Montana Health Study Guide

Much of what this part tests is an absence — a rule everyone expects a state to have, which Montana does not, with a narrower substitute in its place. Start with the biggest one.

There is no state continuation of group health coverage

National material treats state continuation — “mini-COBRA” — as the near-universal fill-in below the federal 20-employee threshold, so candidates arrive looking for a number of months. Montana mandates no general continuation: no provision, no offer requirement, no employer-size band. Any answer shaped like “Montana: N months” is wrong on its face.

The substitute is a conversion right at MCA 33-22-508. On termination of group coverage the person may convert to an individual or group conversion policy without evidence of insurability, on application within 31 days of termination, if insured under the group plan at least 3 months and without other major medical coverage. The section sets no employer-size threshold at all. Its premium ceilings are testable on their own — not more than 200% of the group’s customary rate, 150% only where the person has been insured more than three years — exactly three years is still under the 200% —, and 150% of the highest rate for an alternative basic plan.

Two narrower rights sit alongside it, and neither is a mini-COBRA. MCA 33-22-507 lets a person whose hours are cut below the eligibility minimum stay on the group plan 1 year, but only “with the consent of the employer or the trustees” — an option the employer grants, not a right the employee holds. MCA 33-22-506 continues a child with an intellectual or physical disability past the limiting age while incapable of self-sustaining employment and chiefly dependent on the employee, with proof within 31 days.

Free look, grace, and the section that makes provisions compulsory

Montana writes no separate A&H free-look section. MCA 33-15-415 reaches “each individual life or disability insurance policy,” so health borrows life’s 10 days — except a single-premium nonrenewable disability policy, which gets none. A replacement sale carries 30 days instead (ARM 6.6.306(1)(d)).

The grace period is where the lines genuinely part: life’s is a flat 30 days, while accident and health at MCA 33-22-206 is truly mode-tiered — not less than 7 days weekly premium, 10 days monthly premium, 31 days for every other policy.

MCA 33-22-202 is the incorporating section: an individual A&H policy “must contain the provisions specified in 33-22-204 through 33-22-215, as those provisions appear” — twelve required provisions. The optional ones come from a separate range, 33-22-221 through 33-22-230 and 33-22-232 — do not blend them.

Medicare supplement and long-term care

Medicare supplement free look is 30 days, and MCA 33-22-908 adds a form rule: the notice must be prominently printed on the first page of the policy or certificate, or attached to it. Open enrollment is 6 months, beginning the first day of the first month in which the individual is both 65 or older and enrolled in Medicare Part B (ARM 6.6.507B(1)). Montana grants no birthday rule — no annual or continuous right to switch plans.

Long-term care free look is also 30 days from delivery, but MCA 33-22-1119 hides a second 30-day clock on a different event: where the application is denied, any refund due must be made within 30 days of the denial or return of the application.

External review, and two prompt-pay regimes next door to each other

External review runs on published clocks: 120 days from receipt of the adverse determination to file, 45 days for the independent review organization to decide, 72 hours expedited — and expedited review is unavailable for retrospective determinations (MCA 33-32-410(1), (20); 33-32-411(9)(a)). The reviewer’s decision binds the issuer (MCA 33-32-415).

Now the adjoining pair, which measure different things. MCA 33-18-232 is a per-claim duty: pay or deny within 30 days of proof of loss, 60 days where the insurer reasonably requests more information, after which the claim carries 10% annual interest from the date it was due — automatic, and waived only where it would come to $5 or less. MCA 33-18-233 is a portfolio test: the commissioner may fine an insurer that fails as a general business practice to handle claims properly, with a safe harbour measured on the whole book — 90% of the outstanding dollar amount paid within 20 working days and all of it within 30 working days, over the six months before the hearing. Note the switch from plain days in 232 to working days in 233, and the sting in MCA 33-18-232(3): compliance or noncompliance “may not be the basis of a private cause of action,” and evidence of it is inadmissible in one.