Montana Administrative Code

6.6.302 PURPOSE The purpose of this subchapter is: to regulate the activities of insurers and producers with respect to the replacement of existing life insurance and annuities; to protect the interests of life insurance and annuity purchasers by establishing minimum standards of…

6.6.303 DEFINITIONS "Direct-response solicitation" means a solicitation through mailings, telephone, the internet or other mass communication media. "Existing insurer" means the insurance company whose policy or contract is or will be changed or affected in a manner described wit…

6.6.304 EXEMPTIONS Unless otherwise specifically included, this subchapter shall not apply to transactions involving: credit life insurance; group life insurance or group annuities where there is no direct solicitation of individuals by an insurance producer. Direct solicitation …

6.6.305 DUTIES OF PRODUCERS A producer who initiates an application shall submit to the insurer, with or as part of the application, a statement signed by both the applicant and the producer as to whether the applicant has existing policies or contracts. If the answer is "no," th…

6.6.306 DUTIES OF REPLACING INSURERS THAT USE PRODUCERS Where a replacement is involved in the transaction, the replacing insurer shall: verify that the required forms are received and are in compliance with this subchapter; notify any other existing insurer that may be affected …

6.6.307 DUTIES OF INSURERS WITH RESPECT TO DIRECT RESPONSE SOLICITATIONS In the case of an application that is initiated as a result of a direct response solicitation, the insurer shall require, with or as part of each completed application for a policy or contract, a statement a…

6.6.308 DUTIES OF THE EXISTING INSURER Where a replacement is involved in the transaction, the existing insurer shall: retain and be able to produce all replacement notifications received, indexed by replacing insurer, for at least five years or until the conclusion of the next r…

6.6.309 VIOLATIONS AND PENALTIES Any insurer, agent, representative, officer or employee of such insurer failing to comply with the requirements of this sub-chapter shall be subject to such penalties as may be appropriate under the insurance laws of Montana. Any failure to comply…

6.6.310 SAMPLE FORMS (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-18-204, MCA History: NEW, 1978 MAR p. 1302, Eff. 12/15/78; REP, 2001 MAR p. 2221, Eff. 1/1/02.

6.6.3101 PURPOSE, SCOPE, AND AUTHORITY In accordance with 33-22-1101, et seq., MCA, the Commissioner of Insurance declares that the purpose of these rules is to implement Title 33, chapter 22, part 11, MCA, to promote the public interest, to promote the availability of long-term …

6.6.3102 DEFINITIONS For purposes of these rules, in addition to the definitions in 33-22-1107, MCA, the following definitions apply: "Benefit trigger," for the purposes of independent review, means a contractual provision in the insured's policy of long-term care insurance condi…

6.6.3103 POLICY DEFINITIONS No long-term care insurance policy or certificate delivered or issued for delivery in Montana may use the terms set forth below, unless the terms are defined in the policy or certificate as follows in this rule. "Activities of daily living" as defined …

6.6.3104 POLICY PRACTICES AND PROVISIONS The terms "guaranteed renewable" and "noncancellable" shall not be used in any individual long-term care insurance policy or certificate without further explanatory language in accordance with the disclosure requirements of ARM 6.6.3105. N…

6.6.3104A UNINTENTIONAL LAPSE Each issuer offering long-term care insurance shall, as a protection against unintentional lapse, comply with the following: No individual long-term care policy or certificate shall be issued until the issuer has received from the applicant either a …

6.6.3105 REQUIRED DISCLOSURE PROVISIONS Individual long-term care insurance policies and certificates shall contain a renewability provision. The provision shall be appropriately captioned, shall appear on the first page of the policy or certificate, and shall clearly state the d…

6.6.3106 PROHIBITION AGAINST POST-CLAIMS UNDERWRITING All applications for long-term care insurance policies or certificates except those which are guaranteed issue shall contain clear and unambiguous questions designed to ascertain the health condition of the applicant. If an ap…

6.6.3107 MINIMUM STANDARDS FOR HOME HEALTH CARE BENEFITS IN LONG-TERM CARE INSURANCE POLICIES A long-term care insurance policy or certificate may not, if it provides benefits for home health care services, limit or exclude benefits: by requiring that the insured or claimant woul…

6.6.3108 REQUIREMENT TO OFFER INFLATION PROTECTION No issuer may offer a long-term insurance policy or certificate unless the issuer also offers to the policyholder, in addition to any other inflation protection, the option to purchase a policy or certificate that provides for be…

6.6.3109 REQUIREMENTS FOR APPLICATION FORMS AND REPLACEMENT COVERAGE Application forms shall include the following questions designed to elicit information as to whether, as of the date of the application, the applicant has another long-term care insurance policy or certificate i…

6.6.3109A REPORTING REQUIREMENTS Every issuer shall maintain records for each producer of that producer's amount of replacement sales as a percentage of the producer's total annual sales and the amount of lapses of long-term care insurance policies sold by the producer as a perce…

6.6.3109B LICENSING A producer may not market, sell, solicit, negotiate, or otherwise act as an insurance producer with respect to long-term care insurance in this state except as authorized by Title 33, chapter 17, part 2, MCA. The producer must also meet the training requiremen…

6.6.311 DUTIES OF ALL INSURERS THAT USE PRODUCERS Each insurer shall: maintain a system of supervision and control to insure compliance with the requirements of this subchapter that shall include at least the following: inform its producers of the requirements of this subchapter …

6.6.3110 DISCRETIONARY POWERS OF COMMISSIONER OF INSURANCE The Commissioner of Insurance may upon written request and after administrative hearing, issue an order to modify or suspend a specific provision or provisions of these rules with respect to a specific long-term care insu…

6.6.3111 RESERVE STANDARDS When long-term care benefits are provided through the acceleration of benefits under group or individual life policies or riders to such policies, policy reserves for such benefits shall be determined in accordance with 33-2-523, MCA. Claim reserves mus…

6.6.3112 LOSS RATIO Benefits under individual long-term care insurance policies shall be deemed reasonable in relation to premiums provided the expected loss ratio is at least 60%, calculated in a manner which provides for adequate reserving of the long-term insurance risk. In ev…

6.6.3113 FILING REQUIREMENT Prior to an issuer offering long-term care insurance to a resident of Montana pursuant to 33-22-1120, MCA, the issuer shall file with the Commissioner of Insurance the policy or certificate for approval by this state. The policy or certificate and all …

6.6.3113A FILING REQUIREMENTS FOR ADVERTISING Every issuer, health service corporation or health maintenance organization or other entity providing long-term care insurance or benefits in Montana shall provide a copy of any long-term care insurance advertisement intended for use …

6.6.3114 STANDARD FORMAT OUTLINE OF COVERAGE This rule implements, interprets and makes specific the provisions of 33-22-1111, MCA, in prescribing a standard format and the content of an outline of coverage. The outline of coverage shall be a free-standing document, using no smal…

6.6.3115 REQUIREMENT TO DELIVER SHOPPER'S GUIDE A long-term care insurance shopper's guide in the format developed by the National Association of Insurance Commissioners, or a guide developed or approved by the Commissioner of Insurance, shall be provided to all prospective appli…

6.6.3116 EFFECTIVE DATE (REPEALED) Authorizing statute(s): 33-1-313, MCA Implementing statute(s): 33-22-1101 through 33-22-1121, MCA History: NEW, 1991 MAR p. 119, Eff. 2/1/91; REP, 2008 MAR p. 615, Eff. 10/1/08.

6.6.3117 STANDARDS FOR MARKETING Every issuer, health service corporation, health maintenance organization or other entity marketing long-term care insurance coverage in this state, directly or through its producers, shall: establish marketing procedures and producer training req…

6.6.3118 SUITABILITY STANDARDS Every issuer, health service corporation, health maintenance organization or other entity marketing long-term care insurance (the "issuer") shall: develop and use appropriate suitability standards to determine whether the purchase or replacement of …

6.6.3119 NONFORFEITURE BENEFIT REQUIREMENT An insurance company offering a long-term care insurance policy or certificate shall offer to each prospective purchaser the choice between a policy that includes nonforfeiture benefits to the defaulting or surrendering policyholder or c…

6.6.312 SEVERABILITY If any rule or portion of a rule of this subchapter, or its applicability to any person or circumstances, is held invalid by a court, the remainder of this subchapter, or the applicability of its provision to other persons, shall not be affected. Authorizing …

6.6.3120 ADOPTION OF FORMS The following forms are adopted and made a part of these rules for all purposes, and the same must be used as herein directed in giving notice. LTC Form A Rescission Reporting Form LTC Form A RESCISSION REPORTING FORM FOR LONG-TERM CARE POLICIES FOR THE…

6.6.3121 REQUIRED DISCLOSURE OF RATING PRACTICES TO CONSUMERS This rule shall apply as follows: except as provided in (2), this provision applies to any long-term care policy issued in Montana on or after January 1, 2009; and for certificates issued on or after the effective date…

6.6.3122 INITIAL FILING REQUIREMENTS This rule applies to any long-term care policy issued in this state on or after January 1, 2009. An insurer shall provide the information listed in this rule to the commissioner 30 days prior to making a long-term care insurance form available…

6.6.3123 RECOUPING PAST LOSSES In reviewing loss ratio and premium rate schedule increases, the commissioner will ensure that any issuer does not recoup past losses. For premium rate increases, to ensure that issuers do not recoup past losses, premium deficiencies prior to a requ…

6.6.3124 PREMIUM RATE SCHEDULE INCREASES Except as provided in (2), this rule applies to any long-term care policy issued in this state on or after January 1, 2009. For policies issued on or after the effective date of this amended rule under a group long-term care insurance poli…

6.6.3125 PREMIUM RATE INCREASE -- ASSET YIELD RATES An issuer may not use asset investment yield rate changes to justify any premium rate schedule increase for a long-term care insurance policy. This does not prohibit the commissioner from considering an issuer's potential insolv…

6.6.3126 PROHIBITION AGAINST PREEXISTING CONDITIONS AND PROBATIONARY PERIODS IN REPLACEMENT POLICIES If a long-term care insurance policy replaces another long-term care policy, the replacing issuer shall waive any time periods applicable to preexisting conditions and probationar…

6.6.3128 AVAILABILITY OF NEW SERVICES OR PROVIDERS An issuer shall notify policyholders of the availability of a new long-term policy series that provides coverage for new long-term care services or providers, material in nature, and not previously available through the issuer to…

6.6.3129 RIGHT TO REDUCE COVERAGE AND LOWER PREMIUMS Every long-term care insurance policy shall include a provision that allows the policyholder or certificateholder to reduce coverage and lower the policy premium in at least one of the following ways: reducing the maximum benef…

6.6.313 SAMPLE FORMS The State Auditor's Office adopts and incorporates by reference Appendix A, B, and C, which are set forth in the National Association of Insurance Commissioners' (NAIC) Life Insurance and Annuities Replacement Model Regulation, adoptedin 2015. Copies of appen…

6.6.3130 APPEALING AN INSURER'S DETERMINATION THAT THE BENEFIT TRIGGER IS NOT MET For purposes of this rule, "authorized representative" means a person authorized to act as the covered person's personal representative within the meaning of 45 CFR 164.502(g) promulgated by the Sec…

6.6.3131 LONG-TERM CARE INDEPENDENT REVIEW ORGANIZATIONS The commissioner shall certify or approve a qualified long-term care insurance independent review organization, provided the organization demonstrates to the satisfaction of the commissioner that it is unbiased and that: th…

6.6.3201 PURPOSE AND SCOPE (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313, MCA Implementing statute(s): Sec. 33-16-231 through 33-16-236, MCA History: NEW, 1991 MAR p. 253, Eff. 3/1/91; REP, 1996 MAR p. 267, Eff. 1/26/96.