reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-510. Insured's family -- conversion entitlement

33-22-510. 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 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. 1229, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-511. Applicability

33-22-511. 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.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-512. Coverage for well-child care

33-22-512. Coverage for well-child care.
(1) Each group disability policy or certificate of insurance that is delivered, issued for delivery, renewed, extended, or modified in this state by a disability insurer and that provides coverage for a family member of the insured or subscriber must provide coverage for well-child care for children from the moment of birth through 7 years of age. Benefits provided under this coverage are exempt from any deductible provision that may be in force in the policy or certificate issued under the policy.
(2) Coverage for well-child care under subsection (1) must include:
(a) a history, physical examination, developmental assessment, anticipatory guidance, and laboratory tests, according to the schedule of visits adopted under the early and periodic screening, diagnosis, and treatment services program provided for in 53-6-101; and
(b) routine immunizations according to the schedule for immunizations recommended by the immunization practices advisory committee of the U.S. department of health and human services.
(3) Minimum benefits may be limited to one visit payable to one provider for all of the services provided at each visit cited in this section.
(4) This section does not apply to disability income, specified disease, accident-only, medicare supplement, or hospital indemnity policies or certificates.
(5) For purposes of this section:
(a) "developmental assessment" and "anticipatory guidance" mean the services described in the Guidelines for Health Supervision II, published by the American academy of pediatrics; and
(b) "well-child care" means the services described in subsection (2) and delivered by a physician or a health care professional supervised by a physician.
(6) When a group disability policy or certificate of insurance issued under the policy provides coverage or benefits to a resident of this state, it is considered to be delivered in this state within the meaning of this section, whether the insurer that issued or delivered the policy or certificate is located inside or outside of this state.
History: En. Sec. 2, Ch. 199, L. 1991; amd. Sec. 40, Ch. 380, L. 2003; amd. Sec. 3, Ch. 390, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-513. Limitation of eligibility on conversion

33-22-513. Limitation of eligibility on conversion.
An individual who purchases a policy of insurance under 33-22-508 ceases to be eligible for a conversion policy if the individual insured by the policy:
(1) fails to pay the premium on the policy purchased under 33-22-508; or
(2) enrolls under another major medical disability insurance policy or plan, except that the individual may maintain the conversion policy during any waiting period established under any new disability insurance policy or plan that the insured individual purchases.
History: En. Sec. 3, Ch. 200, L. 1991; amd. Sec. 15, Ch. 399, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-514. Preexisting conditions relating to group market

33-22-514. Preexisting conditions relating to group market.
(1) A group health plan or a health insurance issuer offering group health insurance coverage may not exclude coverage for a preexisting condition unless:
(a) medical advice, diagnosis, care, or treatment was recommended or received by the participant or beneficiary within the 6-month period ending on the enrollment date;
(b) exclusion of coverage extends for a period of not more than 12 months or 18 months in the case of a late enrollee; and
(c) the period of the preexisting condition exclusion is reduced by the aggregate of the periods of creditable coverage applicable to the participant or beneficiary as of the enrollment date.
(2) Genetic information may not be excluded as a preexisting condition in the absence of a diagnosis of the condition related to the genetic information.
(3) Pregnancy may not be excluded as a preexisting condition.
History: En. Sec. 39, Ch. 416, L. 1997; amd. Sec. 44, Ch. 472, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-521. Disclosure standards -- group policy

33-22-521. Disclosure standards -- group policy.
(1) In order to provide for full and fair disclosure in the sale of disability insurance, a group disability insurance policy may not be delivered or issued for delivery in this state unless an outline of coverage is filed with and approved by the insurance commissioner in accordance with 33-1-501 and is delivered to the applicant at the time the application is made.
(2) The outline of coverage must include:
(a) a general description of the principal benefits and coverages provided by the policy;
(b) a general description of the insured's financial responsibility under the policy, including, if applicable, the amount of the deductible, the amount or percentage of copayment, and the maximum annual out-of-pocket expenses to be paid by the insured;
(c) a statement of the maximum lifetime benefit available under the policy;
(d) a statement of the estimated periodic premium to be paid by the insured;
(e) a general description of the factors or case characteristics that the insurer may consider in establishing or changing the premiums and, if applicable, in determining the insurability of the applicant;
(f) a description of any preauthorization or other preapproval requirements for medical care;
(g) a prominently displayed statement of the insured's responsibility for payment of billed charges beyond those charges reimbursed by the insurer when the insured uses health care services from a health care provider who is outside a network of health care providers used by the insurer; and
(h) a general description of the trend of premium increases or decreases for comparable policies issued by the insurer during the preceding 5 years, if the trend data is available.
(3) If applicable, the outline of coverage must disclose that the policy does not contain coverage for mental illness or chemical dependency.
(4) The outline of coverage may include any other information that the insurer considers relevant to the applicant's selection of an appropriate group disability policy.
(5) An insurer or producer shall provide to an individual, upon request, an outline of coverage for any health benefit product marketed to the general public. The outline of coverage provided under this subsection may exclude the statement of the estimated periodic premium to be paid by the insured.
(6) An outline of coverage must also be sent to an employee when an employee is sent a certificate of insurance.
(7) Prior to issuance of a group disability insurance policy, written informational materials describing the policy's cancer screening coverages must be provided to a prospective applicant. The informational materials are not subject to filing with and approval of the insurance commissioner.
History: En. Sec. 6, Ch. 527, L. 1995; amd. Sec. 3, Ch. 336, L. 2001; amd. Sec. 4, Ch. 463, L. 2007; amd. Sec. 2, Ch. 207, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-522. Repealed

33-22-522. Repealed.
Sec. 22, Ch. 169, L. 2013.
History: En. Sec. 9, Ch. 527, L. 1995; amd. Sec. 2, Ch. 504, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-523. Special enrollment periods

33-22-523. Special enrollment periods.
(1) A group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan shall permit an employee or a dependent of an employee who is eligible, but not enrolled, for coverage under the terms of the group health plan to enroll for coverage under the terms of the group health plan if:
(a) the employee or dependent was covered under a group health plan or had health insurance coverage at the time that coverage was previously offered to the employee or dependent;
(b) the employee stated in writing at the time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or health insurance issuer required the statement at the time and provided the employee with notice of the requirement and the consequences of the requirement at the time;
(c) the employee's or dependent's coverage described in subsection (1)(a) was:
(i) under a COBRA continuation provision and was exhausted; or
(ii) not under a COBRA continuation provision and was terminated as a result of loss of eligibility for the coverage or because employer contributions toward the coverage were terminated; and
(d) under the terms of the group health plan, the employee requests the enrollment not later than 30 days after the date of exhaustion of coverage described in subsection (1)(c)(i) or termination of coverage or employer contribution described in subsection (1)(c)(ii).
(2) (a) A group health plan must provide for a dependent special enrollment period described in subsection (2)(b) during which a dependent may be enrolled under the group health plan as a dependent of the individual if the person becomes a dependent of the individual through marriage, birth, adoption, or placement for adoption. In the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if the spouse is otherwise eligible for coverage.
(b) A dependent special enrollment period under this subsection (2) is a period of not less than 30 days that begins on the later of:
(i) the date dependent coverage is made available; or
(ii) the date of the marriage, birth, adoption, or placement for adoption.
(3) If an individual seeks to enroll a dependent during the first 30 days of the dependent special enrollment period, the coverage of the dependent becomes effective:
(a) in the case of marriage, not later than the first day of the first month beginning after the date on which the completed request for enrollment is received;
(b) in the case of a dependent's birth, as of the date of birth; or
(c) in the case of a dependent's adoption or placement for adoption, the date of the adoption or placement for adoption.
History: En. Sec. 35, Ch. 416, L. 1997; amd. Sec. 45, Ch. 472, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-525. Guaranteed renewability in multiple employer welfare arrangements

33-22-525. Guaranteed renewability in multiple employer welfare arrangements.
A group health plan that is a multiple employer welfare arrangement, as defined by 29 U.S.C. 1002, may not deny an employer whose employees are covered under the group health plan continued access to the same or different coverage under the terms of the group health plan other than:
(1) for nonpayment of contributions;
(2) for fraud or other intentional misrepresentation of material fact by the employer;
(3) for noncompliance with material plan provisions;
(4) because the group health plan is ceasing to offer any coverage in a geographic area;
(5) in the case of a group health plan that offers benefits through a network plan, because there is no longer any individual enrolled through the employer who lives, resides, or works in the service area of the network plan and the group health plan applies to this section uniformly without regard to the claims experience of employers or any health status-related factor of those individuals or their dependents; or
(6) for failure to meet the terms of an applicable collective bargaining agreement, to renew a collective bargaining or other agreement requiring or authorizing contributions to the group health plan, or to employ employees covered by the agreement.
History: En. Sec. 42, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-526. Group health discrimination prohibited

33-22-526. Group health discrimination prohibited.
(1) (a) A group health plan or a health insurance issuer offering group health insurance coverage may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the group health plan based on any of the following health status-related factors of the individual or a dependent of the individual:
(i) health status;
(ii) medical condition, including both physical and mental illnesses;
(iii) claims experience;
(iv) receipt of health care;
(v) medical history;
(vi) genetic information;
(vii) evidence of insurability, including conditions arising out of acts of domestic violence; or
(viii) disability.
(b) This subsection does not:
(i) require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of the group health plan or group health insurance coverage; or
(ii) prevent the group health plan or group health insurance coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the group health plan or group health insurance coverage.
(c) For purposes of subsection (1)(a), rules for eligibility to enroll under a group health plan include rules defining an applicable waiting period for the enrollment.
(2) (a) A group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan may not require an individual, as a condition of enrollment or continued enrollment under the group health plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the group health plan on the basis of any health status-related factor of the individual or of an individual enrolled under the plan as a dependent of the individual.
(b) This subsection (2) does not:
(i) restrict the amount that an employer may be charged for coverage under a group health plan; or
(ii) prevent a group health plan and a health insurance issuer offering group health insurance coverage from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
History: En. Sec. 44, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 5. Group Disability Insurance › 33-22-530. Notice required for cancellation for nonpayment of group health insurance

33-22-530. Notice required for cancellation for nonpayment of group health insurance.
(1) A health insurance issuer shall provide at least 15 days prior notification of cancellation for nonpayment of premium for group health insurance coverage.
(2) The notice must be sent to the policyholder at the policyholder's last-known address and must specify the date of cancellation of coverage. The insurer shall attach a properly executed proof of mailing to this notice and maintain a copy of the proof of mailing in its records.
(3) The health insurance issuer shall hold for processing of payment any claims for covered benefits incurred during the 15-day notification period for nonpayment of premium for group health insurance coverage. Upon receipt of the premium, claims held for the 15-day notification period must be processed for payment.
(4) The policy continues in full force and effect, subject to the requirements of subsection (3), until the proper 15-day notice has been given, unless the coverage has already been replaced.
(5) The 15-day period begins to run from the date of the proof of mailing.
(6) The issuer may collect premiums for any time period that the coverage remains in effect.
(7) When coverage is actually canceled, notice must also be mailed to all certificate holders at:
(a) their last-known home addresses if available; or
(b) the business address of the group policyholder.
(8) The notice of cancellation to certificate holders must be separate from the certificate of creditable coverage required in 33-22-142, although it may be mailed simultaneously with the certificate.
History: En. Sec. 2, Ch. 384, L. 2003; amd. Sec. 28, Ch. 271, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 6. Blanket Disability Insurance › 33-22-601. Blanket disability insurance defined

33-22-601. Blanket disability insurance defined.
Blanket disability insurance is hereby declared to be that form of disability insurance covering groups of persons as enumerated in one of the following subsections:
(1) under a policy or contract issued to any common carrier or to any operator, owner, or lessee of a means of transportation, who or which shall be deemed the policyholder, covering a group defined as all persons or all persons of a class who may become passengers on such common carrier or such means of transportation;
(2) under a policy or contract issued to an employer, who shall be deemed the policyholder, covering all employees, dependents, or guests, defined by reference to specified hazards incident to the activities or operations of the employer or any class of employees, dependents, or guests similarly defined;
(3) under a policy or contract issued to a school or other institution of learning, camp or sponsor thereof; or to the head or principal thereof, who or which shall be deemed the policyholder, covering students or campers. Supervisors and employees may be included.
(4) under a policy or contract issued in the name of any religious, charitable, recreational, educational, or civic organization, which shall be deemed the policyholder, covering participants in activities sponsored by the organization;
(5) under a policy or contract issued to a sports team or sponsors thereof, which shall be deemed the policyholder, covering members, officials, and supervisors;
(6) under a policy or contract issued in the name of any volunteer fire department, first aid, or other such volunteer group, or agency having jurisdiction thereof, which shall be deemed the policyholder, covering all of the members of such fire department or group;
(7) under a policy or contract issued to cover any other risk or class of risks which in the discretion of the commissioner may be properly eligible for blanket disability insurance. The discretion of the commissioner may be exercised on an individual risk basis or class of risks, or both.
History: En. Sec. 388, Ch. 286, L. 1959; R.C.M. 1947, 40-4104.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 6. Blanket Disability Insurance › 33-22-603. Application and certificates not required

33-22-603. Application and certificates not required.
An individual application shall not be required from a person covered under a blanket disability policy or contract, nor shall it be necessary for the insurer to furnish each person a certificate.
History: En. Sec. 390, Ch. 286, L. 1959; R.C.M. 1947, 40-4106.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 6. Blanket Disability Insurance › 33-22-604. Payment of claims -- discharge

33-22-604. Payment of claims -- discharge.
(1) (a) Subject to subsection (1)(b), all benefits under a blanket disability policy must be payable to:
(i) the person insured or to the person's designated beneficiary or beneficiaries or to the person's estate, except that if the person insured is a minor or is mentally incompetent, the benefits may be made payable to the parent, guardian, or other person actually supporting the person; or
(ii) the employer, if the entire cost of the insurance has been borne by the employer.
(b) The policy may provide that all or any portion of any indemnities provided by the policy on account of hospital, nursing, medical, or surgical services may, at the insurer's option, be paid directly to the hospital or person rendering the services, but the policy may not require that the service be rendered by a particular hospital or person.
(2) Payment made as provided in subsection (1) discharges the insurer's obligation with respect to the amount of insurance paid.
History: En. Sec. 391, Ch. 286, L. 1959; R.C.M. 1947, 40-4107; amd. Sec. 1230, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 7. Montana Mental Health Parity Act › 33-22-701. Short title -- purpose -- scope of part -- exceptions

33-22-701. Short title -- purpose -- scope of part -- exceptions.
(1) This part may be cited as the "Montana Mental Health Parity Act".
(2) The purpose of this part is to ensure that Montana law applies the same level of parity between mental health and physical health benefits as existed in federal law on January 1, 2017.
(3) The provisions of this part apply to all policies and certificates of individual and group health insurance and group health plans offered to, renewed for, or issued to Montana residents by any health insurance issuer.
(4) This part does not apply to a short-term travel policy, a blanket disability policy as defined in 33-22-601, or excepted benefits as defined in 33-22-140.
History: En. Sec. 1, Ch. 197, L. 1979; amd. Sec. 1, Ch. 535, L. 1981; amd. Sec. 1, Ch. 593, L. 1983; amd. Sec. 4, Ch. 384, L. 1987; amd. Sec. 2, Ch. 348, L. 1999; amd. Sec. 55, Ch. 227, L. 2001; amd. Sec. 2, Ch. 245, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 7. Montana Mental Health Parity Act › 33-22-703. Coverage for mental illness, severe mental illness, and substance use disorders -- definition

33-22-703. Coverage for mental illness, severe mental illness, and substance use disorders -- definition.
(1) A health insurance issuer that issues, modifies, or renews individual or group health insurance coverage or a group health plan shall provide for the necessary care and treatment of mental illness, severe mental illness, and substance use disorders at a level of benefits that is no less favorable than the level provided for physical illness generally, including:
(a) inpatient benefits;
(b) outpatient benefits;
(c) emergency care; and
(d) prescription drugs.
(2) For the purposes of this section, "no less favorable" means the same level of parity as required under the Mental Health Parity and Addiction Equity Act of 2008 and related federal regulations as of January 1, 2017.
(3) Coverage for a child with autism who is 18 years of age or younger must comply with 33-22-515(3) through 33-22-515(5) if the child is diagnosed with:
(a) autistic disorder;
(b) Asperger's disorder; or
(c) pervasive developmental disorder not otherwise specified.
History: En. Sec. 3, Ch. 197, L. 1979; amd. Sec. 3, Ch. 535, L. 1981; amd. Sec. 3, Ch. 593, L. 1983; amd. Sec. 5, Ch. 139, L. 1987; amd. Sec. 5, Ch. 384, L. 1987; amd. Sec. 2, Ch. 448, L. 1995; amd. Sec. 150, Ch. 42, L. 1997; amd. Sec. 9, Ch. 416, L. 1997; amd. Sec. 1, Ch. 477, L. 1999; amd. Sec. 57, Ch. 227, L. 2001; amd. Sec. 15, Ch. 55, L. 2015; amd. Sec. 4, Ch. 245, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 7. Montana Mental Health Parity Act › 33-22-704. Repealed

33-22-704. Repealed.
Sec. 9, Ch. 245, L. 2017.
History: En. Sec. 4, Ch. 197, L. 1979; amd. Sec. 4, Ch. 535, L. 1981; amd. Sec. 4, Ch. 593, L. 1983; amd. Sec. 6, Ch. 384, L. 1987; amd. Sec. 4, Ch. 348, L. 1999; amd. Sec. 58, Ch. 227, L. 2001.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 7. Montana Mental Health Parity Act › 33-22-706. Repealed

33-22-706. Repealed.
Sec. 9, Ch. 245, L. 2017.
History: En. Sec. 1, Ch. 348, L. 1999; amd. Sec. 1, Ch. 367, L. 2001; amd. Sec. 5, Ch. 325, L. 2003; amd. Sec. 3, Ch. 359, L. 2009; amd. Sec. 22, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 7. Montana Mental Health Parity Act › 33-22-707. Parity compliance records

33-22-707. Parity compliance records.
A health insurance issuer that issues, modifies, or renews individual or group health insurance coverage that provides mental health or substance use disorder benefits shall submit a report to the commissioner on or before April 1 of the year following the effective date of this section, and upon request of the commissioner for each year thereafter, that complies with the mental health and substance use disorder parity analysis requirements of 42 U.S.C. 300gg-26(a)(8).
History: En. Sec. 1, Ch. 323, L. 2021.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-801. Repealed

33-22-801. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 1, Ch. 61, L. 1965; R.C.M. 1947, 40-5401.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-802. Repealed

33-22-802. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 2, Ch. 61, L. 1965; R.C.M. 1947, 40-5402.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-803. Repealed

33-22-803. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 3, Ch. 61, L. 1965; R.C.M. 1947, 40-5403(part).
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-804. Repealed

33-22-804. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 5, Ch. 61, L. 1965; R.C.M. 1947, 40-5405; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 68, Ch. 596, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-805. Repealed

33-22-805. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 7, Ch. 61, L. 1965; R.C.M. 1947, 40-5407(part); amd. Sec. 1, Ch. 713, L. 1989.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-806. Repealed

33-22-806. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 8, Ch. 61, L. 1965; R.C.M. 1947, 40-5408.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-811. Repealed

33-22-811. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 3, Ch. 61, L. 1965; R.C.M. 1947, 40-5403(part).
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-812. Repealed

33-22-812. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 6, Ch. 61, L. 1965; R.C.M. 1947, 40-5406(part); amd. Sec. 24, Ch. 303, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-813. Repealed

33-22-813. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Secs. 3, 4, Ch. 61, L. 1965; R.C.M. 1947, 40-5403(part), 40-5404; amd. Sec. 13, Ch. 345, L. 1979; amd. Sec. 1, Ch. 713, L. 1989.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-814. Repealed

33-22-814. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 7, Ch. 61, L. 1965; R.C.M. 1947, 40-5407(part).
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-815. Repealed

33-22-815. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 6, Ch. 61, L. 1965; R.C.M. 1947, 40-5406(part).
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 8. Extended Health Insurance (Repealed) › 33-22-816. Repealed

33-22-816. Repealed.
Sec. 69, Ch. 472, L. 1999.
History: En. Sec. 6, Ch. 61, L. 1965; R.C.M. 1947, 40-5406(part).
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-902. Purpose

33-22-902. Purpose.
The purpose of this part is to establish minimum standards for medicare supplement policies and certificates and to establish a regulatory program that meets the requirements of 42 U.S.C. 1395ss(p)(1)(A).
History: En. Sec. 2, Ch. 298, L. 1981; amd. Sec. 1, Ch. 163, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-904. Standards for policy provisions -- rules

33-22-904. Standards for policy provisions -- rules.
(1) A medicare supplement policy or certificate in force in this state may not contain benefits that duplicate benefits provided by medicare.
(2) The commissioner shall adopt reasonable rules to establish specific standards for policy provisions of medicare supplement policies and certificates. A requirement of this code relating to minimum required policy benefits, other than the minimum standards contained in this part, may not apply to medicare supplement policies and certificates. The standards are in addition to and in accordance with applicable laws of this state, including the provisions of Title 33, chapter 22, and may cover but are not limited to:
(a) terms of renewability;
(b) initial and subsequent conditions of eligibility;
(c) nonduplication of coverage;
(d) probationary periods;
(e) benefit limitations, exceptions, and reductions;
(f) elimination periods;
(g) requirements for replacement;
(h) recurrent conditions; and
(i) definitions of terms.
(3) The commissioner may adopt reasonable rules that prohibit policy or certificate provisions not otherwise specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under a medicare supplement policy or certificate.
(4) Notwithstanding any other provisions of the law, a medicare supplement policy or certificate may not exclude or limit benefits for losses incurred more than 6 months from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.
(5) The commissioner may adopt rules necessary to conform medicare supplement policies and certificates to the requirements of federal law and federal regulations, including but not limited to rules:
(a) requiring refunds or credits if the policies or certificates do not meet loss requirements;
(b) establishing a uniform methodology for calculating and reporting loss ratios;
(c) ensuring public access to policies, premiums, and loss ratio information of issuers of medicare supplement insurance;
(d) establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases; and
(e) establishing a policy for holding public hearings prior to approval of premium increases.
History: En. Sec. 4, Ch. 298, L. 1981; amd. Sec. 3, Ch. 682, L. 1989; amd. Sec. 3, Ch. 163, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-905. Minimum standards for benefits and payment of claims -- rules

33-22-905. Minimum standards for benefits and payment of claims -- rules.
The commissioner shall adopt reasonable rules to establish minimum standards for benefits, payment of claims, marketing practices, compensation arrangements, and reporting practices for medicare supplement policies and certificates.
History: En. Sec. 5, Ch. 298, L. 1981; amd. Sec. 4, Ch. 682, L. 1989; amd. Sec. 4, Ch. 163, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-906. Loss ratio standards and filing requirements -- limits on compensation

33-22-906. Loss ratio standards and filing requirements -- limits on compensation.
(1) Medicare supplement policies and certificates must return to policyholders or certificate holders benefits that are reasonable in relation to the premium charged. The commissioner shall adopt reasonable rules to establish minimum standards for loss ratios of medicare supplement policies and certificates on the basis of incurred claims experience or incurred health care expenses, where coverage is provided by a health maintenance organization on a service rather than reimbursement basis, and earned premiums for the entire period for which rates are computed to provide coverage and in accordance with accepted actuarial principles and practices. Every entity providing medicare supplement insurance benefits to a resident of this state shall make premium adjustments:
(a) necessary to produce an expected loss ratio under the policy or certificate that meets the minimum loss ratio standards for medicare supplement policies and certificates as established by rule; and
(b) expected to result in a loss ratio at least as great as that originally anticipated by the entity when it established current premiums for the medicare supplement policy or certificate.
(2) The commissioner shall by rule establish the timing and manner of the premium adjustments. Every entity providing medicare supplement policies or certificates in this state shall annually file with the commissioner its rates, rating schedule, and supporting documentation demonstrating that it is in compliance with the applicable loss ratio standards of this part. An entity transacting medicare supplement insurance in this state may not adjust its rates more than twice a year and may not adjust its rates for the first year a policy is in force, except to allow for changes in federal laws or regulations relating to medicare. Each filing of rates and rating schedules must demonstrate that the actual and expected losses in relation to premiums complies with the requirements of this part.
(3) An entity may not provide compensation to its insurance producers that is greater than the renewal compensation that would be paid on an existing policy or certificate if:
(a) the existing policy or certificate were replaced by another policy or certificate with the same insurer and the new benefits are substantially similar to the benefits under the old policy or certificate; and
(b) the old policy or certificate was issued by the same insurer or insurance group.
History: En. Sec. 6, Ch. 298, L. 1981; amd. Sec. 5, Ch. 682, L. 1989; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 5, Ch. 163, L. 1993; amd. Sec. 26, Ch. 151, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-908. Notice of free examination

33-22-908. Notice of free examination.
Medicare supplement policies and certificates must have a notice prominently printed on the first page of the policy or certificate or attached to the policy or certificate stating in substance that the applicant has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate, the applicant is not satisfied for any reason. The issuer shall pay any refund made pursuant to this section directly to the applicant in a timely manner.
History: En. Sec. 8, Ch. 298, L. 1981; amd. Sec. 7, Ch. 682, L. 1989; amd. Sec. 7, Ch. 163, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-909. Administrative procedures

33-22-909. Administrative procedures.
Rules adopted pursuant to this part are subject to the provisions of 33-1-313 and Title 2, chapter 4.
History: En. Sec. 9, Ch. 298, L. 1981.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-910. Filing requirements for advertising

33-22-910. Filing requirements for advertising.
Every issuer of medicare supplement policies or certificates in this state shall provide to the commissioner for the commissioner's approval a copy of any medicare supplement advertising intended for use in this state, whether through written, radio, or television medium.
History: En. Sec. 8, Ch. 682, L. 1989; amd. Sec. 8, Ch. 163, L. 1993; amd. Sec. 33, Ch. 531, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-911. Penalties

33-22-911. Penalties.
In addition to any other penalties for violations of the insurance code, the commissioner may after hearing require issuers violating any provision of or rule adopted under Title 33, chapter 16, or this part to cease marketing a medicare supplement policy or certificate in this state that is related directly or indirectly to the violation or take action that is necessary to comply with the provisions of Title 33, chapter 16, or this part or the rules adopted under Title 33, chapter 16, or this part, or both.
History: En. Sec. 9, Ch. 682, L. 1989; amd. Sec. 9, Ch. 163, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-921. Discontinuance or nonrenewal -- alternate policy or certificate -- same insurer

33-22-921. Discontinuance or nonrenewal -- alternate policy or certificate -- same insurer.
(1) If a disability insurer discontinues or does not renew a medicare supplement policy product or certificate and offers an alternate medicare supplement policy or certificate to its insureds within this state, it may not deny benefits under the replacing policy or certificate to an insured who receives treatment for a condition that was a covered expense under the replaced policy or certificate and is a covered expense under the replacing policy or certificate if the insured enrolls in and pays the premium for the replacing policy or certificate within 31 days after the termination of the replaced policy or certificate.
(2) A disability insurer who discontinues or does not renew a medicare supplement policy product or certificate and offers an alternate medicare supplement policy or certificate shall base its premium for the alternate policy or certificate on the rates currently in place for that policy or certificate.
(3) If the insured has not satisfied the preexisting condition limitation under the replaced medicare supplement policy or certificate, any period of time that was covered by that policy or certificate must be credited toward the preexisting condition limitation period of the replacing policy or certificate.
History: En. Sec. 1, Ch. 125, L. 1987; amd. Sec. 12, Ch. 798, L. 1991.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-922. Discontinuance or nonrenewal -- alternate policy -- unauthorized bulk reinsurance

33-22-922. Discontinuance or nonrenewal -- alternate policy -- unauthorized bulk reinsurance.
(1) Alternate medicare supplement coverage as provided in 33-22-921 must be offered to its insureds by a disability insurer that:
(a) bulk cedes its medicare supplement policy business to an insurer that does not meet the requirements of chapter 2;
(b) authorizes the bulk reinsurer to administer the medicare supplement policies on its behalf; and
(c) discontinues or does not renew a medicare supplement policy product.
(2) The premium for the alternate policy referred to in subsection (1) must be based on actuarially justified rates.
History: En. Sec. 2, Ch. 125, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-923. Replacement policy or certificate -- different insurer

33-22-923. Replacement policy or certificate -- different insurer.
(1) If a disability insurer replaces a medicare supplement policy or certificate, it may not deny benefits under the replacing policy or certificate to an insured who receives treatment for a condition that was a covered expense under the replaced policy or certificate and is a covered expense under the replacing policy or certificate if the insured pays the premium for the replacing policy or certificate when due or within 31 days after the termination of the replaced policy or certificate.
(2) An insurer who replaces a medicare supplement policy or certificate shall base its premium for the replacement policy or certificate on the rates currently in place for that policy or certificate.
(3) If the insured has not satisfied the preexisting condition limitation under the replaced medicare supplement policy or certificate, any period of time that was covered by that policy or certificate must be credited toward the preexisting condition limitation period of the replacing policy or certificate.
(4) To receive the benefits of subsections (1) through (3), a person shall submit to the replacing insurer proof of prior coverage, evidence of benefits provided under the previous policy or certificate, and the effective date and the date of termination of coverage under the previous policy or certificate.
History: En. Sec. 3, Ch. 125, L. 1987; amd. Sec. 13, Ch. 798, L. 1991.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 9. Medicare Supplement Insurance Minimum Standards › 33-22-924. Renewal requirement

33-22-924. Renewal requirement.
(1) If a person pays a renewal premium on the date it is due or within 31 days after it is due, an insurer may not refuse to renew a medicare supplement policy or certificate unless the insurer:
(a) refuses to renew all policies or certificates in this state that are of the same form and issued to persons of the same class; and
(b) offers a replacement policy or certificate at actuarially justified rates.
(2) If an insurer refuses to renew all policies or certificates in this state that are of the same form and issued to persons of the same class, the policies or certificates will remain in force during the grace period stated in the replaced policy or certificate. An insurer's refusal to renew a policy or certificate may not affect a claim that arose under the discontinued policy or certificate during the period in which an insured was confined without interruption to a medical care facility for treatment.
History: En. Sec. 4, Ch. 125, L. 1987; amd. Sec. 14, Ch. 798, L. 1991.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 10. Home Health Care Coverage › 33-22-1001. Definition of home health care

33-22-1001. Definition of home health care.
"Home health care" means services provided by a licensed home health agency to an insured in the insured's place of residence that is prescribed by the insured's attending physician as part of a written plan of care. Services provided by home health care include:
(1) nursing;
(2) home health aide services;
(3) physical therapy;
(4) occupational therapy;
(5) speech therapy;
(6) hospice service;
(7) medical supplies and equipment suitable for use in the home; and
(8) medically necessary personal hygiene, grooming, and dietary assistance.
History: En. Sec. 1, Ch. 508, L. 1981; amd. Sec. 1231, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 10. Home Health Care Coverage › 33-22-1002. Availability of coverage for home health care

33-22-1002. Availability of coverage for home health care.
Insurers and health service corporations transacting health insurance business in this state shall make available, under group insurance policies or certificates and under group hospital and medical service plan contracts, benefits for home health care. Applicants for a group policy, certificate, or contract may select any level of benefits that may be offered by the insurer or service plan corporation.
History: En. Sec. 2, Ch. 508, L. 1981; amd. Sec. 59, Ch. 227, L. 2001.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 10. Home Health Care Coverage › 33-22-1003. Applicability

33-22-1003. Applicability.
This part applies to policies, certificates, or contracts delivered or issued for delivery in this state after January 29, 1981, but does not apply to blanket, short-term travel, accident-only, limited or specified disease, or individual conversion policies or contracts, to policies or contracts designed for coverage under Title XVIII of the Social Security Act, known as Medicare, or to any other similar coverage under federal governmental plans.
History: En. Sec. 3, Ch. 508, L. 1981; amd. Sec. 60, Ch. 227, L. 2001.