HOUSE BILL NO. 497

INTRODUCED BY P. BERGSAGEL

A BILL FOR AN ACT ENTITLED: "AN ACT ELIMINATING THE PROHIBITION ON DISCRIMINATION IN INSURANCE BASED ON SEX OR MARITAL STATUS; REQUIRING MATERNITY COVERAGE IN DISABILITY INSURANCE; AMENDING SECTIONS 33-1-502, 33-22-301, 33-22-504, AND 33-30-1001, MCA; REPEALING SECTION 49-2-309, MCA; AND PROVIDING AN EFFECTIVE DATE AND AN APPLICABILITY DATE."

BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:

Section 1. Section 33-1-502, MCA, is amended to read:

"33-1-502. Grounds for disapproval. The commissioner shall disapprove any form filed under 33-1-501 or withdraw any previous approval of a form only if the form:

(1) is in any respect in violation of or does not comply with this code;

(2) contains or incorporates by reference, when the incorporation is otherwise permissible, any inconsistent, ambiguous, or misleading clauses or exceptions and conditions that deceptively affect the risk purported to be assumed in the general coverage of the contract, including a provision in a casualty insurance form permitting defense costs within limits, except as permitted by the commissioner in the commissioner's discretion;

(3) has any title, heading, or other indication of its provisions that is misleading; or

(4) is printed or otherwise reproduced in a manner that renders any provision of the form substantially illegible.

"

Section 2. Section 33-22-301, MCA, is amended to read:

"33-22-301. Coverage of maternity care and newborn under disability policy. (1) Each individual policy of disability insurance issued or issued for delivery in this state must contain coverage for maternity care consisting of prenatal and obstetrical care.

(2) Each individual policy of disability insurance must contain a provision granting immediate accident and sickness coverage, from and after the moment of birth, to each newborn infant of any insured.

(3) The coverage for newborn infants must be the same as provided by the policy for the other covered persons. However, in the coverage for newborn infants, there may not be waiting or elimination periods. A deductible or reduction in benefits applicable to the coverage for newborn infants is not permissible unless it conforms and is consistent with the deductible or reduction in benefits applicable to all other covered persons.

(4) An individual policy of disability insurance may not be issued or amended in this state if it contains any disclaimer, waiver, or other limitation of coverage relative to coverage or insurability of newborn infants of an insured from and after the moment of birth.

(5) The policy or contract may require notification of the birth of a child and payment of a required premium or subscription fee to be furnished to the insurer or nonprofit or indemnity corporation within 31 days of the birth in order to have the coverage extend beyond 31 days.

(6) (a) As used in this section, "individual policy of disability insurance" means:

(i) a hospital or medical expense-incurred policy or certificate;

(ii) a subscriber contract or contract of insurance provided by a health service organization; or

(iii) a health maintenance organization subscriber contract issued or issued for delivery to an individual.

(b) The term does not include:

(i) accident-only insurance;

(ii) specified disease insurance;

(iii) short-term hospital or medical insurance;

(iv) hospital confinement indemnity insurance;

(v) credit insurance;

(vi) dental insurance;

(vii) vision insurance;

(viii) medicare supplement insurance;

(ix) long-term care insurance;

(x) disability income insurance;

(xi) coverage issued as a supplement to liability insurance;

(xii) workers' compensation or similar insurance; or

(xiii) automobile medical payment insurance."

Section 3. Section 33-22-504, MCA, is amended to read:

"33-22-504. Maternity care and newborn infant coverage. (1) A group disability policy or certificate of insurance issued or issued for delivery in this state must contain coverage for maternity care consisting of prenatal and obstetrical care.

(2) A group disability policy or certificate of insurance delivered or issued for delivery in this state may not be issued or amended in this state if it contains any disclaimer, waiver, preexisting condition exclusion, or other limitation of coverage relative to the accident and sickness coverage or insurability of newborn infants of persons covered under the policy from and after the moment of birth.

(3) A policy or certificate subject to this section must contain a provision granting immediate accident and sickness coverage, from and after the moment of birth, to each newborn infant of any person covered under the policy.

(4) The coverage for newborn infants must be the same as provided by the policy for other covered persons. However, for newborn infants, there may not be waiting or elimination periods. A deductible or reduction in benefits applicable to the coverage for newborn infants is not permissible unless it conforms and is consistent with the deductible or reduction in benefits applicable to all other covered persons.

(5) This section does not apply to medicare supplement policies issued by reason of age.

(6) When a group disability policy or certificate issued under the policy provides for coverage or benefits for a resident of this state, the policy or certificate is considered delivered in this state within the meaning of this section regardless of whether the insurer issuing the policy or certificate is located in this state.

(7) The policy or certificate may require notification of the birth of a child and payment of a required premium or subscription fee to be furnished to the insurer or nonprofit or indemnity corporation within 31 days of the birth in order to have the coverage extend beyond 31 days.

(8) As used in this section, "group disability policy or certificate of insurance" means a group hospital or medical expense-incurred policy or certificate. The term does not include:

(a) accident-only insurance;

(b) specified disease insurance;

(c) short-term hospital or medical insurance;

(d) hospital confinement indemnity insurance;

(e) credit insurance;

(f) dental insurance;

(g) vision insurance;

(h) medicare supplement insurance;

(i) long-term care insurance;

(j) disability income insurance;

(k) coverage issued as a supplement to liability insurance;

(l) workers' compensation or similar insurance; or

(m) automobile medical payment insurance."

Section 4. Section 33-30-1001, MCA, is amended to read:

"33-30-1001. Maternity care and newborn infants covered by insurance by health service corporation. (1) A disability insurance plan or group disability insurance plan issued or issued for delivery in this state by a health service corporation must contain coverage for maternity care consisting of prenatal and obstetrical care.

(2) A disability insurance plan or group disability insurance plan issued by a health service corporation may not be issued or amended in this state if it contains any disclaimer, waiver, preexisting condition exclusion, or other limitation of coverage relative to the accident and sickness coverage or insurability of newborn infants of the persons insured from and after the moment of birth. Each policy must contain a provision granting immediate accident and sickness coverage, from and after the moment of birth, to each newborn infant of any insured person. The policy or contract may require notification of the birth of a child and payment of a required premium or subscription fee to be furnished to the insurer or nonprofit or indemnity corporation within 31 days of the birth in order to have the coverage extend beyond 31 days.

(3) As used in this section, "disability insurance plan" or "group disability insurance plan" means a group hospital or medical expense-incurred policy or certificate. The term does not include:

(a) accident-only insurance;

(b) specified disease insurance;

(c) short-term hospital or medical insurance;

(d) hospital confinement indemnity insurance;

(e) credit insurance;

(f) dental insurance;

(g) vision insurance;

(h) medicare supplement insurance;

(i) long-term care insurance;

(j) disability income insurance;

(k) coverage issued as a supplement to liability insurance;

(l) workers' compensation or similar insurance; or

(m) automobile medical payment insurance."

NEW SECTION. Section 5. Repealer. Section 49-2-309, MCA, is repealed.

NEW SECTION. Section 6. Effective date. [This act] is effective July 1, 1999.

NEW SECTION. Section 7. Applicability. [This act] applies to all policies of insurance issued or renewed on or after [the effective date of this act].

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