reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-225. Insurance with other insurers -- provision of service or expense incurred basis

33-22-225. Insurance with other insurers -- provision of service or expense incurred basis.
(1) There may be a provision as follows:
"Insurance with Other Insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on a provision of service basis or on an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability under any expense incurred coverage of this policy shall be for such proportion of the loss as the amount which would otherwise have been payable hereunder plus the total of the like amounts under all such other valid coverages for the same loss of which this insurer had notice bears to the total like amounts under all valid coverages for such loss and for the return of such portion of the premiums paid as shall exceed the pro rata portion for the amount so determined. For the purpose of applying this provision when other coverage is on a provision of service basis, the 'like amount' of such other coverage shall be taken as the amount which the services rendered would have cost in the absence of such coverage."
(2) If the foregoing policy provision is included in a policy which also contains the policy provision set out in 33-22-226, there shall be added to the caption of the foregoing provision the phrase "--Expense Incurred Benefits". The insurer may, at its option, include in this provision a definition of "other valid coverage", approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada and by hospital or medical service organizations and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of such definition such term shall not include group insurance, automobile medical payments insurance, or coverage provided by hospital or medical service organizations or by union welfare plans or employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute, including any workers' compensation or employer's liability statute, whether provided by a governmental agency or otherwise shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying the foregoing policy provision no third-party liability coverage shall be included as "other valid coverage".
History: En. Sec. 370, Ch. 286, L. 1959; R.C.M. 1947, 40-4020.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-226. Insurance with other insurers -- other benefits

33-22-226. Insurance with other insurers -- other benefits.
(1) There may be a provision as follows:
"Insurance with Other Insurers: If there be other valid coverage, not with this insurer, providing benefits for the same loss on other than an expense incurred basis and of which this insurer has not been given written notice prior to the occurrence or commencement of loss, the only liability for such benefits under this policy shall be for such proportion of the indemnities otherwise provided hereunder for such loss as the like indemnities of which the insurer had notice (including the indemnities under this policy) bear to the total amount of all like indemnities for such loss and for the return of such portion of the premium paid as shall exceed the pro rata portion for the indemnities thus determined."
(2) If the foregoing policy provision is included in a policy which also contains the policy provision set out in 33-22-225, there shall be added to the caption of the foregoing provision the phrase "--Other Benefits". The insurer may, at its option, include in this provision a definition of "other valid coverage", approved as to form by the commissioner, which definition shall be limited in subject matter to coverage provided by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada and to any other coverage the inclusion of which may be approved by the commissioner. In the absence of such definition such term shall not include group insurance or benefits provided by union welfare plans or by employer or employee benefit organizations. For the purpose of applying the foregoing policy provision with respect to any insured, any amount of benefit provided for such insured pursuant to any compulsory benefit statute, including any workers' compensation or employer's liability statute, whether provided by a governmental agency or otherwise shall in all cases be deemed to be "other valid coverage" of which the insurer has had notice. In applying the foregoing policy provision no third-party liability coverage shall be included as "other valid coverage".
History: En. Sec. 371, Ch. 286, L. 1959; R.C.M. 1947, 40-4021.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-227. Relation of earnings to insurance

33-22-227. Relation of earnings to insurance.
(1) There may be a provision as follows:
"Relation of Earnings to Insurance: If the total monthly amount of loss-of-time benefits promised for the same loss under all valid loss-of-time coverage upon the insured, whether payable on a weekly or monthly basis, exceeds the monthly earnings of the insured at the time disability commenced or the insured's average monthly earnings for the period of 2 years immediately preceding a disability for which claim is made, whichever is the greater, the insurer will be liable only for the proportionate amount of benefits under this policy that the amount of the monthly earnings or the average monthly earnings of the insured bears to the total amount of monthly benefits for the same loss under all coverage upon the insured at the time the disability commences and for the return of the part of the premiums paid during the 2 years that exceed the pro rata amount of the premiums for the benefits actually paid under this policy. However, this may not operate to reduce the total monthly amount of benefits payable under all coverage upon the insured below the sum of $200 or the sum of the monthly benefits specified in the coverages, whichever is the lesser, and may not operate to reduce benefits other than those payable for loss of time."
(2) The policy provision in subsection (1) may be inserted only in a policy that the insured has the right to continue in force subject to its terms by the timely payment of premiums until at least age 50 or, in the case of a policy issued after age 44, for at least 5 years from its date of issue. The insurer may, at its option, include in this provision a definition of "valid loss of time coverage", approved as to form by the commissioner. The definition must be limited in subject matter to coverage provided by governmental agencies or by organizations subject to regulation by insurance law or by insurance authorities of this or any other state of the United States or any province of Canada or to any other coverage the inclusion of which may be approved by the commissioner or any combination of coverages. In the absence of a definition, the term may not include any coverage provided for the insured pursuant to any compulsory benefit statute, including any workers' compensation or employer's liability statute, or benefits provided by union welfare plans or by employer or employee benefit organizations.
History: En. Sec. 372, Ch. 286, L. 1959; R.C.M. 1947, 40-4022; amd. Sec. 1226, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-228. Unpaid premiums

33-22-228. Unpaid premiums.
There may be a provision as follows:
"Unpaid Premiums: Upon the payment of a claim under this policy, any premium then due and unpaid or covered by any note or written order may be deducted therefrom."
History: En. Sec. 373; Ch. 286, L. 1959; R.C.M. 1947, 40-4023.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-229. Conformity with state statutes

33-22-229. Conformity with state statutes.
There must be a provision or the equivalent thereto as follows:
"Conformity with Montana statutes: The provisions of this policy conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this policy."
History: En. Sec. 374, Ch. 286, L. 1959; R.C.M. 1947, 40-4024; amd. Sec. 10, Ch. 518, L. 1983; amd. Sec. 33, Ch. 798, L. 1991.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-230. Illegal occupation

33-22-230. Illegal occupation.
There may be a provision as follows:
"Illegal Occupation: The insurer shall not be liable for any loss to which a contributing cause was the insured's commission of or attempt to commit a felony or to which a contributing cause was the insured's being engaged in an illegal occupation."
History: En. Sec. 375, Ch. 286, L. 1959; R.C.M. 1947, 40-4025.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-231. Repealed

33-22-231. Repealed.
Sec. 6, Ch. 26, L. 2019.
History: En. Sec. 376, Ch. 286, L. 1959; R.C.M. 1947, 40-4026.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-232. Renewal at option of insurer

33-22-232. Renewal at option of insurer.
(1) Except as provided in subsection (2), disability insurance policies, other than accident insurance only policies, in which the insurer reserves the right to refuse renewal must provide the statement in a policy provision, an endorsement, or an attached rider. The statement must provide that, subject to the insurer's right to terminate the policy upon nonpayment of premium when due, the right to refuse renewal may not be exercised so as to take effect before the renewal date occurring on or after and nearest each policy anniversary or, in the case of lapse and reinstatement, at the renewal date occurring on or after and nearest each anniversary of the last reinstatement and that any refusal of renewal must be without prejudice to any claim originating while the policy is in force. The reference to lapse and reinstatement may be omitted at the insurer's option.
(2) Policies conforming to this section are subject to the guaranteed renewability provisions of 33-22-247 or 33-22-524.
History: En. Sec. 377, Ch. 286, L. 1959; R.C.M. 1947, 40-4027; amd. Sec. 22, Ch. 303, L. 1981; amd. Sec. 26, Ch. 271, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-241. Definitions

33-22-241. Definitions.
As used in 33-22-242 and 33-22-243, unless the context indicates otherwise, the following definitions apply:
(1) "Block of business" means an individual disability insurance policy certificate or contract filed and approved by the commissioner pursuant to 33-1-501 and written and sold by a health care insurer to a defined set of individuals. All individuals covered by the policy or contract are considered to be within the block of business.
(2) "Health care insurer" means a disability insurer, a health service corporation, a health maintenance organization, or a fraternal benefit society.
(3) (a) "Individual health benefit plan" means any hospital or medical expense policy or certificate, subscriber contract, or contract of insurance provided by a prepaid hospital or medical service plan or health maintenance organization subscriber contract and issued for delivery to an individual.
(b) Individual health benefit plan does not include a self-funded group health plan; a self-funded multiemployer group health plan; a group conversion plan; an insured group health plan; accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, medicare supplement, long-term care, or disability income insurance; coverage issued as a supplement to liability insurance; workers' compensation or similar insurance; or automobile medical payment insurance.
(4) "Qualifying previous coverage" means benefits or coverage provided under:
(a) medicare or medicaid;
(b) group health insurance or a health benefit plan that provides benefits similar to or exceeding benefits provided under the plan being applied for; or
(c) an individual health benefit plan, including coverage issued by a health maintenance organization, a prepaid hospital or medical care plan, or a fraternal benefit society, that provides benefits similar to or exceeding the plan being applied for.
History: En. Sec. 1, Ch. 527, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-242. Waiver of preexisting condition exclusion -- exclusion prohibited

33-22-242. Waiver of preexisting condition exclusion -- exclusion prohibited.
(1) A health care insurer shall waive any time period applicable to a preexisting condition exclusion or limitation period with respect to particular services in an individual health benefit plan for the period of time that an individual was previously covered by qualifying previous coverage that provided benefits with respect to those services, if the qualifying previous coverage was continuous to a date not more than 30 days prior to the date of application for new coverage.
(2) A health care insurer that offers individual health insurance coverage to a federally defined eligible individual may not impose a preexisting condition exclusion with respect to that coverage.
History: En. Sec. 2, Ch. 527, L. 1995; amd. Sec. 7, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-243. Premium increases to be distributed proportionately

33-22-243. Premium increases to be distributed proportionately.
(1) A health care insurer may increase the health benefit plan charges for an individual policy, certificate, or contract previously issued by that insurer because of a change in the attained age of the insured. Increases in premium, certificate, or contract charges for individual policies, certificates, or contracts previously issued by that insurer, based on factors other than attained age, must be distributed proportionately across the block of business as defined in 33-22-241.
(2) As used in this section, the following definitions apply:
(a) (i) "Health benefit plan" means a hospital or medical policy or certificate providing for physical and mental health care issued by an insurance company, a fraternal benefit society, or a health service corporation or issued under a health maintenance organization subscriber contract.
(ii) Health benefit plan does not include:
(A) accident-only, credit, dental, vision, specified disease, medicare supplement, long-term care, or disability income insurance;
(B) coverage issued as a supplement to liability insurance, workers' compensation insurance, or similar insurance; or
(C) automobile medical payment insurance.
(b) "Health care insurer" or "insurer" means a disability insurer, a health service corporation, a health maintenance organization, or a fraternal benefit society.
(3) The provisions of Title 33, chapter 1, parts 3 and 7, apply to this section.
History: En. Sec. 3, Ch. 527, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-244. Disclosure standards -- individual policy

33-22-244. Disclosure standards -- individual policy.
(1) In order to provide for full and fair disclosure in the sale of disability insurance, an individual disability insurance policy may not be delivered or issued for delivery in this state unless an outline of coverage is filed with and approved by the insurance commissioner in accordance with 33-1-501 and is delivered to the applicant at the time the application is made.
(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 insured's 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;
(f) a description of any preauthorization or other preapproval requirements for medical care;
(g) a prominently displayed statement of the insured's responsibility for payment of billed charges beyond those charges reimbursed by the insurer when the insured uses health care services from a health care provider who is outside a network of health care providers used by the insurer; and
(h) 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 individual disability policy.
(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.
(5) Prior to issuance of an individual disability insurance policy, written informational materials describing the policy's cancer screening coverages must be provided to a potential applicant. The informational materials are not subject to filing with and approval of the insurance commissioner.
History: En. Sec. 5, Ch. 527, L. 1995; amd. Sec. 2, Ch. 336, L. 2001; amd. Sec. 2, Ch. 463, L. 2007; amd. Sec. 1, Ch. 207, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-245. Repealed

33-22-245. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 8, Ch. 527, L. 1995; amd. Sec. 1, Ch. 504, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-246. Preexisting conditions relating to individual market

33-22-246. Preexisting conditions relating to individual market.
(1) Except as provided in subsection (2), a health insurance issuer offering individual health insurance coverage may not exclude coverage for a preexisting condition unless:
(a) medical advice, diagnosis, care, or treatment was recommended to or received by the participant or beneficiary within the 3 years preceding the effective date of coverage; and
(b) coverage for the condition is excluded for not more than 12 months.
(2) A health insurance issuer offering health insurance coverage may not impose a preexisting condition exclusion on a federally defined eligible individual because of a preexisting condition.
History: En. Sec. 37, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 2. Individual Policy Requirements › 33-22-262. Terminated

33-22-262. Terminated.
Sec. 14, Ch. 325, L. 2003.
History: En. Sec. 2, Ch. 325, L. 2003; amd. Sec. 1, Ch. 174, L. 2005; amd. Sec. 3, Ch. 463, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-301. Coverage of newborn under disability policy

33-22-301. Coverage of newborn under disability policy.
(1) Each policy of disability insurance or certificate issued must contain a provision granting immediate accident and sickness coverage, from and after the moment of birth, to each newborn infant of any insured.
(2) The coverage for newborn infants must be the same as provided by the policy for the other covered persons. However, for newborn infants there may not be waiting or elimination periods. A deductible or reduction in benefits applicable to the coverage for newborn infants is not permissible unless it conforms and is consistent with the deductible or reduction in benefits applicable to all other covered persons.
(3) A policy or certificate of insurance may not be issued or amended in this state if it contains any disclaimer, waiver, or other limitation of coverage relative to the accident and sickness coverage or insurability of newborn infants of an insured from and after the moment of birth.
(4) The policy or contract may require notification of the birth of a child and payment of a required premium or subscription fee to be furnished to the insurer or nonprofit or indemnity corporation within 31 days of the birth in order to have the coverage extend beyond 31 days.
History: (1), (2)En. 40-4002.1 by Sec. 2, Ch. 74, L. 1973; amd. Sec. 2, Ch. 83, L. 1974; Sec. 40-4002.1, R.C.M. 1947; (3)En. Sec. 352, Ch. 286, L. 1959; amd. Sec. 1, Ch. 74, L. 1973; amd. Sec. 1, Ch. 83, L. 1974; Sec. 40-4002, R.C.M. 1947; R.C.M. 1947, 40-4002.1, 40-4002(4); (4)En. Sec. 23, Ch. 303, L. 1981; amd. Sec. 4, Ch. 139, L. 1987; amd. Sec. 60, Ch. 379, L. 1995; amd. Sec. 4, Ch. 325, L. 2003; amd. Sec. 25, Ch. 151, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-302. Age limits -- effect on coverage

33-22-302. Age limits -- effect on coverage.
(1) (a) Except as provided in subsection (1)(b), if any disability policy contains a provision establishing, as an age limit or otherwise, a date after which the coverage provided by the policy will not be effective and if that date falls within a period for which premium is accepted by the insurer or if the insurer accepts a premium after that date, the coverage provided by the policy will continue in force subject to any right of cancellation until the end of the period for which premium has been accepted.
(b) Policies conforming to subsection (1)(a) are subject to the guaranteed renewability provisions of 33-22-247 or 33-22-524.
(2) In the event the age of the insured has been misstated and if, according to the correct age of the insured, the coverage provided by the policy would not have become effective or would have ceased prior to the acceptance of the premium or premiums, then the liability of the insurer is limited to the refund, upon request, of all premium or premiums paid for the period not covered by the policy.
History: En. Sec. 382, Ch. 286, L. 1959; R.C.M. 1947, 40-4032; amd. Sec. 27, Ch. 271, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-303. Coverage for well-child care

33-22-303. Coverage for well-child care.
(1) Each medical expense policy of disability insurance or certificate issued under the policy that is delivered, issued for delivery, renewed, extended, or modified in this state by a disability insurer and that provides coverage for a family member of the insured or subscriber must provide coverage for well-child care for children from the moment of birth through 7 years of age. Benefits provided under this coverage are exempt from any deductible provision that may be in force in the policy or certificate issued under the policy.
(2) Coverage for well-child care under subsection (1) must include:
(a) a history, physical examination, developmental assessment, anticipatory guidance, and laboratory tests, according to the schedule of visits adopted under the early and periodic screening, diagnosis, and treatment services program provided for in 53-6-101; and
(b) routine immunizations according to the schedule for immunizations recommended by the immunization practices advisory committee of the U.S. department of health and human services.
(3) Minimum benefits may be limited to one visit payable to one provider for all of the services provided at each visit cited in this section.
(4) This section does not apply to disability income, specified disease, accident-only, medicare supplement, or hospital indemnity policies.
(5) For purposes of this section:
(a) "developmental assessment" and "anticipatory guidance" mean the services described in the Guidelines for Health Supervision II, published by the American academy of pediatrics; and
(b) "well-child care" means the services described in subsection (2) and delivered by a physician or a health care professional supervised by a physician.
(6) When a policy of disability insurance or a certificate issued under the policy provides coverage or benefits to a resident of this state, it is considered to be delivered in this state within the meaning of this section, whether the insurer that issued or delivered the policy or certificate is located inside or outside of this state.
History: En. Sec. 1, Ch. 199, L. 1991; amd. Sec. 61, Ch. 379, L. 1995; amd. Sec. 39, Ch. 380, L. 2003; amd. Sec. 2, Ch. 390, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-304. Continuation of coverage for individuals with disabilities -- individual contracts

33-22-304. Continuation of coverage for individuals with disabilities -- individual contracts.
(1) An individual hospital or medical expense insurance policy or hospital or medical service plan contract delivered or issued for delivery in this state that provides that coverage of a dependent child terminates upon attainment of the limiting age for dependent children specified in the policy or contract must also provide in substance that attainment of the limiting age may not operate to terminate the coverage of the child while the child is and continues to be both incapable of self-sustaining employment by reason of intellectual disability or physical disability and chiefly dependent upon the policyholder or subscriber for support and maintenance. Proof of intellectual disability or physical disability and dependency must be furnished to the insurer or hospital or medical service plan corporation by the policyholder or subscriber within 31 days of the child's attainment of the limiting age and subsequently as may be required by the insurer or corporation. Proof may not be required more frequently than annually after the 2-year period following the child's attainment of the limiting age.
(2) Notwithstanding any other exemption or contrary law, the provisions of this section have equal application to hospital or medical expense insurance policies and hospital and medical service plan contracts.
History: (1)En. 40-3738 by Sec. 1, Ch. 298, L. 1971; Sec. 40-3738, R.C.M. 1947; (2)En. Sec. 2, Ch. 298, L. 1971; Sec. 40-3740, R.C.M. 1947; R.C.M. 1947, 40-3738, 40-3740; amd. Sec. 22, Ch. 472, L. 1997; amd. Sec. 2, Ch. 68, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-305. Short title

33-22-305. Short title.
Sections 33-22-305 through 33-22-311 may be cited as the "Individual Family Disability Insurance Continuity of Coverage Act".
History: En. Sec. 1, Ch. 245, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-306. Purpose

33-22-306. Purpose.
The purpose of 33-22-305 through 33-22-311 is to provide for the right of covered family members under individual family disability insurance policies to continuity of coverage upon the death of the named insured, the divorce, annulment of marriage, or legal separation of the spouse from the named insured, or any other condition specifically stated in such disability insurance policies under which coverage would otherwise terminate as to the covered spouse or covered dependent children of the named insured.
History: En. Sec. 2, Ch. 245, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-307. Continuity of coverage

33-22-307. Continuity of coverage.
(1) Subject to the requirements of 33-22-305 through 33-22-311 and on the date specified in the policy under which coverage otherwise terminates because of the death of the named insured or for any other reason specified in 33-22-306, as to covered family members, other than for nonpayment of premium, nonrenewal of the policy, or the expiration of the term for which the policy is issued, a covered person, other than one eligible for medicare or any other similar federal or state disability insurance program, including the spouse and any covered dependent child of the last-named insured or the representative of the child, has the right to continuation of coverage under provisions that, at the option of the carrier, are consistent with:
(a) the continuation of the policy, with the person exercising the right of continuation designated as the named insured;
(b) the issuance of a converted policy with the person exercising the conversion right designated as the named insured; or
(c) both (1)(a) and (1)(b).
(2) When continuation of coverage or conversion is made in the name of the spouse of the named insured, the coverage may, at the option of the spouse, include covered dependent children for whom the spouse has the responsibility for care and support.
History: En. Sec. 3, Ch. 245, L. 1981; amd. Sec. 43, Ch. 472, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-308. Form of coverage -- requirements -- evidence of insurability -- preexisting conditions

33-22-308. Form of coverage -- requirements -- evidence of insurability -- preexisting conditions.
(1) Coverage continued through the issuance of a converted policy shall consist of the form of coverage then being offered by the carrier as a conversion policy in the jurisdiction where the person exercising the conversion right resides that most nearly approximates the coverage of the policy from which conversion is exercised. Continued and converted coverages, other than those provided through the exercise of continuation or conversion rights contained in optionally renewable or limited right of renewal contracts, must contain:
(a) provisions allowing the person exercising the continuation or conversion the right to renew the coverage until the attainment of the age of eligibility for medicare or any other similar federal or state disability insurance program, subject to the right of the carrier to nonrenew all such policies in this state as a class; or
(b) other renewal provisions that are not less favorable to the insured than those contained in the policy from which conversion is exercised.
(2) Coverage provided through continuation or conversion may not require additional evidence of insurability except as to overinsurance and may not impose any preexisting condition limitations or other contractual time limitations other than those remaining unexpired under the policy or contract from which continuation or conversion is exercised.
History: En. Sec. 4, Ch. 245, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-309. Notice

33-22-309. Notice.
The eligible covered family member exercising the continuation or conversion right must notify the carrier and make payment of the applicable premium within 31 days following the date such coverage otherwise terminates as specified in the policy or contract from which continuation or conversion is being exercised.
History: En. Sec. 5, Ch. 245, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-310. Nonduplication

33-22-310. Nonduplication.
Benefits otherwise payable under a converted policy may be reduced:
(1) so they are not, during the first policy year of the converted policy, in excess of those benefits that would have been payable had the coverage under the policy from which conversion is exercised not terminated; and
(2) by the amount of benefits, if any, payable as to the same loss under the policy from which conversion is exercised.
History: En. Sec. 6, Ch. 245, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-311. Overinsurance

33-22-311. Overinsurance.
The carrier is not required to issue a converted policy if at the time of application the applicant:
(1) (a) has coverage under other disability insurance policies, health service corporation contracts, or self-insured health benefit plans providing similar benefits;
(b) is eligible for coverage under a group policy or contract providing similar benefits;
(c) is provided with similar benefits required by any statute; or
(d) is covered under any national, state, or governmental plan; and
(2) has coverage under subsection (1) that, together with the converted policy, would result in overinsurance according to the carrier's underwriting standards.
History: En. Sec. 7, Ch. 245, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-312. Limitations on cost sharing for insulin

33-22-312. (Effective January 1, 2024) Limitations on cost sharing for insulin.
(1) Each individual policy of disability insurance or certificate issued that contains coverage for prescription drugs must limit the insured's required copayment or other cost-sharing requirement to $35 for up to a 30-day supply of insulin, regardless of the amount or type of insulin prescribed.
(2) The limitation in this section applies to insulin covered by the insurer's formulary.
(3) Coverage of insulin prescribed for an insured is not subject to a deductible. Cost-sharing amounts paid by the insured for insulin must be counted toward the insured's deductible.
(4) This section does not apply to disability income, hospital indemnity, medicare supplement, accident-only, vision, dental, specific disease, or long-term care policies.
History: En. Sec. 1, Ch. 463, L. 2023.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 3. Requirements for Certain Individual Coverages › 33-22-316. Coverage for self-management training and education for treatment of diabetes

33-22-316. (Effective January 1, 2024) Coverage for self-management training and education for treatment of diabetes.
(1) Each individual policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for outpatient self-management training and education for the treatment of diabetes. Any education must be provided by a licensed health care professional with expertise in diabetes.
(2) (a) Coverage must include an annual benefit for medically necessary and prescribed outpatient self-management training and education for the treatment of diabetes. At a minimum, the benefit must consist of:
(i) 20 visits of training and education in diabetes self-management in either an individual or group setting within the first year of diagnosis if the insured has not received the training and education previously; and
(ii) 12 visits of followup diabetes self-management training and education services in subsequent years for an insured who has previously received and exhausted the initial 20 visits of education under subsection (2)(a)(i).
(b) Nothing in subsection (2)(a) prohibits an insurer from providing a greater benefit.
(c) For the purposes of this subsection (2), the term "visit" refers to a period of 30 minutes.
(3) Annual copayment and deductible provisions are subject to the same terms and conditions applicable to all other covered benefits within a given policy.
(4) This section does not apply to disability income, hospital indemnity, medicare supplement, accident-only, vision, dental, specific disease, or long-term care policies.
History: En. Sec. 1, Ch. 520, L. 2023.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 4. Franchise Disability Insurance (Repealed) › 33-22-401. Repealed

33-22-401. Repealed.
Sec. 1, Ch. 143, L. 2009.
History: En. Sec. 383, Ch. 286, L. 1959; R.C.M. 1947, 40-4033.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-502. Required provisions of group policies

33-22-502. Required provisions of group policies.
Each group disability insurance policy delivered or issued for delivery in this state must contain in substance the following provisions:
(1) a provision that, in the absence of fraud, all statements made by applicants or the policyholder or by an insured person must be considered representations and not warranties and that a statement made for the purpose of effecting insurance may not avoid the insurance or reduce benefits unless contained in a written instrument signed by the policyholder or the insured person, a copy of which has been furnished to the policyholder or to the insured person or the insured person's beneficiary;
(2) a provision that the insurer will furnish to the policyholder for delivery to each employee or member of the insured group a statement in summary form of the essential features of the insurance coverage of the employee or member and to whom benefits are payable. If dependents are included in the coverage, only one certificate is required to be issued for each family unit.
(3) a provision that to the group originally insured may be added from time to time eligible new employees or members or dependents, as the case may be, in accordance with the terms of the policy;
(4) a provision or the equivalent that reads:
"Conformity with Montana statutes. The provisions of this policy conform to the minimum requirements of Montana law and control over any conflicting statutes of any state in which the insured resides on or after the effective date of this policy."
History: En. Sec. 386, Ch. 286, L. 1959; amd. Sec. 4, Ch. 74, L. 1973; amd. Sec. 4, Ch. 83, L. 1974; R.C.M. 1947, 40-4102(part); amd. Sec. 11, Ch. 798, L. 1991; amd. Sec. 1227, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-503. Continuation of benefits to dependents

33-22-503. Continuation of benefits to dependents.
Any group disability policy which contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical, or surgical services for members of the family or dependents of a person in the insured group may provide for the continuation of such benefit provisions, or any part or parts thereof, after the death of the person in the insured group.
History: En. Sec. 385, Ch. 286, L. 1959; amd. Sec. 3, Ch. 74, L. 1973; amd. Sec. 3, Ch. 83, L. 1974; R.C.M. 1947, 40-4101(6).
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-504. Newborn infant coverage

33-22-504. Newborn infant coverage.
(1) A group disability policy or certificate of insurance delivered or issued for delivery in this state may not be issued or amended in this state if it contains any disclaimer, waiver, preexisting condition exclusion, or other limitation of coverage relative to the accident and sickness coverage or insurability of newborn infants of persons covered under the policy from and after the moment of birth.
(2) A policy or certificate subject to this section, must contain a provision granting immediate accident and sickness coverage, from and after the moment of birth, to each newborn infant of any person covered under the policy.
(3) The coverage for newborn infants must be the same as provided by the policy for other covered persons. However, for newborn infants there may not be waiting or elimination periods. A deductible or reduction in benefits applicable to the coverage for newborn infants is not permissible unless it conforms and is consistent with the deductible or reduction in benefits applicable to all other covered persons.
(4) This section does not apply to medicare supplement policies issued by reason of age.
(5) When a group disability policy or certificate issued under the policy provides for coverage or benefits for a resident of this state, the policy or certificate is considered delivered in this state within the meaning of this section regardless of whether the insurer issuing the policy or certificate is located in this state.
(6) The policy or certificate may require notification of the birth of a child and payment of a required premium or subscription fee to be furnished to the insurer or nonprofit or indemnity corporation within 31 days of the birth in order to have the coverage extend beyond 31 days.
History: En. Secs. 385, 386, Ch. 286, L. 1959; amd. Secs. 3, 4, Ch. 74, L. 1973; amd. Secs. 3, 4, Ch. 83, L. 1974; R.C.M. 1947, 40-4101(7), 40-4102(part); amd. Sec. 1, Ch. 384, L. 1987; amd. Sec. 62, Ch. 379, L. 1995; amd. Sec. 8, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-505. Direct payment of hospital and medical services

33-22-505. Direct payment of hospital and medical services.
Any group disability policy may on request by the group policyholder provide that all or any portion of any indemnities provided by any such policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering such services; but the policy may not require that the service be rendered by a particular hospital or person. Payment so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.
History: En. Sec. 387, Ch. 286, L. 1959; R.C.M. 1947, 40-4103.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-506. Continuation of coverage for persons with disabilities -- group contracts

33-22-506. Continuation of coverage for persons with disabilities -- group contracts.
(1) A group hospital or medical expense insurance policy or hospital or medical service plan contract delivered or issued for delivery in this state that provides that coverage of a dependent child of an employee or other member of the covered group terminates upon attainment of the limiting age for dependent children specified in the policy or contract must also provide in substance that attainment of the limiting age may not operate to terminate the coverage of the child while the child is and continues to be both incapable of self-sustaining employment by reason of intellectual disability or physical disability and chiefly dependent upon the employee or member for support and maintenance. Proof of intellectual disability or physical disability and dependency must be furnished to the insurer or hospital or medical service plan corporation by the employee or member within 31 days of the child's attainment of the limiting age and subsequently as may be required by the insurer or corporation. Proof may not be required more frequently than annually after the 2-year period following the child's attainment of the limiting age.
(2) Notwithstanding any other exemption or contrary law, the provisions of this section have equal application to hospital or medical expense insurance policies and hospital and medical service plan contracts.
History: (1)En. 40-3739 by Sec. 1, Ch. 298, L. 1971; Sec. 40-3739, R.C.M. 1947; (2)En. Sec. 2, Ch. 298, L. 1971; Sec. 40-3740, R.C.M. 1947; R.C.M. 1947, 40-3739, 40-3740; amd. Sec. 23, Ch. 472, L. 1997; amd. Sec. 3, Ch. 68, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-507. Continuing group coverage after reduction of work schedule

33-22-507. Continuing group coverage after reduction of work schedule.
A person covered by a group disability insurance policy issued or renewed after October 1, 1981, under 33-22-501(1) may, for a period of 1 year, with the consent of the employer or the trustees, continue coverage under group disability policy during the person's employment notwithstanding any reduction of the person's regular work schedule to less than the minimum time required to qualify for membership in the group, and the premium charged the person must be equal to that charged other members of the group of the same risk class.
History: En. Sec. 3, Ch. 579, L. 1981; amd. Sec. 1228, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-509. Preexisting conditions

33-22-509. Preexisting conditions.
The converted policy may not exclude, as a preexisting condition, any conditions covered by the group contract, including pregnancy of the insured or the insured's spouse or dependents covered by the group contract at the time of conversion.
History: En. Sec. 7, Ch. 579, L. 1981; amd. Sec. 3, Ch. 384, L. 1987.