Montana Code 33-22-1115. Prior hospitalization or institutionalization
33-22-1115. Prior hospitalization or institutionalization. (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:
Terms Used In Montana Code 33-22-1115
- Certificate: means a certificate issued under a group long-term care insurance policy that has been delivered or issued for delivery in this state. 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)on a prior hospitalization requirement;
(b)provided in an institutional care setting on the receipt of a higher level of institutional care; or
(c)other than waiver of premium, postconfinement benefits, postacute care benefits, or recuperative benefits, on a prior institutionalization requirement.
(2)A long-term care insurance policy containing a limitation or condition for eligibility other than those prohibited in subsection (1) must clearly label, in a separate paragraph of the policy or certificate entitled “Limitations or Conditions on Eligibility for Benefits”, the limitations or conditions, including any required number of days of confinement.
(3)A long-term care insurance policy that contains a benefit advertised, marketed, or offered as a home health care benefit may not condition receipt of a benefit on a prior institutionalization requirement.
(4)A long-term care insurance policy that conditions eligibility of noninstitutional benefits on the prior receipt of institutional care may not require a prior institutional stay of more than 30 days.
(5)A long-term care insurance policy that provides benefits only following institutionalization may not condition the benefits upon admission to a facility for the same or a related condition within a period of less than 30 days after discharge from the institution.