reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4204 - QUALIFICATIONS FOR INSTRUCTORS

Current through Register Vol. 13, July 5, 2024
(1) Unless
				exempted by ARM
				6.6.4213, instructors must meet the
				following qualifications for the commissioner to approve the course:
(a) hold a high school diploma or equivalent
				certificate; and
(b) have
				experience in at least one of the following:
(i) have three or more years of managerial,
				supervisory, technical, or teaching experience in the insurance lines the
				individual plans to teach;
(ii)
				have appropriate national designations; or
(iii) have been approved on an exception
				basis by the commissioner.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4205 - EXAMINATIONS

Current through Register Vol. 13, July 5, 2024
(1) Except as provided in (5) below, all
				courses must include an examination which requires a passing score to qualify
				for a certificate of completion.
(2) For each approved course, the sponsoring
				organization shall maintain a pool of tests sufficient to maintain the
				integrity of the testing process.
(3) The sponsoring organization shall
				administer, monitor, grade, and record the results of the test.
(4) The sponsoring organization shall retain
				completed tests for a period of not less than 12 months, and the tests must not
				be returned to any licensee.
(5)
				Courses taught by an approved instructor in a classroom setting are exempted
				from the examination requirement.
33-1-313,
					 33-17-1206, MCA; IMP,
					 33-17-1204,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4206 - LIMIT ON CREDIT FOR COURSES REPEATED AND TIMING OF EARNING CREDITS

Current through Register Vol. 13, July 5, 2024
(1) A licensee may not earn credit for any
				courses repeated as either student or instructor within the same biennial
				cycle.
(2) A licensee may earn
				credit as soon as the licensee is licensed.
33-1-313,
					 33-17-1206, MCA; IMP,
					 33-17-1203,
					 33-17-1204,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4207 - EXTENSIONS OF TIME FOR COURSE COMPLETIONS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-17-1206, MCA; IMP,
					 2-4-631 and
					 33-17-1205,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4208 - NONRESIDENT REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) A nonresident
				licensee may satisfy the continuing education requirements of this state by
				submitting proof of course completion that demonstrates compliance with the
				Continuing Legal Education (CLE) requirements of the home state or designated
				home state in which the nonresident licensee is licensed.
(2) If the home state or designated home
				state in which the nonresident licensee is licensed does not require continuing
				education, the licensee shall submit to this state proof of course completion
				that demonstrates compliance with the basic requirements of
				33-17-1203, MCA.
33-1-313,
					 33-17-1206, MCA; IMP,
					 33-17-1203,
					 33-17-1204,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4209 - COURSE AUDIT

Current through Register Vol. 13, July 5, 2024
(1) The
				commissioner or members of the commissioner's staff may audit courses approved
				for the continuing education program on a no-fee basis and as a regular part of
				course review, with or without notice to the course provider.
(2) A sponsoring organization shall provide
				records at the commissioner's request.
33-1-313 and
					 33-17-1206, MCA; IMP,
					 33-17-1203,
					 33-17-1204 and
					 33-17-1205,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4210 - SANCTIONS AGAINST COURSES AND SPONSORING ORGANIZATION SUSPENSION

Current through Register Vol. 13, July 5, 2024
(1) Approval of a program may be revoked or
				placed under probationary approval if the commissioner determines that:
(a) the program teaching method or program
				content no longer meet the standards of these rules or have been significantly
				changed without approval of the commissioner; or
(b) the sponsoring organization certifies
				that an individual has completed a program in accordance with the standards
				established for certification or completion of the program, when in fact the
				individual has not done so; or
(c)
				the sponsoring organization did not certify licensees who satisfactorily
				completed the program in accordance with the sponsoring organization's
				standards for certification or completion; or
(d) the instructor or sponsoring organization
				no longer meets the standards of these rules, has had a license revoked or
				placed under probationary approval, or lacks education or experience in the
				subject matter of the proposed courses.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4211 - REQUESTS FOR RECONSIDERATION OF CREDIT HOUR ASSIGNMENT

Current through Register Vol. 13, July 5, 2024
(1) A sponsoring organization may request
				reconsideration of the credit hours assigned to a course. Such requests must:
(a) be in writing;
(b) include any additional supporting
				documentation on which the request is based to include documentation to show
				how many blocks of 50 minute instruction are in the course of instruction;
				and
(c) be submitted to the
				commissioner within 20 business days of notification to the sponsoring
				organization of assignment of credit hours to the course.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4212 - REQUESTS FOR RECONSIDERATION OF COURSE DISAPPROVAL

Current through Register Vol. 13, July 5, 2024
(1) A sponsoring organization may request
				reconsideration of the credit hours assigned to a course. Such requests must:
(a) be in writing;
(b) include any additional supporting
				documentation on which the request is based; and
(c) be submitted to the commissioner within
				20 business days of notification to the sponsoring organization of assignment
				of credit hours to the course.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4213 - CONDITIONS OF NONRESIDENT SPONSORING ORGANIZATIONS

Current through Register Vol. 13, July 5, 2024
(1) A nonresident sponsoring organization
				doing business in this state through any agreement conveying reciprocity to
				such an entity is subject to the following conditions:
(a) the commissioner may not require the
				sponsoring organization to file courses for substantive review that have been
				awarded credit by the resident state. However, the sponsoring organization
				shall file a course outline with the commissioner. The sponsoring organization
				shall also file the instructors' names;
(b) the commissioner may disapprove
				instructors or sponsoring organizations who have been the subject of
				disciplinary proceedings or who have otherwise failed to comply with a state's
				laws and rules;
(c) the
				commissioner agrees to notify other states when a sponsoring organization has
				been the subject of a formal administrative action or other disciplinary
				action;
(d) the commissioner shall
				accept the NAIC standard continuing education form or a substantially similar
				form provided by a nonresident sponsoring organization;
(e) the commissioner shall award a course the
				same number of credits and will accept all course topics as approved by the
				sponsoring organization's resident state;
(f) a sponsoring organization shall pay the
				commissioner a $75 fee for each course submitted as required by
				33-17-1204, MCA;
(g) the commissioner is not required to
				accept any topic, provider or instructor that is not eligible for approval
				under this state's laws and regulations.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.42 - Continuing Education Program for Insurance Producers and Consultants › Rule 6.6.4214 - EXTENSIONS OF TIME FOR COURSE COMPLETION

Current through Register Vol. 13, July 5, 2024
(1)
				A request for an extension of time for required credit hour completion must be
				in writing and must include a narrative description of the reasons for the
				request and any available documentation to support the request.
(2) The licensee's licenses and appointments
				will remain in effect during an extension period granted by the commissioner
				unless the licensee terminates his or her license during that period.
33-1-313,
					 33-17-1206, MCA; IMP,
					 2-4-631,
					 33-17-1205,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.43 - Electronic Filing of the Appointment and Termination of Insurance Producers (Repealed) › Rule 6.6.4301 - DEFINITIONS (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313,
					 33-2-709,
					 33-17-236, MCA; IMP:
					 33-2-708,
					 33-17-236,
					 33-17-237,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.43 - Electronic Filing of the Appointment and Termination of Insurance Producers (Repealed) › Rule 6.6.4302 - ALLOWABLE METHODS OF ELECTRONIC FILING (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313,
					 33-2-709,
					 33-17-236, MCA ;IMP:
					 33-2-708,
					 33-17-236,
					 33-17-237,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.43 - Electronic Filing of the Appointment and Termination of Insurance Producers (Repealed) › Rule 6.6.4303 - PROCEDURES FOR ELECTRONIC FILING OF APPOINTMENTS (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313,
					 33-2-709,
					 33-17-236, MCA; IMP:
					 33-2-708,
					 33-17-236,
					 33-17-237,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.44 - Debt Collections › Rule 6.6.4401 - PURPOSE AND SCOPE

Current through Register Vol. 13, July 5, 2024
AUTH:
					 30-10-107,
					 33-1-313, MCA IMP:
					 17-4-110
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.44 - Debt Collections › Rule 6.6.4402 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
AUTH:
					 30-10-107,
					 33-1-313, MCA IMP:
					 17-4-110
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.44 - Debt Collections › Rule 6.6.4403 - REFERRAL FOR RECOVERY AND OFFSET

Current through Register Vol. 13, July 5, 2024
AUTH:
					 30-10-107,
					 33-1-313, MCA IMP:
					 17-4-110
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.44 - Debt Collections › Rule 6.6.4404 - UNCOLLECTIBLE DEBT

Current through Register Vol. 13, July 5, 2024
AUTH:
					 30-10-107,
					 33-1-313, MCA IMP:
					 17-4-110
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.46 - Montana Life and Health Insurance Guaranty Association Act and Notice Concerning Coverage Limitations and Exclusions › Rule 6.6.4601 - ADOPTION OF NOTICE

Current through Register Vol. 13, July 5, 2024
(1) The
				commissioner adopts the form and content of the summary notice and disclosure
				document regarding the protection provided by the Montana Life and Health
				Insurance Guaranty Association as set out in Appendix A in
				6.6.4603.
(2) The summary notice and disclosure
				document set out in Appendix A are substantially similar to the National
				Association of Insurance Commissioners' Notice of Protection Provided by
				[State] Life and Health Insurance Guaranty Association, Guideline #1525,
				adopted April, 2010.
33-1-313,
					 33-10-210, MCA; IMP,
					 33-10-210,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.46 - Montana Life and Health Insurance Guaranty Association Act and Notice Concerning Coverage Limitations and Exclusions › Rule 6.6.4602 - DELIVERY OF NOTICE

Current through Register Vol. 13, July 5, 2024
(1) The notice
				adopted in this subchapter shall be delivered where appropriate to the policy,
				certificate, or contract holder.
33-1-313,
					 33-10-210, MCA; IMP,
					 33-10-210,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.48 - Fire Tax › Rule 6.6.4801 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
The following definitions apply to this subchapter:
(1) "Fire premium" means the portion of
				property insurance premium an insurer reasonably attributes to insurance
				against fire, in relation to all other risks covered by the property insurance
				policy at issue.
(2) "Presumptively
				reasonable allocation" means the minimum percentage of fire premium the CSI
				determines to be reasonable pursuant to
				33-2-705(3), MCA,
				without further justification from the insurer.
AUTH:
					 33-1-313, MCA; IMP:
					 33-2-705, MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.48 - Fire Tax › Rule 6.6.4802 - FIRE PREMIUM ALLOCATION PROCEDURE

Current through Register Vol. 13, July 5, 2024
(1)
				Insurers paying fire premium tax required by
				50-3-109(1), MCA,
				shall provide to the CSI the calculation of fire premium separately for each
				line of business identified in
				50-3-109(2),
				MCA.
(2) For each line of business
				identified in
				50-3-109(2), MCA,
				the following apply to an insurer's reporting obligation under (1):
(a) If the percentage of fire premium
				reported is at or above the presumptively reasonable allocation, the insurer
				need not provide any other documentation to justify that fire
				premium;
(b) If the percentage of
				fire premium reported is below the presumptively reasonable allocation, the
				insurer shall provide the basis for the calculation of fire premium along with
				any supporting documentation to the CSI. If the CSI accepts the insurer's
				calculation of fire premium, and in subsequent years the percentage of fire
				premium remains the same, the insurer is not required to provide such
				justification to the CSI; or
(c)
				Unless the presumptively reasonable allocation for a line of business is 0% as
				provided in ARM 6.6.4803(1), if the fire premium reported is zero, the insurer
				shall provide the policy terms which show that risk of fire is excluded from
				the policy. If the CSI accepts the insurer's calculation of fire premium, and
				in subsequent years the calculation and policy terms remain the same, the
				insurer is not required to provide such policy terms to the CSI.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.48 - Fire Tax › Rule 6.6.4803 - PRESUMPTIVELY REASONABLE ALLOCATIONS

Current through Register Vol. 13, July 5, 2024
(1) For
				purposes of
				33-2-705(3) and
				50-3-109(2), MCA,
				the presumptively reasonable allocations for the following lines of business
				are 50-3-109 as follows:
(a) for fire, 100%;
(b) for allied lines, 30%;
(c) for farmowners multi-peril,
				40%;
(d) for homeowners
				multi-peril, 40%;
(e) for
				commercial multi-peril (nonliability), 50%;
(f) for commercial multi-peril (liability),
				0%;
(g) for ocean marine,
				12%;
(h) for inland marine,
				15%;
(i) for other private
				passenger auto liability, 0%;
(j)
				for other commercial auto liability, 0%;
(k) for private passenger auto physical
				damage, 9%;
(l) for commercial auto
				physical damage, 9%;
(m) for
				aircraft, 15%;
(n) for burglary and
				theft, 0%; and
(o) for boiler and
				machinery, 0%.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4901

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4902

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4903

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4905

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4906

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4907

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4908

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.49 - Patient-Centered Medical Homes › Rule 6.6.4909

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-40-104, MCA; IMP:
					 33-40-104,
					 33-40-105,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5001 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
For the purposes of this sub-chapter, the following terms
				  have the following definitions:
(1)
				"Act" means the Montana Small Employer Health Insurance Availability
				Act.
(2) "Adjusted gross income"
				means gross income minus deductions recognized by the Internal Revenue
				Code.
(3) "Associate member of an
				employee organization" means any individual who participates in an employee
				benefit plan, as defined in 29 U.S.C. 1002 (1), that is a
				multiemployer plan, as defined in
				29 U.S.C.
				1002 (37A), other than the following:
(a) An individual (or the eligible dependent
				of such individual) who is employed by a participating employer within a
				bargaining unit covered by at least one of the collective bargaining agreements
				under or pursuant to which the employee benefit plan is established or
				maintained; or
(b) An individual
				who is a present or former employee (or an eligible dependent of such employee)
				of the sponsoring employee organization, of an employer who is, or was a party
				to at least one of the collective bargaining agreements under or pursuant to
				which the employee benefit plan is established or maintained, or of the
				employee benefit plan, or of a related plan.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5004 - APPLICABILITY, SCOPE, AND TRANSITION

Current through Register Vol. 13, July 5, 2024
(1)
				Except as provided elsewhere in this rule, this subchapter applies to any
				health benefit plan, whether provided on a group or individual basis, which:
(a) Meets one or more of the conditions set
				forth in 33-22-1804, MCA; and
(b) Provides coverage to one or more
				employees of a small employer located in this state, without regard to whether
				the policy or certificate was issued in this state.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5008 - COVERED SERVICES OF POLICIES UNDER STANDARD PLAN

Current through Register Vol. 13, July 5, 2024
(1) Coverage for all usual, customary, and
				reasonable charges related to medically necessary services rendered, as defined
				by the small employer carrier includes as follows:
(a) The benefits provided shall be
				coordinated pursuant to ARM
				6.6.2401 through
				6.6.2405.
(b) Coverage for all statutory mandated
				benefits, including, but not limited to those mandated by
				33-22-132, MCA, (mammography
				examinations) ;
				33-22-512, MCA,
				33-30-1014, MCA (well child care)
				; 33-22-703, MCA (mental illness,
				and chemical dependency) ;
				33-22-114, MCA, (services of
				physician's assistants - certified) ;
				33-22-125, MCA, (independent
				chiropractic examination and review) ;
				33-22-130, MCA, (treatment of
				adopted children) ;
				33-22-131, MCA, (phenylketonuria
				treatment) ;
				33-22-301, MCA,
				33-22-504, MCA, and
				33-30-1001, MCA, (newborns) ;
				33-22-304, MCA,
				33-22-506, MCA, and
				33-30-1004, MCA, (continuation of
				coverage for the handicapped) ;
				33-22-305 through
				33-22-311, MCA (the Individual
				Family Disability Insurance Continuation of Coverage Act) ;
				33-22-503, MCA (regarding
				continuation of benefits to dependents) ;
				33-22-507, MCA (regarding
				continuing group coverage after reduction of work schedule) ;
				33-22-508, MCA (regarding
				conversion on termination of eligibility) ;
				33-22-509, MCA (regarding
				imposition of pre-existing conditions to a converted policy covered by a group
				contract) ; and
				33-22-510, MCA (insured
				family-conversion entitlement).
(c)
				Standard plans must comply with
				49-2-309, MCA.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5012 - COVERED PREVENTIVE CARE AND HEALTH MAINTENANCE SERVICE OF POLICIES UNDER STANDARD PLAN (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802 and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5016 - SERVICES THAT MAY BE EXCLUDED FROM COVERAGE UNDER THE STANDARD PLAN (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802 and 33-22- 1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5020 - DEDUCTIBLE CHARGES, COINSURANCE, MAXIMUM ALLOWABLE OUT-OF-POCKET CHARGES, AND LIFETIME MAXIMUM BENEFIT LEVEL UNDER THE STANDARD PLAN (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1812, and
					 33-22-1828,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5024 - HMO COST SHARING SCHEDULE AND EXCEPTION TO STANDARD PLAN PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) Standard plans offered by HMOs must
				comply with ARM
				6.6.5008. HMO plans may require
				that all services provided in ARM
				6.6.5008 must be rendered or
				referred by a primary care provider.
(2) Standard plans offered by HMOs must offer
				a comparable level of benefits to a standard plan contemplated in
				33-22-1828, MCA and ARM
				6.6.5008 as determined by the
				benefit value.
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1812, and
					 33-22-1828,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5028 - CONTRACT LANGUAGE (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802 and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5032 - CRITERIA OF POLICIES OFFERED UNDER BASIC PLAN

Current through Register Vol. 13, July 5, 2024
(1) Any health benefit plan offered to a
				small employer group that has a benefit value, as calculated in ARM
				6.6.5036, of less than the benefit
				value of the insurer's standard plan will qualify as a basic health benefit
				plan contemplated by
				33-22-1827, MCA.
(2) Any HMO plan offered by a small employer
				carrier that offers fewer benefits than the carrier's standard HMO plan is
				subject to the commissioner's final determination, as contemplated by
				33-22-1827, MCA.
(3) All basic health benefit plans and basic
				HMO plans contemplated by
				33-22-1827, MCA, may exclude
				coverage for services of any category of licensed practitioners and any type of
				health care service otherwise required by law or rule, except as specified in
				33-22-1827 and
				33-22-1903, MCA. Basic health
				benefit plans must comply with
				49-2-309, MCA.
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1812, and
					 33-22-1827,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5040 - COST CONTAINMENT FEATURES OF BASIC AND STANDARD PLANS (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802 and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5044 - FILING AND APPROVAL OF BASIC AND STANDARD PLANS (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313,
					 33-1-501 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1811, and 33- 22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5050 - STATUS OF CARRIERS AS SMALL EMPLOYER CARRIERS - PERMISSION TO REENTER - ANNUAL REPORTING REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) In order to
				enter the small employer market, health insurance carriers must:
(a) Have prior approval by the commissioner
				of at least one basic and one standard health benefit plan for issuance in the
				small employer market; and
(b)
				Notify the commissioner of:
(i) All the
				carrier's health benefit plans intended for use in the small employer market,
				and the date of approval of all forms used in connection with those plans;
				and
(ii) The carrier's intent to
				comply with all provisions of the Small Employer Health Insurance Availability
				Act, including guaranteed issue requirements for all health benefit plans
				actively marketed by the carrier.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5054 - APPLICATION TO REENTER STATE (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1810, and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5058 - REQUIREMENT TO INSURE ENTIRE GROUPS

Current through Register Vol. 13, July 5, 2024
(1) A
				carrier providing health insurance coverage to a small employer shall offer
				coverage to all eligible employees and their dependents and shall issue
				coverage to all eligible employees and their dependents who make timely
				application and who do not waive coverage under (6). Except as provided in (2),
				such small employer carriers shall provide the same health benefit plan to each
				such eligible employee and dependent.
(2) Small employer carriers may offer the
				employees of a small employer the option of choosing among any health plans
				which have been chosen by the employer. The choice among benefit plans may not
				be limited, restricted, or conditioned based upon the risk characteristics of
				the employees or their dependents or upon any factors set forth in
				33-22-526, MCA.
(3) A small employer has the sole discretion,
				within the parameters of
				33-22-1803(13),
				MCA and ARM
				6.6.5001(8), to
				define the hourly workweek eligibility criteria as a normal workweek between 20
				and 40 hours, provided the criteria is applied uniformly among all employees.
				If the employer has chosen to define the hourly eligibility as other than 30
				hours a week, the employer must sign a contract endorsement stating the
				following:
(a) the specific hourly employee
				eligibility requirement with a normal workweek between 20 and 40
				hours;
(b) that all employees have
				been, and new employees will be, informed of the eligibility
				requirement;
(c) that the hourly
				eligibility requirement was not established for the purposes of excluding an
				employee or dependent of an employee because of the individual's health status,
				claims experience, risk characteristics, or any factor set forth in
				33-22-526, MCA; and
(d) that the eligibility requirement applies
				uniformly among all employees.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5060 - COVERAGE THROUGH ASSOCIATIONS

Current through Register Vol. 13, July 5, 2024
(1) A bona fide
				association must:
(a) Meet all the
				requirements listed in
				33-22-1803(8),
				MCA; for purposes of meeting the requirement of being actively in existence for
				at least 5 years, activities for that duration must include legitimate trade or
				association business; and
(b) Make
				health insurance coverage offered through the association available to all
				members of the association. Bona fide associations may create membership
				categories that will not be offered association health insurance coverage,
				provided that such membership categories must not be based on health status or
				insurability or designed in any way to circumvent Montana health insurance
				law.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5062 - RESTORATION OF COVERAGE (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1809,
					 33-22-1812, and
					 33-22-1814,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5066 - QUALIFYING PREVIOUS AND QUALIFYING EXISTING COVERAGES (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1802,
					 33-22-1810,
					 33-22-1811, and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5070 - CONSIDERATION OF TRADE, OCCUPATION, OR INDUSTRY IN DECIDING WHETHER TO OFFER COVERAGE (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-22-1822, MCA; IMP,
					 33-22-1802,
					 33-22-1809,
					 33-22-1811, and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5074 - RESTRICTIVE RIDERS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-22-1822, MCA; IMP,
					 33-22-1802,
					 33-22-1811,
					 33-22-1811, and
					 33-22-1812,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5078 - FAIR MARKETING STANDARDS

Current through Register Vol. 13, July 5, 2024
(1) Small employer
				carriers shall actively market each of their basic and standard health benefit
				plans to small employers in this state, and shall comply with the guaranteed
				availability of coverage and disclosure requirements set forth in ARM
				6.6.5079A and ARM
				6.6.5079B. Examples of active
				marketing include, but are not limited to, promotional materials for agents and
				consumers, marketing classes for agents, direct mail to small business, and
				paid media advertising. Small employer carriers may not suspend the marketing
				or issuance of the basic and standard health benefit plans except for good
				cause and with the prior approval of the commissioner. A small employer carrier
				suspending the marketing and issuance of any small employer plan shall notify
				the commissioner of such suspension by the suspension date.
(2) In marketing basic and standard health
				benefit plans to small employers, small employer carriers shall use at least
				the same sources and methods of distribution that they use to market other
				health benefit plans to small employers. Producers authorized by small employer
				carriers to market health benefit plans to small employers in the state shall
				also be authorized to market the basic and standard health benefit
				plans.
(3) Small employer carriers
				shall provide price quotes to small employers, either directly or through
				authorized producers, within 15 working days of receiving a request for a
				quote. Price quotes must include such information as is necessary to understand
				the quotes. If a small employer carrier needs additional information to provide
				price quotes, it must request such information from the employer within 5
				working days of receiving the request for the price quotes.
(4) Small employer carriers may not apply
				more stringent or detailed requirements related to the application process for
				the basic and standard health benefit plans than are applied for other health
				benefit plans offered by the carrier.
(5) Small employer carriers may not require,
				as a condition to the offer or sale of a health benefit plan to small
				employers, that the small employer purchase or qualify for any other insurance
				product or service.
Sec.
					 33-1-313 and
					 33-22-1822, MCA; IMP,
					 33-22-1802,
					 33-22-1809,
					 33-22-1812, and
					 33-22-1813,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5079 - OPPORTUNITIES FOR INDIVIDUALS TO ENROLL IN SMALL GROUP PLANS

Current through Register Vol. 13, July 5, 2024
(1) Upon the inception of a small group
				health plan all eligible employees and their dependents, and thereafter all new
				eligible employees and their dependents, must be offered an opportunity to
				enroll in the plan. Any waiting period prior to enrollment may not exceed
				twelve months. If a small employer carrier issues more than one health benefit
				plan to a small employer group pursuant to ARM
				6.6.5058(2), all
				eligible employees must be offered the same choice of health benefit plans as
				the other members of the group.
(2)
				Except as provided in (3), eligible employees who do not enroll during an
				initial enrollment opportunity as described in (1), provided that the
				opportunity lasted at least 30 days, may be considered late enrollees. A
				carrier may not impose a preexisting condition exclusion of more than 18 months
				from the date of a late enrollee's application. Although
				33-22-1811(3)
				(c), MCA, allows a carrier to impose an 18
				month period of exclusion from coverage or an 18 month preexisting condition
				exclusion for late enrollees, the federal Health Insurance Portability and
				Accountability Act of 1996 does not allow both and only authorizes a maximum 18
				month preexisting condition exclusion. Therefore, late enrollees may only be
				subject to the 18 month preexisting condition exclusion from the date of
				application and a carrier must not impose unreasonable delays in issuing
				coverage from the date of such application.
(3) Eligible individuals who meet the
				requirements set forth in
				33-22-140(17) (a), (b) or
				(c) which provides exceptions to late
				enrollee status, or who qualify for a special enrollment period under
				33-22-523, MCA, are not considered
				late enrollees. Individuals qualifying for special enrollment must be given an
				opportunity to enroll according to the terms of
				33-22-523, MCA. Eligible
				individuals who are not late enrollees under the terms of
				33-22-140(17) (a), (b) or
				(c), MCA, must be given opportunities to
				enroll as set forth in (1), and the enrollment period must extend at least 30
				days.
(4) On or before the time an
				employee is offered an initial opportunity to enroll in a group health plan,
				the plan is required to provide the employee with a description, as set forth
				in ARM 6.6.50791(3) of the plan's special enrollment rules. Additionally, the
				plan shall provide at the same time a description of opportunities to enroll
				under 33-22-140(17) (a), (b) or
				(c), MCA, and as a late enrollee.
Sec.
					 33-22-143 and
					 33-22-1822, MCA; IMP, Sec.
					 33-22-140,
					 33-22-523,
					 33-22-526, and
					 33-22-1811,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5079A - GUARANTEED AVAILABILITY OF COVERAGE IN THE SMALL GROUP MARKET - GUARANTEED ISSUE REQUIREMENTS - EXCEPTIONS

Current through Register Vol. 13, July 5, 2024
(1)
				Except for coverage offered only through a bona fide association, and subject
				to (2), (3), and (4), each small group carrier that offers health insurance
				coverage in the small group market must offer, to any small employer in the
				state, all products that are approved for sale in the small group market and
				that the issuer is actively marketing, and must accept any small employer that
				applies for any of those products.
(2) A small employer carrier is not required
				to issue coverage to a small group employer that does not meet the minimum
				participation and contribution requirements of the carrier, as permitted by
				33-22-1811(3)
				(d), MCA. If a carrier refuses to issue any
				plan to a small employer on the basis that the small employer does not meet
				participation or contribution requirements, the carrier may not issue any other
				plan to the small group employer.
(3) A small employer carrier is not required
				to issue coverage in circumstances set forth in
				33-22-1811(4),
				MCA. In the event that a small employer carrier denies coverage to a small
				employer under that section and is prevented from offering coverage for 180
				days, the responsibilities of the small employer carrier to renew existing
				coverage pursuant to
				33-22-524 and
				33-22-1810, MCA,
				continue.
(4) A small employer
				carrier may not issue coverage to a small employer under circumstances
				described in
				33-22-1811(3) (e)
				(iv), MCA.
(5) For purposes of this rule, "product"
				refers to a health benefit plan, and includes all contract provisions included
				in the contract language for a health benefit plan issued to a small group
				employer.
Sec.
					 33-22-1822, MCA; IMP, Sec.
					 33-22-1811,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5079B - DISCLOSURE OF INFORMATION

Current through Register Vol. 13, July 5, 2024
(1) In connection
				with the offering of any health insurance coverage to a small employer, a small
				employer carrier is required to:
(a) Make a
				reasonable disclosure to the employer, as part of its solicitation and sales
				materials, of the availability of the information described in (2) of this rule
				for all plans marketed by the carrier; and
(b) Upon request of the employer, provide
				that information to the employer.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5079C - PREEXISTING CONDITIONS - PERMISSIBLE RESTRICTIONS IN SMALL GROUPS

Current through Register Vol. 13, July 5, 2024
(1) Eligible employees and their dependents
				making timely application must be accepted for coverage in a small employer's
				group health plan without any restrictions or limitations on coverage related
				to risk characteristics of the eligible individuals, except as provided in
				33-22-1811(3),
				MCA, and this rule.
(2) A
				preexisting condition exclusion must relate to a condition based on presence of
				a condition for which 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 as defined in
				33-22-140, MCA. Medical advice,
				diagnosis, care, or treatment may be taken into account only if it is
				recommended by, or received from, an individual licensed or similarly
				authorized to provide such services under state law and operating within the
				scope of practice authorized by state law. A negative diagnosis does not
				constitute medical advice, diagnosis, care, or treatment for purposes of
				determining whether there is a preexisting condition.
(3) A preexisting exclusion period may not
				extend more than the following periods of time:
(a) For an employee or dependent obtaining
				coverage within the initial period of eligibility, twelve months from the
				coverage effective date;
(b) For an
				employee or dependent obtaining coverage through a special enrollment period as
				set forth in
				33-22-523, MCA, or an employee or
				dependent qualifying for a later enrollment period pursuant to
				33-22-140(17),
				MCA, twelve months from the coverage effective date;
(c) For an employee or dependent obtaining
				coverage as a late enrollee as defined in
				33-22-140(17),
				MCA, eighteen months from the enrollment date.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.50 - Small Employer Health Insurance Rules › Rule 6.6.5079D - SMALL EMPLOYER HEALTH INSURANCE SUBJECT TO GENERAL HEALTH INSURANCE AND GROUP RULES

Current through Register Vol. 13, July 5, 2024
(1) Unless
				otherwise specified in Title 33, chapter 22, part 18, MCA, or this subchapter,
				small employer carriers and small employer health plans are subject to
				applicable statutes in Title 33, chapter 22, MCA. Those sections include, but
				are not limited to, provision regarding:
(a)
				Definitions in
				33-22-140, MCA;
(b) Crediting previous coverage and issuing
				certificates of creditable coverage in
				33-22-141 and
				33-22-142, MCA;
(c) Special enrollment periods in
				33-22-523, MCA;
(d) Guaranteed renewability in the group
				market at 33-22-524, MCA; and
(e) Prohibiting discrimination in the group
				market at 33-22-526, MCA.