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Montana Title 33. Insurance and Insurance Companies § 33-22-241. Definitions

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As used in 33-22-242 and 33-22-243, unless the context indicates otherwise, the following definitions apply:

(1) “Block of business” means an individual disability insurance policy certificate or contract filed and approved by the commissioner pursuant to 33-1-501 and written and sold by a health care insurer to a defined set of individuals. All individuals covered by the policy or contract are considered to be within the block of business.

(2) “Health care insurer” means a disability insurer, a health service corporation, a health maintenance organization, or a fraternal benefit society.

(3)(a) “Individual health benefit plan” means any hospital or medical expense policy or certificate, subscriber contract, or contract of insurance provided by a prepaid hospital or medical service plan or health maintenance organization subscriber contract and issued for delivery to an individual.

(b) Individual health benefit plan does not include a self-funded group health plan;  a self-funded multiemployer group health plan;  a group conversion plan;  an insured group health plan;  accident-only, specified disease, short-term hospital or medical, hospital confinement indemnity, credit, dental, vision, medicare supplement, long-term care, or disability income insurance;  coverage issued as a supplement to liability insurance;  workers' compensation or similar insurance;  or automobile medical payment insurance.

(4) “Qualifying previous coverage” means benefits or coverage provided under:

(a) medicare or medicaid;

(b) group health insurance or a health benefit plan that provides benefits similar to or exceeding benefits provided under the plan being applied for;  or

(c) an individual health benefit plan, including coverage issued by a health maintenance organization, a prepaid hospital or medical care plan, or a fraternal benefit society, that provides benefits similar to or exceeding the plan being applied for.

Cite this article: - Montana Title 33. Insurance and Insurance Companies § 33-22-241. Definitions - last updated April 27, 2021 |

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