Montana Code 33-22-156. Health insurance rates — filing required — use
33-22-156. Health insurance rates — filing required — use. (1) Each health insurance issuer that issues, delivers, or renews individual or small employer group health insurance coverage in the individual or small employer group market shall, at least 60 days before the rate goes into effect, file with the commissioner its rates, fees, dues, and other charges for each product form intended for use in Montana, together with sufficient information to support the premium to be charged as described in 33-22-156 through 33-22-159. This filing may be made simultaneously with a notice of premium increase to policyholders and certificate holders required by 33-22-107.
Terms Used In Montana Code 33-22-156
- Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
- Excepted benefits: means :
(a)coverage only for accident or disability income insurance, or both;
(b)coverage issued as a supplement to liability insurance;
(c)liability insurance, including general liability insurance and automobile liability insurance;
(d)workers' compensation or similar insurance;
(e)automobile medical payment insurance;
(f)credit-only insurance;
(g)coverage for onsite medical clinics;
(h)other similar insurance coverage under which benefits for medical care are secondary or incidental to other insurance benefits, as approved by the commissioner;
(i)if offered separately, any of the following:
(i)limited-scope dental or vision benefits;
(ii)benefits for long-term care, nursing home care, home health care, community-based care, or any combination of these types of care; or
(iii)other similar, limited benefits as approved by the commissioner;
(j)if offered as independent, noncoordinated benefits, any of the following:
(i)coverage only for a specified disease or illness; or
(ii)hospital indemnity or other fixed indemnity insurance;
(k)if offered as a separate insurance policy:
(i)medicare supplement coverage;
(ii)coverage supplemental to the coverage provided under Title 10, chapter 55, of the United States Code; and
(iii)similar supplemental coverage provided under a group health plan. 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
- Health insurance issuer: means an insurer, a health service corporation, or a health maintenance organization. See Montana Code 33-22-140
- Small group market: means the health insurance market under which individuals obtain health insurance coverage directly or through an arrangement, on behalf of themselves and their dependents, through a group health plan or group health insurance coverage maintained by a small employer as defined in 33-22-1803. See Montana Code 33-22-140
(2)A health insurance issuer may submit a single combined justification for rate increases subject to review affecting multiple products if the claims experience of all products has been aggregated to calculate the rate increases and the rate increases are the same for all products. Rate increases are determined by combining the total amount of increases taken on a single product form or market segment, if the rate increase is the same for all products, over a 12-month period. A market segment means the individual or small group market.
(3)The commissioner may waive the 60-day filing requirement under subsection (1) if the rate increase is implemented pursuant to 33-22-107(1)(b). However, the rates and justifications for the rate increase still must be filed.
(4)The health insurance issuer shall submit a new filing to reflect any material change to the previous rate filing. For all other changes, the insurer shall submit an amendment to a previous rate filing. The insurer may file an actuarial trend to phase in rate increases over a 12-month period. The insurer may file amendments to that trend within the 12-month period.
(5)The filing of rates for health plans must include:
(a)the product form number or numbers and approval date of the product form or forms to which the rate applies;
(b)a statement of actuarial justification; and
(c)information sufficient to support the rate as described in 33-22-157.
(6)The commissioner shall prescribe the form and content of the information required under this section.
(7)A rate filing required under this section must be submitted by a qualified actuary representing the health insurance issuer. The qualified actuary shall certify in a form prescribed by the commissioner that, to the best of the actuary’s knowledge and belief, the rates are not excessive, inadequate, unjustified, or unfairly discriminatory, as described in 33-22-157, and comply with the applicable provisions of Title 33 and rules adopted pursuant to Title 33.
(8)The rate filing must be delivered by the national association of insurance commissioners’ system for electronic rate and form filing.
(9)Subject to 33-22-157(4), an insurer may use a rate filing under this section 60 days after the date of filing with the commissioner.
(10)Sections 33-22-156 through 33-22-159 do not apply to coverage consisting solely of excepted benefits as defined in 33-22-140.