§ 33-22-101 Exceptions to scope
§ 33-22-102 Third-party ownership
§ 33-22-103 Repealed
§ 33-22-107 Premium increase restriction — exception — notice of rate increase and policy changes
§ 33-22-108 reserved
§ 33-22-109 Riders
§ 33-22-110 Preexisting conditions
§ 33-22-111 Policies and certificates to provide for freedom of choice of practitioners — professional practice not enlarged
§ 33-22-112 Disability insurance coverage of services of state institutions — provision void — rate of payment
§ 33-22-113 Disability insurance coverage of persons eligible for public medical assistance
§ 33-22-114 Coverage required for services provided by physician assistants, advanced practice registered nurses, and registered nurse first assistants
§ 33-22-115 Provider agreement limited to covered services — dental network constraints — penalty — definitions
§ 33-22-116 Prohibition on coverage of abortion services in qualified health plans
§ 33-22-117 Construction
§ 33-22-121 Notice required for cancellation or refusal to renew
§ 33-22-122 Contents of notice — proof — limitation on recovery — exemptions
§ 33-22-123 Return of unearned premium
§ 33-22-124 reserved
§ 33-22-125 Independent chiropractic physical examination or review of records
§ 33-22-126 reserved
§ 33-22-127 Coverage of oral therapy — opioid use disorder
§ 33-22-128 Coverage for children with hearing loss — definitions
§ 33-22-129 Coverage for treatment of diabetes — outpatient self-management training and education — limited benefit for medically necessary equipment and supplies — limitations on cost-sharing requirements for insulin
§ 33-22-130 Coverage for adopted children from time of placement — preexisting conditions
§ 33-22-131 Coverage for treatment of inborn errors of metabolism
§ 33-22-132 Coverage for minimum mammography and other breast examinations
§ 33-22-133 Coverage for minimum hospital stay following childbirth
§ 33-22-134 Postmastectomy care
§ 33-22-135 Coverage for reconstructive breast surgery after mastectomy — benefits and conditions
§ 33-22-136 Insurance for spouse and dependents of deceased peace officer, game warden, or firefighter
§ 33-22-137 Cost-sharing requirements — applicability
§ 33-22-138 Coverage for telehealth services — rulemaking
§ 33-22-139 Coverage of therapies for Down syndrome
§ 33-22-140 Definitions
§ 33-22-141 Crediting previous coverage
§ 33-22-142 Certification of creditable coverage
§ 33-22-143 Rules
§ 33-22-150 Reciprocal limitations on claim filing and claim audits — time limit for reimbursements or offsets — exceptions
§ 33-22-151 Offset agreement
§ 33-22-152 Continuation of dependent coverage
§ 33-22-153 Coverage of routine patient costs for participants in cancer clinical trials — definitions — limitations
§ 33-22-154 Coverage for refill of eyedrops
§ 33-22-155 Coverage of contraceptives
§ 33-22-156 Health insurance rates — filing required — use
§ 33-22-157 Standards for review — notice of deficiency
§ 33-22-158 Trade secret disclosure exemption
§ 33-22-159 Rulemaking
§ 33-22-166 Repealed
§ 33-22-170 Definitions
§ 33-22-171 Maximum allowable cost list — limitations on drugs
§ 33-22-172 Maximum allowable cost or reference price list — price formulation, updating, and disclosure — exceptions
§ 33-22-173 Maximum allowable cost — appeals process
§ 33-22-174 Opt-out of reference pricing — notification
§ 33-22-175 Allowable and prohibited fees on pharmacies
§ 33-22-176 Limitation on copayments
§ 33-22-177 Rights of pharmacies
§ 33-22-180 Contract coverage — nondiscrimination — penalty

Terms Used In Montana Code > Title 33 > Chapter 22 > Part 1 - General Provisions

  • Affidavit: A written statement of facts confirmed by the oath of the party making it, before a notary or officer having authority to administer oaths.
  • Affidavit: means a sworn written declaration made before an officer authorized to administer oaths or an unsworn written declaration made under penalty of perjury as provided in 1-6-105. See Montana Code 1-1-203
  • 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.
  • Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
  • Baseline: Projection of the receipts, outlays, and other budget amounts that would ensue in the future without any change in existing policy. Baseline projections are used to gauge the extent to which proposed legislation, if enacted into law, would alter current spending and revenue levels.
  • Church plan: 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

  • 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.
  • Elimination rider: means a provision attached to a policy that excludes coverage for a specific condition that would otherwise be covered under the policy. 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
  • 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.
  • 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
  • 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
  • Individual market: means the market for health insurance coverage offered to individuals other than in connection with group health insurance coverage. See Montana Code 33-22-140
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • Large employer: means , in connection with a group health plan, with respect to a calendar year and a plan year, an employer who employed an average of at least 51 employees on business days during the preceding calendar year and who employs at least two employees on the first day of the plan year. 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
  • Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
  • 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
  • Peace officer: has the meaning as defined in 46-1-202. See Montana Code 1-1-207
  • 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
  • Process: means a writ or summons issued in the course of judicial proceedings. See Montana Code 1-1-202
  • Public law: A public bill or joint resolution that has passed both chambers and been enacted into law. Public laws have general applicability nationwide.
  • Several: means two or more. See Montana Code 1-1-201
  • 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
  • Trial: A hearing that takes place when the defendant pleads "not guilty" and witnesses are required to come to court to give evidence.
  • United States: includes the District of Columbia and the territories. See Montana Code 1-1-201
  • 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