BEFORE THE STATE AUDITOR AND COMMISSIONER OF INSURANCE

OF THE STATE OF MONTANA

 

In the matter of the amendment of ARM 6.6.2403, pertaining to Group Coordination of Benefits

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NOTICE OF PUBLIC HEARING ON PROPOSED AMENDMENT

 

TO:  All Concerned Persons

 

1.  On December 13, 2012, at 10:00 a.m., the Office of the Commissioner of Securities and Insurance, Montana State Auditor (CSI), will hold a public hearing in the 2nd floor conference room, at the State Auditor's Office, 840 Helena Ave., Helena, Montana, to consider the proposed amendment of the above-stated rule.

 

2.  The CSI will make reasonable accommodations for persons with disabilities who wish to participate in this public hearing, or need an alternative accessible format of this notice.  If you require an accommodation, contact the CSI no later than 5:00 p.m., December 6, 2012, to advise us of the nature of the accommodation that you need.  Please contact Darla Sautter, CSI, 840 Helena Avenue, Helena, Montana, 59601; telephone (406) 444-2726; TDD (406) 444-3246; fax (406) 444-3499; or e-mail dsautter@mt.gov.

 

3.  The rule as proposed to be amended provides as follows, stricken matter interlined, new matter underlined:

 

6.6.2403  DEFINITIONS  As used in these rules, these words and terms have the following meanings, unless the context clearly indicates otherwise:

(1) through (11)(b)(vi) remain the same.

            (vii)  Medicare or other governmental benefits, as permitted by law, except as provided in (11)(c)(viii).  That part of the definition of plan may be limited to the hospital, medical, and surgical benefits of the governmental program.

            (c)  the term does not include:

            (i)  excepted benefits pursuant to 33-22-140(8)(a), (b), (c), (d), (e), (f), (g), (h), (j), and (k) hospital indemnity coverage benefits or other fixed indemnity coverage;

            (ii)  accident-only coverage;

            (iii)  specified disease or specified accident coverage;

            (iv)  limited benefit health coverage, if the commissioner determines pursuant to 33-22-140 that the coverage qualifies as an "excepted benefit";

            (v) remains the same, but is renumbered (ii).

            (vi) (iii)  benefits provided in long-term care insurance policies for nonmedical services, for example:  personal care, adult day care, homemaker services, assistance with activities of daily living, respite care and custodial care, or for contracts that pay a fixed daily benefit without regard to expenses incurred or the receipt of services; or

            (vii)  Medicare supplement policies;

            (viii)  a state plan under Medicaid;

            (ix) (iv)  a governmental plan, which, by law, provides benefits that are in excess of those of any private insurance plan or other nongovernmental plan; or

            (x)  third party automobile liability coverage.

            (d)  these policies, contracts, or certificates may be delivered, or issued for delivery in this state only if the outline of coverage is completed and delivered as required by this part, and the policy or certificate is clearly labeled as a limited benefit policy or certificate.

            (12) through (14) remain the same.

           

            AUTH:  33-1-313, MCA

IMP:  33-15-304, 33-18-201, 33-22-225, 33-22-226, 33-22-502, MCA

 

            4.  STATEMENT OF REASONABLE NECESSITY:  The amendment is necessary to incorporate the full intent of the NAIC model act concerning coordination of benefits.  The NAIC model act permits the exclusion of limited benefit health coverage for accident and sickness, but is not intended to exclude dental and vision benefits.  However, under the original rule, dental and vision benefits were excluded from coordination because they were excepted benefits under 33-22-140, MCA.  Therefore, a change in the rule is necessary to allow such coordination.  Another proposed modification would remove duplicative language already included within the definition of "excepted benefits" under 33-22-140, MCA.

 

            5.  Concerned persons may submit their data, views, or arguments concerning the proposed actions either orally or in writing at the hearing.  Written data, views, or arguments may also be submitted to Brett O'Neil, Staff Attorney, Office of the Commissioner of Securities and Insurance, Montana State Auditor, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-2040; fax (406) 444-3499; or e-mail BO'Neil@mt.gov, and must be received no later than 5:00 p.m., December 21, 2012.

 

            6.  Brett O'Neil, staff attorney, has been designated to preside over and conduct this hearing.

 

            7.  The CSI maintains a list of concerned persons who wish to receive notices of rulemaking actions proposed by this agency.  Persons who wish to have their name added to the list shall make a written request that includes the name and mailing address of the person to receive notices and specifies for which program the person wishes to receive notices.  Such written request may be mailed or delivered to Darla Sautter, Office of the Commissioner of Securities and Insurance, 840 Helena Ave., Helena, Montana, 59601; telephone (406) 444-2726; fax (406) 444-3499; or e-mail dsautter@mt.gov or may be made by completing a request form at any rules hearing held by the CSI.

 

            8.  An electronic copy of this proposal notice is available through the Secretary of State's web site at http://sos.mt.gov/ARM/Register.  The Secretary of State strives to make the electronic copy of the notice conform to the official version of the notice, as printed in the Montana Administrative Register, but advises all concerned persons that in the event of a discrepancy between the official printed text of the notice and the electronic version of the notice, only the official printed text will be considered.  In addition, although the Secretary of State works to keep its web site accessible at all times, concerned persons should be aware that the web site may be unavailable during some periods, due to system maintenance or technical problems.

 

            9.  Pursuant to 2-4-302, MCA, the bill sponsor contact requirements do not apply.

 

            /s/Brett O'Neil                                    /s/Jesse Laslovich               

            Brett O'Neil                                        Jesse Laslovich

            Rule Reviewer                                   Chief Legal Counsel

 

            Certified to the Secretary of State November 13, 2012.