House Bill No. 155

Introduced By tropila

By Request of the State Auditor

A Bill for an Act entitled: "An Act requiring that disability insurance contracts include a numerical comparison of the value of the benefits provided by the contract with the value of the same benefits with limits based on a nationally recognized standard; requiring the commissioner of insurance to issue rules governing numerical comparisons; and amending section

33-15-308, MCA."

STATEMENT OF INTENT

A statement of intent is required for this bill because [section 1] requires the commissioner of insurance to adopt rules that establish a method by which an insured can compare the value of the benefits provided by a disability insurance plan with the value of the benefits that would be provided if the plan were based on a nationally recognized standard. In selecting the specific standard or standards to be used, the commissioner may consider Medical Data Research, the Resource Based Relative Value System, the McGraw Hill Value Schedule, or another recognized standard. The rules must designate the specific standard or standards to be used and the methodology for making comparisons.

Be it enacted by the Legislature of the State of Montana:

Section 1.  Section 33-15-308, MCA, is amended to read:

"33-15-308.   Explanation of charges. A disability An insurer, a health service corporation, or a health maintenance organization that issues policies, certificates, or contracts, that issues policies, certificates, or contracts for delivery in this state, or that, renews, extends, or modifies policies, certificates, or contracts on or after October 1, 1995, a policy, certificate, membership contract, or health care services agreement for delivery in this state shall include in the disability policies, certificates, or contracts definitions for terms that limit that limits payment of health care services based on standards described as usual and customary, reasonable and customary, prevailing fee, allowable charges, or a relative value schedule or described in other comparable terms shall include in the policy, certificate, membership contract, or health care services agreement:. These definitions must inform

(1) a definition of each term pertaining to the basis for limiting payment;

(2) a statement informing the insured that the insured's health care provider may charge more than the limits established by the defined terms and that such the additional charges may not be covered by the policy, certificate, or contract, or agreement;

(3) a numerical comparison of the value of the benefits of a policy, certificate, contract, or agreement to the value of the same benefits based on a nationally recognized standard or standards designated by rule by the commissioner; and

(4) if a standard designated in accordance with subsection (3) or a term defined in accordance with subsection (1) is derived from a data base, a statement informing the insured or the certificate holder of the method used to define the geographic or demographic area from which the data to determine the standard or term is derived."

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