reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.18 - Standard Valuation and Standard Nonforfeiture › Rule 6.6.1803 - ADOPTION OF TABLES ALTERNATE TO THE 1980 CSO AND 1980 CET FOR NONFORFEITURE PURPOSES UNDER AN EMPLOYER SPONSORED RETIREMENT BENEFIT PROGRAM

Current through Register Vol. 13, July 5, 2024
For any policy of insurance on the life of either a male or
				  female insured delivered or issued for delivery in this state after October 1,
				  1983 that complies with
				  33-20-208, MCA and for all
				  policies issued on or after January 1, 1989, the following may be substituted
				  for use in determining minimum cash surrender values and amounts of paid-up
				  nonforfeiture benefits:
(1) A
				mortality table which is a blend of the 1980 CSO Table (M) and 1980 CSO Table
				(F) with or without 10-year select mortality factors may at the option of the
				company be substituted for the 1980 CSO Table, with or without the 10-year
				select mortality factors, and
(2)
				The mortality table (M), with or without 10-year select mortality factors, may
				at the option of the company be substituted for the 1980 CSO Table, with or
				without 10-year select mortality factors, and
(3) A mortality table which is of the same
				blend as used in (1) but applied to form a blend of the 1980 CET Table (M) and
				the 1980 CET Table (F)
(4) The 1980
				CET Table (M) may at the option of the company be substituted for the 1980 CET
				Table.
33-2-313 and
					 33-20-208(8) (f),
					 MCA; IMP, 33-20-208(8),
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.18 - Standard Valuation and Standard Nonforfeiture › Rule 6.6.1804 - UNFAIR DISCRIMINATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 61-10-155, MCA; IMP:
					 61-10-141,
					 61-10-154,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.18 - Standard Valuation and Standard Nonforfeiture › Rule 6.6.1805 - SEPARABILITY

Current through Register Vol. 13, July 5, 2024
(1) If any provision of this rule or the
				application thereof to any person or circumstance is for any reason held to be
				invalid, the remainder of the regulation and the application of such provision
				to other persons or circumstances shall not be affected thereby.
33-1-313 and
					 33-20-208(8) (f),
					 MCA; IMP, 33-20-208(8),
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1901 - INSURANCE ARRANGEMENT REPORTING REQUIREMENTS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-22-1502, MCA; IMP,
					 33-22-1503,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1902 - APPLICABILITY OF INSURANCE CODE (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-22-1502, MCA; IMP,
					 33-22-1502,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1903 - GENERAL REQUIREMENTS OF THE MONTANA COMPREHENSIVE HEALTH CARE ASSOCIATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-22-1502, MCA; IMP,
					 33-22-1503 and
					 33-22-1521,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1904 - GENERAL REGULATIONS FOR THE BOARD OF DIRECTORS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-22-1502, MCA; IMP,
					 33-22-1504,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1905 - ASSESSMENTS - ASSOCIATION AND BOARD EXPENSES (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-22-1502, MCA; IMP,
					 33-22-1504,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1906 - OPERATING RULES FOR THE ASSOCIATION

Current through Register Vol. 13, July 5, 2024
(1) For the
				purpose of carrying out the provisions and purposes of Title 33, chapter 22,
				part 15, MCA, Comprehensive Health Association and Plan, the commissioner
				adopts and incorporates by reference the bylaws of the Montana Comprehensive
				Health Association (MCHA), adopted on July 22, 1987, amended on August 1, 2000,
				and approved by the commissioner on December 27, 2000, and the operating rules
				of the MCHA, approved by the commissioner on August 22, 2006. A copy of the
				bylaws and operating rules is available for inspection at the office of the
				Commissioner of Insurance, 840 Helena Avenue, Helena, Montana.
(2) The bylaws and operating rules of the
				MCHA will also apply to the Montana Affordable Care Plan (MACP) risk pool,
				unless those rules conflict with the Administrative Rules of Montana (ARM)
				contained in this part, or the Patient Protection and Affordable Care Act (
				Public Law
				111-148 ).
33-22-1502, MCA; IMP,
					 33-22-1502,
					 33-22-1503,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1907 - ESTABLISHING THE MONTANA AFFORDABLE CARE PLAN

Current through Register Vol. 13, July 5, 2024
(1)
				In order to provide immediate access to insurance for uninsured individuals in
				Montana with a preexisting condition, as described in H.R. 3590, the Patient
				Protection and Affordable Care Act (PPACA) Section 1101 (
				Public Law
				111-148 ), the commissioner, or the MCHA with the
				commissioner's approval, may contract with the U.S. Department of Health and
				Human Services to establish a new temporary high risk pool plan, "the Montana
				Affordable Care Plan" (MACP), that will provide coverage for individuals who
				meet the eligibility criteria established in PPACA.
(2) The MACP will begin accepting
				applications for coverage on July 1, 2010.
(3) Coverage for the MACP must be provided by
				a risk pool that is administered and maintained separate and apart from the
				risk pools for the association plan, including the premium assistance plan
				(traditional high risk pool), and the association portability plan (portability
				pool), as defined in
				33-22-1501, MCA. Commingling of
				funds between the existing MCHA pools and the MACP pool is not
				allowed.
(4) The funding for the
				MACP high risk pool will consist of money awarded by contract or grant from the
				federal government and premiums paid by the covered individuals in the MACP. No
				money from the state of Montana, the lead carrier, or assessments paid by the
				association members pursuant to
				33-22-1513, MCA, may be used to
				fund the MACP.
(5) Claims and
				administrative expenses for the covered individuals in the MACP must be paid
				solely from the MACP temporary high risk pool.
33-22-1502, MCA; IMP,
					 33-22-1502,
					 33-22-1503,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1908 - ELIGIBILITY REQUIREMENTS FOR THE MACP HIGH RISK POOL PLAN

Current through Register Vol. 13, July 5, 2024
(1) "Federally defined PPACA high risk pool
				individual" or "MACP eligible," means an individual who:
(a) is a citizen, or national, of the United
				States, or is lawfully present in the United States in accordance with the
				applicable provisions of PPACA;
(b)
				has not been covered under creditable coverage as defined in
				33-22-140, MCA (2009), during the
				six month period prior to the date on which such individual is applying for
				coverage under the MACP;
(c) is a
				Montana resident; and
(d) has a
				preexisting condition.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1910 - ENROLLMENT CAPS AND OTHER FUNDING LIMITATIONS

Current through Register Vol. 13, July 5, 2024
(1) The MCHA board, relying on the advice of
				a qualified actuary, may propose that the commissioner limit enrollment in the
				MACP to a specified number of covered individuals. The commissioner shall
				approve or disapprove the proposed enrollment cap.
(2) The MCHA board is responsible for setting
				an appropriate reserve for incurred but not reported claims, and for monitoring
				the financial condition of the MACP pool. The lead carrier is responsible for
				giving complete and accurate financial and claims payment information,
				including, but not limited to, appropriate financial projections and a
				projection of incurred but not reported claims, as required by the board to
				enable it to set appropriate reserves. The board shall submit a financial
				report for the MACP to the commissioner once every quarter, or more often if
				necessary, or if requested by the commissioner. The first quarterly report must
				be submitted on October 31, 2010.
(3) If applications for the MACP exceed an
				enrollment cap set by the commissioner, the MCHA shall create a waiting list
				for eligible individuals. The date of the application will determine an
				individual's place on the waiting list.
(4) If actuarial projections indicate that
				current claims, and incurred but not reported claims, threaten to exceed
				available revenue for the MACP pool, and if no additional federal funding is
				forthcoming, the board may recommend that the commissioner dissolve the MACP
				pool and terminate all coverage issued through that pool. The commissioner
				shall approve or disapprove the termination of coverage in the MACP pool. If
				termination of coverage is approved, covered individuals will receive:
(a) a 30 day notice of cancellation;
				and
(b) an opportunity to enroll in
				one of the association plans, with no break in coverage.
(i) Individuals who move to an association
				plan will:
(A) pay the same rates as other
				similarly situated individuals covered under that association plan;
(B) be allowed to choose any benefit design
				currently offered in the traditional high risk pool; and
(C) be given full credit for any annual
				out-of-pocket expenses already met in the MACP.
(ii) No preexisting condition exclusions will
				be applied to individuals from the MACP who transfer to an association plan
				because their coverage was terminated under the provisions of this
				rule.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1911 - MACP BENEFIT PLAN AND RATES

Current through Register Vol. 13, July 5, 2024
(1) The board
				shall choose an existing benefit design from the association plans or the
				association portability plans, make any necessary modifications in order to
				comply with PPACA Section 1101(c)(2), and submit the MACP to the commissioner,
				who will approve or disapprove the plans.
(2) In order to facilitate enrollment, the
				board may amend its application for insurance coverage to comply with PPACA and
				these rules, and use the same application for all three risk pools.
(3) The rates for the MACP shall be
				established at a standard rate for a standard population. In order to determine
				that rate, the board shall follow the procedure described in
				33-22-1512(1),
				MCA, for determining the "average premium rate," with no additional mark-up and
				apply the rating rules described in PPACA Section 1101(c)(2)(C) and (D). The
				board shall submit its rate recommendation for the MACP to the commissioner,
				who will approve or disapprove the rates.
33-22-1502, MCA; IMP,
					 33-22-1502,
					 33-22-1503,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1913 - LEAD CARRIER CONTRACT

Current through Register Vol. 13, July 5, 2024
(1) The board may,
				with the approval of the commissioner, choose to amend the existing lead
				carrier contract to include the provision of administrative services for the
				MACP. Payment for those administrative services may not exceed any cap on
				administrative fees imposed by the Secretary of the U.S. Department of Health
				and Human Services.
33-22-1502, MCA; IMP,
					 33-22-1502,
					 33-22-1503,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.19 - Comprehensive Health Care Association and Plan › Rule 6.6.1914 - FRAUD, DUMPING AND RECISSION

Current through Register Vol. 13, July 5, 2024
(1) The
				provisions of
				33-1-1202,
				33-18-214, and
				33-22-1518, MCA, apply to persons
				who misrepresent their own eligibility status, the eligibility status of any
				other individual, or who advise another person to misrepresent the eligibility
				status of any individual.
(2)
				Rescission of coverage under
				33-15-403, MCA, may occur, but
				only if there was a misrepresentation as to eligibility status on an
				application that is fraudulent or proven to be an intentional misrepresentation
				of material fact.
(3) The board,
				with the approval of the commissioner, may require a reasonable amount of
				information from applicants in order to verify eligibility status.
33-22-1502, MCA; IMP,
					 33-22-1502,
					 33-22-1503,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2001 - PURPOSE AND APPLICABILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2002 - DEFINITIONS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2003 - MID-TERM CANCALLATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2004 - ANNIVERSARY CANCELLATION AND ANNIVERSARY RATE INCREASES (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2005 - NON-RENEWAL (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2006 - RENEWAL WITH ALTERED TERMS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2007 - INFORMATION ABOUT GROUNDS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2008 - HOMEOWNERS INSURANCE AFFECTED BY DAY-CARE OPERATIONS (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2009 - UNFAIR TRADE PRACTICES (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.20 - Unfair Trade Practices on Cancellations, Non-Renewals, or Premium Increases of Casualty or Property Insurance › Rule 6.6.2010 - SEVERABILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-18-1003,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.21 - Discrimination in Insurance › Rule 6.6.2101 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) The term "insurer" as used in this
				subchapter means any financial institution, or person, as those terms are
				defined in
				49-2-101,
				33-1-201, and
				33-1-202, MCA, that issues,
				transacts, sells, or otherwise provides any type of insurance policy, plan,
				certificate, membership contract, or coverage.
33-1-313, MCA; IMP :
					 33-1-502,
					 49-2-309,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.21 - Discrimination in Insurance › Rule 6.6.2102 - RATES AND PREMIUMS; PROPERTY AND CASUALTY INSURANCE

Current through Register Vol. 13, July 5, 2024
(1)
Factors which an insurer may take into account to determine
				  rates or premiums for motor vehicle liability and property coverage include,
				  but are not limited to:
(a) the age of
				the driver;
(b) the sex of the
				driver;
(c) the marital status of
				the driver;
(d) the length of
				driving experience;
(e) the number
				of years licensed to operate a motor vehicle;
(f) a determination of which driver, among
				several insured individuals, is the primary driver of a covered vehicle, based
				upon the proportionate use of each vehicle insured under the policy by
				individual drivers insured or to be insured under the policy;
(g) average number of miles driven over a
				period of time;
(h) type of use,
				such as business, farm, or pleasure use;
(i) vehicle characteristics, features, and
				options such as engine displacement, ability of vehicle and its equipment to
				protect passengers from injury, vehicle make and model, and design
				characteristics related to damageability of the vehicle;
(j) commuting mileage over a period of
				time;
(k) the number of cars
				insured or number of licensed operators in the household;
(l) the amount of insurance;
(m) the anticipated cost of vehicle repairs
				or replacement, which may be measured by age, price, cost, or value of the
				insured automobile, and other related factors;
(n) geographic location;
(o) the accident record of the insured,
				including accidents for which the insured, although not cited, was
				substantially at fault; and
(p) the
				driving record of the insured, including citations.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.21 - Discrimination in Insurance › Rule 6.6.2103 - PAYMENT OR BENEFITS (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313, MCA
					 IMP:
					 33-1-502,
					 49-2-309,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.21 - Discrimination in Insurance › Rule 6.6.2104 - JURISDICTION AND APPLICABILITY DATE

Current through Register Vol. 13, July 5, 2024
(1) Section
				49-2-309, MCA, and this subchapter
				are applicable to all insurance policies, plans, and coverages subject to the
				laws of Montana and issued or entered into on or after October 1,
				1985.
(2) Any term, payment, or
				benefit of an insurance policy, plan, or coverage in effect prior to October 1,
				1985, may be exercised in accordance with the terms of that policy, plan, or
				coverage. Options to increase or decrease coverage, annual rate adjustments,
				and settlement options in life insurance policies are examples of terms which
				if included in a policy, plan, or coverage in effect prior to October 1, 1985,
				may be exercised without regard to
				49-2-309, MCA, or these
				rules.
(3) Section
				49-2-309, MCA, and these rules,
				are applicable to any agreement whereby an insurer and an insured agree to an
				extension or continuation of a pre-October 1, 1985, insurance policy plan or
				coverage when no consideration was given in the pre-October 1, 1985, contract
				for the right to extend or continue upon the same terms. The fact that the
				contract formed by extension or continuation is identical to the pre-October 1,
				1985, contract is not material if no consideration for the right to extend or
				continue the pre-October 1, 1985, terms was given.
33-1-313, MCA; IMP,
					 33-1-502,
					 49-2-309,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.21 - Discrimination in Insurance › Rule 6.6.2106 - UNFAIR DISCRIMINATION ON THE BASIS OF BLINDNESS

Current through Register Vol. 13, July 5, 2024
(1) Refusing to insure, or refusing to
				continue to insure, or limiting the amount, extent, or kind of coverage
				available to an individual, or charging an individual a different rate for the
				same coverage solely because of blindness or partial blindness, is an act or
				practice that constitutes unfair discrimination between individuals of the same
				class, except where the refusal, limitation, or rate differential is based on
				sound actuarial principles, or is related to actual or reasonably anticipated
				experience.
33-1-313, MCA; IMP,
					 33-18-206,
					 33-18-210,
					 33-30-306,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.22 - Title Insurance › Rule 6.6.2201 - LIENS, ENCUMBRANCES, AND STANDARDS OF INSURABILITY

Current through Register Vol. 13, July 5, 2024
(1)
(a) The
				provisions of subsections (2) and(3) of ARM
				6.6.2201 do not apply to defects in
				title. Defects in title arise when a document or proceeding upon which title
				depends fails to accomplish its stated purpose. Defects of title include, but
				are not limited to, a break in the chain of title, a defective probate
				proceeding, an improperly acknowledged deed, or an error in a legal
				description.
(b) The provisions of
				subsections (2) and (3) of ARM
				6.6.2201 apply to other interests
				against the property. "Other interests against the property" means those
				interests created by documents the purpose of which is to encumber title.
				"Other interests against the property" include recorded liens or
				encumbrances.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.22 - Title Insurance › Rule 6.6.2203 - REBATES AND INDUCEMENTS

Current through Register Vol. 13, July 5, 2024
(1) "Rebate" means
				the payment or return of any charge or any portion thereof of the amount
				constituting the total rate for title insurance or services constituting the
				business of title insurance or the rates on file with the commissioner to any
				person.
(2) "Inducements" entail
				the following activities or practices:
(a)
				furnishing title information in written form without charge or at a charge less
				than the applicable rate filing. However, cancellation of a title commitment
				due to the failure of any party to complete the transaction at a charge
				determined by an underwriter's filed rate schedule shall not be considered an
				inducement;
(b) furnishing
				information packets, listing kits or hybrid forms of title
				information;
(c) paying or offering
				to pay any charges which constitute an obligation of any producer of title
				business for the cancellation of an existing title insurance order with a
				competing company;
(d) furnishing
				escrow, closing, or settlement services for a charge (independent of the rate
				charged for involved title insurance) less than the reasonable cost of so
				providing;
(e) deferring any
				payment for insurance or services,including title commitments or preliminary
				reports, otherwise due or payable for more than 60 days;
(f) furnishing or offering to furnish
				services not reasonably related to bona fide insurance or escrow, closing, or
				settlement transactions, including, but not limited to:
(i) computer services;
(ii) nonrelated delivery services;
(iii) mailing services;
(iv) accounting assistance; or
(v) the referral of legal matters to an
				attorney with whom the title company has a referral arrangement, unless
				disclosure is made of that fact and the customer has been advised that the
				attorney is an agent of the title company and does not represent the
				individual;
(g) renting
				or offering to rent as either landlord or tenant at a rental favorable to any
				producer of title business, title insurer, title insurance producer, or any
				employee or agent of any of the aforementioned, as compared with terms
				otherwise generally available;
(h)
				providing or paying for, as an inducement, the sale of title insurance or
				escrow services of any of the following non-exclusive items:
(i) credit extensions;
(ii) prizes;
(iii) vacations;
(iv) travel expenses;
(v) membership or registration fees;
				or
(vi) lodging; and
(i) depositing funds, whether
				interest bearing or not, with a credit or lending institution based on an
				understanding that title insurance business will be referred to a particular
				agent or insurer.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2301 - DEFINITIONS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-205,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2302 - AGENT COMMISSION (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-205,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2303 - APPLICATIONS AND APPLICATION FEES (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-221,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2304 - FISCAL ARRANGEMENT (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-225,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2305 - UNAVAILABILITY (IS HEREBY RRPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205 and
					 33-8-212, MCA; IMP, Sec.
					 33-8-221(1) (c),
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2306 - ELIGIBLE APPLICANTS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-225(1),
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2307 - LINES OF INSURANCE (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-227(3),
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2308 - EFFECTIVE DATE OF POLICY (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-228,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.23 - Montana Insurance Assistance Plan › Rule 6.6.2309 - SEVERABILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-8-205, MCA; IMP, Sec.
					 33-8-201 through
					 33-8-231,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2401 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of these rules is to:
(a) adopt the Coordination of Benefits Model
				Regulation, as promulgated by the National Association of Insurance
				Commissioners (NAIC);
(b) establish
				a uniform order of benefit determination under which plans pay
				claims;
(c) establish uniformity in
				the permissive use of overinsurance provisions and to avoid claim delays and
				misunderstandings that could otherwise result from the use of inconsistent or
				incompatible provisions among plans;
(d) reduce duplication of benefits by
				permitting a reduction of the benefits to be paid by plans that, pursuant to
				rules established by this subchapter, do not have to pay their benefits first;
				and
(e) provide greater efficiency
				in the processing of claims when a person is covered under more than one
				plan.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2402 - APPLICABILITY AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) These rules
				apply to each-contract providing health care benefits issued or delivered in
				Montana after the effective date of these rules, January 1, 2011.
(2) A contract providing health care benefits
				issued or delivered in Montana before the effective date of these rules must be
				brought into compliance with these rules by the later of:
(a) the next anniversary date, renewal date,
				or plan year of the contract; or
(b) the expiration of any applicable
				collectively bargained contract pursuant to which it was written.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2404 - USE OF MODEL COB CONTRACT PROVISION

Current through Register Vol. 13, July 5, 2024
(1)
				Appendix A in ARM
				6.6.2410 contains a model COB
				provision for use in group contracts. The use of this model COB provision is
				subject to the provisions of (2), (3), and (4), and to the provisions of ARM
				6.6.2405.
(2) Appendix B in ARM
				6.6.2411 is a plain language
				description of the COB process that explains to the covered person how health
				plans will implement coordination of benefits. It is not intended to replace or
				change the provisions that are set forth in the contract. Its purpose is to
				explain the process by which the two or more plans will pay for or provide
				benefits.
(3) The COB provision
				contained in Appendix A in ARM 6.6.2410, and the plain language explanation in
				Appendix B in ARM 6.6.2411, do not have to use the specific words and format
				shown in Appendix A or Appendix B. Changes may be made to fit the language and
				style of the rest of the contract or to reflect differences among plans that
				provide services, pay benefits for expenses incurred, and indemnify. No
				substantive changes are permitted.
(4) A COB provision may not be used that
				permits a plan to reduce its benefits on the basis that:
(a) another plan exists and the covered
				person did not enroll in that plan;
(b) a person is or could have been covered
				under another plan; or
(c) a person
				has elected an option under another plan providing a lower level of benefits
				than another option which could have been elected.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2405 - RULES FOR COORDINATION OF BENEFITS

Current through Register Vol. 13, July 5, 2024
(1)
				When a person is covered by two or more plans, the rules for determining the
				order of benefit payments are as follows:
(a)
				The primary plan must pay or provide its benefits as if the secondary plan or
				plans did not exist;
(b) If the
				primary plan is a closed panel plan and the secondary plan is not a closed
				panel plan, the secondary plan shall pay or provide benefits as if it were the
				primary plan when a covered person uses a nonpanel provider, except for
				emergency services or authorized referrals that are paid or provided by the
				primary plan;
(c) When multiple
				contracts providing coordinated coverage are treated as a single plan under
				this subchapter, this rule applies only to the plan as a whole, and
				coordination among the component contracts is governed by the terms of the
				contracts. If more than one carrier pays or provides benefits under the plan,
				the carrier designated as primary within the plan shall be responsible for the
				plan's compliance with this subchapter; and
(d) If a person is covered by more than one
				secondary plan, the order of benefit determination rules of this subchapter
				decide the order in which secondary plans benefits are determined in relation
				to each other. Each secondary plan shall take into consideration the benefits
				of the primary plan or plans and the benefits of any other plan, which under
				the rules of this subchapter, has its benefits determined before those of that
				secondary plan.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2406 - PROCEDURE TO BE FOLLOWED BY SECONDARY PLAN TO CALCULATE BENEFITS AND PAY A CLAIM

Current through Register Vol. 13, July 5, 2024
(1) In determining
				the amount to be paid by the secondary plan on a claim, should the plan wish to
				coordinate benefits, the secondary plan shall calculate the benefits it would
				have paid on the claim in the absence of other health care coverage, and apply
				that calculated amount to any allowable expense under its plan that is unpaid
				by the primary plan. The secondary plan may reduce its payment by the amount so
				that, when combined with the amount paid by the primary plan, the total
				benefits paid or provided by all plans for the claim do not exceed 100 percent
				of the total allowable expense for that claim. In addition, the secondary plan
				shall credit to its plan deductible any amounts it would have credited to its
				deductible in the absence of other health care coverage.
33-1-313, MCA; IMP,
					 33-15-304,
					 33-18-201,
					 33-22-225,
					 33-22-226,
					 33-22-502,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2407 - NOTICE TO COVERED PERSONS

Current through Register Vol. 13, July 5, 2024
(1) A plan
				shall, in its explanation of benefits provided to covered persons, include the
				following language: "If you are covered by more than one health benefit plan,
				you should file all your claims with each plan."
33-1-313, MCA; IMP,
					 33-15-304,
					 33-18-201,
					 33-22-225,
					 33-22-226,
					 33-22-502,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2408 - MISCELLANEOUS PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) A secondary
				plan that provides benefits in the form of services may recover the reasonable
				cash value of the services from the primary plan, to the extent that benefits
				for the services are covered by the primary plan and have not already been paid
				or provided by the primary plan. Nothing in this provision shall be interpreted
				to require a plan to reimburse a covered person in cash for the value of
				services provided by a plan that provides benefits in the form of
				services.
(2) A plan with order of
				benefit determination rules that comply with this subchapter (complying plan)
				may coordinate its benefits with a plan that is "excess" or "always secondary,"
				or that uses order of benefit determination rules that are inconsistent with
				those contained in this subchapter (noncomplying plan) on the following basis:
(a) If the complying plan is the primary
				plan, it shall pay or provide its benefits first;
(b) If the complying plan is the secondary
				plan, it shall pay or provide its benefits first, but the amount of the
				benefits payable shall be determined as if the complying plan were the
				secondary plan. In such a situation, the payment shall be the limit of the
				complying plan's liability; and
(c)
				If the noncomplying plan does not provide the information needed by the
				complying plan to determine its benefits within a reasonable time after it is
				requested to do so, the complying plan must assume that the benefits of the
				noncomplying plan are identical to its own, and shall pay its benefits
				accordingly. If, within two years of payment, the complying plan receives
				information as to the actual benefits of the noncomplying plan, it shall adjust
				payments accordingly.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2410 - APPENDIX "A" MODEL COB CONTRACT PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) The model COB contract provisions are set
				forth in this rule and referred to as "Appendix A:"
(a)
APPENDIX A. MODEL COB CONTRACT
				PROVISIONS
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.24 - Group Coordination of Benefits › Rule 6.6.2411 - APPENDIX "B" MODEL COB CONSUMER EXPLANATORY BOOKLET

Current through Register Vol. 13, July 5, 2024
(1) The provisions of the model COB consumer
				explanatory booklet are set forth in this rule and referred to as "Appendix B:"
(a)
APPENDIX B. CONSUMER EXPLANATORY
				BOOKLET
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2501 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of these rules is to
				implement the Montana Health Maintenance Organization Act to assure the
				availability, accessibility, and continuity of services provided by health
				maintenance organizations and to provide reasonable standards for terms and
				provisions contained in health maintenance organization contracts and evidences
				of coverage.
33-31-103, MCA; IMP,
					 33-31-101 through
					 33-31-405,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2502 - APPLICABILITY AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) These rules
				apply 60 days after effective date to all health maintenance organizations that
				are required to obtain a certificate of authority in this state. If these rules
				conflict with other rules adopted by the commissioner, these rules control as
				to health maintenance organizations.
(2) A new contract or evidence of coverage
				may not be delivered or issued for delivery in this state 60 days after the
				effective date of these rules unless it complies with these rules.
(3) A contract or evidence of coverage may
				not be reissued, renewed, amended, or extended in this state on or after the
				effective date of these rules unless it complies with these rules. A contract
				or evidence of coverage approved before the effective date of these rules is
				considered to be reissued, renewed, amended, or extended on the date the health
				maintenance organization changes the terms of the contract or evidence of
				coverage or adjusts the premiums charged. A contract or evidence of coverage
				must comply with these rules when it is amended or within 12 months after the
				effective date of these rules, whichever is earlier.
33-31-103, MCA; IMP,
					 33-31-101 through
					 33-31-405,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2503 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
As used in this subchapter, the Montana Health Maintenance
				  Organization Act, and for the purpose of any terms used in the contract and
				  evidence of coverage:
(1) "Contract
				holder" means a person or entity consisting of employees or eligible persons
				that has entered into a group contract with a health maintenance organization
				for the provision of specified health care services to its eligible employees
				or eligible persons.
(2)
				"Copayment" means the amount an enrollee must pay to receive a specific service
				that is not fully prepaid.
(3)
				"Emergency care services" means the same as "emergency services," and
				incorporating "emergency medical condition," as defined in
				33-36-103,
				MCA.
(a) if within the service area:
(i) covered health care services rendered by
				affiliated providers under unforeseen conditions that require immediate medical
				attention; and
(ii) covered health
				care services from non-affiliated providers under unforeseen conditions that
				require immediate medical attention, but only when delay in receiving care from
				the health maintenance organization could reasonably be expected to cause
				severe jeopardy to the enrollee's condition; and
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2504 - FILING EXEMPTION FOR HEALTH MAINTENANCE OPERATED BY INSURER OR HEALTH SERVICE CORPORATION AS A PLAN

Current through Register Vol. 13, July 5, 2024
(1) A health
				maintenance organization operated as a plan (defined in
				33-31-102,
				MCA) need not file with the commissioner, as part of its application for a
				certificate of authority, the financial statement required by
				33-31-201,
				MCA, if the same financial statement has been filed with the commissioner
				already.
AUTH:
					 33-31-103,
					 33-31-201,
					 MCA; IMP:
					 33-31-201,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2505 - MULTIDISCIPLINARY ADVISORY BOARDS

Current through Register Vol. 13, July 5, 2024
(1) The
				membership of a health maintenance organization advisory board must include
				providers or other individual representatives from at least three different
				health-related fields.
AUTH:
					 33-31-103, MCA
					 and SB 353, statement of intent, p. 2, lines 15-18; IMP:
					 33-31-222,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2507 - PROHIBITED PRACTICES

Current through Register Vol. 13, July 5, 2024
(1) A health
				maintenance organization may not include in its contract and evidence of
				coverage a provision setting forth exclusions or limitations of services for
				preexisting conditions at the time of enrollment, except as permitted under
				33-22-246,
				33-22-514,
				or
				33-22-1811,
				MCA.
(2) In addition to the
				requirements of (1), a health maintenance organization may not exclude or limit
				services for a preexisting condition when the enrollee transfers coverage from
				one individual contract to another or when the enrollee converts coverage under
				his conversion option, except to the extent of a preexisting condition
				limitation or exclusion remaining unexpired under the prior contract.
(3) A health maintenance organization may not
				unfairly discriminate against any enrollee or applicant for enrollment on the
				basis of the age, sex, race, color, creed, national origin, ancestry, religion,
				marital status, or lawful occupation of an enrollee, because of the frequency
				of utilization of services of an enrollee, or for any reason prohibited by
				33-22-526,
				MCA.
(4) Representing as a group
				contract a contract that refuses, within the eligibility period, to enroll an
				individual member of a group on the basis of the health status or health care
				needs of the individual enrollee or member is deceptive and misleading and
				violative of
				33-18-203,
				MCA.
AUTH:
					 33-31-103, MCA;
					 IMP:
					 33-18-203,
					 33-22-1811,
					 33-31-111,
					 33-31-301,
					 33-31-312,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2508 - SERVICES

Current through Register Vol. 13, July 5, 2024
(1) A health maintenance organization shall
				establish and maintain adequate arrangements to provide the health services
				contracted for by its subscribers including:
(a) reasonable proximity to the business or
				personal residences of the enrollees so as not to result in unreasonable
				barriers to accessibility;
(b)
				reasonable hours of operation and after-hours services;
(c) emergency care services available and
				accessible within the service area 24 hours a day, seven days a week; and
(d) sufficient providers and
				personnel, including health professionals, administrators and support staff, to
				assure that all services contracted for will be accessible to enrollees on an
				appropriate basis without delays detrimental to the health of
				enrollees.