20-25-1301. Purpose. The purpose of this part is to establish the structure by which the Montana university system may develop group benefits plans for employees of the Montana university system and their dependents and to clarify that the plan design and employee premium levels are not mandatory subjects for collective bargaining under Title 39, chapter 31. […]
20-25-1302. Definitions. As used in this part, the following definitions apply: (1) ”Advisory committee” means the Montana university system interunit benefits advisory committee established in 2-15-1530. (2) ”Group benefits” means group hospitalization, health, medical, surgical, disability, life, and other related group benefits provided to employees and dependents of the Montana university system. The term does not include casualty […]
20-25-1303. Duties of commissioner — group benefits plans and employee premium levels not mandatory subjects for collective bargaining. (1) The commissioner shall: (a) design group benefits plans and establish premium levels for employees; (b) establish specifications for bids and accept or reject bids for administering group benefits plans; (c) negotiate and administer contracts for group benefits plans; (d) prepare an […]
20-25-1304. Functions of advisory committee. (1) The commissioner shall consult with the advisory committee before modifying Montana university system group benefits plans or before adjusting employee premium levels. (2) The advisory committee shall meet at least semiannually to: (a) review the existing employee group benefits plans; (b) review claims experience, projections, and problems; (c) recommend changes in plan design; (d) recommend […]
20-25-1305 through 20-25-1309 reserved.
20-25-1310. Alternatives to conventional insurance for providing employee group benefits — requirements. (1) The commissioner may establish alternative plans to conventional insurance for providing Montana university system employee group benefits. In developing an alternative plan, the commissioner shall: (a) maintain an alternative group benefits plan on an actuarially sound basis; (b) maintain reserves sufficient to liquidate the unrevealed […]
20-25-1311 through 20-25-1314 reserved.
20-25-1315. Legislative findings and purpose. (1) The legislature finds that: (a) air ambulance services provide a necessary, and sometimes lifesaving, means of transporting Montanans experiencing health emergencies; (b) Montanans desire adequate access to air ambulance services; (c) in many cases the high charges assessed by out-of-network air ambulance services and limited insurer and health plan reimbursements have resulted in […]
20-25-1316. Hold harmless. (1) If a covered person receives services from a non-Montana hospital-controlled out-of-network air ambulance service for an emergency medical condition, an insurer or health plan shall assume the covered person’s responsibility, if any, for amounts charged in excess of allowed amounts for covered services and supplies, applicable copayments, coinsurance, and deductibles. (2) An insurer […]
20-25-1317. Disclosures by air ambulance service. An out-of-network nonhospital-controlled air ambulance service must disclose by July 1 of each year any relationships or financial arrangements with health care providers, insurers, or health plans. This includes but is not limited to employment arrangements, ownership interests, first call agreements, and board memberships. This information must be filed with […]
20-25-1318. Independent dispute resolution. (1) If an insurer or health plan and air ambulance service enter into dispute resolution, the procedure in 20-25-1319 is to be used to determine the fair market price of the services that are the subject of the claim. (2) Payment of the fair market price calculated pursuant to 20-25-1319 constitutes payment in […]
20-25-1319. Independent dispute resolution procedure — exemptions. (1) To initiate a dispute resolution procedure under 20-25-1315 through 20-25-1320, the parties shall file a written notice of dispute with the insurance commissioner. (2) Except as provided in subsection (3), within 30 days after the date of receipt of the notice of dispute, and if no independent reviewer is […]
20-25-1320. Insurance commissioner duties — independent reviewer qualifications. (1) The insurance commissioner shall: (a) approve any independent reviewer that is eligible to adjudicate disputes under 20-25-1315 through 20-25-1320; (b) maintain a list of independent reviewers eligible to adjudicate disputes under 20-25-1315 through 20-25-1320; (c) terminate approval of an independent reviewer and remove the independent reviewer from the list of […]
