Terms Used In Montana Code > Title 33 > Chapter 22 > Part 5 - Group Disability Insurance

• 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}
• Beneficiary: has the meaning given the term by 29 U. See Montana Code 33-22-140
• COBRA continuation provision: means :

  (a)section 4980B of the Internal Revenue Code, 26 U. See Montana Code 33-22-140

• Contract: A legal written agreement that becomes binding when signed.
• Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
• Creditable coverage: means coverage of the individual under any of the following:

  (i)a group health plan;

  (ii)health insurance coverage;

  (iii)Title XVIII, part A or B, of the Social Security Act, 42 U. See Montana Code 33-22-140

• Customary: means according to usage. See Montana Code 1-1-206
• 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

• Enrollment date: means , with respect to an individual covered under a group health plan or health insurance coverage, the date of enrollment of the individual in the plan or coverage or, if earlier, the first day of the waiting period for enrollment. See Montana Code 33-22-140
• Entitlement: A Federal program or provision of law that requires payments to any person or unit of government that meets the eligibility criteria established by law. Entitlements constitute a binding obligation on the part of the Federal Government, and eligible recipients have legal recourse if the obligation is not fulfilled. Social Security and veterans' compensation and pensions are examples of entitlement programs.
• 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.
• 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

• Fraud: Intentional deception resulting in injury to another.
• 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
• Large group market: means the health insurance market under which individuals obtain health insurance coverage directly or through any arrangement on behalf of themselves and their dependents through a group health plan or group health insurance coverage issued to a large employer. See Montana Code 33-22-140
• Late enrollee: means an eligible employee or dependent, other than a special enrollee under 33-22-523, who requests enrollment in a group health plan following the initial enrollment period during which the individual was entitled to enroll under the terms of the group health plan if the initial enrollment period was a period of at least 30 days. See Montana Code 33-22-140
• Medical care: means :

  (a)the diagnosis, cure, mitigation, treatment, or prevention of disease or amounts paid for the purpose of affecting any structure or function of the body;

  (b)transportation primarily for and essential to medical care referred to in subsection (19)(a); or

  (c)insurance covering medical care referred to in subsections (19)(a) and (19)(b). See Montana Code 33-22-140

• Network plan: means health insurance coverage offered by a health insurance issuer under which the financing and delivery of medical care, including items and services paid for as medical care, are provided, in whole or in part, through a defined set of providers under contract with the issuer. See Montana Code 33-22-140
• 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.
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Person: includes a corporation or other entity as well as a natural person. See Montana Code 1-1-201
• Plan sponsor: has the meaning provided under section 3(16)(B) of the Employee Retirement Income Security Act of 1974, 29 U. See Montana Code 33-22-140
• Preexisting condition exclusion: means , with respect to coverage, a limitation or exclusion of benefits relating to a condition based on presence of a condition before the enrollment date coverage, whether or not any medical advice, diagnosis, care, or treatment was recommended or received before the enrollment date. 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
• 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
• 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
• Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
• 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
• Writing: includes printing. See Montana Code 1-1-203