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Montana Statutes, Title 33

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Title 33

37 chapters · 1,713 sections in this title.

All chapters in Title 331,713 Ch 2, REGULATION OF INSURANCE COMPANIES311 Ch 22, DISABILITY INSURANCE227 Ch 20, LIFE INSURANCE154 Ch 1, ADMINISTRATION AND GENERAL PROVISIONS106 Ch 17, INSURANCE PRODUCERS, ADJUSTERS, CONS…80 Ch 15, THE INSURANCE CONTRACT72 Ch 18, UNFAIR TRADE PRACTICES67 Ch 3, DOMESTIC STOCK AND MUTUAL INSURERS65 Ch 16, RATES -- RATING AND ADVISORY ORGANIZ…62 Ch 4, FARM MUTUAL INSURERS51 Ch 32, HEALTH UTILIZATION REVIEW47 Ch 30, HEALTH SERVICE CORPORATIONS44 Ch 10, INSURANCE GUARANTY ASSOCIATIONS41 Ch 7, FRATERNAL BENEFIT SOCIETIES39

35 sections·Filtered byTitle 33✕Ch 31✕

Mont. Code Ann. § 33-31-101 Short Title
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This chapter may be cited as the "Montana Health Maintenance Organization Act".
Mont. Code Ann. § 33-31-102 Definitions
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As used in this chapter, unless the context requires otherwise, the following definitions apply: (1) "Accountable care organization" means a group of health care providers that are willing and capable of accepting accountability for the total cost and quality of care for a define…
Mont. Code Ann. § 33-31-103 Rules
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The commissioner may, after notice and hearing, make reasonable rules necessary to effectuate this chapter.
Mont. Code Ann. § 33-31-111 Statutory Construction And Relationship To Other Laws
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(Temporary) Statutory construction and relationship to other laws. (1) Except as otherwise provided in this chapter, the insurance or health service corporation laws do not apply to a health maintenance organization authorized to transact business under this chapter. This provisi…

Mont. Code Ann. § 33-31-112 Filings And Reports As Public Documents

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All applications, filings, and reports required under this chapter, except those that contain trade secrets or privileged or confidential commercial or financial information (other than an annual financial statement that the commissioner may require under 33-31-211), are public d…

Mont. Code Ann. § 33-31-113 Confidentiality Of Medical Information

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(1) Any data or information pertaining to the diagnosis, treatment, or health of an enrollee or applicant obtained from the enrollee, applicant, or a provider by a health maintenance organization must be held in confidence and may not be disclosed to any person except: (a) to the…

Mont. Code Ann. § 33-31-114 Coverage For Adopted Children From Time Of Placement -- Preexisting Conditions

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(1) Each health maintenance contract regulated under this chapter must provide coverage for an adopted child of the enrollee to the same extent as for natural children of the enrollee. (2) The coverage required by this section must be effective from the date of placement for the …

Mont. Code Ann. § 33-31-115 Applicability To Managed Health Care Entity

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(1) The department of public health and human services may limit the amount, scope, and duration of services provided by a managed health care entity under contract for programs established under Title 53. These services may be less than services required by this title. (2) The d…

Mont. Code Ann. § 33-31-201 Establishment Of Health Maintenance Organizations

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(1) Notwithstanding any law of this state to the contrary, a person may apply to the commissioner for and obtain a certificate of authority to establish and operate a health maintenance organization in compliance with this chapter. A person may not establish or operate a health m…

Mont. Code Ann. § 33-31-202 Issuance Of Certificate Of Authority

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(1) The commissioner shall issue or deny a certificate of authority to any person filing an application pursuant to 33-31-201 within 180 days after receipt of the application. The commissioner shall grant a certificate of authority upon payment of the application fee prescribed i…

Mont. Code Ann. § 33-31-203 Powers Of Insurers And Health Service Corporations

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(1) An insurer authorized to transact insurance in this state or a health service corporation authorized to do business in this state may, either directly or through a subsidiary or affiliate, organize and operate a health maintenance organization under the provisions of this cha…

Mont. Code Ann. § 33-31-204 Acquisition, Control, Or Merger Of A Health Maintenance Organization

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(1) Except as provided in 33-2-1106 and subsection (2) of this section, a person may not tender for, request, or invite tenders of, or enter into an agreement to exchange securities for or acquire in the open market or otherwise, any voting security of a health maintenance organi…

Mont. Code Ann. § 33-31-211 Annual Statements -- Revocation For Failure To File -- Penalty For False Swearing

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(1) Unless it is operated by an insurer or a health service corporation as a plan, each authorized health maintenance organization shall annually on or before March 1 file with the commissioner a full and true statement of its financial condition, transactions, and affairs as of …

Mont. Code Ann. § 33-31-212 Fees

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(1) Each health maintenance organization shall pay to the commissioner the following fees: (a) for filing an application for a certificate of authority or amendment to a certificate of authority, $300; (b) for filing an amendment to the organization documents that requires approv…

Mont. Code Ann. § 33-31-215 Investment Regulations

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Except for a health maintenance organization operated as a plan by a health service corporation, a domestic health maintenance organization may invest its funds only as prescribed in chapter 12.

Mont. Code Ann. § 33-31-216 Protection Against Insolvency

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(1) Except as provided in subsections (4) through (7), each authorized health maintenance organization shall deposit with the commissioner cash, securities, or any combination of cash or securities acceptable to the commissioner in the amount set forth in this section. (2) The am…

Mont. Code Ann. § 33-31-221 Powers Of Health Maintenance Organizations

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(1) The powers of a health maintenance organization include but are not limited to the following: (a) the purchase, lease, construction, renovation, operation, or maintenance of a hospital, a medical facility, or both, its ancillary equipment, and property that may reasonably be …

Mont. Code Ann. § 33-31-222 Governing Body

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(1) The governing body of a health maintenance organization may include providers or other individuals, or both. (2) The governing body shall establish a mechanism to give the enrollees an opportunity to participate in matters of policy and operation through the establishment of …

Mont. Code Ann. § 33-31-223 Fiduciary Responsibilities

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(1) Any director, officer, employee, or partner of a health maintenance organization who receives, collects, disburses, or invests funds in connection with the activities of the health maintenance organization is responsible for the funds in the manner of a fiduciary to the healt…

Mont. Code Ann. § 33-31-301 Evidence Of Coverage -- Schedule Of Charges For Health Care Services

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(1) Each enrollee residing in this state is entitled to an evidence of coverage. The health maintenance organization shall issue the evidence of coverage, except that if the enrollee obtains coverage through an insurance policy issued by an insurer or a contract issued by a healt…

Mont. Code Ann. § 33-31-302 Information To Enrollees

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Each authorized health maintenance organization shall provide to its enrollees 30 days' advance notice in writing of any material change in the operation of the health maintenance organization that will affect them directly.

Mont. Code Ann. § 33-31-303 Complaint System

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(1) (a) Each authorized health maintenance organization shall establish and maintain a complaint system to provide reasonable procedures to resolve written complaints initiated by enrollees. A health maintenance organization may not use a complaint system: (i) before the commissi…

Mont. Code Ann. § 33-31-304 Dual Choice

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An employer in this state that offers its employees the option to enroll in a health maintenance organization and an employee benefit fund in this state that offers its members the option to enroll in a health maintenance organization may not be required to pay more for health be…

Mont. Code Ann. § 33-31-305 Dentist Participation As Provider

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A contract for dental care services through a health maintenance organization that is offered, delivered, or renewed under this chapter must allow a dentist to request participation as a provider on the same terms and conditions as those by which other dentists participate. This …

Mont. Code Ann. § 33-31-306 Point-Of-Service Option

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(1) (a) A health maintenance organization that has at least 10,000 enrollees shall offer a point-of-service option benefit plan to each purchaser of a health care services agreement. The purchaser may accept or reject the addition of a point-of-service option to the health care s…

Mont. Code Ann. § 33-31-307 Affiliation Periods

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(1) A health maintenance organization that offers health insurance coverage in connection with a group health plan and that does not impose a preexisting condition exclusion allowed by 33-22-246 or 33-22-514 with respect to any particular coverage option may impose an affiliation…

Mont. Code Ann. § 33-31-311 Insurance Producer License Required

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An individual or business entity may not act as or represent to the public that the individual or business entity is an insurance producer for a health maintenance organization unless the individual or business entity is: (1) licensed as a disability insurance producer by the com…

Mont. Code Ann. § 33-31-312 Prohibited Practices

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(1) A health maintenance organization or representative of a health maintenance organization may not cause or knowingly permit the use of advertising that is untrue or misleading, solicitation that is untrue or misleading, or any form of evidence of coverage that is deceptive. Fo…

Mont. Code Ann. § 33-31-313 Premium Increase Restriction -- Exception

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(1) A health maintenance organization may not increase a premium for an individual's or an individual's group health care services agreement more frequently than once during a 12-month period unless failure to increase the premium more frequently than once during the 12-month per…

Mont. Code Ann. § 33-31-321 Disclosure Standards -- Health Maintenance Organizations

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(1) In order to provide for full and fair disclosure in the sale of disability insurance, an enrollment form or evidence of coverage may not be delivered or issued for delivery in this state by a health maintenance organization unless an outline of coverage is delivered to the ap…

Mont. Code Ann. § 33-31-401 Examination

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(1) The commissioner may examine the affairs of a health maintenance organization as often as is reasonably necessary to protect the interests of the people of this state. The commissioner shall make an examination at least once every 5 years. Similarly, the commissioner shall ex…

Mont. Code Ann. § 33-31-402 Suspension Or Revocation Of Certificate Of Authority

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(1) The commissioner may suspend or revoke any certificate of authority issued to a health maintenance organization under this chapter if the commissioner finds that any of the following conditions exist: (a) The health maintenance organization is operating in contravention of it…

Mont. Code Ann. § 33-31-403 Supervision, Rehabilitation, Or Liquidation Of Health Maintenance Organization

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(1) The supervision, rehabilitation, or liquidation of a health maintenance organization is considered to be the supervision, rehabilitation, or liquidation of an insurer and must be conducted under the supervision of the commissioner pursuant to chapter 2, part 13. The commissio…

Mont. Code Ann. § 33-31-404 Administrative Procedures

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(1) When the commissioner has cause to believe that grounds for the denial of an application for a certificate of authority exist or that grounds for the suspension or revocation of a certificate of authority exist, the commissioner shall give written notice to the health mainten…

Mont. Code Ann. § 33-31-405 Penalties And Enforcement

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(1) The commissioner may, in addition to suspension or revocation of a certificate of authority under 33-31-402, after notice and hearing, impose an administrative penalty in an amount not less than $500 or more than $10,000 if the commissioner gives reasonable notice in writing …