MT CSI Advisory Memorandum of 1996-06-18
Uniform Health Benefit Plan Form Filing Requirements
• ST ATE AUDITOR
STATE OF MONT ANA
••
Mark O'Keefe
STATE
AUDITOR
COMMISSIONER
OF INSURANCE
COMMISSIONER
OF SECURITIES
Carriers Authorized
to Write Disability Insurance'
Frank Cote',
Deputy Insurance
Commissio
June 18, 1996
Uniform Health Benefit Plan Form Filing
TO:
FROM:
DATE:
RE:
On October
10, 1995, this Department
issued a memorandum
to you regarding
uniform health benefit
plan (uniform plan) and temporarily
extended the form filing requirements
for such plans until the Attorney
General for the state of Montana issued an opinion regarding the uniform plan statutory
requirements.
The
uniform plan statutes,
sections
33-22-245
and 33-22-522,
MCA, require every insurer and health service
corporation
delivering
or issuing for delivery a "health benefit plan" in Montana to make a uniform plan
available.
A "health benefit plan" is defined as "a hospital or medical policy or certificate
providing for
physical and mental health care issued by an insurance
company,
a fraternal
benefit society, or a health
service corporation
or issued under a health maintenance
organization."
Section 33-22-243(2)(a)(I),
MCA.
A
health benefit plan does not include "accident
only, credit, dental, vision, specified
disease,
medicare
supplement,
long-term
care, or disability income insurance;
... coverage
issued as a supplement
to liability
insurance,
workers'
compensation
insurance,
or similar insurance;
or ... automobile
medical payment
insurance."
Section 33-22-243(2)(a)(ii),
MCA.
By requesting
an Attorney
General's
opinion, Insurance Commissioner
O'Keefe
sought clarification
regarding
the applicability
of mandated
benefits provisions
to uniform plans.
The law, as enacted,
specifically
requires
inclusion
of benefits described
in Section 33-22-1521 (2), MCA, in uniform plans;
however,
Montana Code Annotated
mandated
benefits provisions
were not expressly
excluded from
application
questing
an Attorney
General's
opinion, Insurance Commissioner
O'Keefe
sought clarification
regarding
the applicability
of mandated
benefits provisions
to uniform plans.
The law, as enacted,
specifically
requires
inclusion
of benefits described
in Section 33-22-1521 (2), MCA, in uniform plans;
however,
Montana Code Annotated
mandated
benefits provisions
were not expressly
excluded from
application.
In early June, the Attorney
General issued the requested
opinion and concluded
that "[u]niform
health benefit plans, authorized
by 1995 Montana Laws chapter 527, must include coverage
for the services
and articles specifically
referred to in sections 33-22-245
and -522 and the mandated
benefit provisions
of
title 33, chapter 22." 46 Gp. Att'y Gen. No. 17, 6 (MT, 1996)
In the event of overlap between the mandated
benefits provisions
and Section 33-22-1521 (2), MCA, the provisions
of Section 33-22-1521 (2), MCA, "must
control, as they are more specific to the uniform health benefit plans and more recent."
Id.
Prior to the issuance
of the Attorney
General's
opinion, this department
extended
the uniform plan
form filing due date until six months after the Attorney General's
opinion issuance
date; however,
the
commissioner
has determined
that, at this time, filing requirements
may not practicably
be applied, nor are
the filing and approval
of uniform plans desirable or necessary
for the protection
of the public under these
circumstances.
As such, pursuant to Section 33-1-501(4),
Commissioner
O'Keefe will exempt uniform
health benefit plans, codified at Sections 33-22-245
and 33-22-522,
MCA, from the filing and approval
requirements
of Section 33-1-501 (1), MCA, until October
1, 1997, after which all uniform plans available in
Montana must be filed and approved
by the Commissioner.
If you have any questions
regarding
uniform health benefit plans and the benefits required therein,
please contact me at the number listed below.
Mitchell Building/PO
Box 4009/Helena,
Montana 59604-4009/(406)
444-2040/1-800-332-6148/FAX:
quirements
of Section 33-1-501 (1), MCA, until October
1, 1997, after which all uniform plans available in
Montana must be filed and approved
by the Commissioner.
If you have any questions
regarding
uniform health benefit plans and the benefits required therein,
please contact me at the number listed below.
Mitchell Building/PO
Box 4009/Helena,
Montana 59604-4009/(406)
444-2040/1-800-332-6148/FAX:
(406) 444-3497