Title 33, Title 33

A certificate issued pursuant to a group long-term care insurance policy that is delivered or issued for delivery in this state must include: (1) a description of the principal benefits and coverage provided in the policy; (2) a statement of the principal exclusions, reductions, …

(1) The commissioner may by rule adopt standards for full and fair disclosure, setting forth the manner, content, and disclosures required to be made in a long-term care insurance policy, including but not limited to: (a) terms of renewability; (b) initial and subsequent conditio…

(1) An insurance company may not issue a refund to a person other than the owner of the policy or certificate. (2) A long-term care insurance policy may not: (a) be canceled, nonrenewed, or otherwise terminated on any grounds other than the insured's or certificate holder's failu…

(1) A long-term care insurance policy may not be delivered or issued for delivery in Montana if the policy conditions eligibility for a benefit: (a) on a prior hospitalization requirement; (b) provided in an institutional care setting on the receipt of a higher level of instituti…

(1) Except as provided in subsection (3), a long-term care insurance policy may not be delivered or issued for delivery in this state unless the policyholder or certificate holder has been offered the option of purchasing a policy that includes a nonforfeiture benefit. The offer …

(1) Appropriate sale criteria must be established and communicated to the consumer prior to the insurance company's acceptance of a person's application for long-term care insurance. (2) This section may not preclude the purchase of a long-term care insurance policy by a consumer…

(1) A long-term care insurance applicant and insured has the right to return the policy within 30 days of the policy's delivery and to have the premium refunded if, after examination of the policy, the applicant or insured is not satisfied for any reason. A long-term care insuran…

(1) It is unlawful for any insurance company issuing disability insurance policies in Montana to exclude from coverage in a disability insurance policy services rendered the insured while a resident in a Montana state institution if the services to the insured would be covered by…

A group long-term care insurance policy or certificate may not be delivered or issued for delivery to a resident of Montana under a group policy issued in another state unless it is approved by: (1) the commissioner; and (2) the insurance regulatory official of a state that has s…

The commissioner may adopt rules necessary to implement this part, including but not limited to rules that: (1) establish loss ratio standards for long-term care insurance policies; (2) promote premium adequacy and protect the policyholder in the event of substantial rate increas…

A waiting or elimination period contained in a long-term care insurance policy under which an insured is required to wait a specified period of time before receiving policy benefits must be concurrent with any 90-day period used to determine whether an individual is a chronically…

(1) If an application for a long-term care insurance policy is approved, the issuer shall deliver the policy to the applicant or policyholder not later than 30 days after the date of approval. (2) (a) At the time of delivery of an individual life insurance policy that provides lo…

If a claim under a long-term care insurance policy is denied, the issuer shall, not later than 60 days after the date of a written request by the policyholder, certificate holder, or the representative of either of them: (1) provide a written explanation of the reasons for the de…

(1) A long-term care insurance policy may not be delivered or issued for delivery in this state unless it complies with the requirements of this section and applicable rules for the triggering of mandatory provision of benefits. (2) (a) A long-term care insurance policy must cond…

(1) For the purposes of this section, the following definitions apply: (a) (i) "Chronically ill individual" has the meaning provided by section 7702B(c)(2) of the Internal Revenue Code, 26 U.S.C. 7702B(c)(2), and means any individual who has been certified by a licensed health ca…

(1) Upon a showing of misrepresentation that is material to the acceptance for coverage, a policy that has been in force for less than 6 months may be rescinded by the insurer or the insurer may deny an otherwise valid long-term care insurance claim. (2) Upon a showing of misrepr…

(1) An individual may not sell, solicit, or negotiate long-term care insurance unless the individual is licensed as an insurance producer for disability or life insurance, has completed a one-time training course, and completes ongoing training within every 24-month period. (2) T…

In addition to any other penalty provided for in Title 33, an insurer or an insurance producer found to have violated any requirement of this state relating to the regulation of long-term care insurance or the marketing of long-term care insurance is subject to a fine of up to th…

No disability insurance policy providing hospital, medical, or surgical expense benefits delivered or issued for delivery in this state on or after July 1, 1979, may contain any provision denying or reducing such benefits for the reason that the person insured is eligible for or …

An insurer, a health service corporation, or any employee health and welfare fund that provides accident or health insurance benefits to residents of this state shall provide, in group and individual insurance contracts, coverage as well as payment or reimbursement for health ser…

(1) A provider agreement entered into or renewed on or after July 1, 2013, between dentists licensed under Title 37, chapter 4, and an issuer that offers an excepted benefits plan for limited-scope dental benefits or a health benefit plan that includes covered services may not: (…

(1) A qualified health plan, as defined by 42 U.S.C. 18021, may not be offered or otherwise made available through a health insurance exchange established in the state pursuant to Public Law 111-148, the Patient Protection and Affordable Care Act, if the plan provides coverage fo…

(1) The provisions of 33-22-116 may not be construed as creating or recognizing a right to abortion. (2) It is not the intent of 33-22-116 to make lawful an abortion that is currently unlawful.

(1) An insurer may not cancel or refuse to renew a disability insurance policy or certificate until the insurer has mailed or delivered to the named insured and to the policyowner or certificate holder, as appropriate if they are not the same as the named insured, at the last-kno…

(1) (a) The notice of cancellation must state: (i) the amount of the premium, installment, or interest due on the policy or certificate; (ii) the place where it must be paid; and (iii) the name and address of the person or company to which the premium is payable. (b) The notice m…

If an insured pays a premium in advance for coverage to any disability insurer licensed in this state and the insured subsequently cancels the coverage, the disability insurer shall refund the unearned portion of the premium. The disability insurer may consider the premium to be …

(1) If a patient's attending health care professional is a licensed chiropractor, the following provisions govern the conduct of a utilization review of the health care services rendered to the patient by the chiropractor: (a) If an independent physical examination is required by…

A health insurance issuer may not impose prior authorization or step therapy requirements for an oral therapy prescription used to treat opioid use disorder.

(1) Health insurance coverage sold in the group or individual market in this state must provide coverage for diagnosis and treatment of various auditory ranges for a covered child 18 years of age or younger in accordance with subsection (2). (2) (a) Except as provided in subsecti…

(1) Each group 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 outpatient self-management training and education for the treatment of diabetes. Any …

(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 an adopted child of the insured or subscriber to the same extent as for…

This part may be cited as the "Montana Reinsurance Association Act". The purpose of this act is to establish a Montana-based public reinsurance program in order to stabilize the individual health insurance market, maintain competition, and reduce premiums.

(1) The Montana reinsurance association is established as a nonprofit legal entity. As a condition of doing business, an insurer that has issued or renewed disability insurance, as defined in 33-1-207, regardless of license type, in this state in the past 12 months must be a memb…

As used in this part, the following definitions apply: (1) "Association" means the Montana reinsurance association provided for in this part. (2) "Attachment point" means the threshold amount for claims costs incurred by an eligible health insurer for an enrolled individual's cov…

(1) The association is governed by a board of directors consisting of five directors who have experience in health care, health insurance, or finance as follows: (a) three directors, one each from the eligible health insurers with the largest enrollment in the individual market. …

(1) The commissioner shall: (a) oversee the activities of the association and the board; (b) examine the affairs of the board and program; (c) approve the plan of operation set by the board as needed within 30 days of receiving the plan or amendments to the plan from the board; (…

(1) The board shall: (a) adopt a plan of operation and the reinsurance parameters for the following year, no later than June 15, 2019, in accordance with the requirements of this part, and update the plan of operation and reinsurance parameters, if needed, no later than May 1 of …

(1) The board shall select an administrator, who is either an employee of the nonprofit association or an independent contractor, to administer the reinsurance program pursuant to the parameters decided by the board of directors. The board shall establish qualifications and compe…

(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.