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6.6.2507    PROHIBTTED PRACTICES

(1) (a) A health maintenance organization may include in its contract and evidence of coverage a provision setting forth exclusions or limitations of services for preexisting conditions at the time of enrollment as permitted under 33-22-246, 33-22-514, or 33-22-1811, MCA.

(b) A health maintenance organization may not exclude or limit services for a preexisting condition when the enrollee transfers coverage from one individual contract to another ox when the enrollee converts coverage under his conversion option, except to the extent of a preexisting condition limitation or exclusion remaining unexpired under the prior contract, unless it clearly discloses that exclusion or limitation in the evidence of coverage.

(2) A health maintenance organization may not unfairly discriminate against any enrollee or applicant for enrollment on the basis of the age, sex, race, color, creed, national origin, ancestry, religion, marital status, or lawful occupation of an enrollee, because of the frequency of utilization of services of an enrollee, or for any reason prohibited by 33-22-526, MCA.

(3) Representing as a group contract a contract that refuses, within the eligibility period, to enroll an individual member of a group on the basis of the health status or health care needs of the individual enrollee or member is deceptive and misleading and violative of 33-18-203, MCA.

History: Sec. 33-22-1811 and 33-31-103, MCA; IMP, 33-18-203, 33-22-1811, 33-31-111(7), 33-31-301(3) (c), and 33-31-312, MCA; NEW, 1987 MAR p. 1770, Eff. 10/16/87; AMD, 1998 MAR p. 1698, Eff. 6/26/98.

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