Montana Code 33-22-523. Special enrollment periods
33-22-523. Special enrollment periods. (1) A group health plan and a health insurance issuer offering group health insurance coverage in connection with a group health plan shall permit an employee or a dependent of an employee who is eligible, but not enrolled, for coverage under the terms of the group health plan to enroll for coverage under the terms of the group health plan if:
Terms Used In Montana Code 33-22-523
- COBRA continuation provision: means :
(a)section 4980B of the Internal Revenue Code, 26 U. See Montana Code 33-22-140
- 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
- Dependent: A person dependent for support upon 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
- 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
- Writing: includes printing. See Montana Code 1-1-203
(a)the employee or dependent was covered under a group health plan or had health insurance coverage at the time that coverage was previously offered to the employee or dependent;
(b)the employee stated in writing at the time that coverage under a group health plan or health insurance coverage was the reason for declining enrollment, but only if the plan sponsor or health insurance issuer required the statement at the time and provided the employee with notice of the requirement and the consequences of the requirement at the time;
(c)the employee’s or dependent’s coverage described in subsection (1)(a) was:
(i)under a COBRA continuation provision and was exhausted; or
(ii)not under a COBRA continuation provision and was terminated as a result of loss of eligibility for the coverage or because employer contributions toward the coverage were terminated; and
(d)under the terms of the group health plan, the employee requests the enrollment not later than 30 days after the date of exhaustion of coverage described in subsection (1)(c)(i) or termination of coverage or employer contribution described in subsection (1)(c)(ii).
(2)(a) A group health plan must provide for a dependent special enrollment period described in subsection (2)(b) during which a dependent may be enrolled under the group health plan as a dependent of the individual if the person becomes a dependent of the individual through marriage, birth, adoption, or placement for adoption. In the case of the birth or adoption of a child, the spouse of the individual may be enrolled as a dependent of the individual if the spouse is otherwise eligible for coverage.
(b)A dependent special enrollment period under this subsection (2) is a period of not less than 30 days that begins on the later of:
(i)the date dependent coverage is made available; or
(ii)the date of the marriage, birth, adoption, or placement for adoption.
(3)If an individual seeks to enroll a dependent during the first 30 days of the dependent special enrollment period, the coverage of the dependent becomes effective:
(a)in the case of marriage, not later than the first day of the first month beginning after the date on which the completed request for enrollment is received;
(b)in the case of a dependent’s birth, as of the date of birth; or
(c)in the case of a dependent’s adoption or placement for adoption, the date of the adoption or placement for adoption.