6.6.5079H PREEXISTING CONDITIONS - PERMISSIBLE RESTRICTIONS IN GROUP PLANS OTHER THAN SMALL EMPLOYER PLANS
group health plan or a health insurance issuer offering group health insurance
coverage may not exclude coverage for a preexisting condition except as set
forth in 33-22-514, MCA, and this rule.
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 exclusionary period may not exceed more than 12 months
after the enrollment date, including exclusionary periods for late enrollees.
(4) Exclusionary riders are not permitted.
following may not be excluded as a preexisting condition:
(a) Genetic information in the absence of diagnosis of the condition related to the
(c) Adopted children as set forth in
33-22-130, MCA; and
(d) Newborns as set forth in 33-22-504,
(6) A group health plan, and health
insurance issuer offering group health insurance under the plan, may not impose
a preexisting condition exclusion with respect to a participant or dependent of
the participant before notifying the participant, in writing, of the existence
and terms of any preexisting condition exclusion under the plan and of the
rights of individuals to demonstrate creditable coverage (and any applicable
waiting periods) . The description of the rights of individuals to demonstrate
creditable coverage includes a description of the right of the individual to
request a certificate from a prior plan or issuer, if necessary, and a
statement that the current plan or issuer will assist in obtaining a
certificate from any prior plan or issuer, if necessary.
History: Sec. 33-22-143, MCA; IMP, Sec. 33-22-514, MCA; NEW, 1998 MAR p. 1698, Eff. 6/26/98.