Montana Administrative Code

6.6.5079B DISCLOSURE OF INFORMATION In connection with the offering of any health insurance coverage to a small employer, a small employer carrier is required to: Make a reasonable disclosure to the employer, as part of its solicitation and sales materials, of the availability of…

6.6.5079C PREEXISTING CONDITIONS - PERMISSIBLE RESTRICTIONS IN SMALL GROUPS Eligible employees and their dependents making timely application must be accepted for coverage in a small employer's group health plan without any restrictions or limitations on coverage related to risk …

6.6.5079D SMALL EMPLOYER HEALTH INSURANCE SUBJECT TO GENERAL HEALTH INSURANCE AND GROUP RULES Unless otherwise specified in Title 33, chapter 22, part 18, MCA, or this subchapter, small employer carriers and small employer health plans are subject to applicable statutes in Title …

6.6.5079E TRANSITION IN LARGE AND SMALL GROUP HEALTH PLANS TO CHANGES UNDER HEALTH INSURANCE PORTABILITY ACCOUNTABILITY ACT (HIPAA) IN MONTANA LAW Group health insurance plans and health insurance coverage offered in connection with group health plans for group health plan and he…

6.6.5079F CREDITABLE COVERAGE AND METHODS OF COUNTING Periods of creditable coverage must be counted for individuals previously covered under any health coverage set forth in 33-22-140(4) (a) , MCA, and for coverage under the association plan or the association portability plan a…

6.6.5079G CERTIFICATION OF CREDITABLE COVERAGE - GROUPS AND INDIVIDUALS A group health plan, and each health insurance issuer offering group health insurance coverage under a group health plan, is required to issue certificates of creditable coverage in accordance with 33-22-142,…

6.6.5079H PREEXISTING CONDITIONS - PERMISSIBLE RESTRICTIONS IN GROUP PLANS OTHER THAN SMALL EMPLOYER PLANS A group health plan or a health insurance issuer offering group health insurance coverage may not exclude coverage for a preexisting condition except as set forth in 33-22-5…

6.6.5079I SPECIAL ENROLLMENT PERIODS If an employee or dependent makes a timely request for enrollment under 33-22-523(1) , MCA, enrollment must be effective not later than the first regular billing date used by the carrier during the month following receipt of the completed requ…

6.6.5079J OPPORTUNITIES FOR INDIVIDUALS TO ENROLL IN GROUP PLANS OTHER THAN SMALL EMPLOYER PLANS Upon issuance of a group health plan all employees and their dependents who are eligible for enrollment under the criteria set by the plan, and thereafter all new eligible employees a…

6.6.5079K TRANSITION IN INDIVIDUAL MARKET TO CHANGES UNDER HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT (HIPAA) UNDER MONTANA LAW An individual health insurance policy issued or renewed after June 30, 1997 must remove any remaining preexisting exclusion periods for any cov…

6.6.5079L PREEXISTING CONDITIONS IN THE INDIVIDUAL, MARKET - DISCLOSURE A health insurer offering individual health insurance coverage may not limit coverage for a preexisting condition except as set forth in 33-22-246, MCA, and this rule. Additionally, the following provisions p…

6.6.5079M CERTIFICATION OF CREDITABLE COVERAGE ISSUED BY INSURERS IN THE INDIVIDUAL MARKET Insurers providing health insurance coverage in the individual market must issue certificates of creditable coverage as set forth in 33-22-142(6) , MCA and ARM 6.6.5079G. Authorizing statut…

6.6.507A STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 1990 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY ON OR AFTER JULY 1993, AND WITH AN EFFECTIVE DATE FOR COVERAGE PRIOR TO JUNE 1, 2010 An issuer shall make available to each pros…

6.6.507B OPEN ENROLLMENT No issuer may deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, re…

6.6.507C GUARANTEED ISSUE FOR ELIGIBLE PERSONS The following are general provisions relating to guaranteed issue: Eligible persons are those individuals described in (2) who enroll under the policy during the period specified in (3) and who submit evidence of the date of terminat…

6.6.507D BENEFIT STANDARDS FOR 2010 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY WITH AN EFFECTIVE DATE FOR COVERAGE ON OR AFTER JUNE 1, 2010 The following standards are applicable to all Medicare supplement policies or certificates d…

6.6.507E STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 2010 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED WITH AN EFFECTIVE DATE FOR COVERAGE ON OR AFTER JUNE 1, 2010 The following standards are applicable to all Medicare supplement policies or ce…

6.6.507F STANDARD MEDICARE SUPPLEMENT BENEFIT PLANS FOR 2020 STANDARDIZED MEDICARE SUPPLEMENT BENEFIT PLAN POLICIES OR CERTIFICATES ISSUED FOR DELIVERY TO INDIVIDUALS NEWLY ELIGIBLE FOR MEDICARE ON OR AFTER JANUARY 1, 2020 The Medicare Access and CHIP Reauthorization Act of 2015 …

6.6.508 LOSS RATIO STANDARDS AND REFUND OR CREDIT OF PREMIUM A Medicare supplement policy form or certificate form must not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are compu…

6.6.5082 ESTABLISHMENT OF CLASSES OF BUSINESS Every small employer carrier that establishes more than one class of business pursuant to 33-22-1808 , MCA, shall maintain on file for inspection by the commissioner the following information with respect to each class of business so …

6.6.5086 TRANSITION FOR ASSUMPTIONS OF BUSINESS FROM ANOTHER CARRIER No small employer carrier may transfer or assume the entire insurance obligation and/or risk of a health benefit plan covering a small employer in this state unless: The transfer has been approved by the commiss…

6.6.508A FILING AND APPROVAL OF POLICIES AND CERTIFICATES AND PREMIUM RATES An issuer may not deliver, or issue for delivery, a policy or certificate to a resident of this state unless the policy form or certificate has been filed with and approved by the commissioner in accordan…

6.6.509 REQUIRED DISCLOSURE PROVISIONS Medicare supplement policies and certificates must include a renewal or continuation provision. The language or specifications of the provision must be consistent with the type of contract to be issued. The provision must be appropriately ca…

6.6.5090 RATE MANUAL AND RATE RESTRICTION GUIDELINES Each small employer carrier shall develop a separate rate manual for each class of business, which must be the basis for all premium rates and new business premium rates charged to small employers by the small employer carrier.…

6.6.5094 CALCULATIONS RELATING TO PREMIUM RATE RESTRICTIONS (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, and 33-22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; REP, 1995 MAR p. 2127…

6.6.5098 ANNUAL FILING OF ACTUARIAL CERTIFICATION (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1802, 33-22-1808, 33-22-1809 and 33-22-1812, MCA History: NEW, 1994 MAR p. 1528, Eff. 6/10/94; REP, 1995 MAR p. 212…

6.6.510 REQUIREMENTS FOR APPLICATION FORMS AND REPLACEMENT COVERAGE Application forms must include the following questions designed to elicit information as to whether, as of the date of application, the applicant currently has Medicare supplement, Medicare advantage, Medicaid co…

6.6.5101 PLAN OF OPERATION (REPEALED) Authorizing statute(s): 33-1-313, 33-22-1822, MCA Implementing statute(s): 33-22-1819, MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; AMD, 1995 MAR p. 1932, Eff. 9/29/95; AMD, 1997 MAR p. 1989, Eff. 11/4/97; AMD, 1998 MAR p. 1406, Eff. 5/2…

6.6.5103 DEFINITIONS (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1819, MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5105 BOARD OF DIRECTORS OF PROGRAM (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1819, MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; AMD, 1994 MAR p. 2926, Eff. 11/11/94; REP, 1995 MAR p. 1932, Eff. 9/29…

6.6.5107 SUPPORT COMMITTEES (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1819, MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5109 SELECTION, POWERS AND DUTIES OF ADMINISTERING CARRIER (IS HEREBY REPEALED) Authorizing statute(s): Sec. 33-1-313 and 33-22-1822, MCA Implementing statute(s): Sec. 33-22-1819, MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.511 FORMS OUTLINING COVERAGE (REPEALED) Authorizing statute(s): 33-1-313, 33-22-904, MCA Implementing statute(s): 33-15-303, 33-22-901, 33-22-902, 33-22-903, 33-22-904, 33-22-905, 33-22-906, 33-22-907, 33-22-908, 33-22-909, 33-22-910, 33-22-911, 33-22-921, 33-22-922, 33-22-92…

6.6.5111 REINSURANCE WITH THE PROGRAM IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5113 AUDIT FUNCTIONS IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5115 ASSESSMENTS IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5117 REPORTS OF REINSURED RISKS IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5119 FINANCIAL RECORD KEEPING AND ADMINISTRATION IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.511A FORMS OUTLINING COVERAGE (REPEALED) Authorizing statute(s): 33-1-313, 33-22-904, MCA Implementing statute(s): 33-15-303, 33-22-901, 33-22-902, 33-22-903, 33-22-904, 33-22-905, 33-22-906, 33-22-907, 33-22-908, 33-22-909, 33-22-910, 33-22-911, 33-22-921, 33-22-922, 33-22-9…

6.6.512 SEVERABILITY (IS HEREBY REPEALED) Authorizing statute(s): 33-1-313, MCA Implementing statute(s): 33-22-901 to 33-22-909, MCA History: NEW, 1981 MAR p. 1474, Eff. 2/1/82; REP, 1993 MAR p. 1487, Eff. 7/16/93.

6.6.5121 ERRORS, ADJUSTMENTS, PENALTIES, AND SUBMISSION OF DISPUTES IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; AMD, 1994 MAR p. 2926, Eff. 11/11/94; REP, 19…

6.6.5123 PROPOSALS FOR AMENDMENTS TO PLAN IS HEREBY REPEALED Authorizing statute(s): Sec. 33-1-313 and 33-22-1822 MCA Implementing statute(s): Sec. 33-22-1819 MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; REP, 1995 MAR p. 1932, Eff. 9/29/95.

6.6.5125 STANDARDS FOR PRODUCER COMPENSATION LEVELS AND FAIR MARKETING OF PLANS (REPEALED) Authorizing statute(s): 33-1-313 and 33-22-1822, MCA Implementing statute(s): 33-22-1819, MCA History: NEW, 1994 MAR p. 2111, Eff. 8/12/94; AMD, 1994 MAR p. 2926, Eff. 11/11/94; REP, 1995 M…

6.6.513 EFFECTIVE DATE (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, 1981 MAR p. 1474, Eff. 2/1/82; AMD, 1990 MAR p. 1688, Eff. 9/1/90; REP, 1993 MAR p. 1487, Eff. 7/1…

6.6.514 BENEFIT CONVERSION REQUIREMENTS DURING TRANSITION (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…

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/…