Montana Code 33-22-904. Standards for policy provisions — rules
33-22-904. Standards for policy provisions — rules. (1) A medicare supplement policy or certificate in force in this state may not contain benefits that duplicate benefits provided by medicare.
Terms Used In Montana Code 33-22-904
- Certificate: means a certificate delivered or issued for delivery in this state under a group medicare supplement policy. See Montana Code 33-22-903
- Medicare: means Health Insurance for the Aged, Title XVIII of the Social Security Amendments of 1965, as then constituted or later amended. See Montana Code 33-22-903
- Medicare supplement policy: means a group or individual policy of disability insurance or a subscriber contract of a health service corporation, other than a policy issued pursuant to a contract under 42 U. See Montana Code 33-22-903
- Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
- Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
- State: when applied to the different parts of the United States, includes the District of Columbia and the territories. See Montana Code 1-1-201
- Statute: A law passed by a legislature.
(2)The commissioner shall adopt reasonable rules to establish specific standards for policy provisions of medicare supplement policies and certificates. A requirement of this code relating to minimum required policy benefits, other than the minimum standards contained in this part, may not apply to medicare supplement policies and certificates. The standards are in addition to and in accordance with applicable laws of this state, including the provisions of Title 33, chapter 22, and may cover but are not limited to:
(a)terms of renewability;
(b)initial and subsequent conditions of eligibility;
(c)nonduplication of coverage;
(d)probationary periods;
(e)benefit limitations, exceptions, and reductions;
(f)elimination periods;
(g)requirements for replacement;
(h)recurrent conditions; and
(i)definitions of terms.
(3)The commissioner may adopt reasonable rules that prohibit policy or certificate provisions not otherwise specifically authorized by statute that, in the opinion of the commissioner, are unjust, unfair, or unfairly discriminatory to any person insured or proposed for coverage under a medicare supplement policy or certificate.
(4)Notwithstanding any other provisions of the law, a medicare supplement policy or certificate may not exclude or limit benefits for losses incurred more than 6 months from the effective date of coverage because it involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage.
(5)The commissioner may adopt rules necessary to conform medicare supplement policies and certificates to the requirements of federal law and federal regulations, including but not limited to rules:
(a)requiring refunds or credits if the policies or certificates do not meet loss requirements;
(b)establishing a uniform methodology for calculating and reporting loss ratios;
(c)ensuring public access to policies, premiums, and loss ratio information of issuers of medicare supplement insurance;
(d)establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases; and
(e)establishing a policy for holding public hearings prior to approval of premium increases.