INSURANCE DEPARTMENT

6.6.5703 INAPPLICABILITY OF THE LIFE AND HEALTH GUARANTY PROVISIONS The provisions of Title 33, chapter 10, part 2, MCA, do not apply to a MEWA nor do any of the provisions of Title 33, chapter 2, part 13, MCA, such as 33-2-1303 (10) and 33-2-1371 (3) , MCA as they relate to the …

6.6.5704 APPLICATION OF THESE RULES ARE TO BE CONSISTENT WITH ERISA These rules are to be interpreted so as to be consistent with the provisions of the Employee Retirement Income Security Act(ERISA) and to the extent that they conflict with ERISA they shall not apply. Authorizing…

6.6.5705 DEFINITIONS "Delinquency proceeding" as it appears in the statutory provisions means any proceeding instituted against an insurer for the purpose of liquidating, rehabilitating or reorganizing, or conserving such insurer due to the insolvency of the insurer. "Insurer" as…

6.6.5706 COMMISSIONER'S SUMMARY ORDERS AND SUPERVISION PROCEEDINGS 33-2-1321 (1) , MCA, shall be deleted and in its place shall be inserted: "Whenever the commissioner has established than an insurer is insolvent, he may make and serve upon the insurer and any other person involv…

6.6.5707 TERMINATION OF POLICY COVERAGE 33-2-1343 , MCA, shall be deleted and in its place shall be inserted: "All policies issued by an insurer in effect at the time of issuance of an order of liquidation shall terminate upon issuance of the order of liquidation." Authorizing st…

6.6.5708 PRIORITY OF DISTRIBUTION The introductory language in 33-2-1360 (1) , MCA, shall be deleted and in its place the following language shall be inserted: "As soon as practicable but not more than 180 days from the date of an order of liquidation of an insurer which provides…

6.6.5801 MANAGED CARE COMMUNITY NETWORKS: DEFINITIONS (REPEALED) Authorizing statute(s): 33-31-103, 33-31-115, 53-6-703, MCA Implementing statute(s): 53-6-703, MCA History: NEW, 1995 MAR p. 2675, Eff. 12/8/95; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5802 CRITERIA FOR ASSESSING THE FINANCIAL SOUNDNESS OF A NETWORK (REPEALED) Authorizing statute(s): 53-6-703(3), MCA Implementing statute(s): 53-6-703, MCA History: NEW, 1995 MAR p. 2675, Eff. 12/8/95; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5803 PROTECTION AGAINST INSOLVENCY (REPEALED) Authorizing statute(s): 33-31-115, 53-6-703(6), MCA Implementing statute(s): 53-6-703, MCA History: NEW, 1995 MAR p. 2675, Eff. 12/8/95; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5804 REDUCTION OR ELIMINATION OF REQUIREMENTS (REPEALED) Authorizing statute(s): 33-31-103, 33-31-115, 53-6-703(1)(a), MCA Implementing statute(s): 53-6-703, MCA History: NEW, 1995 MAR p. 2675, Eff. 12/8/95; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5805 APPLICATION REVIEW FEE (REPEALED) Authorizing statute(s): 33-31-115, 53-6-703(4), MCA Implementing statute(s): 53-6-703, MCA History: NEW, 1995 MAR p. 2675, Eff. 12/8/95; REP, 2017 MAR p. 1887, Eff. 10/14/17.

6.6.5901 APPLICABILITY AND IDENTIFICATION OF DIFFERENT LEVELS OF ADEQUACY A health care insurer who issues disability benefits and meets the requirements of 33-22-1706(4)(c), MCA, is deemed to have an adequate network, for that category of health care providers, provided that the…

6.6.5902 NETWORK ADEQUACY The commissioner may determine that an insurer has an adequate network, even if the network does not meet all of the percentages for various types of providers or facilities specified in 33-22-1706(4)(c), MCA. As used in 33-22-1706(4)(c), MCA, and this c…

6.6.5903 FILING PROVIDER LISTS An insurer shall file on the date specified in filing instructions from the commissioner, an electronic report of all participating providers in that insurer's network on a form and in a manner prescribed by the commissioner. If the insurer maintain…

6.6.5905 CHOICE OF PRIMARY CARE PHYSICIAN If an insurer requires a covered person to choose a primary care provider and ties claims payment to that choice or requires a primary care provider referral before seeking specialty provider services, that insurer shall provide the cover…

6.6.5906 REQUIRED DISCLOSURES REGARDING NETWORK ADEQUACY Each insurer shall have a preferred provider directory on its web site and available in hard copy, if requested. The provider directory must be searchable by specialty, including primary provider designation, county and cit…

6.6.5907 GEOGRAPHIC SERVICES AREAS An insurer may offer health plans with a limited geographic area to individuals who live or work in that area, as long as the insurer meets the network adequacy requirements set forth in these rules and provides the commissioner with the followi…

6.6.5908 CONTINUITY OF CARE When an insured's provider is dropped for any reason from the network, an insurer shall establish reasonable procedures to transition the insured to a preferred provider in a manner that ensures continuity of care. If the insured requests it and the tr…

6.6.6001 DEFINITIONS For the purposes of this subchapter, the following terms have the following meanings: "Bail bond agency" means a surety bail insurance producer agency which may be a corporation, limited liability company, partnership, limited partnership, limited liability p…

6.6.6002 BOND INSTRUMENTS A surety bail insurance producer may not sign or countersign bail bonds in blank. A surety bail insurance producer may not give power of attorney to, or otherwise authorize, anyone to countersign the surety bail insurance producer's signature to bonds. B…

6.6.6003 COLLATERAL, TRUST ACCOUNTS, RECORDS OF ARREST AND SURRENDER, LIST OF FORFEITURES, COSTS, NOTICE OF INCARCERATION Any collateral security required by a surety bail insurance producer must be commercially reasonable in relation to the amount of the bond. The value of any c…

6.6.6004 PROHIBITED PRACTICES A surety bail insurance producer may not: pay a fee or rebate, or give or promise anything of value, directly or indirectly to any public official, employee, or agent, who has power to arrest or hold in custody, in order to secure a settlement, compr…

6.6.6005 PORTION OF BOND PREMIUM PAYMENTS DEFERRED If an agreement between the principal and surety bail insurance producer calls for some portion of the bond premium payments to be deferred or paid after the principal is released from custody, the surety bail insurance producer …

6.6.6006 BAIL BOND DOCUMENTS The following requirements apply to documentation a surety bail insurance producer uses in connection with transacting business: an indemnity agreement must: be in writing; be signed by the principal; be signed by the indemnitor, if any; be signed by …

6.6.601 APPLICATION AND SCOPE This rule shall No policy or certificate may be advertised as a medicare select policy or certificate unless it meets the requirements of ARM 6.6.601 through 6.6.614. apply to medicare select policies and certificates, as defined in ARM 6.6.601 throu…

6.6.602 DEFINITIONS For the purposes of ARM 6.6.601 through 6.6.614: "Complaint" means any dissatisfaction expressed by an individual concerning a medicare select issuer or its network providers. "Grievance" means dissatisfaction expressed in writing by an individual insured unde…

6.6.603 AUTHORIZATION OF THE COMMISSIONER The commissioner may authorize an issuer to offer a medicare select policy or certificate, pursuant to ARM 6.6.601 through 6.6.614 and section 4358 of the Omnibus Budget Reconciliation Act (OBRA) of 1990, if the commissioner finds that th…

6.6.604 PLAN TO BE APPROVED BY COMMISSIONER BEFORE BEING ISSUED A medicare select issuer shall not issue a medicare select policy or certificate in this state until its plan of operation has been approved by the commissioner. Authorizing statute(s): 33-22-904 and 33-22-905, MCA I…

6.6.605 PLAN TO BE FILED AND THE REQUIREMENTS A medicare select issuer shall file a proposed plan of operation with the commissioner in a format prescribed by the commissioner. The plan of operation shall contain at least the following information: evidence that all covered servi…

6.6.606 PLAN CHANGES TO BE FILED AND APPROVED A medicare select issuer shall file for approval with the commissioner any proposed changes to the plan of operation, except for changes to the list of network providers, prior to implementing such changes. An updated list of network …

6.6.607 MEDICARE SELECT FULL COVERAGE A medicare select policy or certificate must not restrict payment for covered services provided by non-network providers if: the services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury …

6.6.608 DISCLOSURE REQUIREMENTS A medicare select issuer shall make full and fair disclosure in writing of the provisions, restrictions, and limitations of the medicare select policy or certificate to each applicant. This disclosure shall include at least the following: an outlin…

6.6.609 ACKNOWLEDGMENT OF UNDERSTANDING BY APPLICANT Prior to the sale of a medicare select policy or certificate, a medicare select issuer shall obtain from the applicant a signed and dated form stating that the applicant has received the information provided pursuant to ARM 6.6…

6.6.610 GRIEVANCE AND COMPLAINT PROCEDURE A medicare select issuer shall have and use procedures for hearing complaints and resolving written grievances from the subscribers. Such procedures shall be aimed at mutual agreement for settlement and may include arbitration procedures.…

6.6.611 AVAILABILITY TO PURCHASE ANY PRODUCT At the time of initial purchase, a medicare select issuer shall make available to each applicant for a medicare select policy or certificate the opportunity to purchase any medicare supplement policy or certificate otherwise offered by…

6.6.612 INSURED MAY PURCHASE A COMPARABLE OR LESSER BENEFIT POLICY OR CERTIFICATE WITHOUT A RESTRICTED NETWORK PROVISION At the request of an individual insured under a medicare select policy or certificate, a medicare select issuer shall make available to the individual insured …

6.6.613 PROVISION FOR CONTINUED COVERAGE Medicare select policies and certificates shall provide for continuation of coverage in the event the United States department of health and human services determines that medicare select policies and certificates issued pursuant to ARM 6.…

6.6.614 ISSUER SHALL COMPLY WITH REASONABLE REQUESTS FOR DATA A medicare select issuer shall comply with reasonable requests for data made by state or federal agencies, including the United States department of health and human services, for the purpose of evaluating the medicare…

6.6.6501 PURPOSE The purpose of these rules is to prescribe: guidelines and standards for statements of actuarial opinion which are to be submitted in accordance with 33-2-407(5) and (6) and 33-7-118(2), MCA, and for memoranda in support thereof; rules applicable to the appointme…

6.6.6502 AUTHORITY These rules are issued pursuant to the authority vested in the Commissioner of Insurance of the state of Montana under 33-2-407, MCA. These rules will take effect for annual statements for the year 2009. Authorizing statute(s): 33-1-313, 33-2-407, MCA Implement…

6.6.6503 SCOPE These rules shall apply to all life insurance companies and fraternal benefit societies doing business in this state and to all life insurance companies and fraternal benefit societies which are authorized to reinsure life insurance, annuities or disability insuran…

6.6.6504 DEFINITIONS "Actuarial opinion" means the opinion of an appointed actuary regarding the adequacy of the reserves and related actuarial items based on an asset adequacy test in accordance with ARM 6.6.6508 and with applicable Actuarial Standards of Practice. "Actuarial St…

6.6.6505 GENERAL REQUIREMENTS As to the submission of Statement of Actuarial Opinion, the following requirements apply: there is to be included on or attached to page one of the annual statement for each year beginning with the year in which this regulation becomes effective the …

6.6.6506 REQUIRED OPINIONS (REPEALED) Authorizing statute(s): 33-2-521, MCA Implementing statute(s): 33-2-521 through 33-2-537, MCA History: NEW, 1996 MAR p. 1371, Eff. 5/24/96; REP, 2008 MAR p. 2622, Eff. 12/25/08.

6.6.6507 STATEMENT OF ACTUARIAL OPINION NOT INCLUDING AN ASSET ADEQUACY ANALYSIS (REPEALED) Authorizing statute(s): 33-2-521, MCA Implementing statute(s): 33-2-521 through 33-2-537, MCA History: NEW, 1996 MAR p. 1371, Eff. 5/24/96; REP, 2008 MAR p. 2622, Eff. 12/25/08.

6.6.6508 STATEMENT OF ACTUARIAL OPINION BASED ON AN ASSET ADEQUACY ANALYSIS The statement of actuarial opinion submitted in accordance with this rule shall consist of: a paragraph identifying the appointed actuary and his or her qualifications (see (2)(a)); a scope paragraph iden…

6.6.6509 DESCRIPTION OF ACTUARIAL MEMORANDUM INCLUDING AN ASSET ADEQUACY ANALYSIS AND REGULATORY ASSET ADEQUACY ISSUES SUMMARY In accordance with 33-2-407(5) and (6), and 33-7-118(2), MCA, the appointed actuary shall prepare a memorandum to the company describing the analysis don…

6.6.6510 ADDITIONAL CONSIDERATIONS FOR ANALYSIS (REPEALED) Authorizing statute(s): 33-2-521, MCA Implementing statute(s): 33-2-521 through 33-2-537, MCA History: NEW, 1996 MAR p. 1371, Eff. 5/24/96; REP, 2008 MAR p. 2622, Eff. 12/25/08.

6.6.6601 FIDELITY BOND The amount of fidelity bond coverage required by 33-3-307, MCA, for officers of a domestic insurer must be calculated as follows: The sum of the calculations in (i) and (ii) equals the amount of the insurer's exposure index: 5% of the insurer's admitted ass…

6.6.6701 PURPOSE The purpose ofARM 6.6.6701 through 6.6.6713is to provide: tables of select mortality factors and rules for their use; rules concerning a minimum standard for the valuation of plans with nonlevel premiums or benefits; and rules concerning a minimum standard for th…