6.6.5079L PREEXISTING CONDITIONS IN THE INDIVIDUAL, MARKET - DISCLOSURE
health insurer offering individual health insurance coverage may not limit
coverage for a preexisting condition except as set forth in 33-22-246, MCA, and
this rule. Additionally, the following provisions prohibit or limit preexisting
condition exclusions for:
(a) Newborns ( 33-22-301, MCA) ;
(b) Adopted children ( 33-22-130, MCA) ; and
(c) Genetic conditions ( 33-18-206(4) , MCA) .
(2) For purposes of a preexisting condition
exclusion, medical advice, diagnosis, care or treatment may be taken into
account only if it is recommended by, or received from, an individual licensed
or similarly authorized to provide such services under state law and operating
within the scope of practice authorized by state law. A negative diagnosis does
not constitute medical advice, diagnosis, care, or treatment for purposes of
determining whether there is a preexisting condition.
health insurance carrier may not impose a preexisting condition exclusion on a
covered individual before notifying the individual, in writing, of the
existence and terms of any preexisting condition exclusion and of the
individual's right to demonstrate any qualifying previous coverage as provided
for in 33-22-242, MCA.
History: Sec. 33-1-313 and 33-22-143, MCA; IMP, Sec. 33-18-206(4), 33-22-130, 33-22-246, and 33-22-301, MCA; NEW, 1998 MAR p. 1698, Eff. 6/26/98.