Montana Code 33-35-202. Eligibility for certificate of authority
33-35-202. Eligibility for certificate of authority. The commissioner may not issue a certificate of authority to a self-funded multiple employer welfare arrangement unless the arrangement establishes to the reasonable satisfaction of the commissioner that the following requirements have been satisfied by the arrangement:
Terms Used In Montana Code 33-35-202
- arrangement: means a multiple employer welfare arrangement that does not provide for payment of benefits under the arrangement solely through a policy or policies of insurance issued by one or more insurance companies with a certificate of authority under this title. See Montana Code 33-35-103
- Bona fide association: means an association of employers that has been in existence for a period of not less than 5 years prior to sponsoring a self-funded multiple employer welfare arrangement, during which time the association has engaged in substantial activities relating to the common interests of member employers, and that continues to engage in substantial activities in addition to sponsoring an arrangement. See Montana Code 33-35-103
- Contract: A legal written agreement that becomes binding when signed.
- Customary: means according to usage. See Montana Code 1-1-206
- Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
- Multiple employer welfare arrangement: means a multiple employer welfare arrangement as defined by 29 U. See Montana Code 33-35-103
- Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
(1)the employers participating in the self-funded multiple employer welfare arrangement are either engaged in the same trade, profession, or industry or the employers participating in the arrangement are members of a bona fide association;
(2)the employers participating in the arrangement exercise control over the arrangement, as follows:
(a)Subject to subsection (2)(b), control exists if the employers participating in the arrangement have the right to elect at least 75% of the individuals designated in the arrangement’s organizational documents as having control over the operations of the arrangement and the individuals designated in the arrangement’s organizational documents in fact exercise control over the operation of the arrangement.
(b)The use of a third-party administrator to process claims and to assist in the administration of the arrangement is not evidence of the lack of exercise of control over the operation of the arrangement.
(3)the arrangement provides only allowable benefits. However, an arrangement may provide life insurance coverage to its participants if the coverage is provided pursuant to contracts of insurance that comply with Title 33, chapter 20, parts 10 through 12.
(4)the arrangement provides allowable benefits to not less than 2 employers and not less than 75 employees;
(5)the arrangement may not solicit participation in the arrangement from the general public. However, the arrangement may employ or independently contract with a licensed insurance producer who may be paid a commission or other remuneration to enroll employers in the arrangement, and employees of the arrangement, employees of the association sponsoring the arrangement, or employees of affiliates of the association, other than licensed insurance producers, may enroll employers in the arrangement if the employees do not receive a commission or other remuneration in addition to their customary compensation for enrolling employers.
(6)the arrangement is not organized or maintained solely as a conduit for the collection of premiums and the forwarding of premiums to an insurance company. However, it is permissible for a self-funded multiple employer welfare arrangement to act as a conduit for the collection and forwarding of premiums for life insurance coverage pursuant to subsection (3).