reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2509 - OTHER REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) A health
				maintenance organization shall provide its subscribers with a list of the names
				and locations of all of its providers no later than the time of enrollment or
				the time the contract and evidence of coverage are issued and upon request
				thereafter.
(a) If a provider is no longer
				affiliated with a health maintenance organization, the health maintenance
				organization shall provide notice of such change to its affected subscribers in
				a timely manner.
(b) Subject to the
				approval of the commissioner, a health maintenance organization may provide its
				subscribers with a list of providers or provider groups for a segment of the
				service area. However, a health maintenance organization must make a list of
				all providers available to subscribers upon request.
(c) Any list of providers must contain a
				notice regarding the availability of the listed primary care physicians. The
				notice must be in not less than 12-point type and be placed in a prominent
				place on the list of providers. The notice must contain the following or
				similar language: "Enrolling in [name of health maintenance organization] does
				not guarantee services by a particular provider on this list. If you wish to be
				sure of receiving care from specific providers listed, you should contact those
				providers to be sure that they are accepting additional patients for [name of
				health maintenance organization]."
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.25 - Health Maintenance Organizations › Rule 6.6.2510 - PENALTIES

Current through Register Vol. 13, July 5, 2024
(1) A violation of these rules is punishable
				as provided for in
				33-31-402 and
				33-31-405, MCA, and any other
				applicable law of this state.
Sec.
					 33-31-103 MCA; IMP, Sec.
					 33-31-101 through
					 33-31-405
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.26 - Independent Liability Funds › Rule 6.6.2601 - PURPOSE AND APPLICABILITY

Current through Register Vol. 13, July 5, 2024
(1) The purpose
				of these rules is to protect members of the public who deal with business
				entities that have elected to insure their third-party liabilities or any
				portion thereof through the use of independent liability funds as authorized by
				the Independent Liability Fund Act by:
(a)
				regulating the registration and annual reporting of data pertinent to the
				inviolability and health of independent liability funds;
(b) regulating the responsible administration
				of independent liability funds;
(c)
				providing for the coordination of efforts between the department of revenue and
				the commissioner to assure the inviolability and health of independent
				liability funds;
(d) providing
				mechanisms for the sanctioning of independent liability funds that do not
				comply with the Independent Liability Fund Act or these rules or that are not
				inviolable, healthy, or secure.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.26 - Independent Liability Funds › Rule 6.6.2602 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
As used in this subchapter and Title 33, chapter 27, MCA,
				  the following definitions apply unless the context requires otherwise:
(1) "Health" means the extent to which:
(a) assets in an independent liability fund
				are accurately valued; and
(b) the
				investments and assets constituting an independent liability fund meet the
				criteria established by
				33-2-501 and
				33-2-502,
				MCA.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.26 - Independent Liability Funds › Rule 6.6.2603 - REGISTRATION OF INDEPENDENT LIABILITY FUNDS

Current through Register Vol. 13, July 5, 2024
(1)
				On or before February 1 of each year, or within one calendar month of the end
				of the business entity's fiscal year, the business entity shall provide the
				commissioner with the following information on a form prescribed by the
				commissioner:
(a) name of the business
				entity;
(b) if a corporation, the
				state where it is incorporated;
(c)
				the address and telephone number of its principal place of business;
(d) the name of its staff member responsible
				for handling independent liability fund questions;
(e) the name, address, and telephone number
				of its third-party administrator;
(f) if it has no third-party administrator,
				the name, address, and telephone number of its in-house
				administrator;
(g) the name,
				address, and telephone number of the surety insurer for the in-house
				administrator;
(h) a copy of the
				bond issued on the in-house administrator;
(i) all relevant information regarding the
				investments and assets that make up the bond of the independent liability fund,
				including the type of contribution, the amount, the date of its acquisition,
				the actual physical location of the asset or investment, its acquisitions of
				independent liability fund assets or investments during the year, its disposals
				of independent liability fund assets or investments during the year, and any
				other documentation that the commissioner considers necessary or
				relevant.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.26 - Independent Liability Funds › Rule 6.6.2604 - ADMINISTRATION OF INDEPENDENT LIABILITY FUNDS

Current through Register Vol. 13, July 5, 2024
A business entity may use one of the two following methods to
				  administer its independent liability fund:
(1) A third party having no close connection
				with the business entity may administer the fund, provided that the third party
				is either a trust company registered in the state of Montana to conduct such
				business or a person or entity bonded by an authorized surety insurer for the
				full amount, including principal and interest, of the funds contained in the
				independent liability fund.
(2) An
				in-house officer or employee of the business entity may administer the fund if
				the officer or employee is bonded by an authorized surety insurer for the full
				amount including principal and interest, of the funds contained in the
				independent liability fund. If an in-house officer or employee administers the
				independent liability fund:
(a) that officer
				or employee must have exclusive control of the assets or investments contained
				in the independent liability fund;
(b) the business entity shall file a copy of
				the bond insuring the officer or employee with the commissioner; and
(c) the surety insurer issuing the bond shall
				notify the commissioner in writing 30 days before the effective date of a
				cancellation of the bond.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.26 - Independent Liability Funds › Rule 6.6.2605 - OVERSIGHT OF INDEPENDENT LIABILITY FUND

Current through Register Vol. 13, July 5, 2024
(1)
				The commissioner shall at all times be allowed access to any records of a
				business entity that bear upon the health, inviolability, authenticity,
				viability, and security of that entity's independent liability fund.
(2) A business entity using an independent
				liability fund shall be required to execute any documents necessary to give the
				commissioner access to records of a third-party relating to that entity's
				independent liability fund assets and investments.
(3) A business entity using an independent
				liability fund shall bear the costs of any review, investigation, or
				examination of its independent liability fund conducted by the commissioner or
				her authorized agents.
Sec.
					 33-27-104, MCA; IMP, Title 33, Ch.
					 27, MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.26 - Independent Liability Funds › Rule 6.6.2606 - PENALTIES (Repealed)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-27-104, MCA;
					 IMP: Title 33, ch. 27, MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2701 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of these rules is to
				implement 33-2-705(7), MCA,
				allowing the commissioner to adopt rules to establish a quarterly schedule for
				payment of the premium tax during the year in which the tax liability is
				accrued.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2702 - APPLICABILITY AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) These rules
				apply to all insurers required to pay premium tax pursuant to
				33-2-705(2), MCA.
				If these rules conflict with, or are found by a court of competent jurisdiction
				to be in conflict with,
				33-2-705, MCA, the statute will
				control the collection of the premium tax.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2703 - EFFECTIVE DATE

Current through Register Vol. 13, July 5, 2024
(1) Beginning April
				15, 1988, and thereafter, every insurer shall remit to the commissioner its
				premium tax in accordance with these rules.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2704 - METHODS OF CALCULATION

Current through Register Vol. 13, July 5, 2024
(1) Every insurer
				shall pay its quarterly premium tax obligation as follows:
(a) pay an amount equal to 100% of its prior
				calendar year premium tax in four equal payments, or
(b) pay an amount equal to 90% of its current
				year premium tax obligation, as calculated pursuant to
				33-2-705(2) MCA,
				in four equal payments.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2705 - PAYMENT DATES

Current through Register Vol. 13, July 5, 2024
(1) The payment
				dates of the equal quarterly premium tax payments are as follows: first payment
				due April 15; second payment due June 15; third payment due September 15; and
				fourth payment due December 15.
(2)
				An insurer, subject to the provisions of these rules, who by virtue of the
				pattern of its sale of insurance, receives more than 75% of its premium within
				the final calendar quarter of a year, may request from the commissioner
				permission to pay its tax obligation for the current year under these rules in
				one full payment on December 15 of the year in which the obligation
				accrues.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2706 - ADJUSTMENTS

Current through Register Vol. 13, July 5, 2024
(1) Over the course of the calendar year, the
				insurer shall make the periodic payments in the amounts specified by ARM
				6.6.2704. Any adjustments in the
				amounts paid must be made in conjunction with the filing of the report and
				payment of tax on March 1 of each year. Any credit must be carried forward and
				used to offset future periodic payments.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2707 - CESSATION OF BUSINESS

Current through Register Vol. 13, July 5, 2024
(1) If an insurer
				notifies the commissioner in writing that it is no longer writing new or
				renewing existing insurance policies of any type in the state, the commissioner
				may waive the periodic payment requirements established in these
				rules.
AUTH:
					 33-2-705,
					 MCA; IMP:
					 33-2-705,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2708 - APPLICATION FOR REFUND

Current through Register Vol. 13, July 5, 2024
(1) If an insurer,
				on a form approved by the commissioner and under oath, notifies the
				commissioner that it is entitled to a refund, the commissioner may authorize a
				refund. An insurer is not entitled to receive interest on the refund.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.27 - Periodic Payment of Premium Taxes › Rule 6.6.2709 - PENALTY

Current through Register Vol. 13, July 5, 2024
(1) Any insurer who is late in making or does
				not pay the quarterly premium tax as set forth in these rules is subject to the
				penalties in
				33-2-705(5) and
				(6), MCA.
Sec.
					 33-2-705(7) MCA;
					 IMP, 33-2-705(7)
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2801 - PURPOSE AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) In accordance
				with 33-2-301 et seq., MCA, the
				commissioner declares that the purpose of these rules is to implement Title 33,
				chapter 2, part 3, MCA. ARM
				6.6.2801 through
				6.6.2810 implement
				33-2-301, et seq., MCA, the
				surplus lines insurance law.
33-1-313,
					 33-2-316,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2802 - DELEGATION OF AUTHORITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313,
					 33-2-316, MCA; IMP,
					 33-2-301 through
					 33-2-326,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2803 - FILING OF SUBMISSIONS, EXAMINATION OF SUBMISSIONS AND RECORDS RETAINED

Current through Register Vol. 13, July 5, 2024
(1) Every Montana-licensed surplus lines
				insurance producer and insured who independently procured insurance shall
				submit to the department all information required to be filed by
				33-2-301, et seq., MCA, and these
				rules.
(2) Surplus lines
				submissions to the department shall be made in a manner and form approved by
				the commissioner. There are standardized submission forms available from the
				department. Submissions may be made by:
(a)
				sending paper submissions to the department; or
(b) electronically filing submissions via the
				surplus lines business portal via the department's web site.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2804 - COLLECTION OF STAMPING FEE

Current through Register Vol. 13, July 5, 2024
(1) Pursuant to
				33-2-321,
				MCA, the commissioner has determined that CSI will not collect a stamping fee
				on the base premium, including any monied endorsement, payable for each surplus
				lines insurance policy transacted in the state.
AUTH:
					 33-1-313,
					 33-2-216, MCA; IMP:
					 33-2-321,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2805 - ORGANIZATION AND DUTIES OF SURPLUS LINES ADVISORY ORGANIZATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313,
					 33-2-316, MCA; IMP,
					 33-2-301 through
					 33-2-326,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2806 - OPERATING EXPENSES (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313,
					 33-2-316, MCA; IMP,
					 33-2-301 through
					 33-2-326,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2807 - MEMBERSHIP IN SURPLUS LINES ADVISORY ORGANIZATION (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313,
					 33-2-316, MCA; IMP,
					 33-2-301 through
					 33-2-326,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2808 - ELIGIBLE SURPLUS LINES INSURERS LIST

Current through Register Vol. 13, July 5, 2024
(1) At
				least semiannually, the department shall make available a complete current list
				of eligible surplus lines insurers approved by the commissioner.
33-1-313,
					 33-2-316,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2809 - APPROVED RISK LIST - INSURANCE PRESUMED UNOBTAINABLE FROM AUTHORIZED INSURERS (REPEALED)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313,
					 33-2-316, MCA; IMP,
					 33-2-301,
					 33-2-302,
					 33-2-303,
					 33-2-305,
					 33-2-306,
					 33-2-308,
					 33-2-310,
					 33-2-311,
					 33-2-312,
					 33-2-313,
					 33-2-316,
					 33-2-321
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.28 - Surplus Lines Insurance Transactions › Rule 6.6.2810 - ANNUAL REPORTING PERIOD - TAX AND FEE STATEMENT

Current through Register Vol. 13, July 5, 2024
(1) The reporting period for surplus lines
				insurance premium taxes and stamping fees shall be the calendar year.
(2) The department shall produce for each
				surplus lines insurance producer, and insured who independently procured
				insurance, in a form approved by the commissioner, an annual tax and fee
				statement complying with the requirements of
				33-2-310, MCA.
(3) By March 1 of each year, the department
				shall distribute such annual tax and fee statements for the preceding calendar
				year to surplus lines insurance producers and insureds who independently
				procured insurance for their review and submission to the
				commissioner.
(4) By April 1 of
				each year, surplus lines insurance producers and insureds who independently
				procured insurance shall file with the commissioner the annual tax and fee
				statement for the preceding calendar year and pay the taxes and fees.
(5) Insureds who independently procured
				insurance may pay the associated taxes and fees to the department when filing
				the surplus lines submission with the department.
(6) Nothing in this section or in the annual
				tax and fee statement prepared by the department shall relieve a surplus lines
				insurance producer or an insured who independently procured insurance from the
				duties and obligations imposed by
				33-2-310,
				33-2-311,
				33-2-312, and
				33-2-321, MCA.
33-1-313,
					 33-2-316,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2901 - PURPOSE AND SCOPE (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2902 - DEFINITIONS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2903 - QUALIFICATIONS FOR PROGRAM DIRECTORS AND INSTRUCTORS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2904 - EDUCATIONAL REQUIREMENTS FOR LIFE AND DISABILITY INSURANCE PRELICENSING EDUCATION COURSES (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2905 - EDUCATIONAL REQUIREMENTS FOR PROPERTY AND CASUALTY INSURANCE PRELICENSING EDUCATION COURSES (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2906 - REQUIREMENTS FOR COURSE COMPLETION CERTIFICATES (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.29 - Prelicensing Education Program › Rule 6.6.2907 - SUBMISSIONS AND CERTIFICATES (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-17-207 through
					 33-17-209,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3001 - PURPOSE AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of
				these rules is to set forth procedures for the development and filing of
				prospective loss cost and supplementary rating information filings of property
				and casualty rating organizations. These filings can be made in place of full
				advisory rates. Member or subscriber insurers may refer to and incorporate in
				whole or in part filings made by advisory/rating organizations.
(2) These rules apply to the kinds and lines
				of insurance to which Title 33, chapter 16, MCA applies, as indicated in
				33-16-103, MCA, and to insurers
				and rating organizations making filings under
				33-16-203, MCA, except they do not
				apply to workers' compensation insurance.
AUTH:
					 33-1-313, MCA IMP:
					 33-16-201,
					 33-16-202,
					 33-16-203,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3002 - AUTHORITY

Current through Register Vol. 13, July 5, 2024
(1) These rules are issued pursuant to the
				authority vested in the commissioner by
				33-1-313 and
				33-16-202, MCA.
Sec.
					 33-1-313, MCA; IMP,
					 33-16-201 through
					 33-16-203,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3003 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Expenses" means the portion of a rate
				attributable to costs of loss adjustment, acquisition, field supervision,
				collection expenses, general expenses, taxes, licenses, and fees.
(2) "Prospective loss costs" means the
				portion of a rate that does not include provisions for expenses (other than
				loss adjustment expenses at the discretion of the rating organization) or
				profit, and which is based on historical aggregate losses and loss adjustment
				expenses adjusted through development to their ultimate value and projected
				through trending to a future point in time.
(3) "Rate" means the cost of insurance per
				exposure unit, whether expressed as a single number or as a prospective loss
				cost with an adjustment to account for the treatment of expenses, profit and
				variations in loss experience, prior to any application of individual risk
				variations based on loss or expense considerations. The term does not include
				minimum premiums.
(4) "Rating
				organization" is an organization licensed pursuant to
				33-16-403, MCA.
(5) "Supplementary rating information" means
				any classification system, territory code or description, manual or plan of
				rates, classification, rating schedule, minimum premium, policy fee, rating
				rule, rate-related underwriting rule, experience rating plan, statistical plan
				and any other similar information needed to determine the applicable rate in
				effect or to be in effect.
(6)
				"Supporting information" means:
(a) the
				experience and judgment of the insurer and the experience or data of other
				insurers or rating organizations relied upon by the insurer;
(b) the interpretation of any statistical
				data relied upon by the insurer;
(c) descriptions of methods used in making
				the rates; and
(d) other similar
				information required by the commissioner to be filed.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3004 - RATING ORGANIZATION REFERENCE FILINGS OF ADVISORY PROSPECTIVE LOSS COSTS

Current through Register Vol. 13, July 5, 2024
(1) Rating
				organizations may develop and may make reference filings containing advisory
				prospective loss costs. Such filings shall contain the statistical data and
				supporting information for any calculations or assumptions underlying those
				prospective loss costs. The reference filings shall be filed and be effective
				in the same manner as rates filed pursuant to
				33-16-203, MCA.
(2) An insurer may satisfy its obligation to
				make rate filings by:
(a) becoming a
				participating insurer of a licensed rating organization which makes reference
				filings of advisory prospective loss costs;
(b) filing with the commissioner the
				information required in ARM
				6.6.3005; and
(c) authorizing the commissioner to accept
				such reference filings on its behalf.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3005 - REQUIRED FILING DOCUMENTS

Current through Register Vol. 13, July 5, 2024
(1) All filings by
				insurers which refer to a reference filing of prospective loss costs made by a
				rating organization shall include, in the order listed, the following
				documents:
(a) reference filing adoption form
				as specified by the commissioner; and
(b) a summary of supporting
				information.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3006 - RATING ORGANIZATION FILINGS OF ADVISORY SUPPLEMENTARY RATING INFORMATION

Current through Register Vol. 13, July 5, 2024
(1) Rating
				organizations may develop and make filings of supplementary rating information.
				These filings shall be made in accordance with
				33-16-203, MCA.
(2) An insurer may satisfy its obligation to
				make filings of supplementary rate information by becoming a participating
				insurer of a licensed rating organization and by authorizing the commissioner
				to accept filings by that organization on behalf of the insurer. The insurer's
				supplementary rating information shall be that filed by the rating
				organization, subject to any modifications filed by the insurer.
Sec.
					 33-1-313, MCA; IMP,
					 33-16-201 through
					 33-16-203,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.30 - Loss Cost Advisory Rate Filings › Rule 6.6.3007 - EXISTING RATES AND DEVIATIONS REMAIN IN EFFECT UNTIL DISAPPROVED, REPLACED, OR MODIFIED

Current through Register Vol. 13, July 5, 2024
(1) Nothing in this
				subchapter requires rating organizations or their participating insurers to
				immediately refile rates in effect. Any participating insurer of a rating
				organization may continue to use all rates and deviations in effect until such
				rates are disapproved or until the insurer makes its own filing to change its
				rates, either by making an independent filing or by filing a reference filing
				adoption form adopting the rating organization's prospective loss costs, or the
				insurer's modification of them.
AUTH:
					 33-1-313, MCA IMP:
					 33-16-201,
					 33-16-202,
					 33-16-203,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3101 - PURPOSE, SCOPE, AND AUTHORITY

Current through Register Vol. 13, July 5, 2024
(1) In
				accordance with
				33-22-1101, et seq.,
				MCA, the Commissioner of Insurance declares that the purpose of these rules is
				to implement Title 33, chapter 22, part 11, MCA, to promote the public
				interest, to promote the availability of long-term care insurance, as defined
				in ARM
				6.6.3102(7),
				to protect the public from unfair or deceptive sales or enrollment practices,
				to facilitate public understanding and comparison of long-term care insurance
				coverages, and to facilitate flexibility and innovation in the development of
				long-term care insurance.
(2)
				Except as otherwise specifically provided, these rules apply to:
(a) all long-term care insurance policies or
				certificates including qualified long-term care contracts and life insurance
				policies that accelerate benefits for long-term care delivered or issued for
				delivery in this state on or after January 1, 1991, by issuers, fraternal
				benefit societies, nonprofit health, hospital, medical service corporations,
				prepaid health plans, health maintenance organizations, and all similar
				organizations; and
(b) policies
				having indemnity benefits that are triggered by activities of daily living and
				sold as disability income insurance, if:
(i)
				the benefits of the disability income policy are dependent upon or vary in
				amount based on the receipt of long-term care services;
(ii) the disability income policy is
				advertised, marketed, or offered as insurance for long-term care services;
				or
(iii) benefits under the policy
				may commence after the policyholder has reached social security's normal
				retirement age unless benefits are designed to replace lost income or pay for
				specific expenses other than long-term care services.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3102 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
For purposes of these rules, in addition to the definitions
				  in
				  33-22-1107, MCA, the
				  following definitions apply:
(1)
				"Benefit trigger," for the purposes of independent review, means a contractual
				provision in the insured's policy of long-term care insurance conditioning the
				payment of benefits on a determination of the insured's ability to perform
				activities of daily living and on cognitive impairment. For purposes of a
				tax-qualified long-term care insurance contract, as defined in Section 770B of
				the Internal Revenue Code of 1986, as amended, "benefit trigger" shall include
				a determination by a licensed health care practitioner that an insured is a
				chronically ill individual.
(2)
				"Commissioner" means the Montana State Auditor and Ex Officio Commissioner of
				Insurance.
(3) "Exceptional
				increase" means a premium rate increase filed by an insurer as exceptional; and
(a) for which the commissioner determines the
				need for a rate increase to be justified:
(i)
				due to a change in laws or rules applicable to long-term care coverage in this
				state; or
(ii) due to increased and
				unexpected utilization that affects the majority of insurers of similar
				products.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3104 - POLICY PRACTICES AND PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) The terms
				"guaranteed renewable" and "noncancellable" shall not be used in any individual
				long-term care insurance policy or certificate without further explanatory
				language in accordance with the disclosure requirements of ARM
				6.6.3105.
(2) No such policy or certificate issued to
				an individual shall contain renewal provisions less favorable to the insured
				than "guaranteed renewable." The commissioner of insurance may authorize
				nonrenewal on a statewide basis, on terms and conditions deemed necessary by
				the commissioner of insurance, to best protect the interests of the insureds,
				if the issuer demonstrates:
(a) that renewal
				will jeopardize the issuer's solvency; or
(b) that the actual paid claims and expenses
				have substantially exceeded the premium and investment income associated with
				the policies; and
(c) the policies
				will continue to experience substantial and unexpected losses over their
				lifetime; and
(d) the projected
				loss experience of the policies cannot be significantly improved or mitigated
				through reasonable rate adjustments or other reasonable methods; and (e) the
				issuer has made repeated and good faith attempts to stabilize loss experience
				of the policies, including the timely filing for rate adjustments.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3105 - REQUIRED DISCLOSURE PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1)
				Individual long-term care insurance policies and certificates shall contain a
				renewability provision.
(a) The provision
				shall be appropriately captioned, shall appear on the first page of the policy
				or certificate, and shall clearly state the duration, where limited, of
				renewability and the duration of the term of coverage for which the policy or
				certificate is issued and for which it may be renewed. This provision shall not
				apply to policies which do not contain a renewability provision, and under
				which the right to nonrenew is reserved solely to the policyholder;
				and
(b) A long-term care insurance
				policy, other than one where the insurer does not have the right to change the
				premium, shall include a statement that the premium rates may change.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3106 - PROHIBITION AGAINST POST-CLAIMS UNDERWRITING

Current through Register Vol. 13, July 5, 2024
(1) All applications for long-term care
				insurance policies or certificates except those which are guaranteed issue
				shall contain clear and unambiguous questions designed to ascertain the health
				condition of the applicant.
(2) If
				an application for long-term care insurance contains a question which asks
				whether the applicant has had medication prescribed by a physician, it must
				also ask the applicant to list the medication that has been prescribed. If the
				medications listed in such application were known by the issuer, or should have
				been known at the time of application, to be directly related to a medical
				condition for which coverage would otherwise be denied, then the policy or
				certificate shall not be rescinded for that condition.
(3) Except for policies or certificates which
				are guaranteed issue, the following language shall be set out conspicuously and
				in close conjunction with the applicant's signature block on an application for
				a long-term care insurance policy or certificate:
Caution: If your
				answers on this application are incorrect or untrue, [company] may have the
				right to deny benefits or rescind your [policy] [certificate], pursuant to ARM
				6.6.3104(13).
(4) The following language, or language
				substantially similar to the following, shall be set out conspicuously on the
				long-term care insurance policy or certificate at the time of delivery:
Caution: The issuance of this long-term care insurance
[policy][certificate] is based upon your responses to
				  the questions on your application. A copy of your [application] [enrollment
				  form] [is enclosed] [was retained by you when you applied]. If your answers are
				  incorrect or untrue, the company has the right to deny benefits or rescind your
				  [policy] [certificate]. The best time to clear up any questions is now, before
				  a claim arises! If, for any reason, any of your answers are incorrect, contact
				  the company at this address: [insert address]
(5) Prior to issuance of a long-term care
				policy or certificate to an applicant age 80 or older, the issuer shall obtain
				one of the following:
(a) a report of a
				physical examination;
(b) an
				assessment of functional capacity;
(c) an attending physician's statement;
				or
(d) copies of medical
				records.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3107 - MINIMUM STANDARDS FOR HOME HEALTH CARE BENEFITS IN LONG-TERM CARE INSURANCE POLICIES

Current through Register Vol. 13, July 5, 2024
(1) A long-term
				care insurance policy or certificate may not, if it provides benefits for home
				health care services, limit or exclude benefits:
(a) by requiring that the insured or claimant
				would need skilled care in a skilled nursing facility if home health care
				services were not provided;
(b) by
				requiring that the insured or claimant first or simultaneously receive nursing
				or therapeutic services in a home, community or institutional setting before
				home health care services are covered;
(c) by limiting eligible services to services
				provided by registered nurses or licensed practical nurses;
(d) by requiring that a nurse or therapist
				provide services covered by the policy or certificate that can be provided by a
				home health aide, or other licensed or certified home care worker acting within
				the scope of his or her licensure of certification;
(e) by excluding coverage for personal care
				services provided by a home health aide;
(f) by requiring that the provision of home
				health care services be at a level of certification or licensure greater than
				that required by the eligible service;
(g) by requiring that the insured or claimant
				have an acute condition before home health care services are covered;
(h) by limiting benefits to services provided
				by Medicare-certified agencies or providers.
(i) by excluding coverage for adult day care
				services.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3108 - REQUIREMENT TO OFFER INFLATION PROTECTION

Current through Register Vol. 13, July 5, 2024
(1)
				No issuer may offer a long-term insurance policy or certificate unless the
				issuer also offers to the policyholder, in addition to any other inflation
				protection, the option to purchase a policy or certificate that provides for
				benefit levels to increase with benefit maximums or reasonable durations which
				are meaningful to account for reasonably anticipated increases in the costs of
				long-term care services covered by the policy or certificate. Issuers must
				offer to each policyholder, at the time of purchase, the option to purchase a
				policy or certificate with an inflation protection feature no less favorable
				than one of the following:
(a) increases
				benefit levels annually in a manner so that the increases are compounded
				annually at a rate not less than 5%;
(b) guarantees the insured individual the
				right to periodically increase benefit levels without providing evidence of
				insurability or health status so long as the option for the previous period has
				not been declined. The amount of the additional benefit shall be no less than
				the difference between the existing policy benefit and that benefit compounded
				annually at a rate of at least 5% for the period beginning with the purchase of
				the existing benefit and extending until the year in which the offer is made;
				or
(c) covers a specified
				percentage of actual or reasonable charges and does not include a maximum
				specified indemnity amount or limit.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3109 - REQUIREMENTS FOR APPLICATION FORMS AND REPLACEMENT COVERAGE

Current through Register Vol. 13, July 5, 2024
(1) Application forms shall include the
				following questions designed to elicit information as to whether, as of the
				date of the application, the applicant has another long-term care insurance
				policy or certificate in force or whether a long-term care policy or
				certificate is intended to replace any other accident and sickness or long-term
				care insurance policy or certificate presently in force. A supplementary
				application or other form to be signed by the applicant and producer, except
				where the coverage is sold without a producer, containing the following
				questions shall be used:
1. Do you have
				another long-term care insurance policy or certificate in force (including
				health care service contract, health maintenance organization
				contract).
2. Did you have another
				long-term care insurance policy or certificate in force during the last 12
				months.
a. If so, with which
				company.
b. If that policy or
				certificate lapsed, when did it lapse.
3. Are you covered by Medicaid.
4. Do you intend to replace any of your
				medical or health insurance coverage with this policy [certificate].
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3109A - REPORTING REQUIREMENTS

Current through Register Vol. 13, July 5, 2024
(1) Every issuer
				shall maintain records for each producer of that producer's amount of
				replacement sales as a percentage of the producer's total annual sales and the
				amount of lapses of long-term care insurance policies sold by the producer as a
				percentage of the producer's total annual sales.
(2) Every issuer shall report annually by
				June 30, on LTC Form G in ARM
				6.6.3120(1)(g),
				the 10% of its producers with the greatest percentages of lapses and
				replacements as measured by (1).
(3) Reported replacement and lapse rates do
				not alone constitute a violation of insurance laws or necessarily imply
				wrongdoing. The reports are for the purpose of reviewing more closely producer
				activities regarding the sale of long-term care insurance.
(4) Every issuer shall report annually by
				June 30, on LTC Form E in ARM
				6.6.3120(1)(e),
				the number of lapsed policies as a percentage of its total annual sales and as
				a percentage of its total number of policies in force as of the end of the
				preceding calendar year.
(5) Every
				issuer shall report annually by June 30 the number of replacement policies sold
				as a percentage of its total annual sales and as a percentage of its total
				number of policies in force as of the preceding calendar year.
(6) Every issuer shall report annually by
				June 30, for qualified long-term care insurance contracts, the number of claims
				denied for each class of business, expressed as a percentage of claims denied,
				other than claims denied for failure to meet the waiting period or because of
				an applicable preexisting condition.
(7) For purposes of this rule:
(a) "policy" means only long-term care
				insurance;
(b) subject to (7)(c)
				"claim" means a request for payment of benefits under an in-force policy
				regardless of whether the benefit claimed is covered under the policy or any
				terms or conditions of the policy have been met;
(c) "denied" means the insurer refuses to pay
				a claim for any reason other than for claims not paid for failure to meet the
				waiting period or because of an applicable preexisting condition; and
(d) "report" means on a statewide
				basis.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3109B - LICENSING

Current through Register Vol. 13, July 5, 2024
(1) A producer may not market, sell,
				solicit,negotiate, or otherwise act as an insurance producer with respect to
				long-term care insurance in this state except as authorized by Title 33,
				chapter 17, part 2, MCA. The producer must also meet the training requirements
				set forth in
				33-22-1128, MCA.
33-1-313,
					 33-22-1121, MCA; IMP,
					 33-17-201,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.31 - Long-Term Care › Rule 6.6.3110 - DISCRETIONARY POWERS OF COMMISSIONER OF INSURANCE

Current through Register Vol. 13, July 5, 2024
(1) The Commissioner of Insurance may upon
				written request and after administrative hearing, issue an order to modify or
				suspend a specific provision or provisions of these rules with respect to a
				specific long-term care insurance policy or certificate upon a written finding
				that:
(a) the modification or suspension
				would be in the best interest of the insureds; and
(b) the purposes to be achieved could not be
				effectively or efficiently achieved without the modification or suspension; and
(i) the modification or suspension is
				necessary to the development of an innovative and reasonable approach for
				insuring long-term care; or
(ii)
				the policy or certificate is to be issued to residents of a life care or
				continuing care retirement community or some other residential community for
				the elderly and the modification or suspension is reasonably related to the
				special needs or nature of such a community; or
(iii) the modification or suspension is
				necessary to permit long-term care insurance to be sold as part of, or in
				conjunction with, another insurance product.