Temporary Extension Form Filing Requirements for Uniform health Benefit Plans

Mark O'Keefe STATE AUDITOR TO: FROM: DATE: RE: ST ATE AUDITOR STATE OF MONTANA COMMISSIONER OF INSURANCE COMMISSIONER OF SECURITIES Carriers Authorized to Write Disability Insur Montana Frank Cote, Deputy Insurance Commissione October 10, 1:995 Temporary Extension of Form Filing Requirements for Uniform Health Benefit Plans Effective January 1, 1996, every insurer and health service corporation which delivers or issues for delivery a health benefit plan in Montana must make a uniform health benefit plan available to Montanans. See ~~ 33-22-245 and 33-22-522, Montana Code Annotated (1995), [hereinafter ~eferred to as MCA]. These statutes were enacted as a result of the cooperative efforts of insurers, insurer organizations, and health care reform advocates, and were intended to provide a health plan offering the benefits described in ~ 33-22-1521(2), MCA; however, those involved in the process of formulating the plan coverages did not intend to subject group and individual uniform health benefit plans to statutes requiring inclusion of mandated benefit coverages (i.e., well child care, phenylketonuria treatment, and mental illness, alcoholism, and drug abuse treatment) . The law, as enacted, specifically requires inclusion of benefits described in ~ 33-22-1521(2), MCA, in the uniform plans, but it does not expressly exclude application of mandated benefit statutes to the uniform plans. As such, the legal effect of the law and the effect intended by those. involved in drafting it are at odds with each other. In order to clarify the issue concerning whether mandated benefits must be included in uniform health benefit plans or not, Mark O'Keefe, the Montana Insurance Commissioner, has requested an Attorney General's opinion on the issue. Until such time as the Attorney General's opinion concerning the applicability .of mandated benefit statutes to uniform plans is rendered and insurers have had an adequate opportunity to incorporate the Attorney General's finding into their own uniform Mitchell Building/PO Box 4009/Helena, Montana 59604-4009/(406) 444-2040/1-800-332-6148/FAX: (406) 444-3497 health benefit plan formulation, the Commissioner will temporarily extend the date by which uniform health benefit plans must be filed pursuant to ~ 33-1-501, MCA. This temporary extension will expire six months following the date of issuance of the Attorney General's opinion. The Commissioner bases this temporary extension upon the impracticality of requiring such filing approval in light of the questions surrounding application of mandated benefits to uniform health benefit plans. The Attorney General has three months, statutorily, to render an opinion. However, the Commissioner highlighted the need for an expedited opinion under these circumstances. The Insurance Department is looking forward to a speedy resolution of these issues, but in the event an expedited opinion is not forthcoming, the above-described extension will enable the Department and disability carriers to cooperatively address the interpretational problems associated with the codification of uniform plans. Thank you for your patience, cooperation, and assistance in this matter. Please do not hesitate to contact me should you have questions or concerns.