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37.79.505    DISENROLLMENT

(1) Participation in the HMK coverage group is voluntary and an enrollee may withdraw from the program at any time.

(a) HMK coverage group benefits may be terminated for good cause if the enrollee, parent, or guardian has violated rules adopted by the Montana Commissioner of Insurance for enrollment with an insurer.

(b) Good cause is defined as provided in Montana insurance law and rules and does not include an adverse change in health status.

(2) Disenrollment takes effect, at the earliest, the first day of the month after the department receives the request for disenrollment, but no later than the first day of the second calendar month after the request for disenrollment is received.

(a) The enrollee remains enrolled in the HMK coverage group and the HMK coverage group program is responsible for benefits covered under the contract until the effective date of disenrollment, which is the first day of a month.

(b) The department will disenroll a presumptively eligible child the earlier of:

(i) the last day of the month following the PE determination month; or

(ii) the date the department makes an eligibility determination.

(3) The department will disenroll an enrollee if the enrollee becomes ineligible.

(4) Notice of disenrollment will be mailed at least ten days prior to the time the proposed disenrollment or adverse action is to become effective.

(5) Notice is adequate if it includes:

(a) a statement of the proposed adverse action;

(b) the reason for the proposed adverse action;

(c) the specific regulations supporting the proposed adverse action;

(d) a statement of the claimant's right to a hearing;

(e) how to obtain a hearing;

(f) telephone number to call for additional information;

(g) the right to be represented by legal counsel, friend, relative, or other spokesperson;

(h) the availability of free legal assistance if such assistance is known to the department program manager involved in the denial of the claim;

(i) if applicable, whether or not benefits are to be continued and the liability of the claimant for benefits received pending hearing if the hearing decision is adverse; and

(j) any other information as specifically required by applicable law, including department rule.

History: 53-4-1004, 53-4-1009, 53-4-1105, MCA; IMP, 53-4-1003, 53-4-1004, 53-4-1009, 53-4-1103, 53-4-1104, 53-4-1105, MCA; NEW, 2000 MAR p. 1221, Eff. 5/12/00; AMD, 2004 MAR p. 330, Eff. 2/13/04; AMD, 2008 MAR p. 49, Eff. 1/18/08; AMD, 2009 MAR p. 1673, Eff. 10/1/09; AMD, 2011 MAR p. 70, Eff. 1/1/11; AMD, 2013 MAR p. 214, Eff. 2/15/13.

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