INSURANCE DEPARTMENT

6.6.2406 PROCEDURE TO BE FOLLOWED BY SECONDARY PLAN TO CALCULATE BENEFITS AND PAY A CLAIM In determining the amount to be paid by the secondary plan on a claim, should the plan wish to coordinate benefits, the secondary plan shall calculate the benefits it would have paid on the …

6.6.2407 NOTICE TO COVERED PERSONS A plan shall, in its explanation of benefits provided to covered persons, include the following language: "If you are covered by more than one health benefit plan, you should file all your claims with each plan." Authorizing statute(s): 33-1-313…

6.6.2408 MISCELLANEOUS PROVISIONS A secondary plan that provides benefits in the form of services may recover the reasonable cash value of the services from the primary plan, to the extent that benefits for the services are covered by the primary plan and have not already been pa…

6.6.2410 APPENDIX "A" MODEL COB CONTRACT PROVISIONS The model COB contract provisions are set forth in this rule and referred to as "Appendix A:" APPENDIX A. MODEL COB CONTRACT PROVISIONS COORDINATION OF THIS CONTRACT'S BENEFITS WITH OTHER BENEFITS The Coordination of Benefits (C…

6.6.2411 APPENDIX "B" MODEL COB CONSUMER EXPLANATORY BOOKLET The provisions of the model COB consumer explanatory booklet are set forth in this rule and referred to as "Appendix B:" APPENDIX B. CONSUMER EXPLANATORY BOOKLET COORDINATION OF BENEFITS IMPORTANT NOTICE This is a summa…

6.6.2501 PURPOSE The purpose of these rules is to implement the Montana Health Maintenance Organization Act to assure the availability, accessibility, and continuity of services provided by health maintenance organizations and to provide reasonable standards for terms and provisi…

6.6.2502 APPLICABILITY AND SCOPE These rules apply 60 days after effective date to all health maintenance organizations that are required to obtain a certificate of authority in this state. If these rules conflict with other rules adopted by the commissioner, these rules control …

6.6.2503 DEFINITIONS As used in this subchapter, the Montana Health Maintenance Organization Act, and for the purpose of any terms used in the contract and evidence of coverage: "Contract holder" means a person or entity consisting of employees or eligible persons that has entere…

6.6.2504 FILING EXEMPTION FOR HEALTH MAINTENANCE OPERATED BY INSURER OR HEALTH SERVICE CORPORATION AS A PLAN A health maintenance organization operated as a plan (defined in 33-31-102, MCA) need not file with the commissioner, as part of its application for a certificate of autho…

6.6.2505 MULTIDISCIPLINARY ADVISORY BOARDS The membership of a health maintenance organization advisory board must include providers or other individual representatives from at least three different health-related fields. Authorizing statute(s): 33-31-103, MCA and SB 353, stateme…

6.6.2506 REQUIREMENTS FOR CONTRACTS AND EVIDENCES OF COVERAGE Each subscriber is entitled to a contract or evidence of coverage as approved by the commissioner. The contract or evidence of coverage must be delivered or issued for delivery to a subscriber within a reasonable time …

6.6.2507 PROHIBITED PRACTICES A health maintenance organization may not include in its contract and evidence of coverage a provision setting forth exclusions or limitations of services for preexisting conditions at the time of enrollment, except as permitted under33-22-246,33-22-…

6.6.2508 SERVICES A health maintenance organization shall establish and maintain adequate arrangements to provide the health services contracted for by its subscribers including: reasonable proximity to the business or personal residences of the enrollees so as not to result in u…

6.6.2509 OTHER REQUIREMENTS 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…

6.6.2510 PENALTIES 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. Authorizing statute(s): Sec. 33-31-103 MCA Implementing statute(s): Sec. 33-31-101 through 33-31-405 MCA History: NEW, 1987 MAR…

6.6.2601 PURPOSE AND APPLICABILITY 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 I…

6.6.2602 DEFINITIONS As used in this subchapter and Title 33, chapter 27, MCA, the following definitions apply unless the context requires otherwise: "Health" means the extent to which: assets in an independent liability fund are accurately valued; and the investments and assets …

6.6.2603 REGISTRATION OF INDEPENDENT LIABILITY FUNDS 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 c…

6.6.2604 ADMINISTRATION OF INDEPENDENT LIABILITY FUNDS A business entity may use one of the two following methods to administer its independent liability fund: A third party having no close connection with the business entity may administer the fund, provided that the third party…

6.6.2605 OVERSIGHT OF INDEPENDENT LIABILITY FUND 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. A business entit…

6.6.2606 PENALTIES (REPEALED) Authorizing statute(s): 33-27-104, MCA Implementing statute(s): Title 33, ch. 27, MCA History: NEW, 1987 MAR p. 2372, Eff. 12/25/87; REP, 2018 MAR p. 825, Eff. 4/28/18.

6.6.2701 PURPOSE 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. Authorizing statute(s): Sec. 33-2-705(7…

6.6.2702 APPLICABILITY AND SCOPE 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 coll…

6.6.2703 EFFECTIVE DATE Beginning April 15, 1988, and thereafter, every insurer shall remit to the commissioner its premium tax in accordance with these rules. Authorizing statute(s): Sec. 33-2-705(7) MCA Implementing statute(s): 33-2-705(7) MCA History: NEW, 1987 MAR p. 2373, Ef…

6.6.2704 METHODS OF CALCULATION Every insurer shall pay its quarterly premium tax obligation as follows: pay an amount equal to 100% of its prior calendar year premium tax in four equal payments, or pay an amount equal to 90% of its current year premium tax obligation, as calcula…

6.6.2705 PAYMENT DATES 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. An insurer, subject to the provisions of these rules, w…

6.6.2706 ADJUSTMENTS 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 ye…

6.6.2707 CESSATION OF BUSINESS 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. Authorizin…

6.6.2708 APPLICATION FOR REFUND 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. Authorizing stat…

6.6.2709 PENALTY 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. Authorizing statute(s): Sec. 33-2-705(7) MCA Implementing statute(s): 33-2-705(7) MCA History: NEW, …

6.6.2801 PURPOSE AND SCOPE 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. Author…

6.6.2802 DELEGATION OF AUTHORITY (REPEALED) Authorizing statute(s): 33-1-313, 33-2-316, MCA Implementing statute(s): 33-2-301 through 33-2-326, MCA History: NEW, 1990 MAR p. 218, Eff. 1/26/90; REP, 2009 MAR p. 2005, Eff. 10/30/09.

6.6.2803 FILING OF SUBMISSIONS, EXAMINATION OF SUBMISSIONS AND RECORDS RETAINED 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, …

6.6.2804 COLLECTION OF STAMPING FEE Pursuant to 33-2-321, MCA, thecommissioner 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. Authorizing statu…

6.6.2805 ORGANIZATION AND DUTIES OF SURPLUS LINES ADVISORY ORGANIZATION (REPEALED) Authorizing statute(s): 33-1-313, 33-2-316, MCA Implementing statute(s): 33-2-301 through 33-2-326, MCA History: NEW, 1990 MAR p. 218, Eff. 1/26/90; REP, 2009 MAR p. 2005, Eff. 10/30/09.

6.6.2806 OPERATING EXPENSES (REPEALED) Authorizing statute(s): 33-1-313, 33-2-316, MCA Implementing statute(s): 33-2-301 through 33-2-326, MCA History: NEW, 1990 MAR p. 218, Eff. 1/26/90; REP, 2009 MAR p. 2005, Eff. 10/30/09.

6.6.2807 MEMBERSHIP IN SURPLUS LINES ADVISORY ORGANIZATION (REPEALED) Authorizing statute(s): 33-1-313, 33-2-316, MCA Implementing statute(s): 33-2-301 through 33-2-326, MCA History: NEW, 1990 MAR p. 218, Eff. 1/26/90; REP, 2009 MAR p. 2005, Eff. 10/30/09.

6.6.2808 ELIGIBLE SURPLUS LINES INSURERS LIST At least semiannually, the department shall make available a complete current list of eligible surplus lines insurers approved by the commissioner. Authorizing statute(s): 33-1-313, 33-2-316, MCA Implementing statute(s): 33-2-301, 33-…

6.6.2809 APPROVED RISK LIST -- INSURANCE PRESUMED UNOBTAINABLE FROM AUTHORIZED INSURERS (REPEALED) Authorizing statute(s): 33-1-313, 33-2-316, MCA Implementing statute(s): 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…

6.6.2810 ANNUAL REPORTING PERIOD - TAX AND FEE STATEMENT The reporting period for surplus lines insurance premium taxes and stamping fees shall be the calendar year. The department shall produce for each surplus lines insurance producer, and insured who independently procured ins…

6.6.2901 PURPOSE AND SCOPE (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 1996 MAR p. 266, Eff. 1/26/96.

6.6.2902 DEFINITIONS (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 1996 MAR p. 266, Eff. 1/26/96.

6.6.2903 QUALIFICATIONS FOR PROGRAM DIRECTORS AND INSTRUCTORS (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 1996 MAR p. 266, Eff. 1/26/96.

6.6.2904 EDUCATIONAL REQUIREMENTS FOR LIFE AND DISABILITY INSURANCE PRELICENSING EDUCATION COURSES (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 1996…

6.6.2905 EDUCATIONAL REQUIREMENTS FOR PROPERTY AND CASUALTY INSURANCE PRELICENSING EDUCATION COURSES (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 19…

6.6.2906 REQUIREMENTS FOR COURSE COMPLETION CERTIFICATES (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 1996 MAR p. 266, Eff. 1/26/96.

6.6.2907 SUBMISSIONS AND CERTIFICATES (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-17-207 through 33-17-209, MCA History: NEW, 1990 MAR p. 487, Eff. 3/16/90; REP, 1996 MAR p. 266, Eff. 1/26/96.

6.6.3001 PURPOSE AND SCOPE 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…

6.6.3002 AUTHORITY These rules are issued pursuant to the authority vested in the commissioner by 33-1-313 and 33-16-202 , MCA. Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): 33-16-201 through 33-16-203, MCA History: NEW, 1990 MAR p. 2171, Eff. 12/14/90.

6.6.3003 DEFINITIONS "Expenses" means the portion of a rate attributable to costs of loss adjustment, acquisition, field supervision, collection expenses, general expenses, taxes, licenses, and fees. "Prospective loss costs" means the portion of a rate that does not include provi…