Montana Code > Title 33 > Chapter 2 – Regulation of Insurance Companies
Terms Used In Montana Code > Title 33 > Chapter 2 - Regulation of Insurance Companies
- Accident and health insurance: means contracts that incorporate morbidity risk and provide protection against economic loss resulting from accident, sickness, or medical conditions. See Montana Code 33-2-402
- account: means an account established for the payment of qualified health care expenses under the plan. See Montana Code 2-18-1303
- Affiliated: means that a person directly or indirectly controls, is controlled by, or is under common control with the insured. See Montana Code 33-2-301
- Affiliated group: means any group of persons that are affiliated. See Montana Code 33-2-301
- 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.
- Annuity: A periodic (usually annual) payment of a fixed sum of money for either the life of the recipient or for a fixed number of years. A series of payments under a contract from an insurance company, a trust company, or an individual. Annuity payments are made at regular intervals over a period of more than one full year.
- Appellate: About appeals; an appellate court has the power to review the judgement of another lower court or tribunal.
- Appointed actuary: means a qualified actuary who is appointed in accordance with the valuation manual to prepare an actuarial opinion required by this part. See Montana Code 33-2-402
- Appraisal: A determination of property value.
- Appropriation: The provision of funds, through an annual appropriations act or a permanent law, for federal agencies to make payments out of the Treasury for specified purposes. The formal federal spending process consists of two sequential steps: authorization
- Approved risk list: means the list approved by the commissioner of the kinds of insurance presumed unobtainable from authorized insurers when Montana is the home state of the insured. See Montana Code 33-2-301
- Assets: (1) The property comprising the estate of a deceased person, or (2) the property in a trust account.
- Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
- Attorney-in-fact: A person who, acting as an agent, is given written authorization by another person to transact business for him (her) out of court.
- Audit: means a review of the records of a pharmacy by or on behalf of an entity that finances or reimburses the cost of health care services or pharmaceutical products. See Montana Code 33-2-2002
- Authorized insurer: means an insurer authorized pursuant to 33-2-101 to transact insurance in this state. See Montana Code 33-2-301
- Beneficiary: A person who is entitled to receive the benefits or proceeds of a will, trust, insurance policy, retirement plan, annuity, or other contract. Source: OCC
- Business entity: means a corporation, a limited liability company, an association, a partnership, a limited liability partnership, or other legal entity. See Montana Code 33-2-301
- Certificate of insurance: means a document or instrument, regardless of how titled or described, that is prepared or issued by an insurer or insurance producer as evidence of property or casualty insurance coverage. See Montana Code 33-2-1402
- CGAD: means a corporate governance annual disclosure, a confidential report filed by the insurer or insurance group made in accordance with the requirements of this part. See Montana Code 33-2-2103
- Chambers: A judge's office.
- Claims processing services: means the administrative services performed in connection with the processing and adjudicating of claims relating to pharmacist services that include either or both of the following:
(a)receiving payments for pharmacist services; and
(b)making payments to pharmacists or pharmacies. See Montana Code 33-2-2402
- Commissioner: means the insurance commissioner of the state of Montana. See Montana Code 33-2-2103
- Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
- Continuance: Putting off of a hearing ot trial until a later time.
- Contract: A legal written agreement that becomes binding when signed.
- Corrective order: means an order issued by the commissioner specifying corrective actions that the commissioner has determined are required. See Montana Code 33-2-1902
- Counterclaim: A claim that a defendant makes against a plaintiff.
- Customary: means according to usage. See Montana Code 1-1-206
- Deed: The legal instrument used to transfer title in real property from one person to another.
- Defendant: In a civil suit, the person complained against; in a criminal case, the person accused of the crime.
- Department: means the department of administration established in 2-15-1001. See Montana Code 2-18-1303
- Department: means the department of administration created in 2-15-1001. See Montana Code 2-19-101
- Dependent: A person dependent for support upon another.
- Dependent: means the tax-qualified dependent or child of the participant as determined under section 105(b) of the Internal Revenue Code, 26 U. See Montana Code 2-18-1303
- Disability income insurance: has the meaning provided in 33-1-235 for:
(A)individuals employed in professional sports or the entertainment industry; or
(B)a business entity insuring a principal to cover liability or provide assurance for the business entity's loans or contracts. See Montana Code 33-2-301
- Discovery: Lawyers' examination, before trial, of facts and documents in possession of the opponents to help the lawyers prepare for trial.
- distributor: has the meaning provided in 37-7-602. See Montana Code 33-2-2402
- Domestic insurer: means any insurance company or health organization domiciled in this state. See Montana Code 33-2-1902
- Eligible surplus lines insurer: means an unauthorized insurer that is eligible to issue surplus lines insurance under 33-2-307. See Montana Code 33-2-301
- Embezzlement: In most states, embezzlement is defined as theft/larceny of assets (money or property) by a person in a position of trust or responsibility over those assets. Embezzlement typically occurs in the employment and corporate settings. Source: OCC
- Enrollee: means a member, policyholder, subscriber, covered person, beneficiary, dependent, or other individual participating in a health benefit plan. See Montana Code 33-2-2402
- Enterprise risk: means any activity, circumstance, event, or series of events involving one or more affiliates of an insurer that, if not remedied promptly, is likely to have a material adverse effect on the financial condition or liquidity of the insurer or its insurance holding company system as a whole. See Montana Code 33-2-1101
- Entity: includes :
(a)a pharmacy benefits manager;
(b)a health benefit plan;
(c)a third-party administrator; and
(d)a company, group, or agent that represents or is engaged by one of the entities described in this subsection (2). See Montana Code 33-2-2002
- Equitable: Pertaining to civil suits in "equity" rather than in "law." In English legal history, the courts of "law" could order the payment of damages and could afford no other remedy. See damages. A separate court of "equity" could order someone to do something or to cease to do something. See, e.g., injunction. In American jurisprudence, the federal courts have both legal and equitable power, but the distinction is still an important one. For example, a trial by jury is normally available in "law" cases but not in "equity" cases. Source: U.S. Courts
- Escheat: Reversion of real or personal property to the state when 1) a person dies without leaving a will and has no heirs, or 2) when the property (such as a bank account) has been inactive for a certain period of time. Source: OCC
- Escrow: Money given to a third party to be held for payment until certain conditions are met.
- Exempt commercial purchaser: has the meaning provided in 33-2-318. See Montana Code 33-2-301
- Fair market value: The price at which an asset would change hands in a transaction between a willing, informed buyer and a willing, informed seller.
- Federal Reserve System: The central bank of the United States. The Fed, as it is commonly called, regulates the U.S. monetary and financial system. The Federal Reserve System is composed of a central governmental agency in Washington, D.C. (the Board of Governors) and twelve regional Federal Reserve Banks in major cities throughout the United States. Source: OCC
- Federally certified health entity: means a 340B covered entity as described in 42 U. See Montana Code 33-2-2402
- Female: means a member of the human species who, under normal development, has XX chromosomes and produces or would produce relatively large, relatively immobile gametes, or eggs, during her life cycle and has a reproductive and endocrine system oriented around the production of those gametes. See Montana Code 1-1-201
- Fiduciary: A trustee, executor, or administrator.
- Foreclosure: A legal process in which property that is collateral or security for a loan may be sold to help repay the loan when the loan is in default. Source: OCC
- Foreign insurer: means any insurance company licensed to do business in this state under 33-2-116 but not domiciled in this state, or a health organization licensed to do business in this state under Title 33, chapter 31, but not domiciled in this state. See Montana Code 33-2-1902
- Forgery: The fraudulent signing or alteration of another's name to an instrument such as a deed, mortgage, or check. The intent of the forgery is to deceive or defraud. Source: OCC
- Freedom of Information Act: A federal law that mandates that all the records created and kept by federal agencies in the executive branch of government must be open for public inspection and copying. The only exceptions are those records that fall into one of nine exempted categories listed in the statute. Source: OCC
- Garnishment: Generally, garnishment is a court proceeding in which a creditor asks a court to order a third party who owes money to the debtor or otherwise holds assets belonging to the debtor to turn over to the creditor any of the debtor
- Grace period: The number of days you'll have to pay your bill for purchases in full without triggering a finance charge. Source: Federal Reserve
- Grantor: The person who establishes a trust and places property into it.
- Group capital calculation instructions: means the group capital calculation instructions as adopted by the NAIC and as amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. See Montana Code 33-2-1101
- Groupwide supervisor: means the regulatory official authorized to engage in conducting and coordinating groupwide supervision activities who is determined or acknowledged by the commissioner under 33-2-1140 to have sufficient significant contacts with the internationally active insurance group. See Montana Code 33-2-1101
- Health benefit plan: means a policy or certificate that provides health care insurance or major medical expense insurance or that is offered as a substitute for hospital or medical expense insurance. See Montana Code 33-2-2002
- Health benefit plan: means a policy, contract, certificate, or agreement entered into, offered, or issued by a health carrier to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Montana Code 33-2-2402
- Health carrier: means an entity that is subject to the insurance laws and regulations of this state or to the jurisdiction of the commissioner and that contracts or offers to contract or enters into an agreement to provide, deliver, arrange for, pay for, or reimburse any of the costs of health care services. See Montana Code 33-2-2402
- Health organization: means a health maintenance organization or other managed care organization licensed under Title 33, chapter 31. See Montana Code 33-2-1902
- Home state: means , with respect to an insured:
(i)the state in which the insured maintains its principal place of business or, in the case of an individual, the individual's principal residence;
(ii)if 100% of the insured risk is located outside the state referred to in subsection (3)(k)(i), the state with the greatest allocated percentage of the insured's taxable premium for that surplus lines insurance contract;
(iii)if more than one insured from an affiliated group are named insureds on a single surplus lines insurance contract, the home state as determined under subsection (3)(k)(i) or (3)(k)(ii) for the member of the affiliated group that has the largest percentage of premium attributed to it under the surplus lines insurance contract; or
(iv)if a group policyholder pays 100% of the premium from its own funds, the home state of the group policyholder as determined under subsection (3)(k)(i) or, if a group policyholder does not pay 100% of the premiums from its own funds, the home state of the group member as determined under subsection (3)(k)(i). See Montana Code 33-2-301
- Indemnification: In general, a collateral contract or assurance under which one person agrees to secure another person against either anticipated financial losses or potential adverse legal consequences. Source: FDIC
- Independently procured insurance: means surplus lines insurance procured directly by an insured from an eligible surplus lines insurer. See Montana Code 33-2-301
- Insurance group: means those insurers and affiliates included within an insurance holding company system as defined in 33-2-1101. See Montana Code 33-2-2103
- Insurance holding company system: means two or more affiliated persons, one or more of which is an insurer. See Montana Code 33-2-1101
- Insurance producer: means a person required to be licensed under the laws of this state to sell, solicit, or negotiate property or casualty insurance. See Montana Code 33-2-1402
- Insurer: means an entity that:
(a)has written, issued, or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type contracts in Montana and has at least one of the named contracts in force or on claim; or
(b)has written, issued, or reinsured life insurance contracts, accident and health insurance contracts, or deposit-type contracts in any state and is required to hold a certificate of authority to write life insurance, accident and health insurance, or deposit-type contracts in Montana. See Montana Code 33-2-402
- Insurer: has the meaning provided in 33-1-201, except that the term does not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state. See Montana Code 33-2-1101
- Insurer: means an organization that issues property or casualty insurance. See Montana Code 33-2-1402
- Insurer: includes life or other disability insurers, property and casualty insurers, and health organizations. See Montana Code 33-2-1902
- Insurer: has the meaning provided in 33-1-201, except that it may not include agencies, authorities, or instrumentalities of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia, or a state or political subdivision of a state. See Montana Code 33-2-2103
- Intangible property: Property that has no intrinsic value, but is merely the evidence of value such as stock certificates, bonds, and promissory notes.
- Interest rate: The amount paid by a borrower to a lender in exchange for the use of the lender's money for a certain period of time. Interest is paid on loans or on debt instruments, such as notes or bonds, either at regular intervals or as part of a lump sum payment when the issue matures. Source: OCC
- Internationally active insurance group: means an insurance holding company system that includes an insurer registered under 33-2-1111 and meets the following criteria:
(a)premiums are written in at least three countries;
(b)the percentage of gross premiums written outside the United States is at least 10% of the insurance holding company system's total gross written premiums; and
(c)based on a 3-year rolling average, the total assets of the insurance holding company system are at least $50 billion or the total gross written premiums of the insurance holding company system are at least $10 billion. See Montana Code 33-2-1101
- Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
- Liabilities: The aggregate of all debts and other legal obligations of a particular person or legal entity.
- Lien: A claim against real or personal property in satisfaction of a debt.
- Life insurance: means contracts that incorporate mortality risk, including annuity and pure endowment contracts. See Montana Code 33-2-402
- Life or disability insurer: means :
(a)any insurance company licensed under 33-2-116 and engaged in the business of entering into contracts of disability insurance, as described in 33-1-207, or life insurance, as described in 33-1-208;
(b)a licensed property and casualty insurer writing only disability insurance;
(c)any insurer engaged solely in the business of reinsurance of life or disability contracts;
(d)a fraternal benefit society formed under Title 33, chapter 7; or
(e)a health service corporation formed under Title 33, chapter 30. See Montana Code 33-2-1902
- Litigation: A case, controversy, or lawsuit. Participants (plaintiffs and defendants) in lawsuits are called litigants.
- Manufacturer: has the meaning provided in 37-7-602. See Montana Code 33-2-2402
- Mortgage: The written agreement pledging property to a creditor as collateral for a loan.
- Multistate risk: means a risk covered by an unauthorized insurer with insured exposures in more than one state. See Montana Code 33-2-301
- NAIC: means the national association of insurance commissioners. See Montana Code 33-2-402
- NAIC: means the national association of insurance commissioners. See Montana Code 33-2-1101
- NAIC: means the national association of insurance commissioners. See Montana Code 33-2-1902
- NAIC: means the national association of insurance commissioners. See Montana Code 33-2-2103
- NAIC liquidity stress test framework: means a separate NAIC publication that includes a history of the NAIC's development of regulatory liquidity stress testing, the scope criteria applicable for a specific data year, and the liquidity stress test instructions and reporting templates for a specific data year, the scope criteria, instructions, and reporting template as adopted by the NAIC and as amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. See Montana Code 33-2-1101
- Natural disaster multiperil insurance: means any combination of flood, earthquake, and landslide insurance that may be sold as surplus lines insurance. See Montana Code 33-2-301
- Negative trend: means , with respect to a life or health insurer, a negative trend over a period of time, as determined in accordance with the trend test calculation included in the RBC instructions. See Montana Code 33-2-1902
- Oath: A promise to tell the truth.
- Oath: includes an affirmation or declaration. See Montana Code 1-1-201
- Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
- Other prescription drug or device services: means services other than claims processing services that are provided directly or indirectly, whether in connection with or separate from claims processing services, including but not limited to:
(a)negotiating rebates, discounts, or other financial incentives and arrangements with manufacturers, wholesale distributors, or other third parties;
(b)disbursing or distributing rebates;
(c)managing or participating in incentive programs or arrangements for pharmacist services;
(d)negotiating or entering into contractual arrangements with pharmacists, pharmacies, or both;
(e)developing and maintaining formularies;
(f)designing prescription drug benefit programs;
(g)advertising or promoting services; or
(h)administering prior authorization, step therapy, case management, or other utilization review programs. See Montana Code 33-2-2402
- Oversight: Committee review of the activities of a Federal agency or program.
- Participant: means a member who terminates employment and for whom an account is established. See Montana Code 2-18-1303
- Person: means an individual, a corporation, a partnership, an association, a joint-stock company, a trust, an unincorporated organization, any similar entity, or any combination of the foregoing acting in concert. See Montana Code 33-2-1101
- Person: means an individual, partnership, corporation, association, or other legal entity, including any government or governmental subdivision or agency. See Montana Code 33-2-1402
- Personal property: All property that is not real property.
- Personal property: means money, goods, chattels, things in action, and evidences of debt. See Montana Code 1-1-205
- Pharmacist: has the meaning provided in 33-22-170. See Montana Code 33-2-2402
- Pharmacist services: means products, goods, and services or any combination of products, goods, and services provided as part of the practice of pharmacy. See Montana Code 33-2-2402
- Pharmacy: means an established location, either physical or electronic, that is licensed by the board of pharmacy pursuant to Title 37, chapter 7. See Montana Code 33-2-2402
- Pharmacy benefit manager: means a person, including a wholly or partially owned or controlled subsidiary of a pharmacy benefit manager, that provides claims processing services or other prescription drug or device services, or both, to:
(i)enrollees who are residents of this state, for health benefit plans; or
(ii)injured workers of workers' compensation insurance carriers. See Montana Code 33-2-2402
- Pharmacy services administrative organization: means an entity that acts as a contracting agent or provides contracting and other administrative services to pharmacies to assist them in their interactions with third-party payers and pharmacy benefit managers. See Montana Code 33-2-2402
- Plaintiff: The person who files the complaint in a civil lawsuit.
- Plan sponsor: has the meaning provided in 33-10-202. See Montana Code 33-2-2402
- Policyholder behavior: means any action taken by a policyholder, a contract holder, or any other person with the right to elect options, such as the action that a certificate holder may take under a policy or a contract subject to this part. See Montana Code 33-2-402
- Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. Source: OCC
- Precedent: A court decision in an earlier case with facts and law similar to a dispute currently before a court. Precedent will ordinarily govern the decision of a later similar case, unless a party can show that it was wrongly decided or that it differed in some significant way.
- Principal place of business: means the state where the insured business maintains its headquarters and where the insured's high-level officers direct, control, and coordinate the business activities of the insured. See Montana Code 33-2-301
- Principal residence: means the state where an individual insured resides for the greatest number of days during a calendar year or, if the insured's principal residence is located outside of any state, the state to which the greatest percentage of the insured's taxable premium for that insurance contract is located. See Montana Code 33-2-301
- Principle-based valuation: means a reserve valuation that uses one or more methods or one or more assumptions determined by the insurer. See Montana Code 33-2-402
- Producing insurance producer: means a Montana-licensed property and casualty insurance producer dealing directly with a person seeking insurance. See Montana Code 33-2-301
- Property: means real and personal property. See Montana Code 1-1-205
- Property and casualty insurer: means :
(i)any insurance company licensed under 33-2-116 and engaged in the business of entering into contracts of property insurance, as described in 33-1-210, or casualty insurance, as described in 33-1-206;
(ii)any insurance company engaged solely in the business of reinsurance of property and casualty contracts; or
(iii)any insurance company engaged in the business of surety and marine insurance. See Montana Code 33-2-1902
- Prosecute: To charge someone with a crime. A prosecutor tries a criminal case on behalf of the government.
- Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
- Qualified actuary: means an individual who is qualified to sign the applicable statement of actuarial opinion in accordance with the American academy of actuaries qualification standards and meets the requirements specified in the valuation manual. See Montana Code 33-2-402
- Qualified health care expenses: means expenses paid by a participant for medical care, as defined by 26 U. See Montana Code 2-18-1303
- Qualified risk manager: has the meaning provided in 33-2-319. See Montana Code 33-2-301
- Quorum: The number of legislators that must be present to do business.
- RBC instructions: means the RBC report, including risk-based capital instructions adopted by the NAIC, as the RBC instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. See Montana Code 33-2-1902
- RBC plan: means a comprehensive financial plan containing the elements specified in 33-2-1904(2). See Montana Code 33-2-1902
- RBC report: means the report required in 33-2-1903. See Montana Code 33-2-1902
- Real property: Land, and all immovable fixtures erected on, growing on, or affixed to the land.
- Real property: means lands, tenements, hereditaments, and possessory title to public lands. See Montana Code 1-1-205
- Rebates: means all price concessions, however characterized, paid by a manufacturer to a pharmacy benefit manager, including discounts and other remuneration or price concessions, that are based on the actual or estimated utilization of a prescription drug. See Montana Code 33-2-2402
- regulatory action level RBC: means , except for the state fund as provided in subsection (12)(d)(ii), the product of 1. See Montana Code 33-2-1902
- Remainder: An interest in property that takes effect in the future at a specified time or after the occurrence of some event, such as the death of a life tenant.
- Restitution: The court-ordered payment of money by the defendant to the victim for damages caused by the criminal action.
- Sequester: To separate. Sometimes juries are sequestered from outside influences during their deliberations.
- Service of process: The service of writs or summonses to the appropriate party.
- Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
- Several: means two or more. See Montana Code 1-1-201
- Single-state risk: means a risk covered by an unauthorized insurer with exposures in only one state. See Montana Code 33-2-301
- State: means any state of the United States, the District of Columbia, the Commonwealth of Puerto Rico, Guam, the Northern Mariana Islands, the Virgin Islands, and American Samoa. See Montana Code 33-2-301
- State agency: means any state office, board, bureau, commission, department, or agency but does not include any agency operated by a city, town, county, school district, or other political subdivision. See Montana Code 2-19-101
- Statute: A law passed by a legislature.
- Statute of limitations: A law that sets the time within which parties must take action to enforce their rights.
- Subpoena: A command to a witness to appear and give testimony.
- subscription: includes the mark of a person who cannot write if the person's name is written near the mark by another person who also signs that person's own name as a witness. See Montana Code 1-1-203
- Surplus lines insurance: means any property, casualty, or inland marine insurance permitted in a state to be placed directly or through a surplus lines insurance producer with an unauthorized insurer eligible to accept the insurance. See Montana Code 33-2-301
- Surplus lines insurance producer: means an individual or business entity licensed under 33-2-305 to place surplus lines insurance on risks resident, located, or to be performed in this state with unauthorized insurers eligible to accept the insurance. See Montana Code 33-2-301
- Tail risk: means a risk that occurs either when the frequency of low-probability events is higher than expected under a normal probability distribution or when there are observed events of very significant size or magnitude. See Montana Code 33-2-402
- Third persons: means all persons who are not parties to the obligation or transaction concerning which the phrase is used. See Montana Code 1-1-206
- Total adjusted capital: means the sum of:
(a)an insurer's statutory capital and surplus; and
(b)other items, if any, as the RBC instructions may provide. See Montana Code 33-2-1902
- Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
- Trust account: A general term that covers all types of accounts in a trust department, such as estates, guardianships, and agencies. Source: OCC
- Trustee: A person or institution holding and administering property in trust.
- Unauthorized insurer: means , with respect to a state, an insurer not authorized to transact the business of insurance in the state. See Montana Code 33-2-301
- under common control with: means that:
(i)the person directly or indirectly or acting through one or more other persons owns, controls, or has the power to vote 25% or more of any class of voting securities of a business entity; or
(ii)the person controls in any manner the election of a majority of the directors or trustees of a business entity. See Montana Code 33-2-301
- under common control with: means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person. See Montana Code 33-2-1101
- Usury: Charging an illegally high interest rate on a loan. Source: OCC
- Valuation manual: means the valuation manual adopted by the NAIC in accordance with its model law regarding standard valuation and adopted by the commissioner by rule. See Montana Code 33-2-402
- Venue: The geographical location in which a case is tried.
- Voting security: means any security convertible into or evidencing a right to acquire a voting security. See Montana Code 33-2-1101