Montana Code 33-22-526. Group health discrimination prohibited
33-22-526. Group health discrimination prohibited. (1) (a) A group health plan or a health insurance issuer offering group health insurance coverage may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the group health plan based on any of the following health status-related factors of the individual or a dependent of the individual:
Terms Used In Montana Code 33-22-526
- Dependent: A person dependent for support upon another.
- Dependent: means :
(a)a spouse;
(b)an unmarried child under 25 years of age:
(i)who is not an employee eligible for coverage under a group health plan offered by the child's employer for which the child's premium contribution amount is no greater than the premium amount for coverage as a dependent under a parent's individual or group health plan;
(ii)who is not a named subscriber, insured, enrollee, or covered individual under any other individual health insurance coverage, group health plan, government plan, church plan, or group health insurance;
(iii)who is not entitled to benefits under 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
- 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
(i)health status;
(ii)medical condition, including both physical and mental illnesses;
(iii)claims experience;
(iv)receipt of health care;
(v)medical history;
(vi)genetic information;
(vii)evidence of insurability, including conditions arising out of acts of domestic violence; or
(viii)disability.
(b)This subsection does not:
(i)require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of the group health plan or group health insurance coverage; or
(ii)prevent the group health plan or group health insurance coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the group health plan or group health insurance coverage.
(c)For purposes of subsection (1)(a), rules for eligibility to enroll under a group health plan include rules defining an applicable waiting period for the enrollment.
(2)(a) A group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan may not require an individual, as a condition of enrollment or continued enrollment under the group health plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the group health plan on the basis of any health status-related factor of the individual or of an individual enrolled under the plan as a dependent of the individual.
(b)This subsection (2) does not:
(i)restrict the amount that an employer may be charged for coverage under a group health plan; or
(ii)prevent a group health plan and a health insurance issuer offering group health insurance coverage from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.