INSURANCE DEPARTMENT

6.6.4501 ADOPTION BY REFERENCE OF THE NAIC VALUATION MANUAL The Commissioner of Securities and Insurance, Office of the State Auditor, adopts and incorporates by reference the Valuation Manual first adopted by the National Association of Insurance Commissioners (NAIC) on December…

6.6.4601 ADOPTION OF NOTICE The commissioner adopts the form and content of the summary notice and disclosure document regarding the protection provided by the Montana Life and Health Insurance Guaranty Association as set out in Appendix A in 6.6.4603. The summary notice and disc…

6.6.4602 DELIVERY OF NOTICE The notice adopted in this subchapter shall be delivered where appropriate to the policy, certificate, or contract holder. Authorizing statute(s): 33-1-313, 33-10-210, MCA Implementing statute(s): 33-10-210, MCA History: NEW, 1995 MAR p. 456, Eff. 3/31…

6.6.4603 APPENDIX "A" - FORM AND CONTENT OF NOTICE The form and content of the summary notice and disclosure document adopted in ARM 6.6.4601, and referred to as "Appendix A" are as follows: NOTICE OF PROTECTION PROVIDED BY MONTANA LIFE AND HEALTH INSURANCE GUARANTY ASSOCIATION T…

6.6.4701 DEFINITIONS "Commission" means the interstate insurance product regulation commission established under 33-39-101, MCA. "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. "Unif…

6.6.4702 PURPOSE The purpose of these rules is to formally opt out of certain uniform standards pursuant to the procedure in 33-39-103, MCA. Authorizing statute(s): 33-39-101, 33-39-103, MCA Implementing statute(s): 33-39-101, 33-39-103, MCA History: NEW, 2016 MAR p. 2057, Eff. 1…

6.6.4703 GROUP DISABILITY INCOME UNIFORM STANDARDS OPT OUT 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 cit…

6.6.4801 DEFINITIONS The following definitions apply to this subchapter: "Fire premium" means the portion of property insurance premium an insurer reasonably attributes to insurance against fire, in relation to all other risks covered by the property insurance policy at issue. "P…

6.6.4802 FIRE PREMIUM ALLOCATION PROCEDURE Insurers paying fire premium tax required by 50-3-109(1), MCA, shall provide to the CSI the calculation of fire premium separately for each line of business identified in 50-3-109(2), MCA. For each line of business identified in 50-3-109…

6.6.4803 PRESUMPTIVELY REASONABLE ALLOCATIONS For purposes of 33-2-705(3) and 50-3-109(2), MCA, the presumptively reasonable allocations for the following lines of business areas follows: for fire, 100%; for allied lines, 30%; for farmowners multi-peril, 40%; for homeowners multi…

6.6.4901 PURPOSE (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2013 MAR p. 1686, Eff. 9/20/13; REP, 2017 MAR p. 2277, Eff. 12/31/17.

6.6.4902 PATIENT-CENTERED MEDICAL HOME QUALIFICATION (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2013 MAR p. 1686, Eff. 9/20/13; AMD, 2014 MAR p. 3051, Eff. 12/25/14; AMD, 2017 MAR p. 85, Eff. 1/7/17; REP, 201…

6.6.4903 NATIONAL ACCREDITATION (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2013 MAR p. 1686, Eff. 9/20/13; REP, 2017 MAR p. 2277, Eff. 12/31/17.

6.6.4905 ESTABLISHMENT AND DUTIES OF THE PATIENT-CENTERED MEDICAL HOMES STAKEHOLDER COUNCIL (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2013 MAR p. 1686, Eff. 9/20/13; REP, 2017 MAR p. 2277, Eff. 12/31/17.

6.6.4906 TIMELINES FOR REQUIRED REPORTING (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2013 MAR p. 1686, Eff. 9/20/13; AMD, 2014 MAR p. 3051, Eff. 12/25/14; AMD, 2017 MAR p. 85, Eff. 1/7/17; REP, 2017 MAR p. 22…

6.6.4907 PATIENT-CENTERED MEDICAL HOME REPORTING—SPECIFIC QUALITY MEASURES REQUIRED (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2014 MAR p. 3045, Eff. 12/25/14; AMD, 2015 MAR p. 2250, Eff. 12/25/15; AMD, 2017 …

6.6.4908 STANDARDS FOR PAYMENT METHODS (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2014 MAR p. 3045, Eff. 12/25/14; AMD, 2017 MAR p. 85, Eff. 1/7/17; REP, 2017 MAR p. 2277, Eff. 12/31/17.

6.6.4909 MEASURES RELATED TO COST AND MEDICAL USAGE—UTILIZATION MEASURES (REPEALED) Authorizing statute(s): 33-40-104, MCA Implementing statute(s): 33-40-104, 33-40-105, MCA History: NEW, 2014 MAR p. 3045, Eff. 12/25/14; AMD, 2017 MAR p. 85, Eff. 1/7/17; REP, 2017 MAR p. 2277, Ef…

6.6.5001 DEFINITIONS For the purposes of this sub-chapter, the following terms have the following definitions: "Act" means the Montana Small Employer Health Insurance Availability Act. "Adjusted gross income" means gross income minus deductions recognized by the Internal Revenue …

6.6.5004 APPLICABILITY, SCOPE, AND TRANSITION Except as provided elsewhere in this rule, this subchapter applies to any health benefit plan, whether provided on a group or individual basis, which: Meets one or more of the conditions set forth in 33-22-1804 , MCA; and Provides cov…

6.6.5008 COVERED SERVICES OF POLICIES UNDER STANDARD PLAN Coverage for all usual, customary, and reasonable charges related to medically necessary services rendered, as defined by the small employer carrier includes as follows: The benefits provided shall be coordinated pursuant …

6.6.501 DISCLOSURE STATEMENTS IN SALE OF MEDICARE SUPPLEMENTS INFORMATION TO BE FURNISHED PROSPECTIVE INSURED (IS HEREBY REPEALED) Authorizing statute(s): 33-1-313, MCA History: imp, 33-18-204, MCA; NEW, 1978 MAR p. 1610, Eff. 6/1/79; REP, 1981 MAR p. 1474, Eff. 2/1/82.

6.6.5012 COVERED PREVENTIVE CARE AND HEALTH MAINTENANCE SERVICE OF POLICIES UNDER STANDARD PLAN (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802 and 33-22-1812, MCA History: NEW, 1994 MAR p. 1990, Eff. 6/10/94…

6.6.5016 SERVICES THAT MAY BE EXCLUDED FROM COVERAGE UNDER THE STANDARD PLAN (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802 and 33-22- 1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; REP, 1995 MAR p.…

6.6.502 PURPOSE (IS HEREBY REPEALED) Authorizing statute(s): 33-1-313, MCA Implementing statute(s): 33-22-902, MCA History: NEW, 1981 MAR p. 1474, Eff. 2/1/82; REP, 1993 MAR p. 1487, Eff. 7/16/93.

6.6.5020 DEDUCTIBLE CHARGES, COINSURANCE, MAXIMUM ALLOWABLE OUT-OF-POCKET CHARGES, AND LIFETIME MAXIMUM BENEFIT LEVEL UNDER THE STANDARD PLAN (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802, 33-22-1812, and 3…

6.6.5024 HMO COST SHARING SCHEDULE AND EXCEPTION TO STANDARD PLAN PROVISIONS Standard plans offered by HMOs must comply with ARM 6.6.5008. HMO plans may require that all services provided in ARM 6.6.5008 must be rendered or referred by a primary care provider. Standard plans offe…

6.6.5028 CONTRACT LANGUAGE (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802 and 33-22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; AMD, 1995 MAR p. 2127, Eff. 10/13/95; REP, 1998 MAR p. 1698, Eff. 6…

6.6.502A PURPOSE The purpose of this subchapter is to: provide for the reasonable standardization of coverage and simplification of terms and benefits of medicare supplement policies; facilitate public understanding and comparison of such policies; eliminate provisions contained …

6.6.503 APPLICABILITY AND SCOPE 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: all Medicare supplement policies delivered or issued for delivery in this state on or after February 1, 1982,…

6.6.5032 CRITERIA OF POLICIES OFFERED UNDER BASIC PLAN Any health benefit plan offered to a small employer group that has a benefit value, as calculated in ARM 6.6.5036, of less than the benefit value of the insurer's standard plan will qualify as a basic health benefit plan cont…

6.6.5036 CALCULATION OF BENEFIT VALUES For the purposes of determining whether a health benefit plan is a basic health benefit plan under ARM 6.6.5032, a benefit value method may be developed and used by the small employer carrier as contemplated in 33-22-1803 (6) , MCA. The carr…

6.6.504 DEFINITIONS 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. "Bankruptcy" means when a Medicare ad…

6.6.5040 COST CONTAINMENT FEATURES OF BASIC AND STANDARD PLANS (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802 and 33-22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; AMD, 1994 MAR p. 2926, Eff. 11/…

6.6.5044 FILING AND APPROVAL OF BASIC AND STANDARD PLANS (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, 33-1-501 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802, 33-22-1811, and 33- 22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; AMD, 1994 MAR…

6.6.505 POLICY DEFINITIONS AND TERMS 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 requiremen…

6.6.5050 STATUS OF CARRIERS AS SMALL EMPLOYER CARRIERS - PERMISSION TO REENTER - ANNUAL REPORTING REQUIREMENTS In order to enter the small employer market, health insurance carriers must: Have prior approval by the commissioner of at least one basic and one standard health benefi…

6.6.5054 APPLICATION TO REENTER STATE (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802, 33-22-1810, and 33-22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; REP, 1998 MAR p. 1698, Eff. 6/26/98.

6.6.5058 REQUIREMENT TO INSURE ENTIRE GROUPS A carrier providing health insurance coverage to a small employer shall offer coverage to all eligible employees and their dependents and shall issue coverage to all eligible employees and their dependents who make timely application a…

6.6.506 PROHIBITED POLICY PROVISIONS 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 …

6.6.5060 COVERAGE THROUGH ASSOCIATIONS A bona fide association must: Meet all the requirements listed in 33-22-1803 (8) , MCA; for purposes of meeting the requirement of being actively in existence for at least 5 years, activities for that duration must include legitimate trade o…

6.6.5062 RESTORATION OF COVERAGE (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802, 33-22-1809, 33-22-1812, and 33-22-1814, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; AMD, 1995 MAR p. 2127, Eff. 10/13/95…

6.6.5066 QUALIFYING PREVIOUS AND QUALIFYING EXISTING COVERAGES (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802, 33-22-1810, 33-22-1811, and 33-22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; AMD, 1…

6.6.507 BENEFIT STANDARDS FOR MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED OR DELIVERED WITH AN EFFECTIVE DATE FOR COVERAGE PRIOR TO JUNE 1, 2010 The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for…