Montana Code 33-22-1313. Association member assessments
33-22-1313. Association member assessments. (1) (a) (i) For 2020 and each year thereafter, the commissioner shall assess each member insurer 1.2% of its total premium volume covering Montana residents, from the prior calendar year, regardless of type of license.
Terms Used In Montana Code 33-22-1313
- Association: means the Montana reinsurance association provided for in this part. See Montana Code 33-22-1303
- Board: means the association's board of directors provided for in 33-22-1306. See Montana Code 33-22-1303
- Eligible health insurer: means a health insurer, health service corporation, or health maintenance organization that:
(a)offers individual health insurance coverage in the individual market, as defined in 33-22-140;
(b)offers a qualified health plan as defined in 42 U. See Montana Code 33-22-1303
- 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
- Reinsurance payments: means an amount paid by the association to an eligible health insurer under the program. See Montana Code 33-22-1303
- 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
(ii)For purposes of subsection (1)(a)(i), total premium volume may not include premiums that member insurers collect on any coverage issued for excepted benefits as defined in 33-22-140.
(b)The board shall determine the timing of the assessment.
(c)The commissioner shall consider the board’s recommendation when determining the assessment amounts.
(d)The commissioner shall verify the amount of each insurer’s assessment based on annual financial statements and other reports determined to be necessary.
(2)The association shall determine and report to the commissioner the association’s reinsurance payments and other expenses for the previous calendar year, including administrative expenses and any incurred but not reported claims for the previous calendar year.
(a)The report must consider investment income and other appropriate gains.
(b)The report must include an estimate of the assessments needed to cover the expected reinsurance claims for the following calendar year.
(3)If assessments and other funds collected by the association exceed the actual losses and administrative expenses of the association, the board shall use the excess funds to offset future claims or to reduce future assessments.
(4)The commissioner may, after notice and hearing:
(a)suspend or revoke the certificate of authority to transact insurance in this state of any member insurer that fails to pay an assessment;
(b)impose a penalty on any insurer that fails to pay an assessment when due; or
(c)use any power granted to the commissioner to collect any unpaid assessment.
(5)An eligible health insurer may not submit claims for reinsurance payments unless the insurer has a medical loss ratio of 80% or greater, as defined in 45 C.F.R. § 158.232(f).