Title 33, Title 33

(1) Each group or individual medical expense disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for the treatment of inborn errors of metabolism that invol…

(1) (a) (i) For 2020 and each year thereafter, the commissioner shall assess each member insurer 1.2% of its total premium volume covering Montana residents, from the prior calendar year, regardless of type of license. (ii) For purposes of subsection (1)(a)(i), total premium volu…

(1) The board shall design and adjust the payment parameters to ensure that the payment parameters will: (a) stabilize or reduce premium rates in the individual market; (b) increase or maintain participation in the individual market; (c) mitigate the impact high-cost individuals …

(1) Each reinsurance payment must be calculated with respect to an eligible health insurer's incurred claims costs for an individual enrollee's covered benefits in the applicable benefit year. If the claims costs do not exceed the attachment point, the reinsurance payment is $0. …

(1) Claims that are incurred during a benefit year and are submitted for reimbursement in the following benefit year by the date established by the board in the plan of operation will be allocated to the benefit year in which they are incurred. Any claims from the preceding benef…

(1) An eligible health insurer shall: (a) make requests for reinsurance payment in accordance with any requirements established by the board; (b) provide the association with access to data according to the rules and timeline established by the board in the plan of operation or b…

(1) Each group or individual medical expense and blanket disability policy, certificate of insurance, and membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage of minimum mammography and other breast examina…

An association member may not be held liable for the acts or omissions of the association board or the association membership.

(Temporary) State and federal special revenue accounts -- reinsurance program. (1) (a) There is a reinsurance program account in the state special revenue fund established by 17-2-102. The account must be administered by the commissioner for the benefit of the program. The money …

The commissioner, the governor, and the board shall jointly apply, no later than July 1, 2019, to the U.S. secretary of health and human services under 42 U.S.C. 18052 for a state innovation waiver and federal pass-through funding to implement this part for benefit years beginnin…

(1) For the purposes of this section, "attending health care provider" means a person licensed under Title 37 who is responsible for providing obstetrical and pediatric care to a mother and newborn infant. (2) Each group or individual policy, certificate of disability insurance, …

Each group and individual disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for hospital inpatient care for a period of time as is determined by the attend…

(1) Each group and individual disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state must provide coverage for: (a) all stages of reconstruction of the breast on which a mastectomy h…

(1) Any insurer, health service corporation, or health maintenance organization issuing group disability coverage to the spouse or dependents of a peace officer as defined in 45-2-101, a game warden as defined in 19-8-101, a firefighter as defined in 19-13-104, or a volunteer fir…

(1) Each group or individual health insurance policy, certificate of insurance, and membership contract that covers prescription drugs and that is delivered, issued for delivery, renewed, extended, or modified in this state must provide that after the applicable deductible is met…

(1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage for health care services must provide coverage for health care services provided by a health care provider …

(1) Health insurance coverage sold in the group or individual market in this state must provide coverage for diagnosis and treatment of Down syndrome for a covered child 18 years of age or younger. (2) Coverage under this section must include: (a) habilitative or rehabilitative c…

As used in this chapter, unless the context requires otherwise, the following definitions apply: (1) "Beneficiary" has the meaning given the term by 29 U.S.C. 1002(33). (2) "Church plan" has the meaning given the term by 29 U.S.C. 1002(33). (3) "COBRA continuation provision" mean…

(1) (a) A period of creditable coverage may not be counted, with respect to enrollment of an individual under a group health plan, if there was a 63-day break in coverage. (b) The 63-day period provided for in subsection (1)(a) must be counted from the date that the certificate o…

(1) (a) A group health plan and a health insurance issuer offering group or individual health insurance coverage shall issue the certification described in subsection (3) within 10 days after a request by an individual who ceases to be covered under the group or individual health…

The commissioner may adopt rules to implement 33-22-140 through 33-22-142, 33-22-246, 33-22-247, 33-22-514, and 33-22-523 through 33-22-526.

(Effective October 1, 2026) Reciprocity in gender transition treatment coverage required. (1) A group or individual insurance policy that includes coverage for gender transition treatment or subsequent treatment directly related to the provision of gender transition treatment mus…

(1) Except as provided in subsection (3), (4), or (5), if a health insurance issuer limits the time in which a health care provider or other person is required to submit a claim for payment, the health insurance issuer has the same time limit following payment of the claim to per…

A health insurance issuer may not collect a claim overpayment or other reimbursement by offsetting another claim payment made to a health care provider or other person unless the health care provider or other person has previously authorized the health insurance issuer in writing…

A health insurance issuer that issues or renews an individual or a group health insurance policy, certificate, or membership contract under which an individual's or employee's dependents are eligible for coverage may not terminate coverage on the basis of the age of an unmarried …

(1) A plan of group or individual health insurance coverage that is delivered, issued for delivery, renewed, extended, or modified in this state may not: (a) deny participation by a qualified individual in an approved clinical trial; (b) deny, limit, or impose additional conditio…

(1) Each group or individual policy, certificate of disability insurance, subscriber contract, membership contract, or health care services agreement that provides coverage of prescription eyedrops may not deny coverage for a refill of a prescription eyedrop if: (a) the eyedrop i…

(1) Each group or individual disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery, renewed, extended, or modified in this state that includes coverage for prescription contraceptives must provide reimbursement for up to a 12-m…

(1) Each health insurance issuer that issues, delivers, or renews individual or small employer group health insurance coverage in the individual or small employer group market shall, at least 60 days before the rate goes into effect, file with the commissioner its rates, fees, du…

(1) (a) When reviewing a premium rate filing, the commissioner shall consider whether the proposed premium rate is excessive, inadequate, unjustified, or unfairly discriminatory. Rates may be considered excessive if they cause the premium charged for the health insurance coverage…

The commissioner, upon request by the health insurance issuer, may exempt from disclosure any part of a premium rate filing submitted pursuant to 33-22-156 that the commissioner determines to contain trade secrets as defined in 30-14-402. The commissioner may not disclose that pa…

The commissioner may adopt rules necessary to implement the provisions of 33-22-156 through 33-22-159, except that the administrative rules may not include by reference any provisions of Public Law 111-148 and Public Law 111-152 or any regulations promulgated under those laws.

A disability insurance policy subject to this chapter may contain a provision providing that, to the extent necessary for reimbursement of benefits paid to or on behalf of the insured, the insurer is entitled to subrogation, as provided for in 33-22-1602, against a judgment or re…

(1) If an insured intends to institute an action for damages against a third party, the insured shall give the insurer reasonable notice of the intention to institute the action. (2) The insured may request that the insurer pay a proportionate share of the reasonable costs of the…

(Temporary) Definitions. As used in 33-22-170 through 33-22-177 and 33-22-180, the following definitions apply: (1) "Contract pharmacy" means a pharmacy operating under contract with a federally certified health entity to provide dispensing services to the federally certified hea…

This part may be cited as the "Preferred Provider Agreements Act".

The purpose of this part is to allow a health care insurer providing disability insurance benefits to negotiate and contract with health care providers to: (1) provide health care services to its insureds or subscribers at a reduction in the fees customarily charged by the provid…

As used in this part, the following definitions apply: (1) "Emergency medical condition" means a condition manifesting itself by symptoms of sufficient severity, including severe pain, that the absence of immediate medical attention could reasonably be expected to result in any o…

(1) Notwithstanding any other provision of law to the contrary, a health care insurer may: (a) enter into agreements with providers relating to health care services that may be rendered to insureds or subscribers on whose behalf the health care insurer is providing health care co…

(1) A health care insurer may issue a policy or a health benefit plan that provides for incentives for covered persons to use the health care services of preferred providers. The policy or health benefit plan must contain at least: (a) a provision that if a covered person receive…

(1) A provider agreement, insurance policy, or subscriber contract issued or delivered in this state may contain components designed to control the cost and improve the quality of health care for insureds and subscribers as provided in this part. (2) All terms or conditions of an…

The commissioner may adopt rules necessary to implement the provisions of this part.

(Temporary) Maximum allowable cost list -- limitations on drugs. Before a pharmacy benefit manager places or continues a drug on a maximum allowable cost list, the drug: (1) must be listed as "A" or "B" rated in the most recent version of the United States food and drug administr…

(Temporary) Maximum allowable cost or reference price list -- price formulation, updating, and disclosure -- exceptions. (1) At the time of entering into a contract with a pharmacy or a pharmacy services administrative organization and subsequently upon request, a plan sponsor, h…

(1) In contracting with a pharmacy or a pharmacy services administrative organization, a plan sponsor or pharmacy benefit manager shall: (a) provide a procedure by which a pharmacy or a pharmacy services administrative organization may appeal the price of a drug or drugs on the m…

(1) A pharmacist or pharmacy in a network plan with a plan sponsor, health insurance issuer, or pharmacy benefit manager providing covered drugs on a reference pricing basis may decline to provide a brand-name drug, multisource generic drug, supply, or service if the reference pr…