reglab/statecodes huggingface dataset:
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.301 - AUTHORITY

Current through Register Vol. 13, July 5, 2024
This sub-chapter is adopted and promulgated by the
				  commissioner of insurance pursuant to section
				  33-1-313, MCA, and implements
				  section 33-18-204, MCA.
Sec.
					 33-1-313 MCA; IMP, Sec.
					 33-18-204
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.302 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of this subchapter is:
(a) to regulate the activities of insurers
				and producers with respect to the replacement of existing life insurance and
				annuities;
(b) to protect the
				interests of life insurance and annuity purchasers by establishing minimum
				standards of conduct to be observed in replacement, proposed replacement, or
				financed purchase transactions. It will:
(i)
				assure that purchasers receive information with which a decision can be made in
				his or her own best interests;
(ii)
				reduce the opportunity for misrepresentation and incomplete disclosures;
				and
(iii) establish penalties for
				failure to comply with the requirements of this subchapter.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.303 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Direct-response solicitation" means a
				solicitation through mailings, telephone, the internet or other mass
				communication media.
(2) "Existing
				insurer" means the insurance company whose policy or contract is or will be
				changed or affected in a manner described within the definition of
				"replacement".
(3) "Existing policy
				or contract" means an individual life insurance policy or annuity contract in
				force, including a policy under a binding or conditional receipt or a policy or
				a contract that is within an unconditional refund period.
(4) "Financed purchase" means the purchase of
				a new policy involving the actual or intended use of funds obtained by the
				withdrawal or surrender of, or by borrowing from values of an existing policy
				to pay all or part of any premium due on the new policy. For purposes of a
				regulatory review of an individual transaction only, if a withdrawal,
				surrender, or borrowing by an individual involves the policy values of an
				existing policy and is used to pay premiums on a new policy owned by the same
				policyholder and issued by the same company within four months before or 13
				months after the effective date of the new policy, it will be deemed prima
				facie evidence of the policyholder's intent to finance the purchase of the new
				policy with existing policy values. This prima facie standard is not intended
				to increase or decrease the monitoring obligations contained in this
				subchapter.
(5) "Illustration"
				means a presentation or depiction that includes non-guaranteed elements of a
				policy of life insurance over a period of years as described in
				33-20-604, MCA.
(6) "Policy summary," for the purposes of
				this subchapter:
(a) for policies or
				contracts other than universal life policies, means a written statement
				regarding a policy or contract which shall contain to the extent applicable,
				but need not be limited to, the following information:
(i) current death benefit;
(ii) annual contract premium;
(iii) current cash surrender value;
(iv) current dividend;
(v) application of current dividend;
				and
(vi) amount of outstanding
				loan.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.305 - DUTIES OF PRODUCERS

Current through Register Vol. 13, July 5, 2024
(1) A producer who
				initiates an application shall submit to the insurer, with or as part of the
				application, a statement signed by both the applicant and the producer as to
				whether the applicant has existing policies or contracts. If the answer is
				"no," the producer's duties with respect to replacement are complete.
(2) If the applicant answered "yes" to the
				question regarding existing coverage referred to in (1), the producer shall
				present and read to the applicant, not later than at the time of taking the
				application, a notice regarding replacements in the form as described in
				Appendix A or other substantially similar form approved by the commissioner.
				However, no approval shall be required when amendments to the notice are
				limited to the omission of references not applicable to the product being sold
				or replaced. The notice shall be signed by both the applicant and the producer
				attesting that the notice has been read aloud by the producer or that the
				applicant did not wish the notice to be read aloud (in which case the producer
				need not have read the notice aloud) and left with the applicant.
(3) The notice shall list all life insurance
				policies or annuities proposed to be replaced, properly identified by name of
				insurer, the insured or annuitant, and policy or contract number if available;
				and shall include a statement as to whether each policy or contract will be
				replaced or whether a policy will be used as a source of financing for the new
				policy or contract. If a policy or contract number has not been issued by the
				existing insurer, alternative identification, such as an application or receipt
				number, shall be listed.
(4) In
				connection with a replacement transaction the producer shall leave with the
				applicant, at the time an application for a new policy or contract is
				completed, the original or a copy of all sales material. With respect to
				electronically presented sales material, it shall be provided to the policy or
				contract owner in printed form no later than at the time of policy or contract
				delivery.
(5) Except as provided in
				ARM 6.6.306(3), in
				connection with a replacement transaction, the producer shall submit to the
				insurer to which an application for a policy or contract is presented, a copy
				of each document required by this rule, a statement identifying any preprinted
				or electronically presented company approved sales materials used, and copies
				of any individualized sales materials, including any illustrations related to
				the specific policy or contract purchased.
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-18-204,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.306 - DUTIES OF REPLACING INSURERS THAT USE PRODUCERS

Current through Register Vol. 13, July 5, 2024
(1) Where a replacement is involved in the
				transaction, the replacing insurer shall:
(a)
				verify that the required forms are received and are in compliance with this
				subchapter;
(b) notify any other
				existing insurer that may be affected by the proposed replacement within five
				business days of receipt of a completed application indicating replacement or
				when the replacement is identified if not indicated on the application, and
				mail a copy of the available illustration or policy summary for the proposed
				policy or available disclosure document for the proposed contract within five
				business days of a request from an existing insurer;
(c) be able to produce copies of the
				notification regarding replacement required in ARM
				6.6.305(2),
				indexed by producer, for at least five years or until the next regular
				examination by the insurance department of a company's state of domicile,
				whichever is later; and
(d) provide
				to the policy or contract owner notice of the right to return the policy or
				contract within 30 days of the delivery of the contract and receive an
				unconditional full refund of all premiums or considerations paid on it,
				including any policy fees or charges or, in the case of a variable or market
				value adjustment policy or contract, a payment of the cash surrender value
				provided under the policy or contract plus the fees and other charges deducted
				from the gross premiums or considerations or imposed under such policy or
				contract. Such notice may be included in Appendix A or C.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.307 - DUTIES OF INSURERS WITH RESPECT TO DIRECT RESPONSE SOLICITATIONS

Current through Register Vol. 13, July 5, 2024
(1) In the case of an application that is
				initiated as a result of a direct response solicitation, the insurer shall
				require, with or as part of each completed application for a policy or
				contract, a statement asking whether the applicant, by applying for the
				proposed policy or contract, intends to replace, discontinue or change an
				existing policy or contract. If the applicant indicates a replacement or change
				is not intended or if the applicant fails to respond to the statement, the
				insurer shall send the applicant, with the policy or contract, a notice
				regarding replacement in Appendix B, or other substantially similar form
				approved by the commissioner.
(2)
				If the insurer has proposed the replacement or if the applicant indicates a
				replacement is intended and the insurer continues with the replacement, the
				insurer shall:
(a) provide to applicants or
				prospective applicants with the policy or contract a notice, as described in
				Appendix C, or other substantially similar form approved by the commissioner.
				In these instances the insurer may delete the references to the producer,
				including the producer's signature, and references not applicable to the
				product being sold or replaced, without having to obtain approval of the form
				from the commissioner. The insurer's obligation to obtain the applicant's
				signature shall be satisfied if it can demonstrate that it has made a diligent
				effort to secure a signed copy of the notice referred to in this rule. The
				requirement to make a diligent effort shall be deemed satisfied if the insurer
				includes in the mailing a self-addressed postage prepaid envelope with
				instructions for the return of the signed notice referred to in this rule;
				and
(b) comply with the
				requirements of ARM
				6.6.306(1) (b), if
				the applicant furnishes the names of the existing insurers, and the
				requirements of ARM
				6.6.306(1) (c), (1) (d) and
				(2).
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.308 - DUTIES OF THE EXISTING INSURER

Current through Register Vol. 13, July 5, 2024
(1) Where a
				replacement is involved in the transaction, the existing insurer shall:
(a) retain and be able to produce all
				replacement notifications received, indexed by replacing insurer, for at least
				five years or until the conclusion of the next regular examination conducted by
				the insurance department of its state of domicile, whichever is
				later;
(b) send a letter to the
				policy or contract owner of the right to receive information regarding the
				existing policy or contract values including, if available, an in force
				illustration or policy summary if an in force illustration cannot be produced
				within five business days of receipt of a notice that an existing policy or
				contract is being replaced. The information shall be provided within five
				business days of receipt of the request from the policy or contract
				owner;
(c) upon receipt of a
				request to borrow, surrender or withdraw any policy values, send a notice,
				advising the policy owner that the release of policy values may affect the
				guaranteed elements, non-guaranteed elements, face amount or surrender value of
				the policy from which the values are released. The notice shall be sent
				separate from the check if the check is sent to anyone other than the policy
				owner. In the case of consecutive automatic premium loans, the insurer is only
				required to send the notice at the time of the first loan.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.309 - VIOLATIONS AND PENALTIES

Current through Register Vol. 13, July 5, 2024
(1) Any insurer,
				agent, representative, officer or employee of such insurer failing to comply
				with the requirements of this sub-chapter shall be subject to such penalties as
				may be appropriate under the insurance laws of Montana.
(2) Any failure to comply with this
				subchapter shall be considered a violation of
				33-18-204, MCA, Twisting
				Prohibited.
(3) Examples of
				violations include:
(a) any deceptive or
				misleading information set forth in sales material;
(b) failing to ask the applicant in
				completing the application the pertinent questions regarding the possibility of
				financing or replacement;
(c) the
				intentional incorrect recording of an answer;
(d) advising an applicant to respond
				negatively to any question regarding replacement in order to prevent notice to
				the existing insurer; or
(e)
				advising a policy or contract owner to write directly to the company in such a
				way as to attempt to obscure the identity of the replacing producer or
				company.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.310 - SAMPLE FORMS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-18-204,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.311 - DUTIES OF ALL INSURERS THAT USE PRODUCERS

Current through Register Vol. 13, July 5, 2024
(1)
				Each insurer shall:
(a) maintain a system of
				supervision and control to insure compliance with the requirements of this
				subchapter that shall include at least the following:
(i) inform its producers of the requirements
				of this subchapter and incorporate the requirements of the subchapter into all
				relevant producer training manuals prepared by the insurer;
(ii) provide to each producer a written
				statement of the company's position with respect to the acceptability of
				replacements providing guidance to its producer as to the appropriateness of
				these transactions;
(iii) a system
				to review the appropriateness of each replacement transaction that the producer
				does not indicate is in accord with (1) (a) (ii) ;
(iv) procedures to confirm that the
				requirements of this subchapter have been met; and
(v) procedures to detect transactions that
				are replacements of existing policies or contracts by the existing insurer, but
				that have not been reported as such by the applicant or producer. Compliance
				with this rule may include, but shall not be limited to, systematic customer
				surveys, interviews, confirmation letters, or programs of internal
				monitoring.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.312 - SEVERABILITY

Current through Register Vol. 13, July 5, 2024
(1) If any rule or portion of a rule of this
				subchapter, or its applicability to any person or circumstances, is held
				invalid by a court, the remainder of this subchapter, or the applicability of
				its provision to other persons, shall not be affected.
AUTH:
					 33-1-313, MCA IMP:
					 33-18-204,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.3 - Replacement of Life Insurance › Rule 6.6.313 - SAMPLE FORMS

Current through Register Vol. 13, July 5, 2024
(1) The State
				Auditor's Office adopts and incorporates by reference Appendix A, B, and C,
				which are set forth in the National Association of Insurance Commissioners'
				(NAIC) Life Insurance and Annuities Replacement Model Regulation, adopted in
				2015. Copies of appendices A, B, and C are available for public inspection at
				the Office of the Montana State Auditor, 840 Helena Avenue, Helena, MT 59601.
				Copies of these appendices may be obtained by writing to the State Auditor's
				Office, Legal Department, 840 Helena Avenue, Helena, MT 59601. Persons
				obtaining a copy of these appendices must pay the cost of providing such
				copies.
AUTH:
					 33-1-313, MCA
					 IMP:
					 33-18-204,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.401 - APPLICABILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.402 - SUBMISSION AND APPROVAL OF SALES MATERIALS (IS HERRBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec. 33-
					 1-313, MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.403 - REPRESENTATION OF SPECIAL TITLE, POLICY, OR COMPANY DIVISION (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec. 33-1- 313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.404 - REPRESENTATIONS AS TO POLICY VALUE AND SIZE (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec. 33-
					 1-313, MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.405 - DOWN PAYMENT REQUIRED (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.406 - RECEIPTS (IS HEREBY REPEALED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec. 33- 1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.407 - ALLOWABLE FINANCING ARRANGEMENTS (IS HEREBY REPEATED) (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.408 - PROMISSORY NOTES (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.409 - TRANSFER OF PROMISSORY NOTES (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.410 - CANCELLATION, RELEASE, AND REFUND (REPEALED)

Current through Register Vol. 13, July 5, 2024
Sec.
					 33-1-313, MCA; IMP, Sec.
					 33-1-313,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.4501 - INCORPORATION BY REFERENCE OF THE NAIC VALUATION MANUAL

Current through Register Vol. 13, July 5, 2024
(1) The
				Commissioner of Securities and Insurance, Office of the State Auditor, adopts
				and incorporates by reference the Valuation Manual adopted by the National
				Association of Insurance Commissioners (NAIC) on December 2, 2012, which sets
				forth and specifies a principle-based method for the valuation of insurance
				policies and contracts and the establishment of reserves. A copy of the
				Valuation Manual may be obtained from the NAIC web site at the following link:
http://www.naic.org/documents/committees_a_latf_related_valuation_manual_apf_adopted_by_a_cmte.pdf
.
AUTH:
					 33-1-313,
					 33-2-418, MCA; IMP:
					 33-2-402,
					 33-2-403,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.4701 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
(1) "Commission"
				means the interstate insurance product regulation commission established under
				33-39-101, MCA.
(2) "Opt out" means action taken to decline
				to adopt or participate in a promulgated uniform standard adopted by the
				commission under
				33-39-101, MCA.
(3) "Uniform standard" means a standard
				adopted by the commission for a product line under
				33-39-101, MCA.
AUTH:
					 33-39-101,
					 33-39-103, MCA; IMP:
					 33-39-101,
					 33-39-103,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.4702 - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of
				these rules is to formally opt out of certain uniform standards pursuant to the
				procedure in
				33-39-103, MCA.
AUTH:
					 33-39-101,
					 33-39-103, MCA; IMP:
					 33-39-101,
					 33-39-103,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.4 - College Student Life Insurance › Rule 6.6.4703 - GROUP DISABILITY INCOME UNIFORM STANDARDS OPT OUT

Current through Register Vol. 13, July 5, 2024
(1) The insurance
				commissioner finds and concludes, based upon the preponderance of the evidence
				and given the conditions in Montana, that the group disability income standards
				do not provide reasonable protections to the citizens of Montana, and in fact
				would materially lower the level of protection for and materially diminish the
				rights of Montana policyholders, with regard to the following:
(a) the subrogation and claim off-set rights
				of the insurer; and
(b) the
				enforcement of the law of the policyholder's or group contract holder's
				resident state, as opposed to the state of the certificate holder.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.501 - DISCLOSURE STATEMENTS IN SALE OF MEDICARE SUPPLEMENTS INFORMATION TO BE FURNISHED PROSPECTIVE INSURED (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; imp,
					 33-18-204,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.502 - PURPOSE (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-22-902,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.502A - PURPOSE

Current through Register Vol. 13, July 5, 2024
(1) The purpose of this subchapter is to:
(a) provide for the reasonable
				standardization of coverage and simplification of terms and benefits of
				medicare supplement policies;
(b)
				facilitate public understanding and comparison of such policies;
(c) eliminate provisions contained in such
				policies which may be misleading or confusing in connection with the purchase
				of such policies or with the settlement of claims; and
(d) provide for full disclosures in the sale
				of accident and sickness insurance coverages to persons eligible for
				medicare.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.503 - APPLICABILITY AND SCOPE

Current through Register Vol. 13, July 5, 2024
(1) Except as
				otherwise specifically provided in ARM
				6.6.507,
				6.6.507C, 6.6.508, 6.6.509, 6.6.515 and 6.6.521, this subchapter shall apply
				to:
(a) all medicare supplement policies
				delivered or issued for delivery in this state on or after February 1, 1982,
				the effective date of this subchapter; and
(b) all certificates which have been
				delivered or issued for delivery in this state and issued under group Medicare
				supplement policies.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.504 - DEFINITIONS

Current through Register Vol. 13, July 5, 2024
For purposes of this subchapter, the terms defined in
				  33-22-903,
				  MCA, will have the same meaning in this subchapter unless clearly designated
				  otherwise. The following definitions are in addition to those in
				  33-22-903,
				  MCA.
(1) "Bankruptcy" means when a
				Medicare advantage organization that is not an issuer has filed, or has had
				filed against it, a petition for declaration of bankruptcy and has ceased doing
				business in the state.
(2)
				"Continuous period of creditable coverage" means the period during which an
				individual was covered by creditable coverage, if during the period of the
				coverage the individual had no breaks in coverage greater than 63 days. The
				63-day period shall be counted as described in
				33-22-141
				and
				33-22-142,
				MCA.
(3) "Creditable coverage":
(a) means, with respect to an individual,
				coverage of the individual provided under any of the following:
(i) a group health plan;
(ii) health insurance coverage;
(iii) Part A or Part B of Title XVIII of the
				Social Security Act (Medicare);
(iv) Title XIX of the Social Security Act
				(Medicaid), other than coverage consisting solely of benefits under section
				1928;
(v) chapter 55 of Title 10
				USC (CHAMPUS);
(vi) a medical care
				program of the Indian health service or of a tribal organization;
(vii) a state health benefits risk pool;
(viii) a health plan offered under
				chapter 89 of Title 5 USC (Federal Employees Health Benefits Program);
(ix) a public health plan as
				defined in federal regulation; and
(x) a health benefit plan under section 5(e)
				of the Peace Corps Act (
				22 USC
				2504(e) ).
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.505 - POLICY DEFINITIONS AND TERMS

Current through Register Vol. 13, July 5, 2024
(1) No
				insurance policy or certificate may be advertised, solicited, or issued for
				delivery in this state as a medicare supplement policy or certificate unless
				the policy or certificate contains definitions or terms which conform to the
				requirements of this rule and
				33-22-903, MCA.
(2) The following definitions are in addition
				to those in
				33-22-903, MCA:
(a) "Accident," "accidental injury," or
				"accidental means" must be defined to employ "result" language and may not
				include words which establish an accidental means test or use words such as
				"external, violent, visible wounds" or similar words of description or
				characterization.
(i) The definition may not
				be more restrictive than the following: "injury or injuries for which benefits
				are provided means accidental bodily injury sustained by the insured person
				that is the direct result of an accident, independent of disease or bodily
				infirmity or any other cause, and occurs while insurance coverage is in
				force."
(ii) The definition may
				provide that injuries may not include injuries for which benefits are provided
				or available under any workers' compensation, employer's liability or similar
				law, or motor vehicle no-fault plan, unless prohibited by law.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.506 - PROHIBITED POLICY PROVISIONS

Current through Register Vol. 13, July 5, 2024
(1) Except for
				permitted preexisting condition clauses as described in ARM
				6.6.507(1)(a)(i)
				 and 6.6.507D(1)(a)(i), no policy or
				certificate may be advertised, solicited, or issued for delivery in this state
				as a Medicare supplement policy if such policy or certificate contains
				limitations or exclusions on coverage that are more restrictive than those of
				Medicare.
(2) No Medicare
				supplement policy or certificate may use waivers to exclude, limit, or reduce
				coverage or benefits for specifically named or described preexisting diseases
				or physical conditions.
(3) No
				Medicare supplement policy or contract or certificate in force in the state of
				Montana shall contain benefits which duplicate benefits provided by Medicare.
(4) Subject to ARM
				6.6.507(1)(a)(iv)
				and (v):
(a) a Medicare supplement policy or
				certificate with benefits for outpatient prescription drugs in existence prior
				to January 1, 2006, must be renewed for current policyholders or
				certificateholders who do not enroll in Part D at the option of the
				policyholder or certificateholder;
(b) a Medicare supplement policy or
				certificate with benefits for outpatient prescription drugs may not be issued
				after December 31, 2005; and
(c)
				after December 31, 2005, a Medicare supplement policy or certificate with
				benefits for outpatient prescription drugs may not be renewed after the
				policyholder or certificateholder enrolls in Medicare Part D unless:
(i) the policy or certificate is modified to
				eliminate outpatient drugs incurred after the effective date of the
				individual's coverage under a Part D plan; and
(ii) premiums are adjusted to reflect the
				elimination of outpatient prescription drug coverage at the time of Medicare
				Part D enrollment, accounting for any claims paid, if applicable.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.507B - OPEN ENROLLMENT

Current through Register Vol. 13, July 5, 2024
(1) No issuer may
				deny or condition the issuance or effectiveness of any Medicare supplement
				policy or certificate available for sale in this state, nor discriminate in the
				pricing of a policy or certificate because of the health status, claims
				experience, receipt of health care, or medical condition of an applicant where
				an application for a policy or certificate is submitted prior to or during the
				six-month period beginning with the first day of the first month in which an
				individual is both 65 years of age or older and is enrolled for benefits under
				Medicare Part B.
(2) Each Medicare
				supplement policy or certificate currently available from an issuer must be
				made available to all applicants who qualify under this rule without regard to
				age:
(a) If an applicant qualifies under ARM
				6.6.507B(1), submits an application during either time period referenced in (1)
				and, as of the date of application, has had a continuous period of creditable
				coverage of at least six months, the issuer shall not exclude benefits based on
				a preexisting condition; and
(b) If
				the applicant qualifies under ARM 6.6.507B(1), and submits an application
				during either time period referenced in (1) and, as of the date of application,
				has had a continuous period of creditable coverage that is less than six
				months, the issuer shall reduce the period of any preexisting condition
				exclusion by the aggregate of the period of creditable coverage applicable to
				the applicant as of the enrollment date. The secretary shall specify the manner
				of the reduction under this rule.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.507C - GUARANTEED ISSUE FOR ELIGIBLE PERSONS

Current through Register Vol. 13, July 5, 2024
(1) The
				following are general provisions relating to guaranteed issue:
(a) Eligible persons are those individuals
				described in (2) who enroll under the policy during the period specified in (3)
				and who submit evidence of the date of termination, disenrollment, or Medicare
				part D enrollment with the application for a Medicare supplement policy.
(b) with respect to eligible
				persons, an issuer shall not:
(i) deny or
				condition the issuance or effectiveness of a Medicare supplement policy
				described in (5) that is offered and is available for issuance to new enrollees
				by the issuer;
(ii) discriminate in
				the pricing of such a Medicare supplement policy because of health status,
				claims experience, receipt of health care, or medical condition; or
(iii) impose an exclusion of benefits based
				on a preexisting condition under such a Medicare supplement policy.
(c) if an eligible person who
				originally purchased an issue-age rated plan applies for another issue-age plan
				from any issuer on a guaranteed issue basis, then that issuer must rate the
				replacement policy or certificate using the age at which the original policy or
				certificate was rated.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.507F - Standard Medicare Supplement Benefit Plans for 2020 Standardized Medicare Supplement Benefit Plan Policies or Certificates Issued for Delivery to Individuals Newly Eligible for Medicare on or After January 1, 2020

Current through Register Vol. 13, July 5, 2024
(1) The Medicare Access and CHIP
				Requthorization Act of 2015 (MACRA) requires that the following standards are
				applicable to all Medicare supplement policies or certificates delivered or
				issued for delivery in this state to individuals newly eligible for Medicare on
				or after January 1, 2020. No policy or certificate that provides coverage of
				the Medicare part B deductible may be advertised, solicited, delivered, or
				issued for delivery in this state as a Medicare supplement policy or
				certificate to individuals newly eligible for Medicare on or after January 1,
				2020. All policies must comply with the following benefit standards. Benefit
				plan standards applicable to Medicare supplement policies and certificates
				issued to individuals eligible for Medicare before January 1, 2020, remain
				subject to the requirements of the appropriate rules of this
				subchapter.
(2) The standards and
				requirements of ARM 6.6.507E shall apply to all Medicare supplement policies or
				certificates delivered or issued for delivery to individuals newly eligible for
				Medicare on or after January 1, 2020, with the following exceptions:
(a) Standardized Medicare supplement benefit
				Plan C is redesignated as Plan D and shall provide the benefits contained in
				ARM 6.6.507E(7)(c) but shall not provide coverage for 100% or any portion of
				the Medicare Part B deductible.
(b) Standardized Medicare supplement benefit
				Plan F is redesignated as Plan G and shall provide the benefits contained in
				ARM 6.6.507E(7)(e) but shall not provide coverage for 100% or any portion of
				the Medicare Part B deductible.
(c)
				Standardized Medicare supplement benefit Plans C, F, and F with High Deductible
				may not be offered to individuals newly eligible for Medicare on or after
				January 1, 2020.
(d) Standardized
				Medicare supplement benefit Plan F With High Deductible is redesignated as Plan
				G With High Deductible and shall provide the benefits contained in ARM
				6.6.507E(7)(g) but shall not provide coverage for 100% or any portion of the
				Medicare Part B deductible. However, the Medicare Part B deductible paid by the
				beneficiary shall be considered an out-of-pocket expense in meeting the annual
				high deductible.
(e) The reference
				to Plans C or F contained in ARM 6.6.507E(3) is deemed a reference to Plans D
				or G for purposes of this rule.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.508 - LOSS RATIO STANDARDS AND REFUND OR CREDIT OF PREMIUM

Current through Register Vol. 13, July 5, 2024
(1) A Medicare supplement policy form or
				certificate form must not be delivered or issued for delivery unless the policy
				form or certificate form can be expected, as estimated for the entire period
				for which rates are computed to provide coverage, to return to policyholders
				and certificateholders in the form of aggregate benefits (not including
				anticipated refunds or credits) provided under the policy form or certificate
				form:
(a) at least 75% of the aggregate
				amount of premiums earned in the case of group policies; or
(b) at least 65% of the aggregate amount of
				premiums earned in the case of individual policies.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.508A - FILING AND APPROVAL OF POLICIES AND CERTIFICATES AND PREMIUM RATES

Current through Register Vol. 13, July 5, 2024
(1) An issuer may not deliver, or issue for
				delivery, a policy or certificate to a resident of this state unless the policy
				form or certificate has been filed with and approved by the commissioner in
				accordance with filing requirements and procedures prescribed by the
				commissioner.
(a) An issuer's name must be as
				prominently displayed as the name of the association, tradename, or other
				sponsoring organization.
(b) The
				policy and certificate must be identified by the proper plan designation letter
				which must be included anywhere in the form number for the policy.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.511 - FORMS OUTLINING COVERAGE (Repealed)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313,
					 33-22-904,
					 MCA IMP:
					 33-15-303,
					 33-22-901,
					 33-22-902,
					 33-22-903,
					 33-22-904,
					 33-22-905,
					 33-22-906,
					 33-22-907,
					 33-22-908,
					 33-22-909,
					 33-22-910,
					 33-22-911,
					 33-22-921,
					 33-22-922,
					 33-22-923,
					 33-22-924,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.511A - FORMS OUTLINING COVERAGE (Repealed)

Current through Register Vol. 13, July 5, 2024
AUTH:
					 33-1-313,
					 33-22-904,
					 MCA
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.512 - SEVERABILITY (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313, MCA; IMP,
					 33-22-901 to
					 33-22-909,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.513 - EFFECTIVE DATE (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-22-904, MCA; IMP,
					 33-15-303 and
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.514 - BENEFIT CONVERSION REQUIREMENTS DURING TRANSITION (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-22-904, MCA; IMP,
					 33-15-303 and
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.515 - STANDARDS FOR CLAIMS PAYMENT

Current through Register Vol. 13, July 5, 2024
(1) An issuer
				shall comply with section 1882(c) (3) of the Social Security Act (as enacted by
				section 4081(b) (2) (C) of the Omnibus Budget Reconciliation Act of 1987
				(OBRA), Pub. L. No. 100-203 ) by:
(a)
				Accepting a notice from a medicare carrier on dually assigned claims submitted
				by participating physicians and suppliers as a claim form otherwise required
				and making a payment determination on the basis of the information contained in
				that notice;
(b) Notifying the
				participating physician or supplier and the beneficiary of the payment
				determination;
(c) Paying the
				participating physician or supplier directly;
(d) Furnishing, at the time of enrollment,
				each enrollee with a card listing the policy name, number and a central mailing
				address to which notices from a medicare carrier may be sent;
(e) Paying user fees for claim notices that
				are transmitted electronically or otherwise. Any cost may not be passed on to
				the insured as a separate distinguishable charge and the charge may not be
				separated from the premium; and
(f)
				Providing to the secretary of health and human services, at least annually, a
				central mailing address to which all claims may be sent by medicare
				carriers.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.516 - FILING REQUIREMENTS FOR OUT-OF-STATE GROUP POLICIES (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-22-904, MCA; IMP,
					 33-15-303 and
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.517 - PERMITTED COMPENSATION ARRANGEMENTS

Current through Register Vol. 13, July 5, 2024
(1)
				An issuer or other entity may provide commission or other compensation to a
				producer for the sale of a Medicare supplement policy or certificate only if
				the first year commission or other first year compensation is no more than 200%
				of the commission or other compensation paid for selling or servicing the
				policy or certificate in the second year or period.
(2) The commission or other compensation
				provided in subsequent (renewal) years must be the same as that provided in the
				second year or period and must be provided for no fewer than five renewal
				years.
(3) No issuer or other
				entity shall provide compensation to its producers, and no producer shall
				receive, compensation greater than the renewal compensation payable by the
				replacing issuer on renewal policies or certificates if an existing policy or
				certificate is replaced.
(4) For
				purposes of this rule, "compensation" includes pecuniary or non-pecuniary
				remuneration of any kind relating to the sale or renewal of the policy or
				certificate including but not limited to bonuses, gifts, prizes, awards and
				service and finders fees.
(5) As
				part of the annual filing under ARM 6.6.508(7), the entity providing Medicare
				supplement policies shall provide copies of commission schedules.
(a) An issuer must provide reasonable
				compensation, as provided under the plan of operation of the program, to a
				producer, if any, for the sale of a Medicare supplement insurance policy or
				certificate. For purposes of this rule, "reasonable compensation" shall be at
				least 3% of the premium paid for the policy or certificate.
(b) An issuer may not vary the commission
				paid on the sale or renewal of a Medicare supplement insurance policy or
				certificate due to any factor other than the first year or renewal status of
				the policy or certificate. For example, issuers may not vary the commission
				based on the plan marketed or the age, health status, location, or claims
				experience of the insured. Issuers may pay a different commission on a policy
				transferred to a different producer for servicing purposes following the
				initial sale, or on a policy sold over the internet, so long as there is no
				other variation in the commission for any other reason.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.518 - FILING REQUIREMENTS FOR ADVERTISING (REPEALED)

Current through Register Vol. 13, July 5, 2024
33-1-313 and
					 33-22-904, MCA; IMP,
					 33-15-303 and
					 33-22-901 through
					 33-22-924,
					 MCA;
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.519 - STANDARDS FOR MARKETING

Current through Register Vol. 13, July 5, 2024
(1) An issuer
				directly or through its producers shall:
(a)
				establish marketing procedures to assure that any comparison of policies by its
				producers will be fair and accurate.
(b) establish marketing procedures to assure
				excessive insurance is not sold or issued.
(c) establish marketing procedures which set
				forth a mechanism or formula for determining whether a replacement policy or
				certificate contains benefits greater than the benefits under the replaced
				policy.
(d) display prominently by
				type, stamp or other appropriate means, on the first page of the policy the
				following: "Notice to buyer: This policy may not cover all of your medical
				expenses."
(e) inquire and
				otherwise make every reasonable effort to identify whether a prospective
				applicant or enrollee for medicare supplement insurance already has accident
				and sickness insurance and the types and amounts of any such insurance.
(f) establish auditable procedures
				for verifying compliance with this rule.
(g) provide to the enrollee an appropriate
				disclosure statement if the enrollee has accident and sickness insurance. These
				statements must be identical to the disclosure statements in ARM
				6.6.526.
Administrative Rules of Montana › Department 6 - STATE AUDITOR › Chapter 6.6 - INSURANCE DEPARTMENT › Subchapter 6.6.5 - Medicare Supplements › Rule 6.6.520 - APPROPRIATENESS OF RECOMMENDED PURCHASE AND EXCESSIVE INSURANCE

Current through Register Vol. 13, July 5, 2024
(1) In recommending the purchase or
				replacement of any medicare supplement policy or certificate, an insurance
				producer shall make reasonable efforts to determine the appropriateness of a
				recommended purchase or replacement.
(2) Any sale of medicare supplement policy or
				certificate that will provide an individual more than one medicare supplement
				policy or certificate is prohibited.
(3) An issuer may not issue a medicare
				supplement policy or certificate to an individual enrolled in medicare part C
				unless the effective date of the coverage is after the termination date of the
				individual's part C coverage.
33-1-313 and
					 33-22-904, MCA; IMP,
					 33-15-303,
					 33-22-901,
					 33-22-902,
					 33-22-903,
					 33-22-904,
					 33-22-905,
					 33-22-906,
					 33-22-907,
					 33-22-908,
					 33-22-909,
					 33-22-910,
					 33-22-911,
					 33-22-921,
					 33-22-922,
					 33-22-923, and
					 33-22-924,
					 MCA;