Terms Used In Montana Code > Title 33 > Chapter 22 > Part 13 - Montana Reinsurance Association Act

• Association: means the Montana reinsurance association provided for in this part. See Montana Code 33-22-1303
• Attachment: A procedure by which a person's property is seized to pay judgments levied by the court.
• Attachment point: means the threshold amount for claims costs incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, beyond which the claims costs for benefits are eligible for reinsurance payments. See Montana Code 33-22-1303
• Benefit year: means the calendar year for which an eligible health insurer provides coverage through an individual health insurance policy. 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
• Coinsurance rate: means the rate at which the association will reimburse an eligible health insurer for claims incurred for an enrolled individual's covered benefits in a benefit year above the attachment point and below the reinsurance cap. See Montana Code 33-22-1303
• 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.
• 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

• Ex officio: Literally, by virtue of one's office.
• 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

• 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
• 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
• Payment parameters: means the attachment point, reinsurance cap, and coinsurance rate for the Montana reinsurance program. See Montana Code 33-22-1303
• Program: means the Montana reinsurance program operated by the Montana reinsurance association. See Montana Code 33-22-1303
• Reinsurance cap: means the maximum amount of each claim incurred by an eligible health insurer for an enrolled individual's covered benefits in a benefit year, after which the claims costs for benefits are no longer eligible for reinsurance payments. See Montana Code 33-22-1303
• 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