33-22-1113. Disclosure and performance standards for long-term care insurance. (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:

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Terms Used In Montana Code 33-22-1113

  • Group long-term care insurance: means a long-term care insurance policy that is delivered or issued for delivery in this state and issued to:

    (a)(i) one or more employers;

    (ii)a labor organization;

    (iii)a trust established by an employer or labor organization; or

    (iv)a trustee of a fund established by one or more employers or labor organizations or a combination of employers and labor organizations for:

    (A)employees or former employees or a combination of employees and former employees; or

    (B)members or former members of the labor organization or a combination of members and former members;

    (b)any professional, trade, or occupational association for its current, former, or retired members or a combination of current, former, and retired members if the association:

    (i)is composed of individuals all of whom are or were actively engaged in the same profession, trade, or occupation; and

    (ii)has been maintained in good faith for purposes other than obtaining insurance; or

    (c)an association, a trust, or the trustee of a fund established, created, or maintained for the benefit of members of one or more associations. See Montana Code 33-22-1107

  • Policy: means any policy, certificate, contract, membership contract, subscriber agreement, health care services agreement, rider, or endorsement delivered or issued for delivery in this state by an insurer, fraternal benefit society, health service corporation, prepaid health plan, health maintenance organization, or similar organization. See Montana Code 33-22-1107

(a)terms of renewability;

(b)initial and subsequent conditions of eligibility;

(c)nonduplication of coverage provisions;

(d)coverage of dependents;

(e)preexisting conditions;

(f)termination of insurance;

(g)continuation or conversion;

(h)probationary periods;

(i)limitations;

(j)exceptions;

(k)reductions;

(l)elimination periods;

(m)requirements for replacement;

(n)recurrent conditions;

(o)definition of terms;

(p)prohibitions on limitations and exclusions;

(q)extension of benefits;

(r)discontinuance and replacement of policies;

(s)unintentional lapse;

(t)prohibitions against postclaim underwriting;

(u)minimum standards for home health and community care benefits;

(v)inflation protection;

(w)incontestability period; and

(x)tax consequences.

(2)A group long-term care insurance policy must include a provision relating to conversion on termination of eligibility as described in 33-22-508 or include a provision for continuation of coverage that maintains coverage under the existing group policy if the coverage would otherwise terminate.