and are not subject to the assessment in 33-22-1313 if the insurers solely issue or administer one or more of the following coverage types under the Montana Insurance Code:   (a) self-funded multiple employer welfare arrangements licensed under chapter 35;   (b) disability insurance sold through a fraternal benefit society as described in chapter 7;   (c) excepted benefits as defined in 33-22-140;   (d) long-term care insurance as described in chapter 22, part 11; or   (e) disability income insurance as defined in 33-1-235.   History: En. Sec. 2, Ch. 210, L. 2019.
MT Code § 33-22-1303 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1303. Definitions

  33-22-1303. Definitions. As used in this part, the following definitions apply:   (1) "Association" means the Montana reinsurance association provided for in this part.   (2) "Attachment point" means the threshold amount for claims costs incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, beyond which the claims costs for benefits are eligible for reinsurance payments.   (3) "Benefit year" means the calendar year for which an eligible health insurer provides coverage through an individual health insurance policy.   (4) "Board" means the association's board of directors provided for in 33-22-1306.   (5) "Coinsurance rate" means the rate at which the association will reimburse an eligible health insurer for claims incurred for an enrolled individual's covered benefits in a benefit year above the attachment point and below the reinsurance cap.   (6) "Eligible health insurer" means a health insurer, health service corporation, or health maintenance organization that:   (a) offers individual health insurance coverage in the individual market, as defined in 33-22-140;   (b) offers a qualified health plan as defined in 42 U.S.C. 18021(a) that does not discriminate on the basis of health status in rating or issuance, covers all essential health benefits, and does not impose lifetime or annual limits or exclude preexisting conditions; and   (c) incurs claims costs for an individual enrollee's covered benefits in the applicable benefit year.   (7) "Major medical" health insurance includes individual market and employer group health insurance that:   (a) is guaranteed available;   (b) is guaranteed renewable;   (c) does not impose preexisting condition exclusions;   (d) (i) offers essential health benefits as defined in 42 U.S.C. 18022; or   (ii) for large employer group coverage, meets the federal requirements for minimum value;   (e) pays medical claims, with no lifetime or annual limits; and   (f) complies with the federal limits for maximum out-of-pocket.   (8) "Payment parameters" means the attachment point, reinsurance cap, and coinsurance rate for the Montana reinsurance program.   (9) "Program" means the Montana reinsurance program operated by the Montana reinsurance association.   (10) "Reinsurance cap" means the maximum amount of each claim incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, after which the claims costs for benefits are no longer eligible for reinsurance payments.   (11) "Reinsurance payments" means an amount paid by the association to an eligible health insurer under the program.   History: En. Sec. 3, Ch. 210, L. 2019.
MT Code § 33-22-1304 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1304. and 33-22-1305 reserved

  33-22-1304 and 33-22-1305 reserved.
MT Code § 33-22-1306 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1306. Association board of directors

  33-22-1306. Association board of directors. (1) The association is governed by a board of directors consisting of five directors who have experience in health care, health insurance, or finance as follows:   (a) three directors, one each from the eligible health insurers with the largest enrollment in the individual market. If there are fewer than three, the board shall select another director from a health insurance issuer that markets primarily major medical insurance.   (b) one insurer director appointed by the commissioner who is a participating member of the association; and   (c) one director appointed by the governor to represent the public interest.   (2) The board of directors may be reimbursed by the association for travel expenses but may not otherwise be compensated for their services.   (3) Each director has one vote.   (4) Initial appointments must be finalized no later than May 1, 2019, and the board shall meet for the first time no later than May 8, 2019.   History: En. Sec. 4, Ch. 210, L. 2019.
MT Code § 33-22-1307 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1307. Duties of commissioner -- rulemaking

  33-22-1307. Duties of commissioner -- rulemaking. (1) The commissioner shall:   (a) oversee the activities of the association and the board;   (b) examine the affairs of the board and program;   (c) approve the plan of operation set by the board as needed within 30 days of receiving the plan or amendments to the plan from the board;   (d) with the assistance of the association, collect the assessment and the federal funding designated for this program;   (e) designate staff to attend meetings of the board and the association as an ex officio member; and   (f) require all eligible health insurers to calculate the premium amount the eligible health insurer would have charged for the benefit year if the Montana reinsurance program had not been established. The eligible health insurer shall submit this information as part of its rate filing. The commissioner shall consider this information as part of the rate review.   (2) The commissioner may adopt rules necessary to implement this part. Any proposed administrative rules must be submitted to the board for review and comment before the proposed rules are submitted to the secretary of state.   History: En. Sec. 5, Ch. 210, L. 2019.
MT Code § 33-22-1308 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1308. Board duties -- powers

  33-22-1308. Board duties -- powers. (1) The board shall:   (a) adopt a plan of operation and the reinsurance parameters for the following year, no later than June 15, 2019, in accordance with the requirements of this part, and update the plan of operation and reinsurance parameters, if needed, no later than May 1 of each succeeding year. The board shall submit its plan of operation to the commissioner for approval.   (b) establish administrative and accounting procedures for the association and the program;   (c) select an association administrator in accordance with 33-22-1309 who will pay reinsurance claims in accordance with the plan of operation; and   (d) set the budget for the reinsurance program for each policy year, including the assessment levels as provided in 33-22-1313 for the various members of the association.   (2) The board may:   (a) enter into contracts as necessary to carry out the purposes of this part;   (b) appoint appropriate actuarial or other committees as necessary to provide technical assistance and any other functions within the authority of the association; and   (c) apply for funds or grants from public or private sources.   (3) The board may be audited by the legislative auditor.   (4) An annual review of the association and the program for solvency and compliance must be performed by an independent certified public accountant using generally accepted accounting principles and submitted to the commissioner and the economic affairs committee of the legislature provided for in 5-5-223 as provided in 5-11-210 for review by June 30 of each year, beginning in 2020.   (5) The board shall prepare an annual report on operations and finance and send that report to the economic affairs interim committee as provided in 5-11-210 and the commissioner by June 30 of each year, beginning in 2020.   History: En. Sec. 6, Ch. 210, L. 2019.
MT Code § 33-22-1309 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1309. Association administrator

  33-22-1309. Association administrator. (1) The board shall select an administrator, who is either an employee of the nonprofit association or an independent contractor, to administer the reinsurance program pursuant to the parameters decided by the board of directors. The board shall establish qualifications and compensation in the plan of operation for the administrator and the length of the contract of an independent contractor.   (2) The administrator shall:   (a) perform all administrative functions relating to the association;   (b) submit regular reports to the board regarding the operation of the association. The frequency, content, and form of the reports must be set forth in the plan of operation.   (c) pay reinsurance claims as provided for in the plan of operation.   History: En. Sec. 7, Ch. 210, L. 2019.
MT Code § 33-22-1310 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1310. through 33-22-1312 reserved

  33-22-1310 through 33-22-1312 reserved.
MT Code § 33-22-1313 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1313. Association member assessments

  33-22-1313. Association member assessments. (1) (a) (i) For 2020 and each year thereafter, the commissioner shall assess each member insurer 1.2% of its total premium volume covering Montana residents, from the prior calendar year, regardless of type of license.  (ii) For purposes of subsection (1)(a)(i), total premium volume may not include premiums that member insurers collect on any coverage issued for excepted benefits as defined in 33-22-140.   (b) The board shall determine the timing of the assessment.   (c) The commissioner shall consider the board's recommendation when determining the assessment amounts.   (d) The commissioner shall verify the amount of each insurer's assessment based on annual financial statements and other reports determined to be necessary.   (2) The association shall determine and report to the commissioner the association's reinsurance payments and other expenses for the previous calendar year, including administrative expenses and any incurred but not reported claims for the previous calendar year.   (a) The report must consider investment income and other appropriate gains.   (b) The report must include an estimate of the assessments needed to cover the expected reinsurance claims for the following calendar year.   (3) If assessments and other funds collected by the association exceed the actual losses and administrative expenses of the association, the board shall use the excess funds to offset future claims or to reduce future assessments.   (4) The commissioner may, after notice and hearing:   (a) suspend or revoke the certificate of authority to transact insurance in this state of any member insurer that fails to pay an assessment;   (b) impose a penalty on any insurer that fails to pay an assessment when due; or   (c) use any power granted to the commissioner to collect any unpaid assessment.   (5) An eligible health insurer may not submit claims for reinsurance payments unless the insurer has a medical loss ratio of 80% or greater, as defined in 45 CFR 158.232(f).   History: En. Sec. 8, Ch. 210, L. 2019; amd. Sec. 6, Ch. 471, L. 2021.
MT Code § 33-22-1314 (2021)
2021 Montana Code Annotated|Title 33. Insurance and Insurance Companies|Chapter 22. Disability Insurance|Part 13. Montana Reinsurance Association Act|33-22-1314. Payment parameters

  33-22-1314. Payment parameters. (1) The board shall design and adjust the payment parameters to ensure that the payment parameters will:   (a) stabilize or reduce premium rates in the individual market;   (b) increase or maintain participation in the individual market;   (c) mitigate the impact high-cost individuals have on premium rates in the individual market;   (d) consider any federal funding available for the plan; and   (e) consider the total amount available to fund the plan.   (2) The attachment point must be set by the board at $40,000 or more but may not exceed the reinsurance cap.   (3) The coinsurance rate must be set by the board between 50% and 80%.   (4) The reinsurance cap must be set by the board at $1 million or less.   (5) The board may adjust the payment parameters annually to the extent necessary to secure federal approval of the state innovation waiver.   History: En. Sec. 9, Ch. 210, L. 2019.