reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3111 - RESERVE STANDARDS

Current through Register Vol. 13, July 5, 2024
(1) When long-term
				care benefits are provided through the acceleration of benefits under group or
				individual life policies or riders to such policies, policy reserves for such
				benefits shall be determined in accordance with
				33-2-523, MCA. Claim reserves must
				also be established in the case when such policy or rider is in claim
				status.
(2) Reserves for policies
				and riders subject to this rule should be based on the multiple decrement model
				utilizing all relevant decrements except for voluntary termination rates.
				Single decrement approximations are acceptable if the calculation produces
				essentially similar reserves, if the reserve is clearly more conservative, or
				if the reserve is immaterial. The calculations may take into account the
				reduction in life insurance benefits due to the payment of long-term care
				benefits. However, in no event shall the reserves for the long-term care
				benefit and the life insurance benefit be less than the reserves for the life
				insurance benefit assuming no long-term care benefit.
(3) In the development and calculation of
				reserves for policies and riders subject to this rule, due regard shall be
				given to the applicable policy provisions, marketing methods, administrative
				procedures, and all other considerations which have an impact on projected
				claim costs, including, but not limited to the following:
(a) definition of insured events;
(b) covered long-term care
				facilities;
(c) existence of home
				convalescence care coverage;
(d)
				definition of facilities;
(e)
				existence or absence of barriers to eligibility;
(f) premium waiver provision;
(g) renewability;
(h) ability to raise premiums;
(i) marketing method;
(j) underwriting procedures;
(k) claims adjustment procedures;
(l) waiting period;
(m) maximum benefit;
(n) availability of eligible
				facilities;
(o) margins in claim
				costs;
(p) optional nature of
				benefit;
(q) delay in eligibility
				for benefit;
(r) inflation
				protection provisions; and
(s)
				guaranteed insurability option.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3112 - LOSS RATIO

Current through Register Vol. 13, July 5, 2024
(1) Benefits under
				individual long-term care insurance policies shall be deemed reasonable in
				relation to premiums provided the expected loss ratio is at least 60%,
				calculated in a manner which provides for adequate reserving of the long-term
				insurance risk. In evaluating the expected loss ratio, due consideration shall
				be given to all relevant factors, including:
(a) statistical credibility of incurred
				claims experience and earned premiums;
(b) the period for which rates are computed
				to provide coverage;
(c)
				experienced and projected trends;
(d) concentration of experience within early
				policy duration;
(e) expected claim
				fluctuation;
(f) experience
				refunds, adjustments or dividends;
(g) renewability features;
(h) all appropriate expense
				factors;
(i) interest;
(j) experimental nature of the
				coverage;
(k) policy
				reserves;
(l) mix of business by
				risk classification; and
(m)
				product features such as long elimination periods, high deductibles and high
				maximum limits.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3113 - FILING REQUIREMENT

Current through Register Vol. 13, July 5, 2024
(1) Prior to an
				issuer offering long-term care insurance to a resident of Montana pursuant to
				33-22-1120, MCA, the issuer shall
				file with the Commissioner of Insurance the policy or certificate for approval
				by this state.
(2) The policy or
				certificate and all related forms must prominently display the specific kind
				and type(s) of long-term care benefits insured.
33-1-313,
					 33-22-1121, MCA; IMP,
					 33-22-1101,
					 33-22-1102,
					 33-22-1103,
					 33-22-1107,
					 33-22-1108,
					 33-22-1111,
					 33-22-1112,
					 33-22-1113,
					 33-22-1114,
					 33-22-1115,
					 33-22-1116,
					 33-22-1117,
					 33-22-1119,
					 33-22-1120,
					 33-22-1121,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3113A - FILING REQUIREMENTS FOR ADVERTISING

Current through Register Vol. 13, July 5, 2024
(1)
				Every issuer, health service corporation or health maintenance organization or
				other entity providing long-term care insurance or benefits in Montana shall
				provide a copy of any long-term care insurance advertisement intended for use
				in this state whether through written, radio or television medium to the
				commissioner of insurance for review or approval by the commissioner. In
				addition, all advertisements shall be retained by the issuer, health service
				corporation, health maintenance organization or other entity for at least three
				years from the date the advertisement was first used.
(2) The commissioner may exempt from these
				requirements any advertising form or material when, in the commissioner's
				opinion, this requirement may not be reasonably applied.
(3) All advertising and marketing materials
				must prominently display the specific kind and type(s) of long-term care
				benefits insured.
33-1-3113 and
					 33-22-1121, MCA; IMP,
					 33-22-1103,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3115 - REQUIREMENT TO DELIVER SHOPPER'S GUIDE

Current through Register Vol. 13, July 5, 2024
(1) A
				long-term care insurance shopper's guide in the format developed by the
				National Association of Insurance Commissioners, or a guide developed or
				approved by the Commissioner of Insurance, shall be provided to all prospective
				applicants of a long-term care insurance policy or certificate.
(a) In the case of producer solicitations, a
				producer must deliver the shopper's guide prior to the presentation of an
				application or enrollment form.
(b)
				In the case of direct response solicitations, the shopper's guide must be
				presented in conjunction with any application or enrollment form.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3116 - EFFECTIVE DATE (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-22-1101 through
					 33-22-1121,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3117 - STANDARDS FOR MARKETING

Current through Register Vol. 13, July 5, 2024
(1) Every issuer,
				health service corporation, health maintenance organization or other entity
				marketing long-term care insurance coverage in this state, directly or through
				its producers, shall:
(a) establish marketing
				procedures and producer training requirements to assure that:
(i) any marketing activities, including
				comparison of policies, by its producers or other producers, will be fair and
				accurate; and
(ii) excessive
				insurance is not sold or issued;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3118 - SUITABILITY STANDARDS

Current through Register Vol. 13, July 5, 2024
(1) Every issuer,
				health service corporation, health maintenance organization or other entity
				marketing long-term care insurance (the "issuer") shall:
(a) develop and use appropriate suitability
				standards to determine whether the purchase or replacement of long-term care
				insurance is appropriate for the needs of the applicant;
(b) train its producers in the use of its
				suitability standards; and
(c)
				maintain a copy of its suitability standards and make them available for
				inspection upon request by the commissioner.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3119 - NONFORFEITURE BENEFIT REQUIREMENT

Current through Register Vol. 13, July 5, 2024
(1) An
				insurance company offering a long-term care insurance policy or certificate
				shall offer to each prospective purchaser the choice between a policy that
				includes nonforfeiture benefits to the defaulting or surrendering policyholder
				or certificate holder and one that does not include nonforfeiture benefits.
(2) To comply with the requirement
				to offer a nonforfeiture benefit pursuant to the provisions of
				33-22-1116,
				MCA:
(a) A policy or certificate offered with
				nonforfeiture benefits shall have coverage elements, eligibility, benefit
				triggers and benefit length that are the same as coverage to be issued without
				nonforfeiture benefits. The nonforfeiture benefit included in the offer shall
				be the benefit described in (5); and
(b) The offer shall be in writing if the
				nonforfeiture benefit is not otherwise described in the outline of coverage or
				other materials given to the prospective policyholder.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3121 - REQUIRED DISCLOSURE OF RATING PRACTICES TO CONSUMERS

Current through Register Vol. 13, July 5, 2024
(1) This rule shall apply as follows:
(a) except as provided in (2), this provision
				applies to any long-term care policy issued in Montana on or after January 1,
				2009; and
(b) for certificates
				issued on or after the effective date of this amended rule under a group
				long-term care insurance policy as defined in
				33-22-1107(5),
				MCA, which policy was in force at the time this amended rule became effective,
				the provisions of this rule shall apply on the policy anniversary following
				January 1, 2009.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3122 - INITIAL FILING REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) This rule
				applies to any long-term care policy issued in this state on or after January
				1, 2009.
(2) An insurer shall
				provide the information listed in this rule to the commissioner 30 days prior
				to making a long-term care insurance form available for sale:
(a) a copy of the disclosure documents
				required in ARM
				6.6.3121;
				and
(b) an actuarial certification
				consisting of at least the following:
(i) a
				statement that the initial premium rate schedule is sufficient to cover
				anticipated costs under moderately adverse experience and that the premium rate
				schedule is reasonably expected to be sustainable over the life of the form
				with no future premium increases anticipated;
(ii) a statement that the policy design and
				coverage provided have been reviewed and taken into consideration;
(iii) a statement that the underwriting and
				claims adjudication processes have been reviewed and taken into
				consideration;
(iv) a complete
				description of the basis for contract reserves that are anticipated to be held
				under the form, to include:
(A) sufficient
				detail or sample calculations provided so as to have a complete depiction of
				the reserve amounts to be held;
(B)
				a statement that the assumptions used for reserves contain reasonable margins
				for adverse experience;
(C) a
				statement that the net valuation premium for renewal years does not increase,
				except for attained-age rating where permitted; and
(D) a statement that the difference between
				the gross premium and the net valuation premium for renewal years is sufficient
				to cover expected renewal expenses; or if such a statement cannot be made, a
				complete description of the situations where this does not occur:
(I) an aggregate distribution of anticipated
				issues may be used as long as the underlying gross premiums maintain a
				reasonably consistent relationship;
(II) if the gross premiums for certain age
				groups appear to be inconsistent with this requirement, the commissioner may
				request a demonstration under (3), based on a standard age distribution.
(v) a
				statement that the premium rate schedule is not less than the premium rate
				schedule for existing similar policy forms also available from the insurer
				except for reasonable differences attributable to benefits; and
(vi) a comparison of the premium schedules
				for similar policy forms that are currently available from the insurer with an
				explanation of the differences.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3123 - RECOUPING PAST LOSSES

Current through Register Vol. 13, July 5, 2024
(1) In reviewing
				loss ratio and premium rate schedule increases, the commissioner will ensure
				that any issuer does not recoup past losses.
(2) For premium rate increases, to ensure
				that issuers do not recoup past losses, premium deficiencies prior to a
				requested rate increase should not be included in the premium rate increase
				calculation. This is determined by comparing the originally filed lifetime loss
				ratio with the corrected lifetime loss ratio.
(a) The corrected lifetime loss ratio is
				found by recalculating the original premiums given the actual historical
				experience of that block of business combined with the company's revised
				projected assumptions.
(b) The
				originally filed lifetime loss ratio is found by:
(i) for blocks of business issued in Montana
				prior to January 1, 2009, following ARM
				6.6.3112; or
(ii) for blocks of business issued
				in Montana on or after January 1, 2009, following ARM
				6.6.3124.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3125 - PREMIUM RATE INCREASE - ASSET YIELD RATES

Current through Register Vol. 13, July 5, 2024
(1) An issuer may
				not use asset investment yield rate changes to justify any premium rate
				schedule increase for a long-term care insurance policy. This does not prohibit
				the commissioner from considering an issuer's potential insolvency when making
				rate determinations pursuant to ARM
				6.6.3124.
AUTH:
					 33-1-313,
					 33-22-1121, MCA; IMP:
					 33-22-1121,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3126 - PROHIBITION AGAINST PREEXISTING CONDITIONS AND PROBATIONARY PERIODS IN REPLACEMENT POLICIES

Current through Register Vol. 13, July 5, 2024
(1) If a long-term
				care insurance policy replaces another long-term care policy, the replacing
				issuer shall waive any time periods applicable to preexisting conditions and
				probationary periods in the new long-term care policy for similar benefits to
				the extent that similar exclusions have been satisfied under the original
				policy.
33-1-313,
					 33-22-1121, MCA; IMP,
					 33-22-1101,
					 33-22-1102,
					 33-22-1103,
					 33-22-1107,
					 33-22-1108,
					 33-22-1111,
					 33-22-1112,
					 33-22-1113,
					 33-22-1114,
					 33-22-1115,
					 33-22-1116,
					 33-22-1117,
					 33-22-1119,
					 33-22-1120,
					 33-22-1121,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3128 - AVAILABILITY OF NEW SERVICES OR PROVIDERS

Current through Register Vol. 13, July 5, 2024
(1)
				An issuer shall notify policyholders of the availability of a new long-term
				policy series that provides coverage for new long-term care services or
				providers, material in nature, and not previously available through the issuer
				to the general public. The notice shall be provided within twelve months of the
				date the new policy series is made available for sale in Montana.
(2) Notwithstanding (1), notification is not
				required for any policy issued prior to the effective date of this rule or to
				any policy issued prior to the effective date of this rule or to any
				policyholder or certificateholder who is currently eligible for benefits within
				an elimination period or on a claim, or who previously had been in claim
				status, or who would not be eligible to apply for coverage due to issue age
				limitations under the new policy. The issuer may require that policyholders
				meet all eligibility requirements, including underwriting and payment of the
				required premium to add such new services or providers.
(3) The issuer shall make the new coverage
				available in one of the following ways:
(a)
				by adding a rider to the existing policy and charging a separate premium for
				the new rider based on the insured's attained age;
(b) by exchanging the existing policy for one
				with an issue age based on the present age of the insured and recognizing past
				insured status by granting premium credits toward the premiums for the new
				policy. The premium credits shall be based on premiums paid or reserves held
				for the prior policy;
(c) by
				exchanging the existing policy for a new policy in which consideration for past
				insured status shall be recognized by setting the premium for the new policy at
				the issue age of the policy being exchanged. The cost for the new policy may
				recognize the difference in reserves between the new policy and the original
				policy; or
(d) by an alternative
				program developed by the issuer that meets the intent of this rule if the
				program is filed with and approved by the commissioner.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3129 - RIGHT TO REDUCE COVERAGE AND LOWER PREMIUMS

Current through Register Vol. 13, July 5, 2024
(1)
				Every long-term care insurance policy shall include a provision that allows the
				policyholder or certificateholder to reduce coverage and lower the policy
				premium in at least one of the following ways:
(a) reducing the maximum benefit;
				or
(b) reducing the daily, weekly,
				or monthly benefit amount.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3130 - APPEALING AN INSURER'S DETERMINATION THAT THE BENEFIT TRIGGER IS NOT MET

Current through Register Vol. 13, July 5, 2024
(1) For purposes of this rule, "authorized
				representative" means a person authorized to act as the covered person's
				personal representative within the meaning of
				45
				CFR 164.502(g) promulgated
				by the Secretary under the Administrative Simplification provisions of the
				Health Insurance Portability and Accountability Act and means the following:
(a) a person to whom a covered person has
				given express written consent to represent the covered person in an external
				review;
(b) a person authorized by
				law to provide substituted consent for a covered person; or
(c) a family member of the covered person or
				the covered person's treating health care professional only when the covered
				person is unable to provide consent.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3131 - LONG-TERM CARE INDEPENDENT REVIEW ORGANIZATIONS

Current through Register Vol. 13, July 5, 2024
(1) The commissioner shall certify or approve
				a qualified long-term care insurance independent review organization, provided
				the organization demonstrates to the satisfaction of the commissioner that it
				is unbiased and that:
(a) the organization
				will have on staff, or contract with, a qualified and licensed health care
				professional in an appropriate field for determining an insured's functional or
				cognitive impairment (e.g., physical therapy, occupational therapy, neurology,
				physical medicine and rehabilitation) to conduct the review;
(b) neither the organization, nor any of its
				licensed health care professionals, may be related to or affiliated with, in
				any manner, an entity that previously provided medical care to the insured;
(c) the organization will utilize
				a licensed health care professional who is not an employee of the insurer or
				related in any manner to the insured;
(d) neither the organization, nor its
				licensed health care professionals who conduct the reviews, may receive
				compensation of any type that is dependent on the outcome of the review;
(e) the organization will be
				approved or certified by the commissioner before conducting such reviews;
(f) the organization provides a
				description of the fees to be charged by it for independent reviews of a
				long-term care insurance benefit trigger decision;
(g) the organization's fees shall be
				reasonable and customary for the type of long-term care insurance benefit
				trigger decision under review;
(h)
				the organization provides the name of the medical director or health care
				professional responsible for the supervision and oversight of the independent
				review procedure; and
(i) the
				organization will have on staff or contract with a licensed health care
				practitioner, as defined by Section 7702B(c)(4) of the Internal Revenue Code,
				who is qualified to certify that an individual is chronically ill for purposes
				of a qualified long-term care insurance contract.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.32 - Pricing of Noncompetitive or Volatile Lines › Rule 6.6.3201 - PURPOSE AND SCOPE (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-16-231 through
					 33-16-236,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.32 - Pricing of Noncompetitive or Volatile Lines › Rule 6.6.3202 - DEFINITIONS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-16-231 through
					 33-16-236,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.32 - Pricing of Noncompetitive or Volatile Lines › Rule 6.6.3203 - EVALUATION OF A LINE - NONCOMPETITIVE (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-16-231 through
					 33-16-236,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.32 - Pricing of Noncompetitive or Volatile Lines › Rule 6.6.3204 - EVALUATION OF A LINE - VOLATILE (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-16-231 through
					 33-16-236,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.32 - Pricing of Noncompetitive or Volatile Lines › Rule 6.6.3205 - DATA REPORTING REQUIREMENTS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-16-231 through
					 33-16-236,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.32 - Pricing of Noncompetitive or Volatile Lines › Rule 6.6.3206 - FILING REQUIREMENTS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-16-231 through
					 33-16-236,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.33 - Prohibiting Unfair Discrimination for Previously Uninsured Personal Automobile Insurance Applicants › Rule 6.6.3301 - PURPOSE AND APPLICATION

Current through Register Vol. 13, July 5, 2024
(1) The purpose of
				these rules is to prevent unfair discrimination in personal automobile
				insurance based solely on an applicant's lack of prior insurance at the time of
				application for insurance with any insurer. These rules prohibit unfair
				discrimination in underwriting such applicants by insurers, both in determining
				eligibility for insurance and in the pricing of such insurance.
(2) These rules apply to all coverages,
				including applicable deductible options and policy limit's, in an automobile
				insurance policy issued to individuals or families. This includes any policy
				commonly known as an automobile policy, private passenger automobile policy, or
				any similar policy by whatever name, but does not include policies known as
				commercial automobile policies.
(3)
				These rules will support greater compliance with the Unfair Trade Practices
				Act, 33-15-101, et seq., MCA.
Sec.
					 33-1-313 and
					 33-18-102, MCA; IMP, Sec.
					 33-18-210,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.33 - Prohibiting Unfair Discrimination for Previously Uninsured Personal Automobile Insurance Applicants › Rule 6.6.3302 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Prior insurance" means an automobile
				insurance policy in force with any insurer, or an authorized self-insurance
				plan in effect, at the time of or at any time within the three-year period
				prior to application for coverage with any insurer.
(2) "Insurer" means an individual insurance
				company or a group of affiliated insurance companies.
Sec.
					 33-1-313 and
					 33-18-102, MCA; IMP,
					 33-18-210,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.33 - Prohibiting Unfair Discrimination for Previously Uninsured Personal Automobile Insurance Applicants › Rule 6.6.3303 - DISCRIMINATION IN DETERMINING ELIGIBILITY FOR INSURANCE PROHIBITED

Current through Register Vol. 13, July 5, 2024
(1) Except as provided in (1) (a), (1) (b),
				and (3) below, an insurer shall not reject an applicant for insurance solely on
				the basis that the applicant cannot or does not demonstrate the existence of
				prior insurance. This section does not prohibit an insurer from rejecting an
				applicant with no prior insurance under the following circumstances:
(a) The insurer can demonstrate through
				driving records or other objective means that the applicant has at any time in
				the immediately prior three years been operating a motor vehicle in violation
				of any state's compulsory auto insurance laws.
(b) If on the application for coverage the
				applicant represents that prior insurance existed, but fails to provide
				evidence to the insurer, or fails to assist the insurer in securing evidence
				that said prior insurance actually existed.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.33 - Prohibiting Unfair Discrimination for Previously Uninsured Personal Automobile Insurance Applicants › Rule 6.6.3304 - DISCRIMINATION IN PRICING PROHIBITED

Current through Register Vol. 13, July 5, 2024
(1)
				Except as provided in paragraphs (2) and (3) below, once program eligibility
				has been established, the existence or non-existence of prior insurance for a
				policyholder shall not be considered in determining the premium for a policy.
				The premium charged by an insurer for a policyholder with no prior insurance
				shall be the same as if the policyholder had prior insurance and was insured in
				the same program.
(2) An insurer
				may impose a surcharge in accordance with its filed pricing structure on an
				insured who has received a citation within the immediately prior three years
				for driving in violation of any state's mandatory insurance law.
(3) An insurer-may impose a surcharge, not to
				exceed the surcharge permitted in paragraph (2) above, on an insured who in the
				immediately prior three years has driven in violation of any state's mandatory
				insurance law but did not receive a citation for such. The surcharge must be in
				accordance with the insurer's filed pricing structure, and the insurer must
				maintain in the insured's file evidence sufficient to demonstrate that the
				insured operated a motor vehicle in violation of a state's mandatory auto
				insurance law.
Sec.
					 33-1-313 and
					 33-18-102, MCA; IMP, Sec.
					 33-18-210,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.34 - Companies Considered to Be in Hazardous Financial Condition › Rule 6.6.3402 - SCOPE OF COMMISSIONER'S DISCRETION

Current through Register Vol. 13, July 5, 2024
(1)
				For the purposes of making a determination of an insurer's financial condition
				under this subchapter, the commissioner may:
(a) disregard any credit or amount receivable
				resulting from transactions with a reinsurer which is insolvent, impaired, or
				otherwise subject to a delinquency proceeding;
(b) make appropriate adjustments, including
				disallowance, to asset values attributable to investments in, or transactions
				with, parents, subsidiaries, or affiliates consistent with the NAIC Accounting
				Practices and Procedures Manual, state laws and regulations;
(c) refuse to recognize the stated value of
				accounts receivable, if the ability to collect receivables is highly
				speculative in view of the age of the account or the financial condition of the
				debtor; or
(d) increase the
				insurer's liability in an amount equal to any contingent liability, pledge, or
				guarantee not otherwise included, if there is a substantial risk that the
				insurer will be called upon to meet the obligation undertaken within the next
				12-month period.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.34 - Companies Considered to Be in Hazardous Financial Condition › Rule 6.6.3403 - POSSIBLE ADMINISTRATIVE SANCTIONS AGAINST COMPANIES IN HAZARDOUS CONDITION

Current through Register Vol. 13, July 5, 2024
(1) If the
				commissioner determines that the continued operation of the insurer licensed to
				transact business in this state may be hazardous to its policyholders,
				creditors, or the general public, then the commissioner may, upon such a
				determination, issue an order requiring the insurer to:
(a) reduce the total amount of present and
				potential liability for policy benefits by reinsurance;
(b) reduce, suspend, or limit the volume of
				business being accepted or renewed;
(c) reduce general insurance and commission
				expenses by specified methods;
(d)
				increase the insurer's capital and surplus;
(e) suspend or limit the declaration and
				payment of dividend by an insurer to its stockholders or to its
				policyholders;
(f) file reports in
				a form acceptable to the commissioner concerning the market value of an
				insurer's assets;
(g) limit or
				withdraw from certain investments or discontinue certain investment practices
				to the extent the commissioner deems necessary;
(h) document the adequacy of premium rates in
				relation to the risks insured;
(i)
				file, in addition to regular annual statements, interim financial reports on
				the form adopted by the NAIC or in such format as promulgated by the
				commissioner;
(j) correct corporate
				governance practice deficiencies, and adopt and utilize governance practices
				acceptable to the commissioner;
(k)
				provide a business plan to the commissioner in order to continue to transact
				business in the state; and
(l)
				notwithstanding any other provision of law limiting the frequency or amount of
				premium rate adjustments, adjust rates for any non-life insurance product
				written by the insurer that the commissioner considers necessary to improve the
				financial condition of the insurer.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.34 - Companies Considered to Be in Hazardous Financial Condition › Rule 6.6.3404 - ADMINISTRATIVE REMEDIES AVAILABLE TO INSURERS

Current through Register Vol. 13, July 5, 2024
(1) Any health service corporation subject to
				an order under ARM
				6.6.3403 may request a hearing
				pursuant to
				33-1-701, MCA.
(2) Any other insurer, including a captive
				insurance company and a captive risk retention group, subject to an order under
				ARM 6.6.3403 may request a hearing or
				appeal from the order pursuant to
				33-2-1321, MCA.
(3) The notice of hearing shall be served
				upon the respondent pursuant to the Montana Administrative Procedure Act. The
				notice of hearing shall state the time and place of hearing, and the conduct,
				condition, or ground upon which the commissioner based the order. Unless
				mutually agreed between the commissioner and the respondent, the hearing shall
				occur not less that 10 days nor more than 30 days after notice is served, and
				shall be either in Lewis & Clark County, or in some other place convenient
				to the parties to be designated by the commissioner. The commissioner shall
				hold all hearings under this rule privately, unless the respondent requests a
				public hearing, in which case the hearing shall be public.
33-1-313,
					 33-2-1321,
					 33-2-1517,
					 33-28-206, MCA; IMP,
					 33-1-401,
					 33-2-1321,
					 33-2-1323,
					 33-2-1517,
					 33-28-108,
					 33-28-109,
					 33-28-207,
					 33-30-102,
					 33-30-105,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.34 - Companies Considered to Be in Hazardous Financial Condition › Rule 6.6.3405 - JUDICIAL REVIEW

Current through Register Vol. 13, July 5, 2024
(1) Any order or
				decision of the commissioner shall be subject to judicial review in accordance
				with 33-1-711,
				33-2-1323, MCA, and Montana
				Administrative Procedure Act by any party to the proceedings whose interests
				are substantially affected.
33-1-313,
					 33-2-1517,
					 33-28-206, MCA; IMP,
					 33-1-401,
					 33-2-1321,
					 33-2-1517,
					 33-28-108,
					 33-28-109,
					 33-28-207,
					 33-30-102,
					 33-30-105,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3502 - PURPOSE AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of
				this rule is to improve the surveillance of the financial condition of insurers
				by the department of insurance of the state of Montana by requiring:
(a) an annual audit of financial statements
				reporting the financial position, and the results of operations of insurers by
				independent certified public accountants;
(b) communication of internal control related
				matters noted in an audit; and
(c)
				management's report of internal control over financial reporting.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3503 - GENERAL REQUIREMENTS RELATED TO FILING AND EXTENSIONS FOR FILING OF ANNUAL AUDITED FINANCIAL REPORTS AND AUDIT COMMITTEE APPOINTMENT

Current through Register Vol. 13, July 5, 2024
(1) All insurers shall have an annual audit
				by an independent certified public accountant and shall file an audited
				financial report with the commissioner on or before June 1 for the year ended
				December 31 immediately preceding. Upon 90 days advance notice, for good cause,
				the commissioner may require an insurer to file an audited financial report
				earlier than June 1.
(2) Extensions
				of the June 1 filing date may be granted by the commissioner for 30-day periods
				upon showing by the insurer and its independent certified public accountant of
				good cause for an extension. Request for extension must by submitted in writing
				not less than ten days prior to the due date and must be in sufficient detail
				to permit the commissioner to make an informed decision with respect to the
				requested extension.
(3) If an
				extension is granted in accordance with the provisions in ARM
				6.6.3503(2), a
				similar extension of 30 days is granted to the filing of management's report of
				internal control over financial reporting.
(4) Every insurer required to file an annual
				audited financial report pursuant to this subchapter shall designate a group of
				individuals as constituting its audit committee, as defined in ARM
				6.6.3501. The audit committee of an
				entity that controls an insurer may be deemed to be the insurer's audit
				committee for purposes of this subchapter at the election of the controlling
				person.
33-1-313,
					 33-2-1517,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3504 - CONTENTS OF ANNUAL AUDITED FINANCIAL REPORT

Current through Register Vol. 13, July 5, 2024
(1) The annual audited financial report shall
				report the financial position of the insurer as of the end of the most recent
				calendar year and the results of its operations, cash flows and changes in
				capital and surplus for the year then ended, all in conformity with statutory
				accounting practices prescribed, or otherwise permitted, by the department of
				insurance of the state of domicile.
(2) The annual audited financial report shall
				include the following:
(a) report of
				independent certified public accountant;
(b) balance sheet reporting admitted assets,
				liabilities, capital, and surplus;
(c) statement of operations;
(d) statement of cash flow;
(e) statement of changes in capital and
				surplus; and
(f) notes to financial
				statements;
(i) These notes shall be those
				required by the appropriate 2018 NAIC Annual Statement Instructions and the
				March 2018 NAIC Accounting Practices and Procedures Manual, which are adopted
				and incorporated by reference, and may be obtained from the NAIC at
http://www.naic.org/prod_serv_alpha_listing.htm
.
				The notes shall include reconciliation of differences, if any, between the
				audited statutory financial statements and the annual statement filed pursuant
				to
				33-2-701,
				33-4-313,
				33-7-118,
				33-30-107,
				33-31-211,
				MCA, with a written description of the nature of these differences.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3506 - QUALIFICATIONS OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT

Current through Register Vol. 13, July 5, 2024
(1) The commissioner shall not recognize any
				person or firm as a qualified independent certified public accountant if the
				person, or firm:
(a) is not in good standing
				with the AICPA and in all states in which the accountant is licensed to
				practice, or, for a Canadian or British company, that is not a chartered
				accountant; or
(b) has either
				directly or indirectly entered into an agreement of indemnity or release from
				liability (collectively referred to as "indemnification") with respect to the
				audit of the insurer.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3507 - CONSOLIDATED OR COMBINED AUDITS

Current through Register Vol. 13, July 5, 2024
(1) An insurer
				may make written application to the commissioner for authority to file audited
				consolidated or combined financial statements in lieu of separate annual
				audited financial statements, if the insurer is part of a group of insurance
				companies which utilizes a pooling, or 100% reinsurance, agreement that affects
				the solvency and integrity of the insurer's reserves and such insurer cedes all
				of its direct and assumed business to the pool. In such cases, a columnar
				consolidating or combining worksheet shall be filed with the report, as
				follows:
(a) amounts shown on the
				consolidated or combined audited financial report shall be shown on the
				worksheet;
(b) amounts for each
				insurer subject to this section shall be stated separately;
(c) noninsurance operations may be shown on
				the worksheet on a combined or individual basis;
(d) explanations of consolidating and
				eliminating entries shall be included;and
(e) a reconciliation shall be included of any
				differences between the amounts shown in the individual insurer columns of the
				worksheet and comparable amounts shown on the annual statements of the
				insurers.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3508 - SCOPE OF AUDIT AND REPORT OF INDEPENDENT CERTIFIED PUBLIC ACCOUNTANT

Current through Register Vol. 13, July 5, 2024
(1) Financial statements furnished pursuant
				to ARM 6.6.3504 shall be examined by an
				independent certified public accountant. The audit of the insurer's financial
				statements shall be conducted in accordance with generally accepted auditing
				standards. In accordance with AU Section 319 of the Professional Standards of
				the AICPA, Consideration of Internal Control in a Financial Statement Audit,
				the independent certified public accountant should obtain an understanding of
				internal control sufficient to plan the audit. To the extent required by AU
				319, for those insurers required to file a Management's Report of Internal
				Control over Financial Reporting pursuant ARM
				6.6.3517, the independent certified
				public accountant should consider (as that term is defined in Statement on
				Auditing Standards (SAS) No. 102, Defining Professional Requirements in
				Statements on Auditing Standards or its replacement) the most recently
				available report in planning and performing the audit of the statutory
				financial statements. Consideration should also be given to such other
				procedures illustrated in the Financial Condition Examiner's Handbook
				promulgated by the NAIC, as the independent certified public accountant deems
				necessary.
33-1-313,
					 33-2-1517, MCA; IMP,
					 33-2-701,
					 33-2-1517,
					 33-4-313,
					 33-5-413,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3509 - NOTIFICATION OF ADVERSE FINANCIAL CONDITION

Current through Register Vol. 13, July 5, 2024
(1)
				The insurer required to furnish the annual audited financial report shall
				require the independent certified public accountant to report, in writing,
				within five business days to the board of directors or its audit committee any
				determination by the independent certified public accountant that the insurer
				has materially misstated its financial condition as reported to the
				commissioner, as of the balance sheet date currently under audit, or that the
				insurer does not meet the minimum capital and surplus requirement of
				33-2-109,
				33-2-110,
				33-4-401,
				33-5-401,
				33-30-201, and
				33-31-216(9),
				MCA, as of that date. An insurer who has received a report pursuant to this
				rule shall forward a copy of the report to the commissioner within five
				business days of receipt of such report, and shall provide the independent
				certified public accountant making the report with evidence of the report being
				furnished to the commissioner. If the independent certified public accountant
				fails to receive such evidence within the required five-business-day period,
				the independent certified public accountant shall furnish to the commissioner a
				copy of its report within the next five business days.
(2) An independent certified public
				accountant shall not be liable in any manner to any person for any statement
				made in connection with (1) if such statement is made in good faith in
				compliance with (1).
(3) If the
				accountant, subsequent to the date of the audited financial report filed
				pursuant to this rule, becomes aware of facts which might have affected the
				report, it has the obligation to take such action as prescribed in Volume 1,
				Section AU 561 of the Professional Standards of the AICPA.
33-1-313,
					 33-2-1517, MCA; IMP :
					 33-2-701,
					 33-2-1517,
					 33-4-313,
					 33-5-413,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.35 - Annual Audited Reports and Establishing Accounting Practices and Procedures to Be Used in Annual Statements › Rule 6.6.3510 - COMMUNICATION OF INTERNAL CONTROLS RELATED MATTERS NOTED IN AN AUDIT

Current through Register Vol. 13, July 5, 2024
(1) In addition to the annual audited
				financial report, each insurer shall furnish the commissioner with a written
				communication as to any unremediated material weaknesses in its internal
				controls over financial reporting noted during the audit. Such communication
				shall be prepared by the accountant within 60 days after the filing of the
				annual audited financial report, and shall contain a description of any
				unremediated material weakness (as the term material weakness is defined by
				Statement on Auditing Standard 60, communication of internal control related
				matters noted in an audit, or its replacement) as of December 31 immediately
				preceding (so as to coincide with the audited financial report discussed in ARM
				6.6.3503(1) ) in
				the insurer's internal control over financial reporting noted by the accountant
				during the course of their audit of the financial statements. If no
				unremediated material weaknesses were noted, the communication should so
				state.
(2) The insurer shall
				provide a description of remedial actions taken or proposed to correct
				unremediated material weaknesses, if the actions are not described in the
				accountant's communication.
33-1-313,
					 33-2-1517, MCA; IMP,
					 33-2-701,
					 33-2-1517,
					 33-4-313,
					 33-5-413,
					 MCA;