Montana Code 33-22-1303. Definitions
33-22-1303. Definitions. As used in this part, the following definitions apply:
Terms Used In Montana Code 33-22-1303
- Association: means the Montana reinsurance association provided for in this part. See Montana Code 33-22-1303
- Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
- Attachment point: means the threshold amount for claims costs incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, beyond which the claims costs for benefits are eligible for reinsurance payments. See Montana Code 33-22-1303
- Benefit year: means the calendar year for which an eligible health insurer provides coverage through an individual health insurance policy. See Montana Code 33-22-1303
- Board: means the association's board of directors provided for in 33-22-1306. See Montana Code 33-22-1303
- Coinsurance rate: means the rate at which the association will reimburse an eligible health insurer for claims incurred for an enrolled individual's covered benefits in a benefit year above the attachment point and below the reinsurance cap. See Montana Code 33-22-1303
- Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
- Eligible health insurer: means a health insurer, health service corporation, or health maintenance organization that:
(a)offers individual health insurance coverage in the individual market, as defined in 33-22-140;
(b)offers a qualified health plan as defined in 42 U. See Montana Code 33-22-1303
- Health insurance coverage: means benefits consisting of medical care, including items and services paid for as medical care, that are provided directly, through insurance, reimbursement, or otherwise, under a policy, certificate, membership contract, or health care services agreement offered by a health insurance issuer. See Montana Code 33-22-140
- Individual market: means the market for health insurance coverage offered to individuals other than in connection with group health insurance coverage. See Montana Code 33-22-140
- Large employer: means , in connection with a group health plan, with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least two employees on the first day of the plan year. See Montana Code 33-22-140
- Program: means the Montana reinsurance program operated by the Montana reinsurance association. See Montana Code 33-22-1303
- Reinsurance cap: means the maximum amount of each claim incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, after which the claims costs for benefits are no longer eligible for reinsurance payments. See Montana Code 33-22-1303
- Reinsurance payments: means an amount paid by the association to an eligible health insurer under the program. See Montana Code 33-22-1303
(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 covered benefits in a benefit year, beyond which the claims costs for benefits are eligible for reinsurance payments.
(3)”Benefit year” means the calendar year for which an eligible health insurer provides coverage through an individual health insurance policy.
(4)”Board” means the association’s board of directors provided for in 33-22-1306.
(5)”Coinsurance rate” means the rate at which the association will reimburse an eligible health insurer for claims incurred for an enrolled individual’s covered benefits in a benefit year above the attachment point and below the reinsurance cap.
(6)”Eligible health insurer” means a health insurer, health service corporation, or health maintenance organization that:
(a)offers individual health insurance coverage in the individual market, as defined in 33-22-140;
(b)offers a qualified health plan as defined in 42 U.S.C. § 18021(a) that does not discriminate on the basis of health status in rating or issuance, covers all essential health benefits, and does not impose lifetime or annual limits or exclude preexisting conditions; and
(c)incurs claims costs for an individual enrollee’s covered benefits in the applicable benefit year.
(7)”Major medical” health insurance includes individual market and employer group health insurance that:
(a)is guaranteed available;
(b)is guaranteed renewable;
(c)does not impose preexisting condition exclusions;
(d)(i) offers essential health benefits as defined in 42 U.S.C. § 18022; or
(ii)for large employer group coverage, meets the federal requirements for minimum value;
(e)pays medical claims, with no lifetime or annual limits; and
(f)complies with the federal limits for maximum out-of-pocket.
(8)”Payment parameters” means the attachment point, reinsurance cap, and coinsurance rate for the Montana reinsurance program.
(9)”Program” means the Montana reinsurance program operated by the Montana reinsurance association.
(10)”Reinsurance cap” means the maximum amount of each claim incurred by an eligible health insurer for an enrolled individual’s covered benefits in a benefit year, after which the claims costs for benefits are no longer eligible for reinsurance payments.
(11)”Reinsurance payments” means an amount paid by the association to an eligible health insurer under the program.