reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 15. Regulation of Controlled Insurers and Controlling Producers › 33-2-1516. Compliance -- applicability

33-2-1516. Compliance -- applicability.
(1) Controlled insurers and controlling producers who are not in compliance with 33-2-1510 on October 1, 1993, have 60 days to come into compliance and shall comply with 33-2-1514 in all policies written or renewed on or after December 1, 1993.
(2) Sections 33-2-1509 through 33-2-1514 apply to insurers that are domiciled in this state or domiciled in a state that is not an accredited state that has in effect a substantially similar law.
(3) The provisions of Title 33, chapter 2, part 11, to the extent they are not superseded by 33-2-1509 through 33-2-1514, continue to apply to all entities within holding company systems subject to 33-2-1509 through 33-2-1514.
(4) An insurer may not continue to use the services of a managing general agent after December 1, 1993, unless the use complies with part 16 of this chapter.
(5) An insurer or reinsurer may not continue to use the services of a reinsurance intermediary after December 1, 1993, unless the use complies with part 17 of this chapter.
History: En. Sec. 12, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 15. Regulation of Controlled Insurers and Controlling Producers › 33-2-1517. Rulemaking authority

33-2-1517. Rulemaking authority.
(1) The commissioner may adopt rules implementing the provisions of 33-1-408 through 33-1-410, 33-2-1216 through 33-2-1218, 33-2-1391 through 33-2-1394, Title 33, chapter 2, parts 15 through 17, and 33-11-110.
(2) The authority of the commissioner to adopt rules is specifically extended, without limitation, to establish standards for companies considered to be in hazardous financial condition, to require annual audited financial reports, to regulate life and health reinsurance agreements, to provide for reports to the commissioner by holding company systems, and to establish accounting practices and procedures to be used by insurers in their annual statements.
History: En. Sec. 13, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 16. Regulation of Managing General Agents › 33-2-1601. Licensure of managing general agent

33-2-1601. Licensure of managing general agent.
(1) A person, firm, association, or corporation may not act in the capacity of a managing general agent with respect to risks located in this state for an insurer licensed in this state unless the person is a licensed producer in this state.
(2) A person, firm, association, or corporation may not act in the capacity of a managing general agent representing an insurer domiciled in this state with respect to risks located outside this state unless the person is licensed as a resident or nonresident producer in this state pursuant to the provisions of this part.
(3) The commissioner may require a bond in an amount acceptable to the commissioner for the protection of the insurer.
(4) The commissioner may require the managing general agent to maintain a policy on errors and omissions.
History: En. Sec. 14, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 16. Regulation of Managing General Agents › 33-2-1603. Duties of insurers

33-2-1603. Duties of insurers.
(1) The insurer must have on file an independent financial examination, in a form acceptable to the commissioner, of each managing general agent with which it has done business.
(2) If a managing general agent establishes loss reserves, the insurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the managing general agent. This is in addition to any other required loss reserve certification.
(3) At least semiannually, the insurer shall conduct an onsite review of the underwriting and claims processing operations of the managing general agent.
(4) Binding authority for all reinsurance contracts or participation in insurance or reinsurance syndicates rests with an officer of the insurer who is not affiliated with the managing general agent.
(5) Within 30 days of entering into or termination of a contract with a managing general agent, the insurer shall provide the commissioner with written notification of the appointment or termination. Notices of appointment of a managing general agent must include a statement of duties that the applicant is expected to perform on behalf of the insurer, the lines of insurance for which the applicant is to be authorized to act, and any other information the commissioner may request.
(6) An insurer shall review its books and records each quarter to determine if any producer has become a managing general agent. If the insurer determines that a producer has become a managing general agent, the insurer shall promptly notify the producer and the commissioner of the determination and the insurer and the producer shall comply with this part within 30 days.
(7) An insurer may not appoint to its board of directors an officer, director, employee, subproducer, or controlling shareholder of its managing general agent. This subsection does not apply to relationships governed by Title 33, chapter 2, part 11, or 33-2-1509 through 33-2-1514.
History: En. Sec. 16, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 16. Regulation of Managing General Agents › 33-2-1604. Examination authority

33-2-1604. Examination authority.
The acts of the managing general agent are considered to be the acts of the insurer on whose behalf it is acting. A managing general agent may be examined as if it were the insurer.
History: En. Sec. 17, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 16. Regulation of Managing General Agents › 33-2-1605. Penalties and liabilities

33-2-1605. Penalties and liabilities.
(1) If, after a hearing conducted in accordance with Title 33, chapter 1, part 7, the commissioner finds that a person has violated any provision of this part, the commissioner may order:
(a) a penalty in an amount of $5,000 for each separate violation;
(b) revocation or suspension of the producer's license; and
(c) the managing general agent to reimburse the insurer, the rehabilitator, or a liquidator of the insurer for any losses incurred by the insurer caused by a violation of this part committed by the managing general agent.
(2) An order of the commissioner pursuant to subsection (1) is subject to judicial review pursuant to 33-1-711.
(3) This section does not limit the power of the commissioner to impose any other penalty provided in this title.
(4) This part does not limit the rights of policyholders, claimants, or creditors.
History: En. Sec. 18, Ch. 596, L. 1993; amd. Sec. 33, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1702. Required contract provisions -- reinsurance intermediary-brokers

33-2-1702. Required contract provisions -- reinsurance intermediary-brokers.
Transactions between a reinsurance intermediary-broker and the insurer it represents must be entered into pursuant to a written authorization, specifying the responsibilities of each party. The authorization must, at a minimum, contain the following provisions:
(1) The insurer may terminate the reinsurance intermediary-broker's authority at any time.
(2) The reinsurance intermediary-broker shall render to the insurer accounts accurately detailing all material transactions, including information necessary to support all commissions, charges, and other fees received by or owing to the reinsurance intermediary-broker. The reinsurance intermediary-broker shall remit all funds due to the insurer within 30 days of receipt.
(3) All funds collected for the insurer's account must be held by the reinsurance intermediary-broker in a fiduciary capacity in a bank that is a qualified United States financial institution.
(4) The reinsurance intermediary-broker shall comply with the requirements of 33-2-1703.
(5) The reinsurance intermediary-broker shall comply with the written standards established by the insurer for the cession or retrocession of all risks.
(6) The reinsurance intermediary-broker shall disclose to the insurer any relationship with any reinsurer to which business will be ceded or retroceded.
History: En. Sec. 20, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1703. Books and records -- reinsurance intermediary-brokers

33-2-1703. Books and records -- reinsurance intermediary-brokers.
(1) For at least 10 years after expiration of each contract of reinsurance transacted by the reinsurance intermediary-broker, the reinsurance intermediary-broker shall keep a complete record for each transaction, showing:
(a) the type of contract, limits, underwriting restrictions, classes or risks, and territory;
(b) the period of coverage, including the effective and expiration dates, cancellation provisions, and notice required for cancellation;
(c) the reporting and settlement requirements of balances;
(d) the rate used to compute the reinsurance premium;
(e) the names and addresses of assuming reinsurers;
(f) the rates of all reinsurance commissions, including the commissions on any retrocessions handled by the reinsurance intermediary-broker;
(g) any related correspondence and memorandums;
(h) the proof of placement;
(i) the details regarding retrocessions handled by the reinsurance intermediary-broker, including the identity of the party making the retrocession and the percentage of each contract assumed or ceded;
(j) the financial records, including but not limited to premium and loss accounts; and
(k) when the reinsurance intermediary-broker procures a reinsurance contract on behalf of a licensed ceding insurer:
(i) directly from any assuming reinsurer, written evidence that the assuming reinsurer has agreed to assume the risk; or
(ii) if placed through a representative of the assuming reinsurer, other than an employee, written evidence that the reinsurer has delegated binding authority to the representative.
(2) The insurer has access to and may copy and audit all accounts and records maintained by the reinsurance intermediary-broker that are related to the insurer's business, in a form usable by the insurer.
History: En. Sec. 21, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1704. Duties of insurers utilizing the services of a reinsurance intermediary-broker

33-2-1704. Duties of insurers utilizing the services of a reinsurance intermediary-broker.
(1) An insurer may not engage the services of any person, firm, association, or corporation to act as a reinsurance intermediary-broker on its behalf unless the person is licensed as required by 33-2-1701.
(2) An insurer may not employ an individual who is employed by a reinsurance intermediary-broker with which it transacts business unless the reinsurance intermediary-broker is under common control with the insurer and is subject to the provisions of Title 33, chapter 2, part 11.
(3) The insurer shall annually obtain a copy of statements of the financial condition of each reinsurance intermediary-broker with which it transacts business.
History: En. Sec. 22, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1706. Prohibited acts

33-2-1706. Prohibited acts.
A reinsurance intermediary-manager may not:
(1) bind retrocessions on behalf of the reinsurer, except that the reinsurance intermediary-manager may bind facultative retrocessions pursuant to obligatory facultative agreements if the contract with the reinsurer contains reinsurance underwriting guidelines for retrocessions. The guidelines must include a list of reinsurers with which automatic agreements are in effect and, for each reinsurer, must include the coverages, amounts of percentages that may be reinsured, and commission schedules.
(2) commit the reinsurer to participate in reinsurance syndicates;
(3) appoint any producer without ensuring that the producer is licensed to transact the type of reinsurance for which the producer is appointed;
(4) without prior approval of the reinsurer, pay or commit the reinsurer to pay a claim, net of retrocessions, that exceeds the lesser of an amount specified by the reinsurer or 1% of the reinsurer's policyholder's surplus as of December 31 of the last complete calendar year;
(5) collect any payment from a party making a retrocession, or commit the reinsurer to any claim settlement with a party making a retrocession, without prior approval of the reinsurer. If prior approval is given, a report must be promptly forwarded to the reinsurer.
(6) jointly employ an individual who is employed by the reinsurer unless the reinsurance intermediary-manager is under common control with the reinsurer subject to Title 33, chapter 2, part 11;
(7) appoint a subreinsurance intermediary-manager.
History: En. Sec. 24, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1707. Duties of reinsurers using services of reinsurance intermediary-manager

33-2-1707. Duties of reinsurers using services of reinsurance intermediary-manager.
(1) A reinsurer may not engage the services of any person, firm, association, or corporation as a reinsurance intermediary-manager on its behalf unless the person is licensed as required by 33-2-1701.
(2) The reinsurer shall annually obtain a copy of statements of the financial condition of each reinsurance intermediary-manager that the reinsurer has engaged, prepared by an independent certified accountant, in a form acceptable to the commissioner.
(3) If a reinsurance intermediary-manager establishes loss reserves, the reinsurer shall annually obtain the opinion of an actuary attesting to the adequacy of loss reserves established for losses incurred and outstanding on business produced by the reinsurance intermediary-manager. The opinion is in addition to any other required loss reserve certification.
(4) Binding authority for all retrocessional contracts or participation in reinsurance syndicates must rest with an officer of the reinsurer who may not be affiliated with the reinsurance intermediary-manager.
(5) Within 30 days of termination of a contract with a reinsurance intermediary-manager, the reinsurer shall provide written notification of the termination to the commissioner.
(6) A reinsurer may not appoint to its board of directors any officer, director, employee, controlling shareholder, or subproducer of its reinsurance intermediary-manager. This subsection does not apply to relationships governed by Title 33, chapter 2, part 11, or, if applicable, 33-2-1701 through 33-2-1705.
History: En. Sec. 25, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1708. Examination authority

33-2-1708. Examination authority.
(1) A reinsurance intermediary is subject to examination by the commissioner. The commissioner must have access to all books, bank accounts, and records of the reinsurance intermediary in a form usable to the commissioner.
(2) A reinsurance intermediary-manager may be examined as if it were the reinsurer.
History: En. Sec. 26, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 17. Regulation of Reinsurance Intermediaries › 33-2-1709. Penalties and liabilities

33-2-1709. Penalties and liabilities.
(1) (a) A reinsurance intermediary, insurer, or reinsurer found by the commissioner, after a hearing conducted in accordance with Title 33, chapter 1, part 7, to be in violation of any provision of 33-2-1701 through 33-2-1708:
(i) shall, for each separate violation, pay a penalty in an amount not to exceed $5,000; and
(ii) is subject to revocation or suspension of its license.
(b) If a violation was committed by the reinsurance intermediary, the reinsurance intermediary shall make restitution to the insurer, reinsurer, rehabilitator, or liquidator of the insurer or reinsurer for the net losses incurred by the insurer or reinsurer attributable to the violation.
(2) The order of the commissioner pursuant to subsection (1) is subject to judicial review pursuant to Title 33, chapter 1, part 7.
(3) This section does not limit the authority of the commissioner to impose any other penalties provided in the insurance law.
(4) Sections 33-2-1701 through 33-2-1708 do not limit or restrict the rights of policyholders, claimants, creditors, or other third parties or confer any rights upon those persons.
History: En. Sec. 27, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1901. Short title

33-2-1901. Short title.
This part constitutes and may be referred to as "The Risk-Based Capital for Insurers Act".
History: En. Sec. 82, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1906. Authorized control level event

33-2-1906. Authorized control level event.
(1) "Authorized control level event" means any of the following events:
(a) the filing of an RBC report by the insurer that indicates that the insurer's total adjusted capital is greater than or equal to its mandatory control level RBC but less than its authorized control level RBC;
(b) the notification by the commissioner to the insurer of an adjusted RBC report that indicates the event in subsection (1)(a) if the insurer does not challenge the adjusted RBC report under 33-2-1908 or the commissioner rejects the insurer's challenge;
(c) the failure of the insurer to respond, in a manner satisfactory to the commissioner, to a corrective order if the insurer has not challenged the corrective order under 33-2-1908; or
(d) if the insurer has challenged a corrective order under 33-2-1908 and the commissioner has, after a hearing, rejected the challenge or modified the corrective order, the failure of the insurer to respond, in a manner satisfactory to the commissioner, to the corrective order subsequent to rejection or modification by the commissioner.
(2) In the event of an authorized control level event with respect to an insurer, the commissioner shall:
(a) take the actions required under 33-2-1905 regarding an insurer with respect to which a regulatory action level event has occurred; or
(b) if the commissioner considers it to be in the best interests of the policyholders and creditors of the insurer and of the public, take the actions necessary to cause the insurer to be placed under regulatory control under Title 33, chapter 2, part 13. In the event that the commissioner places the insurer under regulatory control, the authorized control level event must be considered sufficient grounds for the commissioner to take action under Title 33, chapter 2, part 13, and the commissioner shall have the rights, powers, and duties with respect to the insurer as are set forth in Title 33, chapter 2, part 13. In the event that the commissioner takes an action under this subsection pursuant to an adjusted RBC report, the insurer is entitled to the protections afforded to insurers under the provisions of 33-2-1321 through 33-2-1323 pertaining to summary proceedings.
History: En. Sec. 87, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1907. Mandatory control level event

33-2-1907. Mandatory control level event.
(1) "Mandatory control level event" means any of the following events:
(a) the filing of an RBC report that indicates that the insurer's total adjusted capital is less than its mandatory control level RBC;
(b) notification by the commissioner to the insurer of an adjusted RBC report that indicates the event in subsection (1)(a) if the insurer does not challenge the adjusted RBC report under 33-2-1908 or the commissioner rejects the insurer's challenge.
(2) In the event of a mandatory control level event:
(a) with respect to a life or disability insurer or a health organization, the commissioner shall take the actions that are necessary to place the insurer under regulatory control under Title 33, chapter 2, part 13. In that event, the mandatory control level event must be considered sufficient grounds for the commissioner to take action under Title 33, chapter 2, part 13, and the commissioner shall have the rights, powers, and duties with respect to the insurer as are set forth in Title 33, chapter 2, part 13. If the commissioner takes an action pursuant to an adjusted RBC report, the insurer is entitled to the protections of 33-2-1321 through 33-2-1323 pertaining to summary proceedings. Notwithstanding any of the foregoing, the commissioner may forego action for up to 90 days after the mandatory control level event if the commissioner finds that there is a reasonable expectation that the mandatory control level event may be eliminated within the 90-day period.
(b) with respect to a property and casualty insurer, the commissioner shall take the actions necessary to place the insurer under regulatory control under Title 33, chapter 2, part 13, or, in the case of an insurer that is not writing business and that is running-off its existing business, may allow the insurer to continue its runoff under the supervision of the commissioner. In either event, the mandatory control level event must be considered sufficient grounds for the commissioner to take action under Title 33, chapter 2, part 13, and the commissioner shall have the rights, powers, and duties with respect to the insurer as are set forth in Title 33, chapter 2, part 13. If the commissioner takes an action pursuant to an adjusted RBC report, the insurer is entitled to the protections of 33-2-1321 through 33-2-1323 pertaining to summary proceedings. Notwithstanding any of the foregoing, the commissioner may forego action for up to 90 days after the mandatory control level event if the commissioner finds there is a reasonable expectation that the mandatory control level event may be eliminated within the 90-day period.
History: En. Sec. 88, Ch. 379, L. 1995; amd. Sec. 20, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1908. Notification and hearing

33-2-1908. Notification and hearing.
(1) An insurer has the right to a hearing before the department upon notification by the commissioner:
(a) of an adjusted RBC report or unsatisfactory RBC plan or revised RBC plan that constitutes a regulatory action level event with respect to the insurer;
(b) that the insurer has failed to adhere to its RBC plan or revised RBC plan and that the failure has a substantial adverse effect on the ability of the insurer to eliminate the company action level event with respect to the insurer in accordance with its RBC plan or revised RBC plan; or
(c) of a corrective order with respect to the insurer.
(2) The insurer shall notify the commissioner of its request for a hearing within 5 days after the notification by the commissioner under subsection (1). Upon receipt of the insurer's request for a hearing, the commissioner shall set a date for the hearing, which may not be less than 10 or more than 30 days after the date of the insurer's request.
History: En. Sec. 89, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1910. Supplemental provisions -- rules -- exemption

33-2-1910. Supplemental provisions -- rules -- exemption.
(1) The provisions of this part are supplemental to any other provisions of the laws of this state and do not preclude or limit any other powers or duties of the commissioner under the law, including but not limited to Title 33, chapter 2, part 13.
(2) The commissioner may adopt reasonable rules necessary for the implementation of this part.
(3) The commissioner may exempt from the application of this part any domestic property and casualty insurer that:
(a) writes direct business only in this state;
(b) writes direct annual premiums of $2 million or less; and
(c) does not assume reinsurance in excess of 5% of direct premium written.
(4) The commissioner may exempt from the application of this part any domestic health organization that:
(a) writes direct business only in this state;
(b) assumes no reinsurance in excess of 5% of direct premium written;
(c) writes direct annual premiums for comprehensive medical business of $1 million or less; and
(d) is a limited health service organization that covers fewer than 1,000 lives.
History: En. Sec. 91, Ch. 379, L. 1995; amd. Sec. 21, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1911. Foreign insurers

33-2-1911. Foreign insurers.
(1) A foreign insurer shall, upon the written request of the commissioner, submit to the commissioner an RBC report for the previous calendar year on the later of:
(a) the date that an RBC report would be required to be filed by a domestic insurer under 33-2-1903; or
(b) 15 days after the request is received by the foreign insurer.
(2) A foreign insurer shall, at the written request of the commissioner, promptly submit to the commissioner a copy of any RBC plan that is filed with the insurance commissioner of any other state.
(3) In the event of a company action level event, regulatory action level event, or authorized control level event, with respect to any foreign insurer as determined under the RBC statute applicable in the state of domicile of the insurer or, if an RBC statute is not in force in that state, under the provisions of this part, if the insurance commissioner of the state of domicile of the foreign insurer fails to require the foreign insurer to file an RBC plan in the manner specified under that state's RBC statute or, if an RBC statute is not in force in that state, under 33-2-1904, the commissioner may require the foreign insurer to file an RBC plan with the commissioner. In that event, the failure of the foreign insurer to file an RBC plan with the commissioner is grounds to order the insurer to cease and desist from writing new insurance business in this state.
(4) In the event of a mandatory control level event with respect to any foreign insurer, if a domiciliary receiver has not been appointed with respect to the foreign insurer under the rehabilitation and liquidation statute applicable in the state of domicile of the foreign insurer, the commissioner may make application to a district court of this state permitted under 33-2-1380 with respect to the liquidation of property of foreign insurers found in this state, and the occurrence of the mandatory control level event must be considered adequate grounds for the application.
History: En. Sec. 92, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1912. Repealed

33-2-1912. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 93, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 19. Risk-Based Capital for Insurers › 33-2-1913. Notices

33-2-1913. Notices.
All notices by the commissioner to an insurer that may result in regulatory action are effective on dispatch if transmitted by certified mail or, in the case of any other transmission, are effective on the insurer's receipt of the notice.
History: En. Sec. 94, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 20. Pharmacy Audit Integrity Act › 33-2-2002. Definitions

33-2-2002. Definitions.
As used in this part, the following definitions apply:
(1) "Audit" means a review of the records of a pharmacy by or on behalf of an entity that finances or reimburses the cost of health care services or pharmaceutical products.
(2) "Entity" includes:
(a) a pharmacy benefits manager;
(b) a health benefit plan;
(c) a third-party administrator; and
(d) a company, group, or agent that represents or is engaged by one of the entities described in this subsection (2).
(3) "Fraud" means an intentional act of deception, misrepresentation, or concealment in order to gain something of value.
(4) "Health benefit plan" means a policy or certificate that provides health care insurance or major medical expense insurance or that is offered as a substitute for hospital or medical expense insurance. The term does not include a policy or certificate that provides benefits solely for accident, dental, vision, income replacement, long-term care, a medicare supplement, a specified disease, or a short-term limited duration or that is offered and marketed as supplemental health insurance.
History: En. Sec. 2, Ch. 114, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 20. Pharmacy Audit Integrity Act › 33-2-2003. Applicability

33-2-2003. Applicability.
(1) Except as provided in subsection (2), this part applies to an audit of the records of a pharmacy licensed under Title 37, chapter 7.
(2) This part does not apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by the review of claims data, statements, physical review, or other investigative methods.
History: En. Sec. 3, Ch. 114, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 20. Pharmacy Audit Integrity Act › 33-2-2004. Audit of pharmacy records

33-2-2004. Audit of pharmacy records.
(1) An entity conducting an audit of pharmacy records shall audit a pharmacy using the same standards and parameters as used by the entity in auditing other pharmacies on behalf of the same audit client.
(2) An audit that involves clinical or professional judgment must be conducted by or in consultation with a licensed pharmacist who is employed by or working with the entity conducting the audit.
(3) If an audit is conducted onsite at a pharmacy, the entity conducting the audit:
(a) shall give the pharmacy 10 days' advance written notice of the audit, along with the range of prescription numbers or a date range that will be included in the audit; and
(b) may not audit the pharmacy during the first 5 business days of the month unless the pharmacy agrees to the timing of the audit.
(4) An entity may not audit prescription records that exceed 275 selected prescriptions. The period covered by the audit may not exceed 24 months from the date that the prescription was submitted to or adjudicated by the entity unless a longer period is required under state or federal law.
(5) Except as required by state or federal law, an entity conducting an audit may have access to a pharmacy's previous audit report only if the previous report was prepared by that entity.
(6) To validate a pharmacy record, a pharmacy may use documented statements of records in the pharmacy or pharmacy system, including medication administration records of a nursing home, assisted living facility, hospital, physician, surgeon, or other prescriber authorized by the laws of this state.
(7) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy to produce additional claims documentation using any commercially reasonable method, including fax, mail, or e-mail.
History: En. Sec. 4, Ch. 114, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 20. Pharmacy Audit Integrity Act › 33-2-2005. Prohibitions -- recoupment -- payment -- interest

33-2-2005. Prohibitions -- recoupment -- payment -- interest.
An entity conducting an audit may not:
(1) include dispensing fees unless a prescription was not actually dispensed, the prescriber denied authorization, the prescription dispensed was a dispensing error by the pharmacy, or the identified overpayment is based solely on an extra dispensing fee;
(2) recoup funds for prescription clerical or recordkeeping errors, including typographical errors, scrivener's errors, and computer errors, in a required document or record unless the error results in actual financial harm to the entity or to a consumer;
(3) collect any funds, charge-backs, or penalties until the audit and all appeals are final unless the entity is alleging fraud or other intentional or willful misrepresentation that is evidenced by the review of claims data, statements, physical review, or other investigative methods;
(4) use extrapolation or other statistical expansion techniques in calculating the amount of any recoupment or penalty;
(5) pay the agent or employee who conducted the audit based on a percentage of the amount recovered; or
(6) charge interest during the audit period.
History: En. Sec. 5, Ch. 114, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 20. Pharmacy Audit Integrity Act › 33-2-2006. Onsite audits -- preliminary and final reports -- appeals

33-2-2006. Onsite audits -- preliminary and final reports -- appeals.
For audits conducted onsite, the following provisions apply:
(1) An entity that audits a pharmacy shall provide the pharmacy with a preliminary audit report, delivered to the pharmacy or its corporate office of record within 60 days after completion of the audit.
(2) A pharmacy has 30 days following receipt of the preliminary audit report to respond to questions, provide additional documentation, and comment on and clarify findings of the audit. The date of receipt of the report must be determined by the postmark date or the date of the electronic transmission if transferred electronically.
(3) If an audit results in the dispute or denial of a claim, the entity conducting the audit shall allow the pharmacy, for 30 days following receipt of the preliminary audit report, to produce additional claims documentation using any commercially reasonable method, including fax, mail, or e-mail.
(4) (a) Within 120 days after the completion of the appeals process under subsection (5), a final audit report must be delivered to the pharmacy or its corporate office of record.
(b) The final audit report must include a disclosure of any money recovered by the entity that conducted the audit.
(5) An entity that audits a pharmacy shall establish a written policy for a pharmacy to appeal a final audit report. If no remedies are specified by contract or in the pharmacy services manual, the pharmacy may seek to resolve the dispute through mediation.
History: En. Sec. 6, Ch. 114, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 21. Corporate Governance Annual Disclosure › 33-2-2102. Purpose -- scope

33-2-2102. Purpose -- scope.
(1) The purpose of this part is to:
(a) provide to the insurance commissioner a summary of an insurer or insurance group's corporate governance structure, policies, and practices to permit the commissioner to gain and maintain an understanding of the insurer's corporate governance framework;
(b) outline the requirements for completing a corporate governance annual disclosure with the insurance commissioner; and
(c) provide for the confidential treatment of the corporate governance annual disclosure and related information that will contain confidential and sensitive information related to an insurer or insurance group's internal operations and proprietary and trade secret information and that, if made public, could potentially cause the insurer or insurance group competitive harm or disadvantage.
(2) (a) Nothing in this part may be construed to prescribe or impose corporate governance standards and internal procedures beyond that which is required under applicable state corporate law.
(b) Notwithstanding subsection (2)(a), nothing in this part may be construed to limit the commissioner's authority or the rights or obligations of third parties under Title 33.
(3) The requirements of this part apply to all insurers domiciled in the state.
History: En. Sec. 2, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 21. Corporate Governance Annual Disclosure › 33-2-2103. Definitions

33-2-2103. Definitions.
As used in this part, the following definitions apply:
(1) "CGAD" means a corporate governance annual disclosure, a confidential report filed by the insurer or insurance group made in accordance with the requirements of this part.
(2) "Commissioner" means the insurance commissioner of the state of Montana.
(3) "Insurance group" means those insurers and affiliates included within an insurance holding company system as defined in 33-2-1101.
(4) "Insurer" has the meaning provided in 33-1-201, except that it may not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state.
(5) "NAIC" means the national association of insurance commissioners.
History: En. Sec. 3, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 21. Corporate Governance Annual Disclosure › 33-2-2104. Disclosure requirement

33-2-2104. Disclosure requirement.
(1) An insurer or the insurance group of which the insurer is a member shall, no later than June 1 of each calendar year, submit to the commissioner a CGAD that contains the information described in 33-2-2106. Notwithstanding any request from the commissioner made pursuant to subsection (3), if the insurer is a member of an insurance group, the insurer shall submit the report required by this section to the commissioner of the lead state for the insurance group, in accordance with the laws of the lead state, as determined by the procedures outlined in the financial analysis handbook adopted by rule by the commissioner.
(2) The CGAD must include a signature of the insurer or insurance group's chief executive officer or corporate secretary attesting to the best of that individual's belief and knowledge that the insurer has implemented the corporate governance practices and that a copy of the disclosure has been provided to the insurer's board of directors or the appropriate committee of the board of directors.
(3) An insurer not required to submit a CGAD under this section shall do so upon the commissioner's request.
(4) For purposes of completing the CGAD, the insurer or insurance group may provide information regarding corporate governance at the ultimate controlling parent level, an intermediate holding company level, or the individual legal entity level, depending on how the insurer or insurance group has structured its system of corporate governance. The insurer or insurance group is encouraged to make the CGAD disclosures at the level at which the insurer's or insurance group's risk appetite is determined, or at which the earnings, capital, liquidity, operations, and reputation of the insurer are overseen collectively and at which the supervision of those factors are coordinated and exercised, or the level at which legal liability for failure of general corporate governance duties would be placed. If the insurer or insurance group determines the level of reporting based on these criteria, it shall indicate which of the three criteria was used to determine the level of reporting and explain any subsequent changes in the level of reporting.
(5) The review of the CGAD and any additional requests for information must be made through the lead state as determined by the procedures within the financial analysis handbook referenced in subsection (1).
(6) Insurers providing information substantially similar to the information required by this part in other documents provided to the commissioner, including a proxy statement filed in conjunction with form B requirements, or other state or federal filings provided to the commissioner may not be required to duplicate that information in the CGAD but may only be required to cross-reference the document in which the information is included.
History: En. Sec. 4, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 21. Corporate Governance Annual Disclosure › 33-2-2105. Rulemaking authority

33-2-2105. Rulemaking authority.
The commissioner may, upon notice and opportunity for all interested persons to be heard, issue rules and orders necessary to carry out the provisions of this part.
History: En. Sec. 5, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 21. Corporate Governance Annual Disclosure › 33-2-2106. Contents of corporate governance annual disclosure

33-2-2106. Contents of corporate governance annual disclosure.
(1) The insurer or insurance group has discretion over the responses to the CGAD inquiries provided that the CGAD contains the material information necessary to permit the commissioner to gain an understanding of the insurer's or group's corporate governance structure, policies, and practices. The commissioner may request additional information that the commissioner deems material and necessary to provide a clear understanding of the corporate governance policies, the reporting or information system, or controls implementing those policies.
(2) Notwithstanding subsection (1), the CGAD must be prepared consistent with any rules adopted by the commissioner. Documentation and supporting information must be maintained and made available upon examination or upon request of the commissioner.
History: En. Sec. 6, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 21. Corporate Governance Annual Disclosure › 33-2-2109. Sanctions -- penalties

33-2-2109. Sanctions -- penalties.
Any insurer failing, without just cause, to timely file the CGAD as required in this part shall, after notice and hearing, pay a penalty of $100 for each day's delay to the commissioner. The penalty must be collected by the commissioner in the name of the state of Montana and deposited in the general fund. The maximum penalty under this section is $1 million. The commissioner may reduce the penalty if the insurer demonstrates to the commissioner that the imposition of the penalty would constitute a financial hardship to the insurer.
History: En. Sec. 9, Ch. 9, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 22. Private Air Ambulance Services › 33-2-2201. Certificate of authority required

33-2-2201. Certificate of authority required.
(1) A private air ambulance service subject to this part shall obtain a certificate of authority from the commissioner prior to selling, soliciting, or negotiating a membership agreement in Montana.
(2) A private air ambulance service applying for a certificate of authority shall submit an application on a form prescribed by the commissioner.
(3) The commissioner may issue a certificate of authority if the private air ambulance service has complied with the applicable provisions of Title 50 and this title unless the commissioner finds that issuance of the certificate of authority is contrary to the public interest.
(4) A private air ambulance service may renew its certificate of authority upon payment of the annual fee specified in 33-2-2202 on or before March 1 of each year and upon continued compliance with the applicable provisions of Title 50 and this title.
(5) The requirements of this section are in addition to any other licensing or registration requirements that apply to the private air ambulance service.
History: En. Sec. 1, Ch. 210, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 22. Private Air Ambulance Services › 33-2-2202. Fees

33-2-2202. Fees.
A private air ambulance service subject to this part shall pay the following fees to the commissioner for services rendered:
(1) issuance of a certificate of authority, $300;
(2) annual renewal fee, $300; and
(3) filing of a membership agreement or other forms, $50.
History: En. Sec. 2, Ch. 210, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 2. Regulation of Insurance Companies › Part 22. Private Air Ambulance Services › 33-2-2203. Suspension or revocation

33-2-2203. Suspension or revocation.
(1) The commissioner may suspend or revoke a private air ambulance service certificate of authority if the private air ambulance service:
(a) no longer meets the requirements for the certificate of authority;
(b) materially fails to comply with a membership agreement issued to residents of Montana;
(c) is in unsound fiscal condition or is demonstrated to be using methods or practices in the conduct of its business that render its further transaction of insurance in this state injurious or hazardous to its members or to the public; or
(d) violates an applicable provision of law.
(2) Unless otherwise provided in the order of suspension or revocation, the private air ambulance service shall continue to honor membership agreements that are in force at the time of revocation or suspension.
History: En. Sec. 4, Ch. 210, L. 2017.