Montana Code 33-22-142. Certification of creditable coverage
33-22-142. Certification of creditable coverage. (1) (a) A group health plan and a health insurance issuer offering group or individual health insurance coverage shall issue the certification described in subsection (3) within 10 days after a request by an individual who ceases to be covered under the group or individual health plan.
Terms Used In Montana Code 33-22-142
- COBRA continuation provision: means :
(a)section 4980B of the Internal Revenue Code, 26 U. See Montana Code 33-22-140
- Creditable coverage: means coverage of the individual under any of the following:
(i)a group health plan;
(ii)health insurance coverage;
(iii)Title XVIII, part A or B, of the Social Security Act, 42 U. See Montana Code 33-22-140
- Group health insurance coverage: means health insurance coverage offered in connection with a group health plan or health insurance coverage offered to an eligible group as described in 33-22-501. See Montana Code 33-22-140
- Group health plan: means an employee welfare benefit plan, as defined in 29 U. See Montana Code 33-22-140
- 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
- Health insurance issuer: means an insurer, a health service corporation, or a health maintenance organization. See Montana Code 33-22-140
- Medical care: means :
(a)the diagnosis, cure, mitigation, treatment, or prevention of disease or amounts paid for the purpose of affecting any structure or function of the body;
(b)transportation primarily for and essential to medical care referred to in subsection (19)(a); or
(c)insurance covering medical care referred to in subsections (19)(a) and (19)(b). See Montana Code 33-22-140
- Waiting period: means , with respect to a group health plan and an individual who is a potential participant or beneficiary in the group health plan, the period that must pass with respect to the individual before the individual is eligible to be covered for benefits under the terms of the group health plan. See Montana Code 33-22-140
(b)A request for the certification may be made no later than 24 months after the date of termination of coverage.
(2)The certification may be provided, to the extent practicable, at a time consistent with notices required under any applicable COBRA continuation provision.
(3)Certification is the written:
(a)certification of the period of creditable coverage of the individual under a group or individual health plan and the coverage under any applicable COBRA continuation provision;
(b)certification of the waiting period, if any, and affiliation period, as defined in 33-31-102, if applicable, imposed with respect to the individual for any coverage under a group health plan;
(c)certification of the date of issuance of the certificate specified on the form; and
(d)notification to the individual of:
(i)the individual’s conversion rights;
(ii)the availability of COBRA continuation coverage; and
(iii)other notification as determined necessary and in the form prescribed by rule by the commissioner.
(4)To the extent that medical care under a group health plan consists of group health insurance coverage, a group health plan satisfies the certification requirement of this section if the health insurance issuer offering the coverage provides the certification in accordance with this section.
(5)In the case of an election described in 33-22-141 by a group health plan or health insurance issuer, if the group health plan or health insurance issuer enrolls an individual for coverage under the group health plan and the individual provides a certification of coverage of the individual, the entity that issued the certification shall upon request of the group health plan or health insurance issuer promptly disclose information on coverage of classes and categories of health benefits available under the certified coverage. The entity may charge the requesting group health plan or health insurance issuer the reasonable cost of disclosing the information.
(6)At the time that an individual ceases to be covered by a group or individual health plan, the group health plan or health insurance issuer shall notify the individual that the individual may request the certification described in subsection (3) within the timeframes described in subsection (1).