33-22-156. Health insurance rates -- filing required -- use. (1) Each health insurance issuer that issues, delivers, or renews individual or small employer group health insurance coverage in the individual or small employer group market shall, at least 60 days before the rate goes into effect, file with the commissioner its rates, fees, dues, and other charges for each product form intended for use in Montana, together with sufficient information to support the premium to be charged as described in 33-22-156 through 33-22-159. This filing may be made simultaneously with a notice of premium increase to policyholders and certificate holders required by 33-22-107.
(2) A health insurance issuer may submit a single combined justification for rate increases subject to review affecting multiple products if the claims experience of all products has been aggregated to calculate the rate increases and the rate increases are the same for all products. Rate increases are determined by combining the total amount of increases taken on a single product form or market segment, if the rate increase is the same for all products, over a 12-month period. A market segment means the individual or small group market.
(3) The commissioner may waive the 60-day filing requirement under subsection (1) if the rate increase is implemented pursuant to 33-22-107(1)(b). However, the rates and justifications for the rate increase still must be filed.
(4) The health insurance issuer shall submit a new filing to reflect any material change to the previous rate filing. For all other changes, the insurer shall submit an amendment to a previous rate filing. The insurer may file an actuarial trend to phase in rate increases over a 12-month period. The insurer may file amendments to that trend within the 12-month period.
(5) The filing of rates for health plans must include:
(a) the product form number or numbers and approval date of the product form or forms to which the rate applies;
(b) a statement of actuarial justification; and
(c) information sufficient to support the rate as described in 33-22-157.
(6) The commissioner shall prescribe the form and content of the information required under this section.
(7) A rate filing required under this section must be submitted by a qualified actuary representing the health insurance issuer. The qualified actuary shall certify in a form prescribed by the commissioner that, to the best of the actuary's knowledge and belief, the rates are not excessive, inadequate, unjustified, or unfairly discriminatory, as described in 33-22-157, and comply with the applicable provisions of Title 33 and rules adopted pursuant to Title 33.
(8) The rate filing must be delivered by the national association of insurance commissioners' system for electronic rate and form filing.
(9) An insurer may use a rate filing under this section 60 days after the date of filing with the commissioner unless the health insurance issuer fails to provide the minimum documentation required in 33-22-157.
(10) Sections 33-22-156 through 33-22-159 do not apply to coverage consisting solely of excepted benefits as defined in 33-22-140.
History: En. Sec. 1, Ch. 334, L. 2013.
Structure Montana Code Annotated
Title 33. Insurance and Insurance Companies
Chapter 22. Disability Insurance
33-22-101. Exceptions to scope
33-22-102. Third-party ownership
33-22-104. through 33-22-106 reserved
33-22-107. Premium increase restriction -- exception -- notice of rate increase and policy changes
33-22-110. Preexisting conditions
33-22-113. Disability insurance coverage of persons eligible for public medical assistance
33-22-116. Prohibition on coverage of abortion services in qualified health plans
33-22-118. through 33-22-120 reserved
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
33-22-125. Independent chiropractic physical examination or review of records
33-22-126. and 33-22-127 reserved
33-22-128. Coverage for children with hearing loss -- definitions
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 mammography 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
33-22-137. Cost-sharing requirements -- applicability
33-22-138. Coverage for telehealth services -- rulemaking
33-22-139. Coverage of therapies for Down syndrome
33-22-141. Crediting previous coverage
33-22-142. Certification of creditable coverage
33-22-144. through 33-22-149 reserved
33-22-152. Continuation of dependent coverage
33-22-154. and 33-22-155 reserved
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
33-22-160. through 33-22-165 reserved
33-22-167. through 33-22-169 reserved
33-22-171. Maximum allowable cost list -- limitations on drugs
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
33-22-178. and 33-22-179 reserved
33-22-180. Contract coverage -- nondiscrimination -- penalty