MontanaHB 6069th Legislature, Regular Session (2025)HouseWALLET

Generally revise state auditor laws

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Bill Overview

Analyzed Economic Effects

23 provisions identified: 8 benefits, 1 costs, 14 mixed.

One-time $40 million for school health trust

The state sets aside $40 million for a district self‑funded school health insurance trust. The money is paid on July 1, 2026, or when the trust qualifies, if the state auditor qualifies a trust by June 30, 2026 for operation beginning July 1, 2026. If no trust qualifies by June 30, 2026, the money moves to the capital developments long‑range building program account.

Fairer payouts for total-loss vehicles

When repairs cost more than a car’s value, damages are measured by the car’s actual cash value right before the damage. Both sides can agree after the loss to use a used‑car “book” value instead. The law still lets book value help determine actual cash value.

Medicare supplement: steadier rates and switching

Beginning October 1, 2025, your Medigap plan cannot refuse renewal if you pay on time or within 31 days. If your insurer stops a product and offers an alternate, it cannot deny benefits for conditions covered under the old plan if you enroll and pay within 31 days; premiums must be based on current and actuarially justified rates. If a different insurer replaces your plan, it cannot deny benefits for a condition covered under the old plan when you pay on time and provide proof of prior coverage; time already served counts toward any preexisting waiting period. Insurers must file rates each year, may change rates no more than twice a year, and not in the first year except for federal Medicare changes. Insurers must give you an outline of coverage at application, filed with the state at least 60 days before delivery. Agents cannot get higher pay for like‑for‑like replacements within the same insurer.

Stronger appeal and denial notice rules

Starting October 1, 2025, insurers must have written review procedures and tell you decisions on time. For prior approvals, they must decide within 7 business days (one extension up to 7 business days). For reviews after care, they must decide within 30 days (one extension up to 15 days). If your request is filed wrong, they must tell you within 3 days and explain how to fix it. Denial notices must give the reason, codes, rules used, what more to send, appeal steps, and commissioner contacts. If coverage is rescinded, you get at least 30 days’ advance notice with details and a right to grieve. If an ongoing certified treatment is cut early, you get notice in time to appeal and your care continues during the internal review.

Limits on late claim take-backs

Beginning October 1, 2025, if an insurer sets a deadline for filing claims, it must use that same time after payment to audit and seek repayment. If there is no filing deadline, the insurer generally has 12 months from payment to ask for money back. When Medicare, workers’ comp, another insurer, or a liable party sends notice, the insurer has 12 months from that notice to act. A hard 24‑month cap applies to non‑fraud repayment requests after the claim was paid. If the insurer reports suspected fraud to the insurance commissioner, the clock pauses until the commissioner says there is not enough evidence.

Lower costs for breast imaging and exams

Starting October 1, 2025, many Montana health plans must cover screening mammograms and related breast exams. Plans must pay at least $70 (or the lower billed charge) for each minimum mammogram before deductibles and copays apply. Plans may not charge cost‑sharing for diagnostic or extra breast exams by a preferred provider; HSA high‑deductible plans may still apply the federal minimum deductible. Some limited policies are excluded, including disability income, hospital indemnity, Medicare supplement, accident‑only, vision, dental, and specified disease policies.

Stronger Medigap protections and disclosures

Beginning October 1, 2025, the commissioner sets minimum loss‑ratio rules for Medicare supplement plans, and insurers must adjust premiums to meet them. If an issuer cedes business to a reinsurer that does not meet chapter 2 rules and then stops a product, it must offer alternate Medigap coverage. Insurers must give Medicare supplement policyholders a notice of benefit changes at least 30 days before the annual effective date, in the format the commissioner sets. The commissioner can require a standard brochure for people eligible for Medicare, delivered with the outline of coverage. If a whole policy form is discontinued, your coverage stays active through the policy’s written grace period.

Telehealth covered the same as in person

Beginning October 1, 2025, your health plan must cover a service by telehealth the same as in person. Plans cannot limit where you or your provider are located, or treat rural and urban telehealth differently. Deductibles and copays for telehealth cannot be higher than for the same in‑person care. Some limited policies are excluded from these telehealth rules, including disability income, hospital indemnity, Medicare supplement, certain disease, and long‑term care policies.

More rules for multi-employer health plans

Beginning October 1, 2025, self‑funded multiple‑employer health plans with a current state certificate must follow more state insurance rules listed in the law, such as telehealth parity. This raises compliance duties for plan sponsors. Employees in these plans gain added consumer protections that apply to insurers.

Insurance privacy aligned with HIPAA

Insurers that are HIPAA‑covered entities follow HIPAA privacy and security rules for those lines of business. They must still give a Montana notice for data not covered by HIPAA, and authorizations last no more than 24 months. A licensee claiming the HIPAA exemption must notify the commissioner in writing. Business associates are exempt only within a valid HIPAA agreement, and the commissioner can examine privacy practices.

Updated securities rules for firms and investors

The law updates which securities are exempt from Montana registration, including many government, bank, utility, and certain nonprofit offerings with a $50 fee and 20‑day notice. Broker‑dealers and advisers must follow revised registration and notice‑filing rules; some federal covered adviser filings take effect when received. Securities lawsuit timing is clarified: 2 years from violation or 1 year from discovery for registration claims, 2 years from discovery for fraud, and no later than 5 years after the transaction. The restitution assistance program is limited until June 30, 2027 to Montana residents and domiciled entities, pays at most one claimant per victim, requires a restitution order not already paid, and must be forfeited if the restitution is later overturned.

Cancer screening info before buying disability

Beginning October 1, 2025, before issuing a group or individual disability policy, insurers must give written information about the policy’s cancer screening coverage. These materials do not need advance approval by the insurance commissioner.

Clear rules for telehealth visits

Starting October 1, 2025, telehealth includes secure audio, video, or other tech, including audio‑only calls. Fax or messaging alone does not count unless used with audio or video. For certain written doctor certifications, audio‑only is allowed only after a prior in‑person visit. The insurance commissioner can write rules to carry out these telehealth standards.

Get denial notices by email or mail

Starting October 1, 2025, health insurers may send utilization review and adverse determination notices by mail or electronically. You or your authorized representative can receive these notices electronically if the insurer uses that method.

Training required for marketplace insurance agents

Insurance producers must complete state‑approved training before selling plans on the health insurance exchange. Training covers coverage levels, who qualifies, Medicaid and Healthy Montana Kids rules, and how to use exchange forms. This helps consumers get accurate help when shopping for coverage.

Check-in rules for long-term disability

Beginning October 1, 2025, policies that pay a loss‑of‑time benefit for at least 2 years may require you to confirm your disability at least every 6 months. This does not reduce benefits you already earned in the prior 6 months. There are exceptions for legal incapacity.

More grace time and clearer insurance info

Beginning October 1, 2025, policies must give a grace period after the first premium: at least 7 days (weekly), 10 days (monthly), and 31 days (all others). If a policy lets the insurer refuse renewal, the insurer must mail written nonrenewal notice at least 30 days before the premium due date. You must give written notice of a claim within 6 months of the loss or as soon as reasonably possible; notice to an authorized agent counts, and policies may allow later notice. For individual and group disability policies, insurers must file an outline with the commissioner and give you the outline when you apply; it must show key benefits, your deductible, copays, max out‑of‑pocket, premium estimate, limits, preauthorization rules, and out‑of‑network warnings. Employees must also receive an outline when they get a group insurance certificate.

New telework limits for state employees

State employees can telework from a home or other worksite in Montana. Some roles—mental health professionals, IT services, medical professionals, certain economic development roles that require living out of state, and specified actuarial associates or fellows—may telework from outside Montana. The Office of Budget and Program Planning must approve any out‑of‑state worksite before work begins.

New license to sell travel insurance

Travel retailers can offer travel insurance under a limited lines license with new rules. A responsible licensed producer must be designated, fingerprinting rules followed, and staff trained. Customers must get written terms, insurer contacts, claims steps, and clear notice that buying other goods is not required to buy the insurance.

Surplus lines: fees and new referrals

The law clarifies surplus lines terms and who qualifies in this market. A surplus lines producer may accept business from a licensed producer and, with the commissioner’s prior agreement, from unappointed individuals or entities, and may compensate them. Producers may charge an inspection fee, but only for the actual cost of inspecting the risk.

When this law starts and sunsets

Most of the law starts October 1, 2025. Two parts (Sections 34 and 36) and the effective‑dates section start on passage and approval. The law also extends two earlier provisions so they now end on June 1, 2029.

Faster form approvals, stronger insurer reporting

Insurers must file forms 60 days before delivery; if the commissioner does not act, the form is deemed approved unless tolled. Insurers must give at least 10 days’ notice before market use, and approval can be tolled or withdrawn for cause. Insurers must tell the commissioner within 30 days when a producer is terminated and immediately if it is for listed causes. They must report suspected violations and provide records, with liability protection for good‑faith reports. The law also sets minimum incorporator and residency rules to form stock and mutual insurers in Montana.

Clearer rules for viatical settlements

The law defines who counts as a viatical settlement provider, broker, purchaser, financing entity, related provider trust, and special purpose entity. It lists exclusions, such as bank collateral assignments and insurer accelerated benefits. These clearer terms help regulate sales of life policies for cash.

Sponsors & Cosponsors

Sponsor

Ed Buttrey
Republican • House

Cosponsors

Sara Novak
Democrat • Senate

Roll Call Votes

All Roll Calls

Yes: 283 • No: 15

House vote • 2/15/2025

Do Concur

Yes: 39 • No: 9

House vote • 2/14/2025