reglab/statecodes huggingface dataset:
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 13. Montana Reinsurance Association Act › 33-22-1322. State innovation waiver

33-22-1322. State innovation waiver.
The commissioner, the governor, and the board shall jointly apply, no later than July 1, 2019, to the U.S. secretary of health and human services under 42 U.S.C. 18052 for a state innovation waiver and federal pass-through funding to implement this part for benefit years beginning January 1, 2020, and future years to maximize federal funding.
History: En. Sec. 15, Ch. 210, L. 2019.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1501. Repealed

33-22-1501. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 1, Ch. 595, L. 1985; amd. Sec. 15, Ch. 798, L. 1991; amd. Sec. 5, Ch. 357, L. 1995; amd. Sec. 17, Ch. 416, L. 1997; amd. Sec. 1, Ch. 173, L. 1999; amd. Sec. 1, Ch. 453, L. 2003; amd. Sec. 29, Ch. 469, L. 2005; amd. Sec. 1, Ch. 133, L. 2011; amd. Sec. 1, Ch. 404, L. 2013; amd. Sec. 23, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1502. Repealed

33-22-1502. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 2, Ch. 595, L. 1985; amd. Sec. 2, Ch. 367, L. 2001; amd. Sec. 2, Ch. 453, L. 2003; amd. Sec. 30, Ch. 469, L. 2005; amd. Sec. 2, Ch. 404, L. 2013; amd. Sec. 24, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1503. Repealed

33-22-1503. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 3, Ch. 595, L. 1985; amd. Sec. 6, Ch. 357, L. 1995; amd. Sec. 2, Ch. 173, L. 1999; amd. Sec. 2, Ch. 528, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1504. Repealed

33-22-1504. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 4, Ch. 595, L. 1985; amd. Sec. 16, Ch. 798, L. 1991; amd. Sec. 7, Ch. 357, L. 1995; amd. Sec. 3, Ch. 173, L. 1999; amd. Sec. 3, Ch. 528, L. 1999; amd. Sec. 2, Ch. 133, L. 2011; amd. Sec. 3, Ch. 404, L. 2013; amd. Sec. 25, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1505. Repealed

33-22-1505. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 13, Ch. 595, L. 1985.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1511. Repealed

33-22-1511. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 5, Ch. 595, L. 1985; amd. Sec. 26, Ch. 798, L. 1991.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1512. Repealed

33-22-1512. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 8, Ch. 595, L. 1985; amd. Sec. 27, Ch. 798, L. 1991; amd. Sec. 8, Ch. 357, L. 1995; amd. Sec. 18, Ch. 416, L. 1997; amd. Sec. 1, Ch. 475, L. 2001; amd. Sec. 41, Ch. 380, L. 2003; amd. Sec. 3, Ch. 133, L. 2011.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1513. Repealed

33-22-1513. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 9, Ch. 595, L. 1985; amd. Sec. 31, Ch. 112, L. 1991; amd. Sec. 17, Ch. 798, L. 1991; amd. Sec. 29, Ch. 349, L. 1993; amd. Sec. 19, Ch. 416, L. 1997; amd. Sec. 4, Ch. 528, L. 1999; amd. Sec. 3, Ch. 367, L. 2001; amd. Sec. 2, Ch. 475, L. 2001; amd. Sec. 42, Ch. 380, L. 2003; amd. Sec. 3, Ch. 453, L. 2003; amd. Sec. 31, Ch. 469, L. 2005; amd. Sec. 26, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1514. Repealed

33-22-1514. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 10, Ch. 595, L. 1985; amd. Sec. 28, Ch. 798, L. 1991; amd. Sec. 5, Ch. 528, L. 1999; amd. Sec. 32, Ch. 469, L. 2005; amd. Sec. 11, Ch. 120, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1515. Repealed

33-22-1515. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 11, Ch. 595, L. 1985; amd. Sec. 1, Ch. 713, L. 1989; amd. Sec. 29, Ch. 798, L. 1991; amd. Sec. 9, Ch. 357, L. 1995; amd. Sec. 5, Ch. 173, L. 1999; amd. Sec. 33, Ch. 469, L. 2005.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1516. Repealed

33-22-1516. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 12, Ch. 595, L. 1985; amd. Sec. 30, Ch. 798, L. 1991; amd. Sec. 10, Ch. 357, L. 1995; amd. Sec. 20, Ch. 416, L. 1997; amd. Sec. 6, Ch. 173, L. 1999; amd. Sec. 4, Ch. 453, L. 2003; amd. Sec. 34, Ch. 469, L. 2005.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1517. Repealed

33-22-1517. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 1, Ch. 357, L. 1995; amd. Sec. 35, Ch. 469, L. 2005; amd. Sec. 16, Ch. 399, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1518. Repealed

33-22-1518. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 2, Ch. 357, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1521. Repealed

33-22-1521. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 6, Ch. 595, L. 1985; amd. Sec. 31, Ch. 798, L. 1991; amd. Sec. 11, Ch. 357, L. 1995; amd. Sec. 152, Ch. 42, L. 1997; amd. Sec. 7, Ch. 173, L. 1999; amd. Sec. 4, Ch. 367, L. 2001; amd. Sec. 4, Ch. 133, L. 2011.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1522. Repealed

33-22-1522. Repealed.
Sec. 34, Ch. 798, L. 1991.
History: En. Sec. 7, Ch. 595, L. 1985.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1523. Repealed

33-22-1523. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 41, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 15. Comprehensive Health Association and Plan (Repealed) › 33-22-1524. Repealed

33-22-1524. Repealed.
Sec. 35, Ch. 63, L. 2015.
History: En. Sec. 1, Ch. 528, L. 1999; amd. Sec. 5, Ch. 453, L. 2003.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 16. Subrogation -- Notice › 33-22-1601. Subrogation rights

33-22-1601. Subrogation rights.
A disability insurance policy subject to this chapter may contain a provision providing that, to the extent necessary for reimbursement of benefits paid to or on behalf of the insured, the insurer is entitled to subrogation, as provided for in 33-22-1602, 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. 1, Ch. 365, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 16. Subrogation -- Notice › 33-22-1602. Notice -- shared costs of third-party action -- limitation

33-22-1602. 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 insurer reasonable notice of the intention to institute the action.
(2) The insured may request that the insurer pay a proportionate share of the reasonable costs of the third-party action, including attorney fees.
(3) An insurer may elect not to participate in the cost of the action. If an election is made, the insurer waives 50% of any subrogation rights granted to it by 33-22-1601.
(4) The insurer's right of subrogation granted in 33-22-1601 may not be enforced until the injured insured has been fully compensated for the insured's injuries.
History: En. Sec. 3, Ch. 365, L. 1987; amd. Sec. 1232, Ch. 56, L. 2009.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 17. Preferred Provider Agreements › 33-22-1702. Purpose

33-22-1702. Purpose.
The purpose of this part is to allow a health care insurer providing disability insurance benefits to negotiate and contract with health care providers to:
(1) provide health care services to its insureds or subscribers at a reduction in the fees customarily charged by the provider; or
(2) enter into agreements in which the participating providers accept negotiated fees as payment in full for health care services the health care insurer is obligated to provide or pay for under the health benefit plan.
History: En. Sec. 2, Ch. 638, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 17. Preferred Provider Agreements › 33-22-1703. Definitions

33-22-1703. Definitions.
As used in this part, the following definitions apply:
(1) "Emergency medical condition" means a condition manifesting itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in any of the following:
(a) the covered person's health would be in serious jeopardy;
(b) the covered person's bodily functions would be seriously impaired; or
(c) a bodily organ or part would be seriously damaged.
(2) "Emergency services" means health care items or services furnished or required to evaluate and treat an emergency medical condition.
(3) "Health benefit plan" means the health insurance policy or subscriber arrangement between the insured or subscriber and the health care insurer that defines the covered services and benefit levels available.
(4) "Health care insurer" means:
(a) an insurer that provides disability insurance as defined in 33-1-207;
(b) a health service corporation as defined in 33-30-101;
(c) a fraternal benefit society as described in 33-7-105; or
(d) any other entity regulated by the commissioner that provides health coverage except a health maintenance organization.
(5) "Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's license or legal authorization or services provided under Title 33, chapter 22, part 7.
(6) "Insured" means an individual entitled to reimbursement for expenses of health care services under a policy or subscriber contract issued or administered by an insurer.
(7) "Preferred provider" means a provider or group of providers who have contracted to provide specified health care services.
(8) "Preferred provider agreement" means a contract between or on behalf of a health care insurer and a preferred provider.
(9) "Provider" means an individual or entity licensed or legally authorized to provide health care services or services covered within Title 33, chapter 22, part 7.
(10) "Subscriber" means a certificate holder or other person on whose behalf the health care insurer is providing or paying for health care coverage.
History: En. Sec. 3, Ch. 638, L. 1987; amd. Sec. 67, Ch. 713, L. 1989; amd. Sec. 40, Ch. 586, L. 1991; amd. Sec. 32, Ch. 451, L. 1993; amd. Sec. 1, Ch. 413, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 17. Preferred Provider Agreements › 33-22-1704. Preferred provider agreements authorized

33-22-1704. Preferred provider agreements authorized.
(1) Notwithstanding any other provision of law to the contrary, a health care insurer may:
(a) enter into agreements with providers relating to health care services that may be rendered to insureds or subscribers on whose behalf the health care insurer is providing health care coverage, including preferred provider agreements relating to:
(i) the amounts an insured may be charged for services rendered; and
(ii) the amount and manner of payment to the provider; and
(b) issue or administer policies or subscriber contracts in this state that include incentives for the insured to use the services of a provider that has entered into an agreement with the insurer pursuant to subsection (1)(a).
(2) A preferred provider agreement issued or delivered in this state may not unfairly deny health benefits for health care services covered.
(3) A preferred provider agreement entered into or renewed after March 26, 1993, must provide each health care provider with the opportunity to participate on the basis of a competitive bid or offer. For each health care service that an insurer proposes to obtain for its insureds from a preferred provider in the geographic area covered by the proposal, the insurer shall provide all known providers of the health care service in that area with an equal opportunity to submit a competitive bid or offer to become a preferred provider. Except as provided in subsection (5), the insurer shall issue a request for proposals and shall select the lowest cost bid or offer. If only one bid or offer is received, the insurer may enter into a preferred provider agreement with the health care provider.
(4) If a bid or an offer is not received in response to a request for proposals under subsection (3), the insurer may not establish a preferred provider agreement for that service in the geographic area except pursuant to a new request for proposals.
(5) An insurer may reserve the right in its request for proposals to reject bids or offers submitted in response to the request, including the lowest cost bid or offer. A bid or offer must be rejected in the manner established in the request for proposals. An insurer may not enter into a preferred provider agreement for a health care service except pursuant to a request for proposals.
History: En. Sec. 4, Ch. 638, L. 1987; amd. Sec. 1, Ch. 714, L. 1991; amd. Sec. 1, Ch. 202, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 17. Preferred Provider Agreements › 33-22-1705. Incentives in health benefit plans

33-22-1705. Incentives in health benefit plans.
(1) A health care insurer may issue a policy or a health benefit plan that provides for incentives for covered persons to use the health care services of preferred providers. The policy or health benefit plan must contain at least:
(a) a provision that if a covered person receives emergency care for services specified in the preferred provider agreement and cannot reasonably reach a preferred provider, the care rendered during the course of the emergency will be reimbursed as though the covered person had been treated by a preferred provider; and
(b) a provision that clearly identifies the difference in benefit levels for health care services of a preferred provider and benefit levels for the same health care services of a nonpreferred provider.
(2) A health care insurer may not require hospital staff privileges as criteria for designation as a preferred provider in a preferred provider agreement.
History: En. Sec. 5, Ch. 638, L. 1987.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 17. Preferred Provider Agreements › 33-22-1706. Permissible and mandatory provisions in provider agreements, insurance policies, and subscriber contracts

33-22-1706. Permissible and mandatory provisions in provider agreements, insurance policies, and subscriber contracts.
(1) A provider agreement, insurance policy, or subscriber contract issued or delivered in this state may contain components designed to control the cost and improve the quality of health care for insureds and subscribers as provided in this part.
(2) All terms or conditions of an insurance policy or subscriber contract, except those already approved by the commissioner, are subject to the prior approval of the commissioner.
(3) Provisions designed to control cost and improve the quality of health care under this section include but are not limited to those that set a payment difference for reimbursement of a nonpreferred provider as compared to a preferred provider and those designed to give policyholders or subscribers an incentive to choose a particular provider consistent with the other provisions of this part.
(4) (a) A health benefit plan that contains a payment difference provision and that the commissioner has determined to have an adequate provider network is not subject to subsection (4)(b).
(b) A health benefit plan that contains a payment difference provision and has not been determined to have an adequate provider network may not exceed a 25% payment difference in the reimbursement level for a preferred provider, and the commissioner shall review differences between copayments, deductibles, and other cost-sharing arrangements under this subsection (4)(b).
(c) For the purposes of this subsection (4), a provider network is adequate if:
(i) the network includes at least 80% of the licensed individual physicians actively practicing in the state of Montana;
(ii) the network includes at least 80% of the licensed individual nonphysician health care providers actively practicing in the state of Montana; and
(iii) the network includes at least 90% of those facilities licensed and operating as hospitals in the state of Montana.
(5) A health benefit plan or other plan offering prepaid dental services under this part shall offer its insureds the right to obtain dental care from any licensed dental care provider of their choice subject to the same terms and conditions imposed under this section.
History: En. Sec. 6, Ch. 638, L. 1987; amd. Sec. 1, Ch. 265, L. 1989; amd. Sec. 1, Ch. 306, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 17. Preferred Provider Agreements › 33-22-1707. Rules

33-22-1707. Rules.
The commissioner may adopt rules necessary to implement the provisions of this part.
History: En. Sec. 7, Ch. 638, L. 1987; amd. Sec. 2, Ch. 413, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1802. Purpose

33-22-1802. Purpose.
(1) This part must be interpreted and construed to effectuate the following express legislative purposes:
(a) to promote the availability of health insurance coverage to small employers regardless of health status or claims experience;
(b) to prevent abusive rating practices;
(c) to require disclosure of rating practices to purchasers;
(d) to establish rules regarding renewability of coverage;
(e) to establish limitations on the use of preexisting condition exclusions;
(f) to provide for the development of basic and standard health benefit plans to be offered to all small employers;
(g) to provide for the establishment of a reinsurance program; and
(h) to improve the overall fairness and efficiency of the small employer health insurance market.
(2) This part is not intended to provide a comprehensive solution to the problem of affordability of health care or health insurance.
History: En. Sec. 23, Ch. 606, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1804. Applicability and scope

33-22-1804. Applicability and scope.
(1) This part applies to a health benefit plan marketed through a small employer that provides coverage to the employees of a small employer in this state if any of the following conditions are met:
(a) a portion of the premium or benefits is paid by or on behalf of the small employer;
(b) an eligible employee or dependent is reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium;
(c) the health benefit plan is treated by the employer or any of the eligible employees or dependents as part of a plan or program for the purposes of section 106, 125, or 162 of the Internal Revenue Code, except a plan or program that is funded entirely by contributions from the employees; or
(d) all of the premium is paid by the employee who obtains coverage through the employer's group health benefit plan.
(2) This part does not apply to an individual health benefit plan for which the entire premium is paid by an employee through payroll deduction or other means.
(3) Unless prohibited by a written opinion from a federal agency, by final regulations implementing Public Law 104-191, or by a ruling by a court of competent jurisdiction, this part does not apply to an individual health benefit plan if the eligible employee or dependent is directly or indirectly reimbursed, whether through wage adjustments or otherwise, by or on behalf of the small employer for any portion of the premium. However, this part does apply to an individual health benefit plan if the employer making the direct or indirect reimbursement for any portion of the premium has had in place an employer-sponsored group health benefit plan in the 12 months preceding the reimbursement.
History: En. Sec. 25, Ch. 606, L. 1993; amd. Sec. 2, Ch. 377, L. 1995; amd. Sec. 22, Ch. 416, L. 1997; amd. Sec. 1, Ch. 403, L. 1999; amd. Sec. 3, Ch. 349, L. 2013; amd. Sec. 27, Ch. 63, L. 2015.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1808. Establishment of classes of business

33-22-1808. Establishment of classes of business.
(1) A small employer carrier may establish a separate class of business only to reflect substantial differences in expected claims experience or administrative costs that are related to the following reasons:
(a) The small employer carrier uses more than one type of system for the marketing and sale of health benefit plans to small employers.
(b) The small employer carrier has acquired a class of business from another small employer carrier.
(c) The small employer carrier provides coverage to one or more association groups that meet the requirements of 33-22-501(2).
(2) A small employer carrier may establish up to nine separate classes of business under subsection (1).
(3) The commissioner shall adopt rules to provide for a period of transition in order for a small employer carrier to come into compliance with subsection (2) in the case of acquisition of an additional class of business from another small employer carrier.
(4) The commissioner may approve the establishment of additional classes of business upon application to the commissioner and a finding by the commissioner that the action would enhance the fairness and efficiency of the small employer health insurance market.
History: En. Sec. 26, Ch. 606, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1810. Renewability of coverage

33-22-1810. Renewability of coverage.
(1) A health benefit plan subject to the provisions of this part is renewable with respect to all eligible employees or their dependents, at the option of the small employer, except in any of the following cases:
(a) nonpayment of the required premium;
(b) fraud or misrepresentation of the small employer or with respect to coverage of individual insureds or their representatives;
(c) noncompliance with the carrier's minimum participation requirements;
(d) noncompliance with the carrier's employer contribution requirements;
(e) repeated misuse of a restricted network provision;
(f) election by the small employer carrier to not renew all of its health benefit plans delivered or issued for delivery to small employers in this state, in which case the small employer carrier shall:
(i) provide advance notice of this decision under this subsection (1)(f) to the commissioner in each state in which it is licensed; and
(ii) at least 180 days prior to the nonrenewal of all small employer health benefit plans by the carrier, provide notice of the decision not to renew coverage to all affected small employers and to the commissioner in each state in which an affected insured individual is known to reside. Notice to the commissioner under this subsection (1)(f) must be provided at least 3 working days prior to the notice to the affected small employers.
(g) the commissioner finds that the continuation of the coverage would:
(i) not be in the best interests of the policyholders or certificate holders; or
(ii) impair the carrier's ability to meet its contractual obligations.
(2) If the commissioner makes a finding under subsection (1)(g), the commissioner shall assist affected small employers in finding replacement coverage.
(3) (a) A small employer carrier that elects not to renew all of its health benefit plans under subsection (1)(f) is prohibited from writing new business in the small employer market in this state for a period of 5 years from the date of notice to the commissioner.
(b) The provisions of 33-22-524(3) apply to a small employer carrier that elects to renew only a portion, but not all, of its small employer health benefit plans.
(4) In the case of a small employer carrier doing business in one established geographic service area of the state, the rules set forth in this section apply only to the carrier's operations in that service area.
History: En. Sec. 28, Ch. 606, L. 1993; amd. Sec. 61, Ch. 227, L. 2001.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1812. Repealed

33-22-1812. Repealed.
Sec. 13, Ch. 377, L. 1995.
History: En. Sec. 31, Ch. 606, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1814. Restoration of terminated coverage

33-22-1814. Restoration of terminated coverage.
The commissioner may promulgate rules to require small employer carriers, as a condition of transacting business with small employers in this state after January 1, 1994, to reissue a health benefit plan to any small employer whose health benefit plan has been terminated or not renewed by the carrier after July 1, 1993. The commissioner may prescribe the terms for the reissuance of coverage that the commissioner finds are reasonable and necessary to provide continuity of coverage to small employers.
History: En. Sec. 36, Ch. 606, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1815. Qualifications for voluntary purchasing pool

33-22-1815. Qualifications for voluntary purchasing pool.
A voluntary purchasing pool of disability insurance purchasers may be formed solely for the purpose of obtaining disability insurance upon compliance with the following provisions:
(1) It contains at least 51 eligible employees.
(2) It establishes requirements for membership. The voluntary purchasing pool shall accept for membership any small employers and may accept for membership any employers with at least 51 eligible employees that otherwise meet the requirements for membership. However, the voluntary purchasing pool may not exclude any small employers that otherwise meet the requirements for membership on the basis of claim experience, occupation, or health status.
(3) It holds an open enrollment period at least once a year during which new members can join the voluntary purchasing pool.
(4) It offers coverage to eligible employees of member employers and to the employees' dependents. Coverage may not be limited to certain employees of member small employers except as provided in 33-22-1811(3)(c).
(5) It does not assume any risk or form self-insurance plans among its members.
(6) (a) Disability insurance policies, certificates, or contracts offered through the voluntary purchasing pool must rate the entire purchasing pool group as a whole and charge each insured person based on a community rate within the common group, adjusted for case characteristics as permitted by the laws governing group disability insurance.
(b) Rates for voluntary purchasing pool groups must be set pursuant to the provisions of 33-22-1809.
(c) At its discretion, premiums may be paid to the disability insurance policies, certificates, or contracts by the voluntary purchasing pool or by member employers.
(7) A person marketing disability insurance policies, certificates, or contracts for a voluntary purchasing pool must be licensed as an insurance producer.
History: En. Sec. 2, Ch. 375, L. 1995; amd. Sec. 51, Ch. 472, L. 1999; amd. Sec. 1, Ch. 376, L. 2003; amd. Sec. 16, Ch. 595, L. 2005; amd. Sec. 27, Ch. 151, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1816. Commissioner powers and duties -- application for registration -- reporting insolvency

33-22-1816. Commissioner powers and duties -- application for registration -- reporting insolvency.
(1) The commissioner shall develop forms for registration of an organization as a voluntary purchasing pool.
(2) An organization seeking to be registered as a voluntary purchasing pool shall make application to the commissioner. The commissioner shall register an organization as a voluntary purchasing pool upon proof of fulfillment of the qualifications provided in 33-22-1815.
(3) Except as provided in subsection (5), on March 1 of each year, the voluntary purchasing pool shall provide a report and financial statement for the previous calendar year to the commissioner so that the commissioner may determine:
(a) whether the operation of the voluntary purchasing pool is fiscally sound;
(b) whether the voluntary purchasing pool is bearing any risk; and
(c) the number of individuals covered.
(4) The annual report of the voluntary purchasing pool must disclose its total administrative cost.
(5) A voluntary purchasing pool may choose to operate on a fiscal year other than on the calendar year. A voluntary purchasing pool that establishes a fiscal year that is other than the calendar year shall provide the report required in subsection (3) to the commissioner within 60 days of the voluntary purchasing pool's fiscal yearend.
History: En. Sec. 3, Ch. 375, L. 1995; amd. Sec. 52, Ch. 472, L. 1999; amd. Sec. 1, Ch. 87, L. 2009; amd. Sec. 28, Ch. 151, L. 2017.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1817. Collection of charges and premiums

33-22-1817. Collection of charges and premiums.
(1) All insurance or premiums collected by a voluntary purchasing pool on behalf of or for an insurer and all return premiums received from the insurer are held by the voluntary purchasing pool in a fiduciary capacity. These funds must be remitted immediately to the person entitled to them or must be deposited promptly in a fiduciary bank account established and maintained by the administrator of the voluntary purchasing pool. If deposited charges or premiums are collected on behalf of or for more than one insurer, the voluntary purchasing pool shall either keep or require the bank in which the fiduciary account is maintained to keep records clearly recording the deposits to and withdrawals from the account on behalf of each insurer. The voluntary purchasing pool shall promptly obtain and keep copies of all these records and shall, upon request of an insurer, furnish the insurer with copies of the records pertaining to deposits and withdrawals on behalf of or for the insurer.
(2) The voluntary purchasing pool may not pay a claim by withdrawals from the fiduciary account. Withdrawals from the fiduciary account must be made, as provided in the written agreement between the voluntary purchasing pool and the insurer, for:
(a) remittance to an insurer entitled to the remittance;
(b) deposit in an account maintained in the name of the insurer;
(c) payment to a group policyholder for remittance to the insurer entitled to the payment; or
(d) remittance of return premiums to the person entitled to the premium.
History: En. Sec. 4, Ch. 375, L. 1995.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1818. Repealed

33-22-1818. Repealed.
Sec. 3, Ch. 103, L. 1999.
History: En. Sec. 30(1)-(3), Ch. 606, L. 1993; amd. Sec. 7, Ch. 377, L. 1995; amd. Sec. 1, Ch. 15, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1819. Repealed

33-22-1819. Repealed.
Sec. 3, Ch. 103, L. 1999.
History: En. Sec. 30(4)-(15), Ch. 606, L. 1993; amd. Sec. 8, Ch. 377, L. 1995; amd. Sec. 66, Ch. 379, L. 1995; amd. Sec. 2, Ch. 15, L. 1997; amd. Sec. 25, Ch. 416, L. 1997; amd. Sec. 35, Ch. 531, L. 1997; amd. Sec. 2, Ch. 103, L. 1999.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1820. Periodic market evaluation -- report

33-22-1820. Periodic market evaluation -- report.
The commissioner may study and report at least every 3 years to the governor or other interested persons on the effectiveness of this part. The report must analyze the effectiveness of this part in promoting rate stability, product availability, and coverage affordability. The report may contain recommendations for actions to improve the overall effectiveness, efficiency, and fairness of the small employer health insurance markets. The report must address whether carriers and producers are fairly and actively marketing or issuing health benefit plans to small employers in fulfillment of the purposes of this part. The report may contain recommendations for market conduct or other regulatory standards or action.
History: En. Sec. 32, Ch. 606, L. 1993; amd. Sec. 9, Ch. 377, L. 1995; amd. Sec. 36, Ch. 531, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1821. Waiver of certain laws

33-22-1821. Waiver of certain laws.
A small employer carrier may exclude any category of licensed health care practitioner and any benefit or coverage for health care services otherwise required by law or rule from a basic health benefit plan delivered or issued for delivery in this state.
History: En. Sec. 33, Ch. 606, L. 1993; amd. Sec. 10, Ch. 377, L. 1995; amd. Sec. 15, Ch. 227, L. 2011.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1822. Administrative procedure

33-22-1822. Administrative procedure.
The commissioner shall adopt rules in accordance with the Montana Administrative Procedure Act to implement and administer this part.
History: En. Sec. 34, Ch. 606, L. 1993.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1827. Repealed

33-22-1827. Repealed.
Sec. 24, Ch. 227, L. 2011.
History: En. Sec. 5, Ch. 377, L. 1995; amd. Sec. 5, Ch. 410, L. 1997; amd. Sec. 26, Ch. 416, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 18. Small Employer Health Insurance Availability Act › 33-22-1828. Repealed

33-22-1828. Repealed.
Sec. 24, Ch. 227, L. 2011.
History: En. Sec. 6, Ch. 377, L. 1995; amd. Sec. 27, Ch. 416, L. 1997; amd. Sec. 37, Ch. 531, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1901. Scope -- purpose

33-22-1901. Scope -- purpose.
The provisions of this part apply to all health benefit plans offered to persons who receive health care services in this state. The purpose of this part is to ensure that obstetricians and gynecologists may be participating primary care physicians under health benefit plans offered to patients who receive health care services in this state and that persons covered by health benefit plans have direct access to the services of a participating obstetrician or gynecologist of their choice.
History: En. Sec. 1, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1902. Definitions

33-22-1902. Definitions.
As used in this part, the following definitions apply:
(1) "Covered person" means a policyholder, subscriber, certificate holder, enrollee, or other individual who is participating in a health benefit plan.
(2) "Health benefit plan" means any individual or group plan, policy, certificate, subscriber contract, contract of insurance provided by a managed care plan, preferred provider agreement, or health maintenance organization subscriber contract that is issued, delivered, issued for delivery, or renewed in this state by a health carrier that pays for, purchases, or furnishes health care services to covered persons who receive health care services in this state. For the purposes of this part, a health benefit plan located or domiciled outside of the state of Montana is subject to the provisions of this part if it receives, processes, adjudicates, pays, or denies claims for health care services submitted by or on behalf of covered persons who reside or who receive health care services in the state of Montana.
(3) "Health carrier" means a disability insurer, health care insurer, health maintenance organization, accident and sickness insurer, fraternal benefit society, nonprofit hospital service corporation, health service corporation, health care service plan, preferred provider organization or arrangement, multiple employer welfare arrangement, or any other person, firm, corporation, joint venture, or similar business entity.
(4) "Obstetrician or gynecologist" means a physician who is board-eligible or board-certified by the American board of obstetrics and gynecology.
(5) "Participating obstetrician or gynecologist" means an obstetrician or gynecologist who is employed by or under contract with a health benefit plan.
(6) "Primary care physician" means a physician who has the responsibility for providing initial and primary care to patients, for maintaining the continuity of patient care, and for initiating referrals for specialist care.
History: En. Sec. 2, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1903. Obstetricians or gynecologists as primary care physicians

33-22-1903. Obstetricians or gynecologists as primary care physicians.
(1) Each health benefit plan that provides coverage for primary care or obstetrical or gynecological care must allow obstetricians and gynecologists to participate as primary care physicians. The health carrier that provides the health benefit plan shall contract with a sufficient number of obstetricians and gynecologists to ensure that covered persons have access to the options under this section without unreasonable delay if there are obstetricians or gynecologists practicing in the geographic service areas in which the plan operates who are willing to participate in the plan. An obstetrician or gynecologist may not be required to accept primary care physician status if the obstetrician or gynecologist does not wish to be designated as a primary care physician. A health benefit plan must use the same criteria with regard to credentials and other selection criteria for a participating obstetrician or gynecologist as are applied by the health benefit plan with respect to other physicians who are participating in the health benefit plan. An obstetrician or gynecologist wishing to accept designation as a primary care physician must meet the same criteria with regard to credentials and other selection criteria for a participating primary care physician as other physicians who are participating as primary care physicians in the health benefit plan.
(2) Each health benefit plan must allow a covered person to select any participating obstetrician or gynecologist of the covered person's choice as the covered person's primary care physician.
History: En. Sec. 3, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1904. Self-referral for obstetrical or gynecological care permitted

33-22-1904. Self-referral for obstetrical or gynecological care permitted.
(1) A health benefit plan must permit self-referral to any participating obstetrician or gynecologist by a covered person who has not selected a participating obstetrician or gynecologist as the covered person's primary care physician for services covered under the health benefit plan. This self-referral is for the purpose of receiving any obstetrical or gynecological examination or care and primary and preventative obstetrical and gynecological services required as a result of any obstetrical or gynecological examination or condition. This self-referral must be allowed without prior authorization or precertification from the health benefit plan or covered person's primary care physician, but the health benefit plan may require the covered person to notify the plan prior to self-referral.
(2) The services covered by this section may be limited to those services defined by the most recent published recommendations of the American college of obstetricians and gynecologists. The self-referral permitted by this section may be limited to one participating obstetrician or gynecologist for obstetrical care and one participating obstetrician or gynecologist for gynecological care of the covered person's choice annually.
(3) The participating obstetrician or gynecologist and the covered person shall comply with the health benefit plan's coordination and referral policies. The health benefit plan may require the participating obstetrician or gynecologist to whom the covered person self-refers to discuss with the covered person's primary care physician any services or treatment the participating obstetrician or gynecologist recommends for the covered person.
(4) Self-referral under this section may not affect the covered person's coverage under the health benefit plan. It is the intent of this section that a covered person must at all times have direct access to the covered services of the participating obstetrician or gynecologist of the covered person's choice under any health benefit plan.
History: En. Sec. 4, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1905. Surcharges not allowed

33-22-1905. Surcharges not allowed.
A health benefit plan may not impose a surcharge or additional copayments or deductibles upon a covered person who seeks or receives health care services under 33-22-1903 or 33-22-1904 unless similar surcharges or additional copayments or deductibles are imposed for other types of health care services not described in 33-22-1903 and 33-22-1904.
History: En. Sec. 5, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1906. Payment of covered services provided by certified advanced practice registered nurses

33-22-1906. Payment of covered services provided by certified advanced practice registered nurses.
A health benefit plan may not deny payment for covered services provided to a covered person under 33-22-1903 and 33-22-1904 by a certified advanced practice registered nurse practicing in collaboration with the participating obstetrician or gynecologist. This section may not be construed to expand the definitions of participating obstetrician or gynecologist or primary care physician in 33-22-1902 to include certified advanced practice registered nurses.
History: En. Sec. 6, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1907. Disclosure

33-22-1907. Disclosure.
Each health benefit plan shall disclose in all of its plan literature, in clear, accurate language, the covered person's option to seek the care described in this part without preapproval, preauthorization, or referral.
History: En. Sec. 7, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 19. Obstetricians and Gynecologists -- Primary Care Physicians › 33-22-1908. Enforcement

33-22-1908. Enforcement.
If the commissioner determines that a health benefit plan does not comply with this part or that a health carrier has not complied with a provision of this part, the commissioner may:
(1) recommend a correction plan that must be followed by the health carrier;
(2) institute corrective action that must be followed by the health carrier;
(3) suspend or revoke the certificate of authority or deny the health carrier's application for a certificate of authority; or
(4) use any of the commissioner's enforcement powers to obtain the health carrier's compliance with this part.
History: En. Sec. 8, Ch. 198, L. 1997.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 20. Small Business Health Insurance Purchasing Pool (Repealed) › 33-22-2001. Repealed

33-22-2001. Repealed.
Sec. 54, Ch. 151, L. 2017.
History: En. Sec. 1, Ch. 595, L. 2005; amd. Sec. 38, Ch. 44, L. 2007; amd. Sec. 17, Ch. 399, L. 2007.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 20. Small Business Health Insurance Purchasing Pool (Repealed) › 33-22-2002. Repealed

33-22-2002. Repealed.
Sec. 54, Ch. 151, L. 2017.
History: En. Sec. 2, Ch. 595, L. 2005; amd. Sec. 18, Ch. 399, L. 2007; amd. Sec. 16, Ch. 227, L. 2011; amd. Sec. 18, Ch. 169, L. 2013.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 20. Small Business Health Insurance Purchasing Pool (Repealed) › 33-22-2003. Repealed

33-22-2003. Repealed.
Sec. 54, Ch. 151, L. 2017.
History: En. Sec. 3, Ch. 595, L. 2005.
2023 Montana Code Annotated › Title 33. Insurance and Insurance Companies › Chapter 22. Disability Insurance › Part 20. Small Business Health Insurance Purchasing Pool (Repealed) › 33-22-2004. Repealed

33-22-2004. Repealed.
Sec. 54, Ch. 151, L. 2017.
History: En. Sec. 4, Ch. 595, L. 2005; amd. Sec. 19, Ch. 399, L. 2007; amd. Sec. 2, Ch. 87, L. 2009; amd. Sec. 17, Ch. 227, L. 2011; amd. Sec. 1, Ch. 331, L. 2013.