INSURANCE DEPARTMENT

6.6.515 STANDARDS FOR CLAIMS PAYMENT 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: Accepting a notice from a medicare carrier on …

6.6.516 FILING REQUIREMENTS FOR OUT-OF-STATE GROUP POLICIES (IS HEREBY REPEALED) Authorizing statute(s): 33-1-313 and 33-22-904, MCA Implementing statute(s): 33-15-303 and 33-22-901 through 33-22-924, MCA History: NEW, 1990 MAR p. 1688, Eff. 9/1/90; REP, 1993 MAR p. 1487, Eff. 7/…

6.6.517 PERMITTED COMPENSATION ARRANGEMENTS 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 …

6.6.518 FILING REQUIREMENTS FOR ADVERTISING (IS HEREBY REPEALED) Authorizing statute(s): 33-1-313 and 33-22-904, MCA Implementing statute(s): 33-15-303 and 33-22-901 through 33-22-924, MCA History: NEW, 1990 MAR p. 1688, Eff. 9/1/90; REP, 1993 MAR p. 1487, Eff. 7/16/93.

6.6.519 STANDARDS FOR MARKETING An issuer directly or through its producers shall: establish marketing procedures to assure that any comparison of policies by its producers will be fair and accurate; establish marketing procedures to assure excessive insurance is not sold or issu…

6.6.520 APPROPRIATENESS OF RECOMMENDED PURCHASE AND EXCESSIVE INSURANCE 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 …

6.6.5201 DEFINITIONS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2001, 33-22-2002, 33-22-2003, 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2013 MAR p. 111, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.…

6.6.5202 SMALL BUSINESS HEALTH INSURANCE PURCHASING POOL--PREMIUM ASSISTANCE AND INCENTIVE PAYMENTS--SMALL BUSINESS HEALTH INSURANCE TAX CREDITS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2001, 33-22-2002, 33-22-2003, 33-22-2004, 33-22-2005,…

6.6.5203 REGISTRATION REQUIRED--ELIGIBILITY (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2001, 33-22-2002, 33-22-2003, 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; AMD, 2006 MAR …

6.6.5204 FISCAL YEAR (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2005 History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5207 MEETINGS OF THE PURCHASING POOL BOARD (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2003, 33-22-2004, 33-22-2005, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5208 PROGRAM MANAGER--ADMINISTRATOR FOR THE PURCHASING POOL (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2001, 33-22-2002, 33-22-2003, 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/2…

6.6.521 REPORTING OF MULTIPLE POLICIES On or before March 1 of each year, every issuer shall report, on the form contained in ARM 6.6.525, information for every individual resident of this state for which the issuer has in force more than one Medicare supplement insurance policy …

6.6.5210 OFFICERS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2003, 33-22-2004, 33-22-2005, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5211 DUTIES OF THE OFFICERS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2003, 33-22-2004, 33-22-2005, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5212 PARLIAMENTARY AUTHORITY (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2003, 33-22-2004, 33-22-2005, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5215 TIMELINE FOR THE PLAN OF OPERATION (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2002, 33-22-2003, 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff…

6.6.5216 TIMELINE FOR AUDITS OF THE BOARD (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2005, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5219 PAYMENT OF PREMIUM ASSISTANCE AND PREMIUM INCENTIVE PAYMENTS TO EMPLOYERS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 M…

6.6.522 PROHIBITION AGAINST PREEXISTING CONDITIONS, WAITING PERIODS, ELIMINATION PERIODS, AND PROBATIONARY PERIODS IN REPLACEMENT POLICIES OR CERTIFICATES If a medicare supplement policy or certificate replaces another medicare supplement policy or certificate, the replacing issu…

6.6.5220 QUALIFIED ASSOCIATIONS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2004, 33-22-2005, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5221 WAITING LIST (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; AMD, 2008 MAR p. 944, Eff. 5/9/08; REP, 2017 MAR p. 1887, Eff. 10/14/17.…

6.6.5224 INSURERS REQUIRED TO REPORT CANCELLATIONS (REPEALED) Authorizing statute(s): 33-22-2005, MCA Implementing statute(s): 33-22-2004, 33-22-2005, 33-22-2006, 33-22-2007, 33-22-2008, MCA History: NEW, 2005 MAR p. 1771, Eff. 9/23/05; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.523 SEPARABILITY If any provision of this subchapter or the application thereof to any person or circumstance is for any reason held to be invalid, the remainder of the subchapter and the application of such provision to other persons or circumstances shall not be affected. A…

6.6.524 APPENDIX A - MEDICARE SUPPLEMENT REFUND CALCULATION FORM This is the appendix referred to in ARM 6.6.508(2) and (3) . MEDICARE SUPPLEMENT REFUND CALCULATION FORM FOR CALENDAR YEAR ______ TYPE 1 _____________________________ SMSBP 2 _________________________ For the State …

6.6.525 APPENDIX B - FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES This is the appendix referred to in ARM 6.6.521. FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES Company Name: ____________________________ Address:____________________________ ____________________________ Phone…

6.6.526 APPENDIX C DISCLOSURE STATEMENTS This is the appendix referred to in ARM 6.6.509(6) . Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare Section 1882(d) of the federal Social Security Act …

6.6.527 PROHIBITION AGAINST USE OF GENETIC INFORMATION AND REQUESTS FOR GENETIC TESTING This subsection applies to all policies with policy years beginning on or after May 21, 2009. An issuer of a Medicare supplement policy or certificate shall not: deny or condition the issuance…

6.6.5301 PURPOSE The purpose of these rules is to recognize the following mortality tables for use in determining the minimum standard of valuation for annuity and pure endowment contracts: the 1983 Table "a"; the 2012 IAR Mortality Table; and the 1994 GAR Table. Authorizing stat…

6.6.5302 DEFINITIONS "1983 Table 'a'" means the individual annuity mortality table developed by the Society of Actuaries Committee to Recommend a New Mortality Basis for Individual Annuity Valuation and adopted as a recognized mortality table for annuities in June 1982 by the Nat…

6.6.5303 INDIVIDUAL ANNUITY AND PURE ENDOWMENT CONTRACTS Except as provided in (2), the 2012 IAR Mortality Table shall be used for determining the minimum standard of valuation for any individual annuity or pure endowment contract issued on or after January 1, 2017. The 1983 Tabl…

6.6.5304 APPLICATION OF THE 2012 IAR MORTALITY TABLE In using the 2012 IAR Mortality Table, the mortality rate for a person age x in year (2012 + n) is calculated as follows: q x 2012+n = q x 2012 (1-G2 x ) n ; the resulting q x 2012+n shall be rounded to three decimal places per…

6.6.5306 GROUP ANNUITY AND PURE ENDOWMENT CONTRACTS The 1994 GAR Table shall be used for determining the minimum standard of valuation for any annuity or pure endowment purchased on or after January 1, 2017, under a group annuity or pure endowment contract. Authorizing statute(s)…

6.6.5307 APPLICATION OF THE 1994 GAR TABLE In using the 1994 GAR Table, the mortality rate for a person age x in year (1994 + n) is calculated as follows: q x 1994+n = q x 1994 (1-AA x ) n where the q x 1994 and AA x are specified in the 1994 GAR Table. Authorizing statute(s): 33…

6.6.5308 INCORPORATION BY REFERENCE OF THE 1983 TABLE "A," THE 2012 IAR MORTALITY TABLE, AND THE 1994 GAR TABLE The Commissioner of Securities and Insurance, Office of the State Auditor, adopts and incorporates by reference the 1983 Table "a" adopted by the National Association o…

6.6.5309 EFFECTIVE DATE The effective date of ARM 6.6.5301 through 6.6.5309 is January 1, 2017. Authorizing statute(s): 33-1-313, 33-2-418, MCA Implementing statute(s): 33-2-410, MCA History: NEW, 2016 MAR p. 2328, Eff. 1/1/17.

6.6.5501 PURPOSE OF RULES The purpose and intent of this subchapter is to standardize the forms used in the billing and reimbursement of health care, reduce the number of forms utilized, increase efficiency in the reimbursement of health care through standardization, and encourag…

6.6.5503 DEFINITIONS For the purposes of this sub-chapter, the following terms have the following meanings: "ASC X12N standard format" means the standards for electronic data interchange within the health care industry developed by the accredited standards committee X12N insuranc…

6.6.5505 APPLICABILITY AND SCOPE Except as otherwise specifically provided, the requirements of this subchapter apply to issuers, health care practitioners, and institutional care practitioners. Nothing in this subchapter shall prevent an issuer from requesting additional informa…

6.6.5507 REQUIREMENTS FOR USE OF HCFA FORM 1500 Health care practitioners, other than dentists, shall use the HCFA Form 1500 and instructions provided by HCFA for use of the HCFA Form 1500 when filing claims with issuers for professional services. Health care practitioners that b…

6.6.5509 REQUIREMENTS FOR USE OF HCFA FORM 1450 (UB-92) Institutional care practitioners shall use the HCFA Form 1450 (UB-92) and instructions provided by HCFA for use of the HCFA Form 1450 (UB-92) when filing claims with issuers for health care services. Institutional care provi…

6.6.5511 REQUIREMENTS FOR USE OF J512 FORM Dentists shall use the J512 form and instructions provided by the American dental association CDT-1 for use of the J512 form for filing claims with issuers for professional services. Dentists that bill patients directly shall provide a p…

6.6.5513 GENERAL PROVISIONS Health care practitioners and institutional care practitioners shall file claims in a manner consistent with the requirements of this subchapter. Claims filed in paper form shall be printed on 8.5" x 11" paper. Issuers shall accept forms submitted in c…

6.6.5515 MANDATORY ELECTRONIC FORMAT Issuers that receive claims or send payments by electronic means shall, within one year after May 26, 1995 or the date on which the health care financing administration requires it of medicare intermediaries and carriers, whichever is earlier,…

6.6.5701 SUPERVISION, REHABILITATION, AND LIQUIDATION The commissioner has the authority to impose sanctions on any self-funded multiple employer welfare arrangement (MEWA) for failure to maintain sufficient reserves as required by 33-35-209, MCA. The commissioner may impose and …

6.6.5702 AUTHORITY IS LIMITED TO INSOLVENCY The commissioner's authority to supervise, rehabilitate and liquidate any self-funded multiple employer welfare arrangement applies only to those instances where they fail to maintain the level of reserves as are required by 33-35-209 ,…