reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 1. General Provisions › 33-30-112. Cease and desist order

33-30-112. Cease and desist order.
(1) The commissioner acting in the name of the state may issue an order directing a health service corporation or a representative of a health service corporation to cease and desist from engaging in any act or practice in violation of the provisions of this chapter.
(2) Within 15 days after service of the order of cease and desist, the respondent may request a hearing on the question of whether acts or practices in violation of this chapter have occurred. These hearings shall be conducted under the Montana Administrative Procedure Act.
History: En. 40-5921 by Sec. 21, Ch. 319, L. 1975; R.C.M. 1947, 40-5921; amd. Sec. 86, Ch. 370, L. 1987; amd. Sec. 9, Ch. 606, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 1. General Provisions › 33-30-113. Injunctive relief

33-30-113. Injunctive relief.
In the case of any violation of the provisions of this chapter if the commissioner elects not to issue a cease and desist order or in the event of noncompliance with a cease and desist order issued under this chapter, the commissioner may institute a proceeding to obtain injunctive relief, receivership, or other appropriate relief in the district court of the county in which the violation occurs or in which the principal place of business of the health service corporation is located. Any proceeding under this section shall conform to the requirements of Title 27, chapter 19 or 20, except that the commissioner shall not be required to allege facts tending to show the lack of an adequate remedy at law or tending to show irreparable damage or loss.
History: En. 40-5922 by Sec. 22, Ch. 319, L. 1975; R.C.M. 1947, 40-5922; amd. Sec. 87, Ch. 370, L. 1987; amd. Sec. 10, Ch. 606, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 2. Finance › 33-30-201. Reserves -- requirements suspended

33-30-201. Reserves -- requirements suspended.
(1) The corporation shall maintain at all times unobligated funds adequate to:
(a) provide the hospital, medical-surgical, and other health services made available to its members and beneficiaries; and
(b) meet all costs and expenses.
(2) In addition, reserves of a health service corporation in cash, certificates of deposit, obligations issued or guaranteed by the government of the United States, or other assets approved by the commissioner must be maintained in an amount not less than:
(a) $500,000 or, if authorized under this chapter after October 1, 1999, $750,000; or
(b) an amount equal to 1 month's average income from dues or fees paid to the corporation by its members or beneficiaries, based on an average of the preceding 12 months, whichever is less.
(3) The determination of minimum reserves is subject, as to amounts payable to participating providers of the health services, to any right of the corporation to prorate the amounts under the terms of its health service contracts with providers.
(4) The commissioner may decrease or suspend the requirements of this section if the commissioner finds that the action is in the best interest of the members of the corporation.
History: En. 40-5905 by Sec. 5, Ch. 319, L. 1975; R.C.M. 1947, 40-5905; amd. Sec. 55, Ch. 472, L. 1999; amd. Sec. 30, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 2. Finance › 33-30-202. Annual report by certified public accountant

33-30-202. Annual report by certified public accountant.
(1) All corporations subject to the provisions of this chapter shall file annually with the commissioner, on or before June 1, a financial statement audited by a certified public accountant pursuant to rules promulgated by the commissioner.
(2) (a) The commissioner may establish rules governing the content and preparation of the report required by subsection (1).
(b) The report must include:
(i) the corporation's financial statements for the most recent calendar year;
(ii) an opinion by the certified public accountant concerning the accuracy and fairness of the corporation's representation of its financial statements; and
(iii) other information that the commissioner specifies by rule.
History: En. 40-5911 by Sec. 11, Ch. 319, L. 1975; R.C.M. 1947, 40-5911; amd. Sec. 70, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 2. Finance › 33-30-203. Premium tax exemption

33-30-203. Premium tax exemption.
A health service corporation is exempt from all premium taxes.
History: En. 40-5915 by Sec. 15, Ch. 319, L. 1975; R.C.M. 1947, 40-5915.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 2. Finance › 33-30-204. Fees

33-30-204. Fees.
(1) Every health service corporation subject to the provisions of this chapter shall pay the following fees to the commissioner for enforcement of the provisions of this chapter:
(a) for a certified copy of any document or other paper filed in the office of the commissioner, per page, 50 cents;
(b) filing of a membership contract, $25;
(c) filing of a membership contract package, $100;
(d) filing annual statement, $25;
(e) issuance of health service corporation certificate of authority, $300; and
(f) annual continuation of health service corporation certificate of authority, $300.
(2) The commissioner shall promptly deposit with the state treasurer, to the credit of the state special revenue fund of the state auditor's office, all fees and certificate of authority fees received under this section.
History: En. 40-5917 by Sec. 17, Ch. 319, L. 1975; R.C.M. 1947, 40-5917; amd. Sec. 1, Ch. 452, L. 1981; amd. Sec. 5, Ch. 558, L. 1987; amd. Sec. 7, Ch. 351, L. 1989; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 71, Ch. 379, L. 1995; amd. Sec. 46, Ch. 380, L. 2003; amd. Sec. 31, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-301. Forms -- filing, approval

33-30-301. Forms -- filing, approval.
A copy of all forms of the membership contract or any type of endorsement or rider shall be filed with and approved by the commissioner of this state and the insurance regulator of the state of domicile of the health service corporation in accordance with chapter 1, part 5.
History: En. 40-5906 by Sec. 6, Ch. 319, L. 1975; R.C.M. 1947, 40-5906; amd. Sec. 2, Ch. 452, L. 1981; amd. Sec. 6, Ch. 558, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-302. Allowed contracts

33-30-302. Allowed contracts.
(1) A corporation subject to the provisions of this chapter may enter into contracts for the rendering of health services on behalf of its members or beneficiaries with:
(a) hospitals maintained by a governmental body or agency;
(b) hospitals maintained by a nonprofit corporation organized for hospital purposes; or
(c) other corporations, organizations, associations, partnerships, or individuals furnishing health services.
(2) A health service corporation may enter into agreements or contracts with other organizations or corporations licensed to do business in this state or in any other state for:
(a) the transfer of members or beneficiaries;
(b) the reciprocal joint provisions of benefits to the members or beneficiaries of the corporation and of those other organizations or corporations; or
(c) other joint undertakings the corporation's board of directors approves.
History: En. 40-5907 by Sec. 7, Ch. 319, L. 1975; R.C.M. 1947, 40-5907.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-303. Grievance procedure for members

33-30-303. Grievance procedure for members.
Any individual member of a corporation, subject to the provisions of this chapter, who believes that the member is aggrieved by any act or omission of the corporation or its officers, directors, or employees may file a statement in writing of the grievance in the office of the commissioner, and the commissioner may investigate the grievance. An investigation by the commissioner may not act as a bar to any suit in a court of competent jurisdiction instituted by an aggrieved member or as a bar to any defense by the involved corporation.
History: En. 40-5913 by Sec. 13, Ch. 319, L. 1975; R.C.M. 1947, 40-5913; amd. Sec. 1243, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-304. Nonliability for injuries caused by contractees

33-30-304. Nonliability for injuries caused by contractees.
A health service corporation is not liable for injuries resulting from neglect, misfeasance, malfeasance, or malpractice on the part of any person, organization, agency, or corporation rendering health services to the health service corporation's members and beneficiaries.
History: En. 40-5914 by Sec. 14, Ch. 319, L. 1975; R.C.M. 1947, 40-5914.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-306. Discrimination between individuals -- restrictions -- ratesetting by commissioner prohibited

33-30-306. Discrimination between individuals -- restrictions -- ratesetting by commissioner prohibited.
(1) No person may knowingly make or permit any unreasonable discrimination between individuals in any classification which may be established by a health service corporation and of essentially the same condition of health in the amount of dues or rates charged for any membership contract or in the benefits payable thereunder or in any of the terms and conditions of such contract or in any manner whatever.
(2) Nothing herein contained shall, however, restrict the right of a health service corporation within the discretion of its board of directors to limit or define the classes of persons who shall be eligible to become members, to limit and to define the benefits which it will furnish, and define such benefits as it undertakes to furnish into classes or kinds. A health service corporation may make available to its members health services, or reimbursement therefor, as the board of directors of that corporation may approve.
(3) Nothing contained in subsection (1) includes within the definition of discrimination any of the following practices:
(a) readjustment of the rate of payment for membership in a health service corporation under a group contract based on the loss or expense experience thereunder at the end of the first or any subsequent contract year thereunder which may be made retroactive only for that contract year;
(b) in the case of membership contracts issued on the preauthorized bank draft or similar plans, making allowance to members in an amount which fairly represents the saving in collection expense;
(c) reduction of the rate of payment for group contracts covering a large number of members, but not exceeding savings in administrative expenses reasonably attributable to these contracts as compared with contracts offering similar benefits to smaller numbers of members;
(d) issuing individual membership contracts on a "salary savings" or payroll deduction plan reasonably commensurate with the savings made by use of such plan.
(4) Nothing in this chapter gives the commissioner power to fix and determine a rate level by classification or otherwise.
History: En. 40-5918, 40-5919 by Secs. 18, 19, Ch. 319, L. 1975; R.C.M. 1947, 40-5918(8), 40-5919.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-307. Repealed

33-30-307. Repealed.
Sec. 9, Ch. 384, L. 2003.
History: En. Sec. 2, Ch. 309, L. 1983; amd. Sec. 7, Ch. 558, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-311. Insurance producer

33-30-311. Insurance producer.
A person who, for compensation, solicits membership in a prepayment health service plan offered by a corporation subject to the provisions of this chapter is an insurance producer of that corporation and is subject to the provisions of 33-2-708 and Title 33, chapter 17.
History: En. 40-5908 by Sec. 8, Ch. 319, L. 1975; R.C.M. 1947, 40-5908; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 72, Ch. 379, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-312. Repealed

33-30-312. Repealed.
Sec. 97, Ch. 379, L. 1995.
History: En. 40-5909 by Sec. 9, Ch. 319, L. 1975; R.C.M. 1947, 40-5909; amd. Sec. 8, Ch. 558, L. 1987; amd. Sec. 8, Ch. 509, L. 1989; amd. Sec. 1, Ch. 713, L. 1989.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 3. Operations › 33-30-313. Repealed

33-30-313. Repealed.
Sec. 97, Ch. 379, L. 1995.
History: En. 40-5910 by Sec. 10, Ch. 319, L. 1975; R.C.M. 1947, 40-5910; amd. Sec. 1, Ch. 713, L. 1989.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1001. Newborn infants covered by insurance by health service corporation

33-30-1001. Newborn infants covered by insurance by health service corporation.
A disability insurance plan or group disability insurance plan issued by a health service corporation 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 the persons insured from and after the moment of birth. Each policy must contain a provision granting immediate accident and sickness coverage, from and after the moment of birth, to each newborn infant of any insured person. 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: En. Sec. 5, Ch. 74, L. 1973; R.C.M. 1947, 15-2304.1; amd. Sec. 28, Ch. 303, L. 1981; amd. Sec. 73, Ch. 379, L. 1995; amd. Sec. 28, Ch. 416, L. 1997; amd. Sec. 6, Ch. 325, L. 2003.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1002. Disability coverage of services received in state institutions -- coverage of persons eligible for public medical assistance

33-30-1002. Disability coverage of services received in state institutions -- coverage of persons eligible for public medical assistance.
(1) It is unlawful for any health service corporation issuing membership contracts in Montana to exclude from coverage in a membership contract services rendered the insured while a resident in a Montana state institution if the services to the insured would be covered by the membership contract if rendered to the insured outside a Montana state institution.
(2) A membership contract is considered issued in Montana if the insured purchasing the membership contract is, at the time of purchase, residing in the state of Montana.
(3) If the exclusion prohibited by this section appears in a membership contract issued in Montana after February 14, 1973, the provision is void and the membership contract will be considered to cover services rendered the insured in a Montana state institution if the services would have been covered if rendered to an insured outside a Montana state institution.
(4) Payment for services rendered in a Montana state institution must be to the same extent and at the same rates, according to the provisions of the membership contract, that would be paid for the services if rendered outside a Montana state institution.
(5) A membership contract issued by a health service corporation on or after July 1, 1979, may not deny or reduce benefits to any member on the ground that the person insured is eligible for or receiving public medical assistance provided under Title 53, chapter 2.
History: En. Secs. 1, 2, 3, 4, Ch. 50, L. 1973; R.C.M. 1947, 40-4035(part), 40-4036, 40-4037, 40-4038; amd. Sec. 3, Ch. 169, L. 1979; amd. Sec. 1244, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1003. Continuation of coverage for persons with disabilities -- individual contracts

33-30-1003. Continuation of coverage for persons with disabilities -- individual contracts.
(1) An individual 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 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 subscriber for support and maintenance. Proof of intellectual disability or physical disability and dependency must be furnished to the hospital or medical service plan corporation by the subscriber within 31 days of the child's attainment of the limiting age and subsequently as may be required by the 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(part), 40-3740; amd. Sec. 24, Ch. 472, L. 1997; amd. Sec. 4, Ch. 68, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1004. Continuation of coverage for persons with disabilities -- group contracts

33-30-1004. Continuation of coverage for persons with disabilities -- group contracts.
(1) A group 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 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 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 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(part), 40-3740; amd. Sec. 25, Ch. 472, L. 1997; amd. Sec. 5, Ch. 68, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1005. Right of rescission

33-30-1005. Right of rescission.
Each membership contract, other than a group contract, issued for delivery in this state on or after January 1, 1980, must contain a notice stating in substance that if the person to whom the contract is issued is not satisfied for any reason, the person is permitted to return the contract within 10 days of its delivery or a longer period that the contract may provide and to have refunded the amount of the premium paid. A contract returned pursuant to this section is void from the beginning.
History: En. Sec. 2, Ch. 342, L. 1979; amd. Sec. 1245, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1006. Continuing group coverage after termination

33-30-1006. Continuing group coverage after termination.
A person covered by a group hospital or medical service plan contract, issued or renewed by a health service corporation after October 1, 1981, may, for a period of 1 year with the consent of the employer or the trustees, continue coverage under the group contract 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 must be equal to that charged the members of the group.
History: En. Sec. 5, Ch. 579, L. 1981; amd. Sec. 1246, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1008. Preexisting conditions

33-30-1008. Preexisting conditions.
The converted policy may not exclude, as a preexisting condition, any conditions covered by the group contract.
History: En. Sec. 7, Ch. 579, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1009. Insured's family -- conversion entitlement

33-30-1009. Insured's family -- conversion entitlement.
Subject to the conditions set forth in this section, the conversion privilege is also available:
(1) to the surviving spouse, if any, at the death of the employee or member, with respect to the spouse and children whose coverage under the group policy terminates by reason of the death, otherwise to each surviving child whose coverage under the group policy terminates by reason of the death, or if the group policy provides for continuation of dependent's coverage following the employee's or member's death, at the end of the continuation;
(2) to the spouse of the employee or member upon termination of coverage of the spouse, by reason of ceasing to be a qualified family member under the group policy, while the employee or member remains under the group policy, including children whose coverage under the group policy terminates at the same time; or
(3) to a child solely with respect to the child upon termination of the child's coverage by reason of ceasing to be a qualified family member under the group policy if a conversion privilege is not otherwise provided in this section with respect to the termination.
History: En. Sec. 8, Ch. 579, L. 1981; amd. Sec. 1247, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1011. Dentists performing services common to both medicine and dentistry

33-30-1011. Dentists performing services common to both medicine and dentistry.
A contract or plan may exclude coverage for dental care or services, but no individual or group membership contract or plan issued or renewed on or after October 1, 1983, may disallow payment to a dentist for health care or services for which a physician would be paid, provided the dentist is licensed under the law of this state to perform such care or service.
History: En. Sec. 1, Ch. 471, L. 1983.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1013. Coverage required for services provided by nurse specialists

33-30-1013. Coverage required for services provided by nurse specialists.
A health service corporation shall provide, in group and individual insurance contracts, coverage for health services provided by a nurse specialist, as specifically listed in 37-8-202, if health care services that nurse specialists are licensed to perform are covered by the contract.
History: En. Sec. 2, Ch. 329, L. 1987; amd. Sec. 5, Ch. 467, L. 2005.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1014. Coverage for well-child care

33-30-1014. Coverage for well-child care.
(1) Each disability insurance plan or group disability insurance plan that is delivered, issued for delivery, renewed, extended, or modified in this state by a health service corporation 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 plan.
(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, 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 at the intervals required in that subsection by a physician or a health care professional supervised by a physician.
(6) When a disability insurance plan or group disability insurance plan issued by a health service corporation 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 health service corporation that issued or delivered the policy or certificate is located inside or outside of this state.
History: En. Sec. 3, Ch. 199, L. 1991; amd. Sec. 4, Ch. 390, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1015. Limitation of eligibility on conversion

33-30-1015. Limitation of eligibility on conversion.
A person who purchases a policy of insurance under 33-30-1007 ceases to be eligible for a conversion policy if the person insured by the policy:
(1) fails to pay the premium on the policy purchased under 33-30-1007; or
(2) enrolls under another major medical disability insurance policy or plan, except that the person may maintain the conversion policy during any waiting period established under any new disability insurance policy or plan that the insured person purchases.
History: En. Sec. 4, Ch. 200, L. 1991; amd. Sec. 22, Ch. 399, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1016. Coverage for adopted children from time of placement -- preexisting conditions

33-30-1016. Coverage for adopted children from time of placement -- preexisting conditions.
(1) Each individual or group membership contract issued or amended by a health service corporation in this state that provides coverage of dependent children of a member must provide coverage for an adopted child of the member to the same extent as for natural children of the member.
(2) The coverage required by this section must be effective from the date of placement for the purpose of adoption and must continue unless the placement is disrupted prior to legal adoption and the child is removed from placement. Coverage at the time of placement must include the necessary care and treatment of medical conditions existing prior to the date of placement.
(3) As used in this section, "placement" has the meaning as defined in 33-22-130.
History: En. Sec. 2, Ch. 387, L. 1991; amd. Sec. 162, Ch. 480, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1017. Coverage required for services provided by naturopathic physicians

33-30-1017. Coverage required for services provided by naturopathic physicians.
A health service corporation shall provide, in group and individual insurance contracts or certificates, coverage for health services provided by a naturopathic physician licensed pursuant to Title 37, chapter 26, if the health care services that naturopathic physicians are licensed to perform are covered by the contract or certificate.
History: En. Sec. 2, Ch. 459, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1018. Coverage required for services provided by physical therapist

33-30-1018. Coverage required for services provided by physical therapist.
A health service corporation shall provide, in group and individual insurance contracts or certificates, coverage for health services provided by a physical therapist licensed pursuant to Title 37, chapter 11, if the health care services that physical therapists are licensed to perform are covered by the contracts or certificates.
History: En. Sec. 2, Ch. 235, L. 2001.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1019. Coverage for services provided under freedom of choice for auxiliary health services

33-30-1019. Coverage for services provided under freedom of choice for auxiliary health services.
A health service corporation shall provide, in group and individual insurance contracts or certificates, coverage for health services provided by a speech-language pathologist or audiologist licensed pursuant to Title 37, chapter 15, or an addiction counselor licensed under Title 37, chapter 39, if the health care services that speech-language pathologists, audiologists, or addiction counselors are licensed to perform are covered by the contracts or certificates.
History: En. Sec. 2, Ch. 342, L. 2015; amd. Sec. 18, Ch. 713, L. 2023.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1020. Coverage for services provided under freedom of choice for mental health services

33-30-1020. Coverage for services provided under freedom of choice for mental health services.
A health service corporation shall provide, in group and individual insurance contracts, coverage for health services provided by marriage and family therapists licensed under Title 37, chapter 39, if the health care services that marriage and family therapists are licensed to perform are covered by the contracts.
History: En. Sec. 2, Ch. 206, L. 2017; amd. Sec. 19, Ch. 713, L. 2023.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 10. Health Service Corporation Plans › 33-30-1021. Applicability

33-30-1021. Applicability.
Notwithstanding any provision of Title 33 or other law to the contrary, it shall be lawful for an insurer and insured to agree to any terms in an insurance contract that provides more favorable terms for the benefit of the insured than authorized in Title 33 or other provisions of law.
History: En. Sec. 9, Ch. 579, L. 1981; MCA 1981, 33-30-1010; redes. 33-30-1021 by Code Commissioner, 1983.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 11. Subrogation -- Notice › 33-30-1101. Subrogation rights

33-30-1101. Subrogation rights.
A hospital or medical service plan contract issued by a health service corporation may contain a provision providing that, to the extent necessary for reimbursement of benefits paid to or on behalf of the insured, the health service corporation is entitled to subrogation, as provided for in 33-30-1102, against a judgment or recovery received by the insured from a third party found liable for a wrongful act or omission that caused the injury necessitating benefit payments.
History: En. Sec. 2, Ch. 365, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 30. Health Service Corporations › Part 11. Subrogation -- Notice › 33-30-1102. Notice -- shared costs of third-party action -- limitation

33-30-1102. Notice -- shared costs of third-party action -- limitation.
(1) If an insured intends to institute an action for damages against a third party, the insured shall give the health service corporation reasonable notice of the intention to institute the action.
(2) The insured may request that the health service corporation pay a proportionate share of the reasonable costs of the third-party action, including attorney fees.
(3) A health service corporation may elect not to participate in the cost of the action. If that election is made, the health service corporation waives 50% of any subrogation rights granted to it by 33-30-1101.
(4) The health service corporation's right of subrogation granted in 33-30-1101 may not be enforced until the injured insured has been fully compensated for the insured's injuries.
History: En. Sec. 4, Ch. 365, L. 1987; amd. Sec. 1248, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 1. General Provisions › 33-31-103. Rules

33-31-103. Rules.
The commissioner may, after notice and hearing, make reasonable rules necessary to effectuate this chapter.
History: En. Sec. 20, Ch. 457, L. 1987; amd. Sec. 2, Ch. 437, L. 1991.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 1. General Provisions › 33-31-112. Filings and reports as public documents

33-31-112. Filings and reports as public documents.
All applications, filings, and reports required under this chapter, except those that contain trade secrets or privileged or confidential commercial or financial information (other than an annual financial statement that the commissioner may require under 33-31-211), are public documents.
History: En. Sec. 25, Ch. 457, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 1. General Provisions › 33-31-113. Confidentiality of medical information

33-31-113. Confidentiality of medical information.
(1) Any data or information pertaining to the diagnosis, treatment, or health of an enrollee or applicant obtained from the enrollee, applicant, or a provider by a health maintenance organization must be held in confidence and may not be disclosed to any person except:
(a) to the extent that it may be necessary to carry out the purposes of this chapter;
(b) upon the express consent of the enrollee or applicant;
(c) pursuant to statute or court order for the production of evidence or the discovery thereof; or
(d) in the event of claim or litigation between the enrollee or applicant and the health maintenance organization wherein the data or information is pertinent.
(2) A health maintenance organization is entitled to claim the same statutory privileges against disclosure that the provider who furnished the information to the health maintenance organization is entitled to claim.
History: En. Sec. 26, Ch. 457, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 1. General Provisions › 33-31-114. Coverage for adopted children from time of placement -- preexisting conditions

33-31-114. Coverage for adopted children from time of placement -- preexisting conditions.
(1) Each health maintenance contract regulated under this chapter must provide coverage for an adopted child of the enrollee to the same extent as for natural children of the enrollee.
(2) The coverage required by this section must be effective from the date of placement for the purpose of adoption and must continue unless the placement is disrupted prior to legal adoption and the child is removed from placement. Coverage at the time of placement must include the necessary care and treatment of medical conditions existing prior to the date of placement.
(3) As used in this section, "placement" has the meaning as defined in 33-22-130.
History: En. Sec. 3, Ch. 387, L. 1991; amd. Sec. 163, Ch. 480, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 1. General Provisions › 33-31-115. Applicability to managed health care entity

33-31-115. Applicability to managed health care entity.
(1) The department of public health and human services may limit the amount, scope, and duration of services provided by a managed health care entity under contract for programs established under Title 53. These services may be less than services required by this title.
(2) The delivery of programs of managed health care services established under Title 53 by a managed health care entity under contract with the department of public health and human services is exempt from the provisions of 33-31-301 and 33-31-321.
History: En. Sec. 10, Ch. 502, L. 1995; amd. Sec. 2, Ch. 577, L. 1999; amd. Sec. 1, Ch. 466, L. 2001; amd. Sec. 4, Ch. 351, L. 2011.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 2. Authorization of Health Maintenance Organizations › 33-31-203. Powers of insurers and health service corporations

33-31-203. Powers of insurers and health service corporations.
(1) An insurer authorized to transact insurance in this state or a health service corporation authorized to do business in this state may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of this chapter. Notwithstanding any other law which may be inconsistent with this section, two or more insurers, health service corporations, or subsidiaries or affiliates thereof may jointly organize and operate a health maintenance organization. The business of insurance is considered to include the provision of health care services by a health maintenance organization owned or operated by an insurer or a subsidiary thereof.
(2) Notwithstanding any insurance or health service corporation laws, an insurer or a health service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through a health maintenance organization and to provide coverage if the health maintenance organization fails to meet its obligations.
(3) The enrollees of a health maintenance organization constitute a permissible group under this title. The insurer or health service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers under the contracts described in subsection (2).
(4) Nothing in this section exempts a health maintenance organization that provides health care services from complying with the applicable certificate of need requirements under Title 50, chapter 5, parts 1 and 3.
History: En. Sec. 16, Ch. 457, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 2. Authorization of Health Maintenance Organizations › 33-31-204. Acquisition, control, or merger of a health maintenance organization

33-31-204. Acquisition, control, or merger of a health maintenance organization.
(1) Except as provided in 33-2-1106 and subsection (2) of this section, a person may not tender for, request, or invite tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organization or enter into any other agreement if, after the consummation of the agreement, that person would, directly or indirectly, or by conversion or by exercise of any right to acquire, be in control of the health maintenance organization.
(2) A person may not enter into an agreement to merge or consolidate with or otherwise to acquire control of a health maintenance organization, unless, at the time any offer, request, or invitation is made or any agreement is entered into, or prior to the acquisition of the securities if no offer or agreement is involved, the acquiring person has filed with the commissioner and has sent to the health maintenance organization information required by 33-2-1104 and the commissioner has approved the offer, request, invitation, agreement, or acquisition pursuant to 33-2-1105.
History: En. Sec. 28, Ch. 457, L. 1987; amd. Sec. 39, Ch. 370, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 2. Authorization of Health Maintenance Organizations › 33-31-212. Fees

33-31-212. Fees.
(1) Each health maintenance organization shall pay to the commissioner the following fees:
(a) for filing an application for a certificate of authority or amendment to a certificate of authority, $300;
(b) for filing an amendment to the organization documents that requires approval, $25;
(c) for filing each annual statement, $25;
(d) for annual continuation of certificate of authority, $300.
(2) All fees, miscellaneous charges, fines, penalties, and those amounts received pursuant to 33-31-211(4) and 33-31-405 collected by the commissioner pursuant to this chapter and the rules adopted under this chapter must be deposited in the state special revenue fund to the credit of the state auditor's office.
History: En. Sec. 22, Ch. 457, L. 1987; amd. Sec. 8, Ch. 351, L. 1989; amd. Sec. 6, Ch. 628, L. 1989; amd. Sec. 5, Ch. 437, L. 1991; amd. Sec. 48, Ch. 380, L. 2003; amd. Sec. 36, Ch. 151, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 2. Authorization of Health Maintenance Organizations › 33-31-215. Investment regulations

33-31-215. Investment regulations.
Except for a health maintenance organization operated as a plan by a health service corporation, a domestic health maintenance organization may invest its funds only as prescribed in chapter 12.
History: En. Sec. 12, Ch. 457, L. 1987; amd. Sec. 49, Ch. 304, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 2. Authorization of Health Maintenance Organizations › 33-31-221. Powers of health maintenance organizations

33-31-221. Powers of health maintenance organizations.
(1) The powers of a health maintenance organization include but are not limited to the following:
(a) the purchase, lease, construction, renovation, operation, or maintenance of a hospital, a medical facility, or both, its ancillary equipment, and property that may reasonably be required for its principal office or for purposes that may be necessary in the transaction of the business of the organization;
(b) the making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation under its control for the purpose of acquiring or constructing a medical facility or hospital or in furtherance of a program providing health care services to enrollees;
(c) the furnishing of health care services through a provider who is under contract with or employed by the health maintenance organization;
(d) the contracting with a person for the performance on its behalf of certain functions, such as marketing, enrollment, and administration;
(e) the contracting with an insurer authorized to transact insurance in this state, or with a health service corporation authorized to do business in this state, for the provision of insurance, indemnity, or reimbursement against the cost of health care services provided by the health maintenance organization; and
(f) the offering of other health care services in addition to basic health care services.
(2) A health maintenance organization shall file notice, with adequate supporting information, with the commissioner before exercising a power granted in subsection (1)(a), (1)(b), or (1)(d). The commissioner may, after notice and hearing, within 60 days disapprove the exercise of a power under subsection (1)(a), (1)(b), or (1)(d) only if, in the commissioner's opinion, it would substantially and adversely affect the financial soundness of the health maintenance organization and endanger its ability to meet its obligations. The commissioner may make reasonable rules exempting from the filing requirement of this subsection those activities having a de minimis effect. The commissioner may exempt certain contracts from the filing requirement whenever exercise of the authority granted in this section would have little or no effect on the health maintenance organization's financial condition and ability to meet obligations.
(3) This section does not exempt the activities of a health maintenance organization from any applicable certificate of need requirements under Title 50, chapter 5, parts 1 and 3.
History: En. Sec. 5, Ch. 457, L. 1987; amd. Sec. 1250, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 31. Health Maintenance Organizations › Part 2. Authorization of Health Maintenance Organizations › 33-31-222. Governing body

33-31-222. Governing body.
(1) The governing body of a health maintenance organization may include providers or other individuals, or both.
(2) The governing body shall establish a mechanism to give the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions, or through the use of other mechanisms.
History: En. Sec. 6, Ch. 457, L. 1987.