reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.521 - REPORTING OF MULTIPLE POLICIES

Current through Register Vol. 13, July 5, 2024
(1) On or
				before March 1 of each year, every issuer shall report, on the form contained
				in ARM 6.6.525, information for every individual resident of this state for
				which the issuer has in force more than one Medicare supplement insurance
				policy or certificate. The following information must be reported:
(a) policy and certificate number;
				and
(b) date of issuance.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.522 - PROHIBITION AGAINST PREEXISTING CONDITIONS, WAITING PERIODS, ELIMINATION PERIODS, AND PROBATIONARY PERIODS IN REPLACEMENT POLICIES OR CERTIFICATES

Current through Register Vol. 13, July 5, 2024
(1) If a medicare supplement policy or
				certificate replaces another medicare supplement policy or certificate, the
				replacing issuer shall waive any time periods applicable to preexisting
				conditions, waiting periods, elimination periods and probationary periods in
				the new medicare supplement policy to the extent such time was spent under the
				original policy.
(2) If a medicare
				supplement policy or certificate replaces another medicare supplement policy or
				certificate which has been in effect for at least six months, the replacing
				policy must not provide any time period applicable to preexisting conditions,
				waiting periods, elimination periods and probationary periods.
33-1-313 and
					 33-22-904, MCA; IMP,
					 33-15-303,
					 33-22-902,
					 33-22-904,
					 33-22-921,
					 33-22-922,
					 33-22-923, and
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.523 - SEPARABILITY

Current through Register Vol. 13, July 5, 2024
(1) If any provision of this subchapter or
				the application thereof to any person or circumstance is for any reason held to
				be invalid, the remainder of the subchapter and the application of such
				provision to other persons or circumstances shall not be affected.
33-1-313, MCA; IMP,
					 33-22-902,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.525 - APPENDIX B - FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES

Current through Register Vol. 13, July 5, 2024 (1) This is the
				appendix referred to in ARM
				6.6.521.
FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES
Company Name:
____________________________
Address:
____________________________
____________________________
Phone Number:
____________________________
Due March 1, annually
The purpose of this form is to report the following
				  information on each resident of this state who has in force more than one
				  Medicare supplement policy or certificate. The information is to be grouped by
				  individual policyholder.
Policy and Date of
Certificate # Issuance
_______________________________
Signature
_______________________________
Name and Title (please type)
_______________________________
Date
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-15-303,
					 33-22-901,
					 33-22-902,
					 33-22-903,
					 33-22-904,
					 33-22-905,
					 33-22-906,
					 33-22-907,
					 33-22-908,
					 33-22-909,
					 33-22-910,
					 33-22-911,
					 33-22-921,
					 33-22-922,
					 33-22-923, and
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.527 - PROHIBITION AGAINST USE OF GENETIC INFORMATION AND REQUESTS FOR GENETIC TESTING

Current through Register Vol. 13, July 5, 2024
(1) This subsection
				applies to all policies with policy years beginning on or after May 21, 2009.
				An issuer of a Medicare supplement policy or certificate shall not:
(a) deny or condition the issuance or
				effectiveness of the policy or certificate (including the imposition of any
				exclusion of benefits under the policy based on a preexisting condition) on the
				basis of the genetic information with respect to such individual; and
(b) discriminate in the pricing of the policy
				or certificate (including the adjustment of premium rates) of an individual on
				the basis of the genetic information with respect to such individual.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.601 - APPLICATION AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) This rule shall
				apply to medicare select policies and certificates, as defined in ARM
				6.6.601 through
				6.6.614.
(2) No policy or certificate may be
				advertised as a medicare select policy or certificate unless it meets the
				requirements of ARM
				6.6.601 through 6.6.614.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.602 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
For the purposes of ARM
				  6.6.601 through
				  6.6.614:
(1) "Complaint" means any dissatisfaction
				expressed by an individual concerning a medicare select issuer or its network
				providers.
(2) "Grievance" means
				dissatisfaction expressed in writing by an individual insured under a medicare
				select policy or certificate with the administration, claims practices, or
				provision of services concerning a medicare select issuer or its network
				providers.
(3) "Medicare select
				issuer" means an issuer offering, or seeking to offer, a medicare select policy
				or certificate.
(4) "Medicare
				select policy" or "medicare select certificate" mean respectively a medicare
				supplement policy or certificate that contains restricted network
				provisions.
(5) "Network provider"
				means a provider of health care, or a group of providers of health care, which
				has entered into a written agreement with the issuer to provide benefits
				insured under a medicare select policy.
(6) "Restricted network provision" means any
				provision which conditions the payment of benefits, in whole or in part, on the
				use of network providers.
(7)
				"Service area" means the geographic area approved by the commissioner within
				which an issuer is authorized to offer a medicare select policy.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.603 - AUTHORIZATION OF THE COMMISSIONER

Current through Register Vol. 13, July 5, 2024
(1) The
				commissioner may authorize an issuer to offer a medicare select policy or
				certificate, pursuant to ARM
				6.6.601 through
				6.6.614 and section 4358 of the
				Omnibus Budget Reconciliation Act (OBRA) of 1990, if the commissioner finds
				that the issuer has satisfied all of the requirements of ARM
				6.6.601 through
				6.6.614 and at the discretion of
				the commissioner has met the requirements of
				33-22-901 through
				33-22-924, MCA and ARM
				6.6.501 through
				6.6.522.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.604 - PLAN TO BE APPROVED BY COMMISSIONER BEFORE BEING ISSUED

Current through Register Vol. 13, July 5, 2024
(1) A medicare select issuer shall not issue
				a medicare select policy or certificate in this state until its plan of
				operation has been approved by the commissioner.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.605 - PLAN TO BE FILED AND THE REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) A
				medicare select issuer shall file a proposed plan of operation with the
				commissioner in a format prescribed by the commissioner. The plan of operation
				shall contain at least the following information:
(a) evidence that all covered services that
				are subject to restricted network provisions are available and accessible
				through network providers, including a demonstration that:
(i) such services can be provided by network
				providers with reasonable promptness with respect to geographic location, hours
				of operation and after-hour care. The hours of operation and availability of
				after-hour care shall reflect usual practice in the local area. Geographic
				availability shall reflect the usual travel times within the
				community;
(ii) the number of
				network providers in the service area is sufficient, with respect to current
				and expected policyholders, either:
(A) to
				deliver adequately all services that are subject to a restricted network
				provision; or
(B) to make
				appropriate referrals;
(iii) there are written agreements with
				network providers describing specific responsibilities;
(iv) emergency care is available 24 hours per
				day and 7 days per week;
(v) in the
				case of covered services that are subject to a restricted network provision and
				are provided on a prepaid basis, there are written agreements with network
				providers prohibiting such providers from billing or otherwise seeking
				reimbursement from or recourse against any individual insured under a medicare
				select policy or certificate. (1) (a) (v) shall not apply to supplemental
				charges or coinsurance amounts as stated in the medicare select policy or
				certificate;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.606 - PLAN CHANGES TO BE FILED AND APPROVED

Current through Register Vol. 13, July 5, 2024
(1) A
				medicare select issuer shall file for approval with the commissioner any
				proposed changes to the plan of operation, except for changes to the list of
				network providers, prior to implementing such changes.
(2) An updated list of network providers
				shall be filed with the commissioner at least quarterly.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.607 - MEDICARE SELECT FULL COVERAGE

Current through Register Vol. 13, July 5, 2024
(1) A medicare
				select policy or certificate must not restrict payment for covered services
				provided by non-network providers if:
(a) the
				services are for symptoms requiring emergency care or are immediately required
				for an unforeseen illness, injury or a condition; and
(b) it is not reasonable to obtain such
				services through a network provider.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.608 - DISCLOSURE REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) A medicare
				select issuer shall make full and fair disclosure in writing of the provisions,
				restrictions, and limitations of the medicare select policy or certificate to
				each applicant. This disclosure shall include at least the following:
(a) an outline of coverage sufficient to
				permit the applicant to compare the coverage and premiums of the medicare
				select policy or certificate with:
(i) other
				medicare supplement policies or certificates offered by the issuer; and
(ii) other medicare select
				policies or certificates;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.609 - ACKNOWLEDGMENT OF UNDERSTANDING BY APPLICANT

Current through Register Vol. 13, July 5, 2024
(1)
				Prior to the sale of a medicare select policy or certificate, a medicare select
				issuer shall obtain from the applicant a signed and dated form stating that the
				applicant has received the information provided pursuant to ARM
				6.6.608 and that the applicant
				understands the restrictions of the medicare select policy or
				certificate.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.610 - GRIEVANCE AND COMPLAINT PROCEDURE

Current through Register Vol. 13, July 5, 2024
(1) A
				medicare select issuer shall have and use procedures for hearing complaints and
				resolving written grievances from the subscribers. Such procedures shall be
				aimed at mutual agreement for settlement and may include arbitration
				procedures.
(2) The grievance
				procedure shall be described in the policies and certificates and in the
				outline of coverage.
(3) At the
				time the policy or certificate is issued, the issuer shall provide detailed
				information to the policyholder describing how a grievance may be registered
				with the issuer.
(4) Grievances
				shall be considered in a timely manner and shall be transmitted to appropriate
				decision-makers who have authority to fully investigate the issue and take
				corrective action.
(5) If a
				grievance is found to be valid, corrective action shall be taken
				promptly.
(6) All concerned parties
				shall be notified about the results of a grievance.
(7) The issuer shall report no later than
				each March 31 to the commissioner regarding its grievance procedure. The report
				shall be in a format prescribed by the commissioner and shall contain the
				number of grievances filed in the past year and a summary of the subject,
				nature and resolution of such grievances.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.611 - AVAILABILITY TO PURCHASE ANY PRODUCT

Current through Register Vol. 13, July 5, 2024
(1) At the
				time of initial purchase, a medicare select issuer shall make available to each
				applicant for a medicare select policy or certificate the opportunity to
				purchase any medicare supplement policy or certificate otherwise offered by the
				issuer.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.612 - INSURED MAY PURCHASE A COMPARABLE OR LESSER BENEFIT POLICY OR CERTIFICATE WITHOUT A RESTRICTED NETWORK PROVISION

Current through Register Vol. 13, July 5, 2024
(1)
				At the request of an individual insured under a medicare select policy or
				certificate, a medicare select issuer shall make available to the individual
				insured the opportunity to purchase a medicare supplement policy or certificate
				offered by the issuer which has comparable or lesser benefits and which does
				not contain a restricted network provision. The issuer shall make such policies
				or certificates available without requiring evidence of insurability after the
				medicare select policy or certificate has been in force for six
				months.
(2) For the purpose of this
				rule, a medicare supplement policy or certificate will be considered to have
				comparable or lesser benefits unless it contains one or more significant
				benefits not included in the medicare select policy or certificate being
				replaced. For the purpose of (2), a significant benefit means coverage for the
				medicare part A deductible, coverage for at-home recovery services, or coverage
				for part B excess charges.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-15-303,
					 33-22-901,
					 33-22-902,
					 33-22-903,
					 33-22-904,
					 33-22-905,
					 33-22-906,
					 33-22-907,
					 33-22-908,
					 33-22-909,
					 33-22-910,
					 33-22-911,
					 33-22-921,
					 33-22-922,
					 33-22-923, and
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.613 - PROVISION FOR CONTINUED COVERAGE

Current through Register Vol. 13, July 5, 2024
(1)
				Medicare select policies and certificates shall provide for continuation of
				coverage in the event the United States department of health and human services
				determines that medicare select policies and certificates issued pursuant to
				ARM 6.6.601 through
				6.6.614 should be discontinued due
				to either the failure of the medicare select program to be reauthorized under
				law or its substantial amendment.
(2) Each medicare select issuer shall make
				available to each individual insured under a medicare select policy or
				certificate the opportunity to purchase any medicare supplement policy or
				certificate offered by the issuer which has comparable or lesser benefits and
				which does not contain a restricted network provision. The issuer shall make
				such policies and certificates available without requiring evidence or
				insurability.
(3) For the purpose
				of this rule, a medicare supplement policy or certificate will be considered to
				have comparable or lesser benefits unless it contains one or more significant
				benefits not included in the medicare select policy or certificate being
				replaced. For the purpose of (3), a significant benefit means coverage for the
				medicare part A deductible, coverage for at-home recovery services, or coverage
				for part B excess charges.
(4) In
				the event of the discontinuance of the medicare select insurance program by an
				entity, (including but not limited to the federal government, an insurer, an
				insurance company, health maintenance organization or health service
				corporation) the insured will have the option to continue medicare supplement
				insurance. The insured may select from any of the medicare supplement insurance
				plans then currently available with no restrictions or limitations.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-15-303,
					 33-22-901,
					 33-22-902,
					 33-22-903,
					 33-22-904,
					 33-22-905,
					 33-22-906,
					 33-22-907,
					 33-22-908,
					 33-22-909,
					 33-22-910,
					 33-22-911,
					 33-22-921,
					 33-22-922,
					 33-22-923, and
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.6 - Medicare Select Policies › Rule 6.6.614 - ISSUER SHALL COMPLY WITH REASONABLE REQUESTS FOR DATA

Current through Register Vol. 13, July 5, 2024
(1) A medicare select issuer shall comply
				with reasonable requests for data made by state or federal agencies, including
				the United States department of health and human services, for the purpose of
				evaluating the medicare select program.
33-22-904 and
					 33-22-905, MCA; IMP,
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.701 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of this subchapter is to
				provide rules for life insurance policy illustrations that will protect
				consumers and foster consumer education. The rules provide illustration
				formats, prescribe standards to be followed when illustrations are used, and
				specify the disclosures that are required in connection with illustrations. The
				goals of these rules are to ensure that illustrations do not mislead purchasers
				of life insurance and to make illustrations more understandable. Insurers will,
				as far as possible, eliminate the use of footnotes and caveats and define terms
				used in the illustration in language that would be understood by a typical
				person within the segment of the public to which the illustration is
				directed.
Sec. 33 -1-313 and
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.702 - AUTHORITY

Current through Register Vol. 13, July 5, 2024
(1) This subchapter is issued based upon the
				authority granted the commissioner under
				33-20-150, MCA.
Sec.
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.703 - APPLICABILITY AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) This subchapter
				applies to all group and individual life insurance policies and certificates
				except:
(a) variable life
				insurance;
(b) individual and group
				annuity contracts;
(c) credit life
				insurance; or
(d) life insurance
				policies with no illustrated death benefits on any individual exceeding
				$10,000.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.704 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
For the purposes of this subchapter:
(1) " Actuarial Standards Board" means the
				board established by the American academy of actuaries to develop and
				promulgate standards of actuarial practice.
(2) " Contract premium" means the gross
				premium that is required to be paid under a fixed premium policy, including the
				premium for a rider for which benefits are shown in the illustration.
(3) "Currently payable scale" means a scale
				of non-guaranteed elements in effect for a policy form as of the preparation
				date of the illustration or declared to become effective within the next 95
				days.
(4) "Disciplined current
				scale " means a scale of non-guaranteed elements constituting a limit on
				illustrations currently being illustrated by an insurer that is based on actual
				recent historical experience, as certified annually by an illustration actuary
				designated by the insurer. Further guidance in determining the disciplined
				current scale as contained in standards established by the actuarial standards
				board may be relied upon if the standards:
(a) are consistent with all provisions of
				this subchapter;
(b) limit a
				disciplined current scale to reflect only actions that have already been taken
				or events that have already occurred;
(c) do not permit a disciplined current scale
				to include any projected trends of improvements in experience or any assumed
				improvements in experience beyond the illustration date; and
(d) do not permit assumed expenses to be less
				than minimum assumed expenses.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.705 - POLICIES TO BE ILLUSTRATED

Current through Register Vol. 13, July 5, 2024
(1) Each insurer
				marketing policies to which this subchapter is applicable shall notify the
				commissioner whether a policy form is to be marketed with or without an
				illustration. For all policy forms being actively marketed on January 1, 2002,
				the insurer shall identify in writing those forms and whether or not an
				illustration will be used with them. For policy forms filed after the effective
				date of this subchapter, the identification shall be made at the time of
				filing. Any previous identification may be changed by notice to the
				commissioner.
(2) If the insurer
				identifies a policy form as one to be marketed without an illustration, any use
				of an illustration for any policy using that form prior to the first policy
				anniversary is prohibited.
(3) If a
				policy form is identified by the insurer as one to be marketed with an
				illustration, a basic illustration prepared and delivered in accordance with
				this subchapter is required, except that a basic illustration need not be
				provided to individual members of a group or to individuals insured under
				multiple lives coverage issued to a single applicant unless the coverage is
				marketed to these individuals. The illustration furnished an applicant for a
				group life insurance policy or policies issued to a single applicant on
				multiple lives may be either an individual or composite illustration
				representative of the coverage on the lives of members of the group or the
				multiple lives covered.
(4)
				Potential enrollees of non-term group life subject to this subchapter shall be
				furnished a quotation with the enrollment materials. The quotation shall show
				potential policy values for sample ages and policy years on a guaranteed and
				non-guaranteed basis appropriate to the group and the coverage. This quotation
				shall not be considered an illustration for purposes of this subchapter, but
				all information provided shall be consistent with the illustrated scale. A
				basic illustration shall be provided at delivery of the certificate to
				enrollees for non-term group life who enroll for more than the minimum premium
				necessary to provide pure death benefit protection. In addition, the insurer
				shall make a basic illustration available to any non-term group life enrollee
				who requests it.
Sec.
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.706 - GENERAL RULES AND PROHIBITIONS

Current through Register Vol. 13, July 5, 2024
(1) An illustration
				used in the sale of a life insurance policy shall satisfy the applicable
				requirements of this subchapter, be clearly labeled "life insurance
				illustration" and contain the following basic information:
(a) name of insurer;
(b) name and business address of producer or
				insurer's authorized representative, if any;
(c) name, age, and sex (if sex is used in
				underwriting) of proposed insured, except where a composite illustration is
				permitted under this subchapter;
(d) underwriting or rating classification
				upon which the illustration is based;
(e) generic name of policy, the company
				product name, if different, and form number;
(f) initial death benefit; and
(g) dividend option election or application
				of non-guaranteed elements, if applicable.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.708 - STANDARDS FOR BASIC ILLUSTRATIONS - NARRATIVE SUMMARY

Current through Register Vol. 13, July 5, 2024
(1) A basic illustration shall include the
				following:
(a) a brief description of the
				policy being illustrated, including a statement that it is a life insurance
				policy;
(b) a brief description of
				the premium outlay or contract premium, as applicable, for the policy. For a
				policy that does not require payment of a specific contract premium, the
				illustration shall show the premium outlay that must be paid to guarantee
				coverage for the term of the contract, subject to maximum premiums allowable to
				qualify as a life insurance policy under the applicable provisions of the
				Internal Revenue Code;
(c) a brief
				description of any policy features, riders or options, guaranteed or
				non-guaranteed, shown in the basic illustration and the impact they may have on
				the benefits and values of the policy;
(d) identification and a brief definition of
				column headings and key terms used in the illustration; and
(e) a statement containing in substance the
				following:
(i) "this illustration assumes
				that the currently illustrated non-guaranteed elements will continue unchanged
				for all years shown. This is not likely to occur, and actual results may be
				more or less favorable than those shown. "
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.709 - STANDARDS FOR BASIC ILLUSTRATIONS - NUMERIC SUMMARY

Current through Register Vol. 13, July 5, 2024
(1) Following the narrative summary, a basic
				illustration shall include a numeric summary of the death benefits and values
				and the premium outlay and contract premium, as applicable. For a policy that
				provides for a contract premium, the guaranteed death benefits and values shall
				be based on the contract premium.
(2) This summary shall be shown for at least
				policy years five, 10 and 20 and at age 70, if applicable, on the three bases
				shown below. For multiple life policies the summary shall show policy years
				five, 10, 20 and 30:
(a) policy
				guarantees;
(b) insurer's
				illustrated scale;
(c) insurer's
				illustrated scale used but with the non-guaranteed elements reduced as follows:
(i) dividends at 50% of the dividends
				contained in the illustrated scale used;
(ii) non-guaranteed credited interest at
				rates that are the average of the guaranteed rates and the rates contained in
				the illustrated scale used; and
(iii) all non-guaranteed charges, including
				but not limited to, term insurance charges, mortality and expense charges, at
				rates that are the average of the guaranteed rates and the rates contained in
				the illustrated scale used.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.710 - STANDARDS FOR BASIC ILLUSTRATIONS - STATEMENTS

Current through Register Vol. 13, July 5, 2024
(1) Statements substantially similar to the
				following shall be included on the same page as the numeric summary and signed
				by the applicant, or the policy owner in the case of an illustration provided
				at time of delivery, as required in this rule.
(2) A statement to be signed and dated by the
				applicant or policy owner reading as follows: "I have received a copy of this
				illustration and understand that any non-guaranteed elements illustrated are
				subject to change and could be either higher or lower. The agent has told me
				they are not guaranteed. "
(3) A
				statement to be signed and dated by the insurance producer or other authorized
				representative of the insurer reading as follows: "I certify that this
				illustration has been presented to the applicant and that I have explained that
				any non-guaranteed elements illustrated are subject to change. I have made no
				statements that are inconsistent with the illustration. "
Sec.
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.711 - STANDARDS FOR BASIC ILLUSTRATIONS - TABULAR DETAIL

Current through Register Vol. 13, July 5, 2024
(1) A basic illustration shall include the
				following for at least each policy year from one to 10 and for every fifth
				policy year thereafter ending at age 100, policy maturity or final expiration;
				and except for term insurance beyond the twentieth year, for any year in which
				the premium outlay and contract premium, if applicable, is to change:
(a) the premium outlay and mode the applicant
				plans to pay and the contract premium, as applicable;
(b) the corresponding guaranteed death
				benefit, as provided in the policy; and
(c) the corresponding guaranteed value
				available upon surrender, as provided in the policy.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.712 - STANDARDS FOR SUPPLEMENTAL ILLUSTRATIONS

Current through Register Vol. 13, July 5, 2024
(1)
				A supplemental illustration may be provided so long as:
(a) it is appended to, accompanied by, or
				preceded by a basic illustration that complies with this subchapter;
(b) the non-guaranteed elements shown are not
				more favorable to the policy owner than the corresponding elements based on the
				scale used in the basic illustration;
(c) it contains the same statement required
				of a basic illustration that non-guaranteed elements are not guaranteed;
				and
(d) for a policy that has a
				contract premium, the contract premium underlying the supplemental illustration
				is equal to the contract premium shown in the basic illustration. For policies
				that do not require a contract premium, the premium outlay underlying the
				supplemental illustration shall be equal to the premium outlay shown in the
				basic illustration.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.714 - ANNUAL REPORT; NOTICE TO POLICY OWNERS

Current through Register Vol. 13, July 5, 2024
(1) In
				the case of a policy designated as one for which illustrations will be used,
				the insurer shall provide each policy owner with an annual report on the status
				of the policy that shall contain at least the following information:
(a) for universal life policies, the report
				shall include the following:
(i) the
				beginning and end date of the current report period;
(ii) the policy value at the end of the
				previous report period and at the end of the current report period;
(iii) the total amounts that have been
				credited or debited to the policy value during the current report period,
				identifying each by type (e.g., interest, mortality, expense and
				riders);
(iv) the current death
				benefit at the end of the current report period on each life covered by the
				policy;
(v) the net cash surrender
				value of the policy as of the end of the current report period;
(vi) the amount of outstanding loans, if any,
				as of the end of the current report period; and
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.715 - ANNUAL CERTIFICATIONS

Current through Register Vol. 13, July 5, 2024
(1) The board
				of directors of each insurer shall appoint one or more illustration
				actuaries.
(2) The illustration
				actuary shall certify that the disciplined current scale used in illustrations
				is in conformity with the Actuarial Standard of Practice for Compliance with
				the NAIC model regulation on life insurance illustrations promulgated by the
				Actuarial Standards Board and that the illustrated scales used in
				insurer-authorized illustrations meet the requirements of this
				subchapter.
(3) The illustration
				actuary shall:
(a) be a member in good
				standing of the American Academy of Actuaries;
(b) be familiar with the standard of practice
				regarding life insurance policy illustrations;
(c) not have been found by the commissioner,
				following appropriate notice and hearing to have:
(i) violated any provision of, or any
				obligation imposed by, the insurance law or other law in the course of his or
				her dealings as an illustration actuary;
(ii) been found guilty of fraudulent or
				dishonest practices;
(iii)
				demonstrated his or her incompetence, lack of cooperation, or untrustworthiness
				to act as an illustration actuary; or
(iv) resigned or been removed as an
				illustration actuary within the past five years as a result of acts or
				omissions indicated in any adverse report on examination or as a result of a
				failure to adhere to generally acceptable actuarial standards.
(d) not fail to notify the
				commissioner of any action taken by a commissioner of another state similar to
				that under (3) above;
(e) disclose
				in the annual certification whether, since the last certification, a currently
				payable scale applicable for business issued within the previous five years and
				within the scope of the certification has been reduced for reasons other than
				changes in the experience factors underlying the disciplined current scale. If
				non-guaranteed elements illustrated for new policies are not consistent with
				those illustrated for similar in force policies, this must be disclosed in the
				annual certification. If non-guaranteed elements illustrated for both new and
				in force policies are not consistent with the non-guaranteed elements actually
				being paid, charged or credited to the same or similar forms, this must be
				disclosed in the annual certification; and
(f) disclose in the annual certification the
				method used to allocate overhead expenses for all illustrations:
(i) fully allocated expenses;
(ii) marginal expenses; or
(iii) a generally recognized expense table
				based on fully allocated expenses representing a significant portion of
				insurance companies and approved by the NAIC or by the commissioner.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.716 - PENALTIES

Current through Register Vol. 13, July 5, 2024
(1) In addition to any other penalties
				provided by the laws of this state, an insurer or producer that violates a
				requirement of this subchapter shall be guilty of a violation of
				33-18-202, MCA.
Sec.
					 33-18-202 and
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.717 - SEVERABILITY

Current through Register Vol. 13, July 5, 2024
(1) If any provision of this subchapter or
				its application to any person or circumstance is for any reason held to be
				invalid by any court of law, the remainder of the subchapter and its
				application to other persons or circumstances shall not be affected.
Sec.
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.7 - Life Insurance Illustrations › Rule 6.6.718 - EFFECTIVE DATE

Current through Register Vol. 13, July 5, 2024
(1) This subchapter
				shall become effective January 1, 2002, and shall apply to policies sold on or
				after the effective date.
Sec.
					 33-20-150, MCA; IMP, Sec.
					 33-18-202 and
					 33-20-150,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.801 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of this subchapter is to
				provide standards for the disclosure of certain minimum information about
				annuity contracts to protect consumers and foster consumer education. These
				rules specify the minimum information which must be disclosed and the method
				for disclosing it in connection with the sale of annuity contracts. The goals
				of these rules are to ensure that purchasers of annuity contracts understand
				certain basic features of annuity contracts.
Sec.
					 33-1-313 and
					 33-20-308, MCA; IMP, Sec.
					 33-20-308,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.802 - AUTHORITY

Current through Register Vol. 13, July 5, 2024
(1) These rules are issued based upon the
				authority granted the commissioner under
				33-20-150, and
				33-20-308, Montana Code Annotated,
				(MCA).
Sec.
					 33-1-313,
					 33-20-150 and
					 33-20-308, MCA; IMP, Sec.
					 33-20-308,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.803 - APPLICABILITY AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) This subchapter
				applies to all annuity contracts and certificates except:
(a) registered or nonregistered variable
				annuities or other registered contracts;
(b) immediate and deferred annuities that
				contain no nonguaranteed elements;
(c) annuities used to fund:
(i) an employee pension plan which is covered
				by the Employee Retirement Income Security Act (ERISA);
(ii) a plan described by section 401(a),
				401(k), 403(b) of the Internal Revenue Code (IRC), where the plan, for purposes
				of ERISA, is established or maintained by an employer;
(iii) a governmental or church plan defined
				in section 414, IRC, or a deferred compensation plan of a state or local
				government or tax exempt organization under section 457, IRC; or
(iv) a nonqualified deferred compensation
				arrangement established or maintained by an employer or plan sponsor.
(d) Notwithstanding (c), this rule
				shall apply to annuities used to fund a plan or arrangement that is funded
				solely by contributions an employee elects to make whether on a pretax or
				after-tax basis, and where the insurance company has been notified that plan
				participants may choose from among two or more fixed annuity providers and
				there is a direct solicitation of an individual employee by a producer for the
				purchase of an annuity contract. As used in this rule, direct solicitation
				shall not include any meeting held by a producer solely for the purpose of
				educating or enrolling employees in the plan or arrangement;
(e) structured settlement
				annuities;
(f) charitable gift
				annuities; and
(g) funding
				agreements.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.805 - STANDARDS FOR THE DISCLOSURE DOCUMENT

Current through Register Vol. 13, July 5, 2024
(1) Where
				the application for an annuity contract is taken in a face-to-face meeting, the
				applicant shall at or before the time of application be given both the
				disclosure document described in (2) and the Buyer's Guide contained in
				Appendix A.
(a) Where the application for an
				annuity contract is taken by means other than in a face-to-face meeting, the
				applicant shall be sent both the disclosure document and the Buyer's Guide no
				later than five business days after the completed application is received by
				the insurer.
(i) With respect to an
				application received as a result of a direct solicitation through the mail:
(A) Providing a Buyer's Guide in a mailing
				inviting prospective applicants to apply for an annuity contract shall be
				deemed to satisfy the requirement that the Buyer's Guide be provided no later
				than five business days after receipt of the application.
(B) Providing a disclosure document in a
				mailing inviting a prospective applicant to apply for an annuity contract shall
				be deemed to satisfy the requirement that the disclosure document be provided
				no later than five business days after receipt of the application.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.806 - ANNUAL NOTICE TO CONTRACT OWNERS

Current through Register Vol. 13, July 5, 2024
(1) For
				annuities in the payout period with changes in nonguaranteed elements and for
				the accumulation period of a deferred annuity, the insurer shall provide each
				contract owner with a report, at least annually, on the status of the contract
				that contains at least the following information:
(a) the beginning and end date of the current
				report period;
(b) the accumulation
				and cash surrender value, if any, at the end of the previous report period and
				at the end of the current report period;
(c) the total amounts, if any, that have been
				credited, charged to the contract value or paid during the current report
				period; and
(d) the amount of
				outstanding loans, if any, as of the end of the current report
				period.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.807 - PENALTIES

Current through Register Vol. 13, July 5, 2024
(1) In addition to any other penalties
				provided by the laws of this state, an insurer or producer that violates a
				requirement of this subchapter shall be guilty of a violation of
				33-1-317, MCA.
33-1-313,
					 33-20-308, MCA; IMP,
					 33-20-308,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.810 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of these rules is to provide:
(a) model forms for mandatory disclosures to
				consumers prior to the recommendation or sale of an annuity and for documenting
				certain events at the time of a recommendation or sale of an annuity;
				and
(b) the process for approving,
				and certifying compliance with, training courses necessary to educate insurance
				producers prior to engaging in the recommendation or sale of an
				annuity.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.811 - MODEL FORMS

Current through Register Vol. 13, July 5, 2024
(1) For purposes of
				the model forms to be provided by the insurance department under
				33-20-805(4),
				MCA, the commissioner adopts and incorporates by reference Appendices A through
				C of the National Association of Insurance Commissioners (NAIC) Model
				Regulation No. 275, Suitability In Annuity Transactions, published Spring 2020,
				which set forth a model form for an insurance agent or producer's disclosure
				prior to the recommendation or sale of an annuity, a model form for use when a
				consumer refuses to provide certain information, and a model form for use when
				a consumer decides to purchase an annuity that is not based on a producer's
				recommendation. A copy of Appendices A through C of NAIC Model Act No. 275 may
				be obtained from the Commissioner of Securities and Insurance, Office of the
				Montana State Auditor, at 840 Helena Ave., Helena, MT 59601.
(2) As used in Appendix A, "cash
				compensation" has the same meaning set forth in the definition found at
				33-20-804,
				MCA.
(3) As used in Appendix B,
				"consumer profile information" has the same meaning set forth in the definition
				found at
				33-20-804,
				MCA.
AUTH:
					 33-1-313, MCA;
					 IMP:
					 33-20-805,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.8 - Annuities › Rule 6.6.813 - STANDARDS FOR INSURER VERIFICATION

Current through Register Vol. 13, July 5, 2024
(1) An
				insurer's obligation to verify that a producer has completed the training
				requirements of
				33-20-807,
				MCA, can be accomplished by either:
(a)
				obtaining certificate(s) of completion of a commissioner-approved training
				course; or
(b) obtaining reports
				from a database system that either reflects on the face of the report
				information establishing that the training includes at least the requirements
				set forth in ARM 6.6.812, as applicable, or can be queried to provide that
				information if requested by the commissioner.