This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(1) The rules contained in this regulation are adopted and promulgated by the commissioner of insurance under the authority of 33-1-313, MCA.

(1) The purpose of this regulation is to require insurers to deliver to purchasers of life insurance information that will improve the buyer's ability to select the most appropriate plan of life insurance for the buyer's needs, improve the buyer's understanding of the basic features of the policy that has been purchased or is under consideration, and improve the ability of the buyer to evaluate the relative costs of similar plans of life insurance.

(2) This regulation does not prohibit the use of additional material that is not a violation of this regulation or any other Montana statute or regulation.

(1) Except as identified in (2), this regulation shall apply to any solicitation, negotiation, or procurement of life insurance occurring within this state. This regulation shall apply to any issuer of life insurance contracts including fraternal benefit societies.

(2) Unless otherwise specifically included, this regulation shall not apply to:

(a) annuities;

(b) credit life insurance;

(c) group life insurance;

(d) life insurance policies issued in connection with pension and welfare plans as defined by and which are subject to the federal Employee Retirement Income Security Act of 1974 (ERISA); or

(e) variable life insurance under which the death benefits and cash values vary in accordance with unit values of investments held in a separate account.

For the purposes of this regulation, the following definitions shall apply:

(1) A "buyer's guide" means the current Life Insurance Buyer's Guide adopted by the National Association of Insurance Commissioners (NAIC) or language contained in ARM 6.6.209 or language approved by the commissioner of insurance.

(2) "Current scale of nonguaranteed elements" means a formula or other mechanism that produces values for an illustration as if there is no change in the basis of those values after the time of illustration.

(3) "Generic name" means a short title that is descriptive of the premium and benefit patterns of a policy or a rider.

(4) "Nonguaranteed elements" means the premiums, credited interest rates (including any bonus), benefits, values, non-interest based credits, charges, or elements of formulas used to determine any of these that are subject to company discretion and are not guaranteed at issue. An element is considered nonguaranteed if any of the underlying nonguaranteed elements are used in its calculation.

(5) "Policy data" means a display or schedule of numerical values, both guaranteed and nonguaranteed for each policy year or a series of designated policy years of the following information:

(a) illustrated annual, other periodic, and terminal dividends;

(b) premiums;

(c) death benefits; and

(d) cash surrender values and endowment benefits.

(6) "Policy summary" means a written statement describing the elements of the policy, including, but not limited to:

(a) a prominently placed title as follows: STATEMENT OF POLICY COST AND BENEFIT INFORMATION;

(b) the name and address of the insurance agent, or if no agent is involved, a statement of the procedure to be followed in order to receive responses to the inquiries regarding the policy summary;

(c) the full name and home office or administrative office address of the company in which the life insurance policy is to be or has been written;

(d) the generic name of the basic policy and each rider; and

(e) the following amounts, where applicable, for the first five policy years and representative policy years thereafter sufficient to clearly illustrate the premium and benefit patterns; including at least one age from sixty through sixty-five and policy maturity:

(i) the annual premium for the basic policy;

(ii) the annual premium for each optional rider;

(iii) the amount payable upon death at the beginning of the policy year regardless of the cause of death, other than suicide or other specifically enumerated exclusions, that is provided under the basic policy and each optional rider; with benefits provided under the basic policy and each rider shown separately;

(iv) the total guaranteed cash surrender values at the end of the year with values shown separately for the basic policy and each rider; and

(v) any endowment amounts payable under the policy that are not included under cash surrender values above.

(f) the effective policy loan annual percentage interest rate, if the policy contains this provision, specifying whether this rate is applied in advance or in arrears. If the policy loan interest rate is adjustable, the policy summary shall also indicate that the annual percentage rate will be determined by the company in accordance with the provisions of the policy and the applicable law; and

(g) the date on which the policy summary is prepared.

(7) "Prearrangement" means funeral insurance, burial insurance, preneed funeral insurance, prearranged funeral plan, preneed arrangement, or other agreement by or for an individual before that individual's death relating to the purchase or provision of specific funeral or cemetery merchandise or services.

(1) Each insurer shall maintain at its home office or principal office, a complete file containing one copy of each document authorized by the insurer for use pursuant to this regulation. Such file shall contain one copy of each authorized form for a period of three years following the date of its last authorized use.

(2) An agent shall inform the prospective purchaser, prior to commencing a life insurance sales presentation, that he or she is acting as a life insurance agent and inform the prospective purchaser of the full name of the insurance company which the agent is representing to the buyer. In sales situations in which an agent is not involved, the insurer shall identify its full name.

(3) Terms such as financial planner, investment advisor, financial consultant, or financial counseling shall not be used in such a way as to imply that the insurance agent is generally engaged in an advisory business in which compensation is unrelated to sales unless such is actually the case.

(4) Any reference to nonguaranteed elements shall include a statement that the item is not guaranteed and is based on the company's current scale of nonguaranteed elements (use appropriate special terms such as "current dividend" or "current rate" scale). If a nonguaranteed element would be reduced by the existence of a policy loan, a statement to that effect shall be included in any reference to nonguaranteed elements. A presentation or depiction of a policy issued after January 1, 2002, that includes nonguaranteed elements over a period of years shall be governed by ARM 6.6.701 through 6.6.718.

(1) The insurer shall provide, to all prospective purchasers, a buyer's guide and a policy summary prior to accepting the applicant's initial premium or premium deposit, unless the policy for which application is made contains an unconditional refund provision of at least 10 days or unless the policy summary contains such an unconditional refund offer, in which event the buyer's guide and policy summary must be delivered with the policy or prior to delivery of the policy. 

(2) The insurer shall provide a policy summary to prospective purchasers where the insurer has identified the policy form as one that will not be marketed with an illustration. The policy summary shall show guarantees only. It shall consist of a separate document with all required information set out in a manner that does not minimize or render any portion of the summary obscure. Any amounts that remain level for two or more years of the policy may be represented by a single number if it is clearly indicated what amounts are applicable for each policy year. Amounts in ARM 6.6.204(6)(e) shall be listed in total, not on a per thousand or per unit basis. If more than one insured is covered under one policy or rider, death benefits shall be displayed separately for each insured, or for each class of insureds if death benefits do not differ with the class. Zero amounts shall be displayed as a blank space. Delivery of the policy summary shall be consistent with the time for delivery of the Buyer's Guide as specified in (1).

(3) Upon request by the policyholder, the insurer shall furnish either policy data or an in-force illustration as follows:

(a) For policies issued prior to January 1, 2002, the insurer shall furnish policy data, or, at its option, an in-force illustration meeting the requirements of ARM 6.6.207.

(b) For policies issued after January 1, 2002, that were declared not to be used with an illustration, the insurer shall furnish policy data, limited to guaranteed values, if it has chosen not to furnish an in-force illustration meeting the requirements of this regulation.

(c) If the policy was issued after January 1, 2002, and declared to be used with an illustration, an in-force illustration shall be provided.

(d) Unless otherwise requested, the policy data shall be provided for 20 consecutive years beginning with the previous policy anniversary. The statement of policy data shall include nonguaranteed elements according to the current scale, the amount of outstanding policy loans, and the current policy loan interest rate. Policy values shown shall be based on the current application of nonguaranteed elements in effect at the time of the request. The insurer may charge a commercially reasonable fee for the preparation of the statement.

(4) If a life insurance company changes its method of determining scales of nonguaranteed elements on existing policies, it shall, no later than when the first payment is made on the new basis, advise each affected policy owner residing in this state of this change and of its implication on affected policies. This requirement shall not apply to policies for which the amount payable upon death under the basic policy as of the date when advice would otherwise be required does not exceed $5,000.

(5) If the insurer makes a material revision in the terms and conditions under which it will limit its right to change a nonguaranteed factor, it shall, no later than the first policy anniversary following the revision, advise each affected policy owner residing in this state.

(1) Failure of an insurer to provide or deliver a buyer's guide or a policy summary as provided in ARM 6.6.206 shall constitute an omission which misrepresents the benefits, advantages, conditions, or terms of an insurance policy.

(1) This regulation shall apply to all solicitations of life insurance which commence on or after December 15, 1978.

(1) The following is a sample form:

(a) The face page of the Buyer's Guide shall read as follows:

Life Insurance Buyer's Guide

This guide can help you when you shop for life insurance. It discusses how to:

find a policy that meets your needs and fits your budget

decide how much insurance you need

make informed decisions when you buy a policy

Prepared by the National Association of Insurance Commissioners

The National Association of Insurance Commissioners is an association of state insurance regulatory officials. This association helps the various insurance departments to coordinate insurance laws for the benefit of all consumers.

This guide does not endorse any company or policy

Reprinted by

IMPORTANT THINGS TO CONSIDER

1. Review your own insurance needs and circumstances. Choose the kind of policy that has benefits that most closely fit your needs. Ask an agent or company to help you.

2. Be sure that you can handle premium payments. Can you afford the initial premium? If the premium increases later and you still need insurance, can you still afford it?

3. Don't sign an insurance application until you review it carefully to be sure all the answers are complete and accurate.

4. Don't buy life insurance unless you intend to stick with your plan. It may be very costly if you quit during the early years of the policy.

5. Don't drop one policy and buy another without a thorough study of the new policy and the one you have now. Replacing your insurance may be costly.

6. Read your policy carefully. Ask your agent or company about anything that is not clear to you.

7. Review your life insurance program with your agent or company every few years to keep up with changes in your income and your needs.

Buying Life Insurance

When you buy life insurance you want coverage that fits your needs.

First, decide how much you need--and for how long--and what you can afford to pay. Keep in mind the major reason you buy life insurance is to cover the financial effects of unexpected or untimely death. Life insurance can also be one of many ways you plan for the future.

Next, learn what kinds of policies will meet your needs and pick the one that best suits you.

Then, choose the combination of policy premium and benefits that emphasizes protection in case of early death, or benefits in case of long life, or a combination of both.

It makes good sense to ask a life insurance agent or company to help you. An agent can help you review your insurance needs and give you information about the available policies. If one kind of policy doesn't seem to fit your needs, ask about others.

This guide provides only basic information. You can get more facts from a life insurance agent or company or from your public library.

What About the Policy You Have Now?

If you are thinking about dropping a life insurance policy, here are some things you should consider:

If you decide to replace your policy, don't cancel your old policy until you have received the new one. You then have a minimum period to review your new policy and decide if it is what you wanted.

It may be costly to replace a policy. Much of what you paid in the early years of the policy you have now, paid for the company's cost of selling and issuing the policy. You may pay this type of cost again if you buy a new policy.

Ask your tax advisor if dropping your policy could affect your income taxes.

If you are older or your health has changed, premiums for the new policy will often be higher. You will not be able to buy a new policy if you are not insurable.

You may have valuable rights and benefits in the policy you now have that are not in the new one.

If the policy you have now no longer meets your needs, you may not have to replace it. You might be able to change your policy or add to it to get the coverage or benefits you now want.

At least in the beginning, a policy may pay no benefits for some causes of death covered in the policy you have now.

In all cases, if you are thinking of buying a new policy, check with the agent or company that issued you the one you have now. When you bought your old policy, you may have seen an illustration of the benefits of your policy. Before replacing your policy, ask your agent or company for an updated illustration. Check to see how the policy has performed and what you might expect in the future, based on the amounts the company is paying now.

How Much Do You Need?

Here are some questions to ask yourself:

How much of the family income do I provide? If I were to die early, how would my survivors, especially my children, get by? Does anyone else depend on me financially, such as a parent, grandparent, brother, or sister?

Do I have children for whom I'd like to set aside money to finish their education in the event of my death?

How will my family pay final expenses and repay debts after my death?

Do I have family members or organizations to whom I would like to leave money?

Will there be estate taxes to pay after my death?

How will inflation affect future needs?

As you figure out what you have to meet these needs, count the life insurance you have now, including any group insurance where you work or veteran's insurance. Don't forget Social Security, and pension plan survivor's benefits. Add other assets you have: savings, investments, real estate, and personal property. Which assets would your family sell or cash in to pay expenses after your death?

What Is the Right Kind of Life Insurance?

All policies are not the same. Some give coverage for your lifetime and others cover you for a specific number of years. Some build up cash values and others do not. Some policies combine different kinds of insurance, and others let you change from one kind of insurance to another. Some policies may offer other benefits while you are still living. Your choice should be based on your needs and what you can afford.

There are two basic types of life insurance: term insurance and cash value insurance. Term insurance generally has lower premiums in the early years, but does not build up cash values that you can use in the future. You may combine cash value life insurance with term insurance for the period of your greatest need for life insurance to replace income.

Term Insurance covers you for a term of one or more years. It pays a death benefit only if you die in that term. Term insurance generally offers the largest insurance protection for your premium dollar. It generally does not build up cash value.

You can renew most term insurance policies for one or more terms, even if your health has changed. Each time you renew the policy for a new term, premiums may be higher. Ask what the premiums will be if you continue to renew the policy. Also ask if you will lose the right to renew the policy at some age. For a higher premium, some companies will give you the right to keep the policy in force for a guaranteed period at the same price each year. At the end of that time you may need to pass a physical examination to continue coverage, and premiums may increase.

You may be able to trade many term insurance policies for a cash value policy during a conversion period even if you are not in good health. Premiums for the new policy will be higher than you have been paying for the term insurance.

Cash Value Life Insurance is a type of insurance where the premiums charged are higher at the beginning than they would be for the same amount of term insurance. The part of the premium that is not used for the cost of insurance is invested by the company and builds up a cash value that may be used in a variety of ways. You may borrow against a policy's cash value by taking a policy loan. If you don't pay back the loan and the interest on it, the amount you owe will be subtracted from the benefits when you die, or from the cash value if you stop paying premiums and take out the remaining cash value. You can also use your cash value to keep insurance protection for a limited time or to buy a reduced amount without having to pay more premiums. You also can use the cash value to increase your income in retirement or to help pay for needs such as a child's tuition without canceling the policy. However, to build up this cash value, you must pay higher premiums in the earlier years of the policy. Cash value life insurance may be one of several types; whole life, universal life, and variable life are all types of cash value insurance.

Whole Life Insurance covers you for as long as you live if your premiums are paid. You generally pay the same amount in premiums for as long as you live. When you first take out the policy, premiums can be several times higher than you would pay initially for the same amount of term insurance. But they are smaller than the premiums you eventually pay if you were to keep renewing a term policy until your later years.

Some whole life policies let you pay premiums for a shorter period such as 20 years, or until age 65. Premiums for these policies are higher since the premium payments are made during a shorter period.

Universal Life Insurance is a kind of flexible policy that lets you vary your premium payments. You can also adjust the face amount of your coverage. Increases may require proof that you qualify for the new death benefit. The premiums you pay (less expense charges) go into a policy account that earns interest. Charges are deducted from the account. If your yearly premium payment plus the interest your account earns is less than the charges, your account value will become lower. If it keeps dropping, eventually your coverage will end. To prevent that, you may need to start making premium payments, or increase your premium payments, or lower your death benefits. Even if there is enough in your account to pay the premiums, continuing to pay premiums yourself means that you build up more cash value.

Variable Life Insurance is a kind of insurance where the death benefits and cash values depend on the investment performance of one or more separate accounts, which may be invested in mutual funds or other investments allowed under the policy. Be sure to get the prospectus from the company when buying this kind of policy and study it carefully. You will have higher death benefits and cash value if the underlying investments do well. Your benefits and cash value will be lower or may disappear if the investments you chose didn't do as well as you expected. You may pay an extra premium for a guaranteed death benefit.

Life Insurance Illustrations

You may be thinking of buying a policy where cash values, death benefits, dividends, or premiums may vary based on events or situations the company does not guarantee (such as interest rates). If so, you may get an illustration from the agent or company that helps explain how the policy works. The illustration will show how the benefits that are not guaranteed will change as interest rates and other factors change. The illustration will show you what the company guarantees. It will also show you what could happen in the future. Remember that nobody knows what will happen in the future. You should be ready to adjust your financial plans if the cash value doesn't increase as quickly as shown in the illustration. You will be asked to sign a statement that says you understand that some of the numbers in the illustration are not guaranteed.

Finding a Good Value in Life Insurance

After you have decided which kind of life insurance is best for you, compare similar policies from different companies to find which one is likely to give you the best value for your money. A simple comparison of the premiums is not enough. There are other things to consider. For example:

Do premiums or benefits vary from year to year?

How much do the benefits build up in the policy?

What part of the premiums or benefits is not guaranteed?

What is the effect of interest on money paid and received at different times on the policy?

Remember that no one company offers the lowest cost at all ages for all kinds and amounts of insurance. You should also consider other factors.

How quickly does the cash value grow? Some policies have low cash values in the early years that build quickly later on. Other policies have a more level cash value build-up. A year-by-year display of values and benefits can be very helpful. (The agent or company will give you a policy summary or an illustration that will show benefits and premiums for selected years.)

Are there special policy features that particularly suit your needs?

How are nonguaranteed values calculated? For example, interest rates are important in determining policy returns. In some companies increases reflect the average interest earnings on all of the company's policies regardless of when issued. In others, the return for policies issued in a recent year, or a group of years, reflects the interest earnings on that group of policies; in this case, amounts paid are likely to change more rapidly when interest rates change.

(1) For a prearrangement that is funded or to be funded by a life insurance policy, the following information shall be adequately disclosed at the time an application is made or prior to accepting the applicant's initial premium or deposit:

(a) the fact that a life insurance policy is involved or being used to fund a prearrangement;

(b) the nature of the relationship among the soliciting agent or agents, the provider of the funeral or cemetery merchandise or services, the administrator and any other person;

(c) the relationship of the life insurance policy to the funding of the prearrangement and the nature and existence of any guarantees relating to the prearrangement;

(d) the impact on the prearrangement, including:

(i) any changes in the life insurance policy including, but not limited to, changes in the assignment, beneficiary designation, or use of the proceeds;

(ii) any penalties to be incurred by the policyholder as a result of failure to make premium payments; and

(iii) any penalties to be incurred or monies to be received as a result of cancellation or surrender of the life insurance policy.

(e) a list of the merchandise and services which are applied or contracted for in the prearrangement and all relevant information concerning the price of the funeral services, including an indication that the purchase price is either guaranteed at the time of purchase or to be determined at the time of need;

(f) all relevant information concerning what occurs and whether any entitlements or obligations arise if there is a difference between the proceeds of the life insurance policy and the amount actually needed to fund the prearrangement;

(g) any penalties or restrictions, including, but not limited to geographic restrictions or the inability of the provider to perform, on the delivery of merchandise, services, or the prearrangement guarantee; and

(h) the fact that a sales commission or other form of compensation is being paid and the identity of the individuals or entities to whom it is paid, if applicable.

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(a) to regulate the activities of insurers and producers with respect to the replacement of existing life insurance and annuities;

(b) to protect the interests of life insurance and annuity purchasers by establishing minimum standards of conduct to be observed in replacement, proposed replacement, or financed purchase transactions.   It will:

(i) assure that purchasers receive information with which a decision can be made in his or her own best interests;

(ii) reduce the opportunity for misrepresentation and incomplete disclosures; and

(iii) establish penalties for failure to comply with the requirements of this subchapter.

(2) "Existing insurer" means the insurance company whose policy or contract is or will be changed or affected in a manner described within the definition of "replacement".

(3) "Existing policy or contract" means an individual life insurance policy or annuity contract in force, including a policy under a binding or conditional receipt or a policy or a contract that is within an unconditional refund period.

(4) "Financed purchase" means the purchase of a new policy involving the actual or intended use of funds obtained by the withdrawal or surrender of, or by borrowing from values of an existing policy to pay all or part of any premium due on the new policy.   For purposes of a regulatory review of an individual transaction only, if a withdrawal, surrender, or borrowing by an individual involves the policy values of an existing policy and is used to pay premiums on a new policy owned by the same policyholder and issued by the same company within four months before or 13 months after the effective date of the new policy, it will be deemed prima facie evidence of the policyholder's intent to finance the purchase of the new policy with existing policy values.   This prima facie standard is not intended to increase or decrease the monitoring obligations contained in this subchapter.

(5) "Illustration" means a presentation or depiction that includes non-guaranteed elements of a policy of life insurance over a period of years as described in 33-20-604, MCA.

(6) "Policy summary," for the purposes of this subchapter:

(a) for policies or contracts other than universal life policies, means a written statement regarding a policy or contract which shall contain to the extent applicable, but need not be limited to, the following information:

(i) current death benefit;

(ii) annual contract premium;

(iii) current cash surrender value;

(iv) current dividend;

(v) application of current dividend; and

(vi) amount of outstanding loan.

(b) for universal life policies, means a written statement that shall contain at least the following information:

(i) the beginning and end date of the current report period;

(ii) the policy value at the end of the previous report period and at the end of the current report period;

(iii) the total amounts that have been credited or debited to the policy value during the current report period, identifying each by type (e.g., interest, mortality, expense and riders) ;

(iv) the current death benefit at the end of the current report period on each life covered by the policy;

(v) the net cash surrender value of the policy as of the end of the current report period; and

(vi) the amount of outstanding loans, if any, as of the end of the current report period.

(7) "Producer" shall be defined to include agents and producers.

(8) "Registered contract" means a variable annuity contract or variable life insurance policy subject to the prospectus delivery requirements of the Securities Act of 1933.

(9) "Replacement" means a transaction in which a new policy or contract is to be purchased, and it is known or should be known to the proposing producer, or to the proposing insurer if there is no producer, that by reason of such transaction, an existing policy or contract has been or is to be:

(a) lapsed, forfeited, surrendered, or partially surrendered, assigned to the replacing insurer or otherwise terminated;

(b) converted to reduced paid-up insurance, continued as extended term insurance, or otherwise reduced in value by the use of nonforfeiture benefits or other policy values;

(c) amended so as to effect either a reduction in benefits or in the term for which coverage would otherwise remain in force or for which benefits would be paid;

(d) reissued with any reduction in cash values; or

(e) used in a financed purchase.

(10) "Replacing insurer" means the insurance company that issues or proposes to issue a new policy or contract that replaces an existing policy or contract or is a financed purchase.

(11) "Sales material" means a sales illustration and any other written, printed or electronically presented information created, or completed or provided by the company or producer and used in the presentation to the policy or contract owner related to the policy or contract purchased.

(1) Unless otherwise specifically included, this subchapter shall not apply to transactions involving:

(a) credit life insurance;            

(b) group life insurance or group annuities where there is no direct solicitation of individuals by an insurance producer.   Direct solicitation shall not include any group meeting held by an insurance producer solely for the purpose of educating or enrolling individuals or, when initiated by an individual member of the group, assisting with the selection of investment options offered by a single insurer in connection with enrolling that individual.   Group life insurance or group annuity certificates marketed through direct response solicitation shall be subject to the provisions of ARM 6.6.307;

(c) an application to the existing insurer that issued the existing policy or contract when a contractual change or a conversion privilege is being exercised, or when the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the commissioner;

(d) proposed life insurance that is to replace life insurance under a binding or conditional receipt issued by the same company;

(e) policies or contracts used to fund:

(i) an employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA) ;

(ii) a plan described by section 401(a) , 401(k) or 403(b) of the Internal Revenue Code, where the plan, for purposes of ERISA, is established or maintained by an employer;

(iii) a governmental or church plan defined in section 414, a governmental or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section 457 of the Internal Revenue Code; or

(iv) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.

(f) notwithstanding (1)(e) , this subchapter shall apply to policies or contracts used to fund any plan or arrangement that is funded solely by contributions an employee elects to make, whether on a pre-tax or after-tax basis, and where the insurance company has been notified that plan participants may choose from among two or more insurers and there is a direct solicitation of an individual employee by an insurance producer for the purchase of a contract or policy.   As used in this rule, direct solicitation shall not include any group meeting held by an insurance producer solely for the purpose of educating individuals about the plan or arrangement or enrolling individuals in the plan or arrangement or, when initiated by an individual employee, assisting with the selection of investment options offered by a single insurer in connection with enrolling that individual employee;

(g) existing life insurance that is a non-convertible term life insurance policy that will expire in five years or less and cannot be renewed; 

(h) where new coverage is provided under a life insurance policy or contract and the cost is borne wholly by the insured's employer or by an association for which the insured is a member; or

(i) immediate annuities that are purchased with proceeds from an existing contract. Immediate annuities purchased with proceeds from an existing policy are not exempted from the requirements of this subchapter; or

(j) structured settlements.

(2) Registered contracts shall be exempt from the requirements of ARM 6.6.306(1)(b) and 6.6.308(1)(b) with respect to the provision of illustrations or policy summaries; however, premium or contract contribution amounts and identification of the appropriate prospectus or offering circular shall be required instead.

(2) If the applicant answered "yes" to the question regarding existing coverage referred to in (1) , the producer shall present and read to the applicant, not later than at the time of taking the application, a notice regarding replacements in the form as described in Appendix A or other substantially similar form approved by the commissioner.   However, no approval shall be required when amendments to the notice are limited to the omission of references not applicable to the product being sold or replaced.   The notice shall be signed by both the applicant and the producer attesting that the notice has been read aloud by the producer or that the applicant did not wish the notice to be read aloud (in which case the producer need not have read the notice aloud) and left with the applicant.

(3) The notice shall list all life insurance policies or annuities proposed to be replaced, properly identified by name of insurer, the insured or annuitant, and policy or contract number if available; and shall include a statement as to whether each policy or contract will be replaced or whether a policy will be used as a source of financing for the new policy or contract.   If a policy or contract number has not been issued by the existing insurer, alternative identification, such as an application or receipt number, shall be listed.

(4) In connection with a replacement transaction the producer shall leave with the applicant, at the time an application for a new policy or contract is completed, the original or a copy of all sales material.   With respect to electronically presented sales material, it shall be provided to the policy or contract owner in printed form no later than at the time of policy or contract delivery.

(5) Except as provided in ARM 6.6.306(3) , in connection with a replacement transaction, the producer shall submit to the insurer to which an application for a policy or contract is presented, a copy of each document required by this rule, a statement identifying any preprinted or electronically presented company approved sales materials used, and copies of any individualized sales materials, including any illustrations related to the specific policy or contract purchased.

(1) Where a replacement is involved in the transaction, the replacing insurer shall:

(a) verify that the required forms are received and are in compliance with this subchapter;

(b) notify any other existing insurer that may be affected by the proposed replacement within five business days of receipt of a completed application indicating replacement or when the replacement is identified if not indicated on the application, and mail a copy of the available illustration or policy summary for the proposed policy or available disclosure document for the proposed contract within five business days of a request from an existing insurer;

(c) be able to produce copies of the notification regarding replacement required in ARM 6.6.305(2) , indexed by producer, for at least five years or until the next regular examination by the insurance department of a company's state of domicile, whichever is later; and

(d) provide to the policy or contract owner notice of the right to return the policy or contract within 30 days of the delivery of the contract and receive an unconditional full refund of all premiums or considerations paid on it, including any policy fees or charges or, in the case of a variable or market value adjustment policy or contract, a payment of the cash surrender value provided under the policy or contract plus the fees and other charges deducted from the gross premiums or considerations or imposed under such policy or contract.   Such notice may be included in Appendix A or C.

(2) In transactions where the replacing insurer and the existing insurer are the same or subsidiaries or affiliates under common ownership or control, allow credit for the period of time that has elapsed under the replaced policy's or contract's incontestability and suicide period up to the face amount of the existing policy or contract.   With regard to financed purchases the credit may be limited to the amount the face amount of the existing policy is reduced by the use of existing policy values to fund the new policy or contract.

(3) If an insurer prohibits the use of sales material other than that approved by the company, as an alternative to the requirements of ARM 6.6.305(5) the insurer may:

(a) require with each application a statement signed by the producer that:

(i) represents that the producer used only company-approved sales material; and

(ii) states that copies of all sales material were left with the applicant in accordance with ARM 6.6.305(4) ; and

(b) within 10 days of the issuance of the policy or contract:

(i) notify the applicant by sending a letter or by verbal communication with the applicant by a person whose duties are separate from the marketing area of the insurer, that the producer has represented that copies of all sales material have been left with the applicant in accordance with ARM 6.6.305(4) ;

(ii) provide the applicant with a toll free number to contact company personnel involved in the compliance function if such is not the case; and

(iii) stress the importance of retaining copies of the sales material for future reference.

(c) be able to produce a copy of the letter or other verification in the policy file at the home or regional office for at least five years after the termination or expiration of the policy or contract.

(2) If the insurer has proposed the replacement or if the applicant indicates a replacement is intended and the insurer continues with the replacement, the insurer shall:

(a) provide to applicants or prospective applicants with the policy or contract a notice, as described in Appendix C, or other substantially similar form approved by the commissioner.   In these instances the insurer may delete the references to the producer, including the producer's signature, and references not applicable to the product being sold or replaced, without having to obtain approval of the form from the commissioner.   The insurer's obligation to obtain the applicant's signature shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the notice referred to in this rule.   The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed notice referred to in this rule; and

(b) comply with the requirements of ARM 6.6.306(1) (b) , if the applicant furnishes the names of the existing insurers, and the requirements of ARM 6.6.306(1) (c) , (1) (d) and (2) .

(a) retain and be able to produce all replacement notifications received, indexed by replacing insurer, for at least five years or until the conclusion of the next regular examination conducted by the insurance department of its state of domicile, whichever is later;

(b) send a letter to the policy or contract owner of the right to receive information regarding the existing policy or contract values including, if available, an in force illustration or policy summary if an in force illustration cannot be produced within five business days of receipt of a notice that an existing policy or contract is being replaced. The information shall be provided within five business days of receipt of the request from the policy or contract owner;

(c) upon receipt of a request to borrow, surrender or withdraw any policy values, send a notice, advising the policy   owner that the release of policy values may affect the guaranteed elements, non-guaranteed elements, face amount or surrender value of the policy from which the values are released.   The notice shall be sent separate from the check if the check is sent to anyone other than the policy owner.   In the case of consecutive automatic premium loans, the insurer is only required to send the notice at the time of the first loan.

(2) Any failure to comply with this subchapter shall be considered a violation of 33-18-204, MCA, Twisting Prohibited.

(3) Examples of violations include:

(a) any deceptive or misleading information set forth in sales material;

(b) failing to ask the applicant in completing the application the pertinent questions regarding the possibility of financing or replacement;

(c) the intentional incorrect recording of an answer;

(d) advising an applicant to respond negatively to any question regarding replacement in order to prevent notice to the existing insurer; or

(e) advising a policy or contract owner to write directly to the company in such a way as to attempt to obscure the identity of the replacing producer or company.

(4) Policy and contract owners have the right to replace existing life insurance policies or annuity contracts after indicating in or as part of the applications for new coverage that replacement is not their intention; however, patterns of such action by policy or contract owners of the same producer shall be deemed prima facie evidence of the producer's knowledge that replacement was intended in connection with the identified transactions, and these patterns of action shall be deemed prima facie evidence of the producer's intent to violate this subchapter.

(5) Where it is determined that the requirements of this subchapter have not been met, the replacing insurer shall provide to the policy owner an in-force illustration if available or policy summary for the replacement policy or available disclosure document for the replacement contract and the notice regarding replacements in Appendix A or C.

This rule has been repealed.

(1) Each insurer shall:

(a) maintain a system of supervision and control to insure compliance with the requirements of this subchapter that shall include at least the following:

(i) inform its producers of the requirements of this subchapter and incorporate the requirements of the subchapter into all relevant producer training manuals prepared by the insurer;

(ii) provide to each producer a written statement of the company's position with respect to the acceptability of replacements providing guidance to its producer as to the appropriateness of these transactions;

(iii) a system to review the appropriateness of each replacement transaction that the producer does not indicate is in accord with (1)(a)(ii);

(iv) procedures to confirm that the requirements of this subchapter have been met; and

(v) procedures to detect transactions that are replacements of existing policies or contracts by the existing insurer, but that have not been reported as such by the applicant or producer. Compliance with this rule may include, but shall not be limited to, systematic customer surveys, interviews, confirmation letters, or programs of internal monitoring.

(b) have the capacity to monitor each producer's life insurance policy and annuity contract replacements for that insurer, and shall produce, upon request, and make such records available to the insurance department. The capacity to monitor shall include the ability to produce records for each producer's:

(i) life replacements, including financed purchases, as a percentage of the producer's total annual sales for life insurance;

(ii) number of lapses of policies by the producer as a percentage of the producer's total annual sales of life insurance;

(iii) annuity contract replacements as a percentage of the producer's total annual annuity contract sales;

(iv) number of transactions that are unreported replacements of existing policies or contracts by the existing insurer detected by the company's monitoring system as required by (1)(a)(v); and

(v) replacements, indexed by replacing producer and existing insurer.

(c) require with or as a part of each application for life insurance or an annuity a signed statement by both the applicant and the producer as to whether the applicant has existing policies or contracts;

(d) require with each application for life insurance or an annuity that indicates an existing policy or contract a completed notice regarding replacements as contained in Appendix A;

(e) when the applicant has existing policies or contracts, each insurer shall be able to produce copies of any sales material as required by ARM 6.6.305(5), the basic illustration and any supplemental illustrations related to the specific policy or contract that is purchased, and the producer's and applicant’s signed statements with respect to financing and replacement for at least five years after the termination or expiration of the proposed policy or contract;

(f) ascertain that the sales material and illustrations used in the replacement meet the requirements of this subchapter and are complete and accurate for the proposed policy or contract;

(g) if an application does not meet the requirements of ARM 6.6.305(5), notify the producer and applicant and fulfill the outstanding requirements; and

(h) maintain records in paper, photographic, microprocess, magnetic, mechanical or electronic media or by any process that accurately reproduces the actual document.

(1) If any rule or portion of a rule of this subchapter, or its applicability to any person or circumstances, is held invalid by a court, the remainder of this subchapter, or the applicability of its provision to other persons, shall not be affected.

(1) The State Auditor's Office adopts and incorporates by reference Appendix A, B, and C, which are set forth in the National Association of Insurance Commissioners' (NAIC) Life Insurance and Annuities Replacement Model Regulation, adopted in 2015. Copies of appendices A, B, and C are available for public inspection at the Office of the Montana State Auditor, 840 Helena Avenue, Helena, MT 59601. Copies of these appendices may be obtained by writing to the State Auditor's Office, Legal Department, 840 Helena Avenue, Helena, MT 59601. Persons obtaining a copy of these appendices must pay the cost of providing such copies.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(a) provide for the reasonable standardization of coverage and simplification of terms and benefits of medicare supplement policies;

(b) facilitate public understanding and comparison of such policies;

(c) eliminate provisions contained in such policies which may be misleading or confusing in connection with the purchase of such policies or with the settlement of claims; and

(d) provide for full disclosures in the sale of accident and sickness insurance coverages to persons eligible for medicare.

(1) Except as otherwise specifically provided in ARM 6.6.507, 6.6.507C, 6.6.508, 6.6.509, 6.6.515 and 6.6.521, this subchapter shall apply to:

(a) all Medicare supplement policies delivered or issued for delivery in this state on or after February 1, 1982, the effective date of this subchapter; and

(b) all certificates which have been delivered or issued for delivery in this state and issued under group Medicare supplement policies.

(2) This subchapter does not apply to a policy or contract of one or more employers or labor organizations, or of the trustees of a fund established by one or more employers or labor organizations, or combination, for employees or former employees, or a combination, or for members or former members, or a combination, of the labor organizations.

For purposes of this subchapter, the terms defined in 33-22-903, MCA, will have the same meaning in this subchapter unless clearly designated otherwise. The following definitions are in addition to those in 33-22-903, MCA.

(1) "Bankruptcy" means when a Medicare advantage organization that is not an issuer has filed, or has had filed against it, a petition for declaration of bankruptcy and has ceased doing business in the state.

(2) "Continuous period of creditable coverage" means the period during which an individual was covered by creditable coverage, if during the period of the coverage the individual had no breaks in coverage greater than 63 days. The 63-day period shall be counted as described in 33-22-141 and 33-22-142, MCA.

(3) "Creditable coverage":

(a) means, with respect to an individual, coverage of the individual provided under any of the following:

(i) a group health plan;

(ii) health insurance coverage;

(iii) Part A or Part B of Title XVIII of the Social Security Act (Medicare);

(iv) Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of benefits under section 1928;

(v) chapter 55 of Title 10 USC (CHAMPUS);

(vi) a medical care program of the Indian health service or of a tribal organization;

(vii) a state health benefits risk pool;

(viii) a health plan offered under chapter 89 of Title 5 USC (Federal Employees Health Benefits Program);

(ix) a public health plan as defined in federal regulation; and

(x) a health benefit plan under section 5(e) of the Peace Corps Act (22 USC 2504(e)).

(b) does not include:

(i) one or more, or any combination of, the following:

(A) coverage only for accident or disability income insurance, or any combination;

(B) coverage issued as a supplement to liability insurance;

(C) liability insurance, including general liability insurance and automobile liability insurance;

(D) workers' compensation or similar insurance;

(E) automobile medical payment insurance;

(F) credit-only insurance;

(G) coverage for on-site medical clinics; and

(H) other similar insurance coverage, specified in federal regulations, under which benefits for medical care are secondary or incidental to other insurance benefits.

(ii) the following benefits if they are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan:

(A) limited scope dental or vision benefits;

(B) benefits for long-term care, nursing home care, home health care, community-based care, or any combination of; and

(C) such other similar, limited benefits as are specified in federal regulations.

(iii) the following benefits if offered as independent, noncoordinated benefits:

(A) coverage only for a specified disease or illness; and

(B) hospital indemnity or other fixed indemnity insurance.

(iv) the following if it is offered as a separate policy, certificate, or contract of insurance:

(A) Medicare supplement health insurance as defined under section 1882(g)(1) of the Social Security Act;

(B) coverage supplemental to the coverage provided under chapter 55 of Title 10, United States Code; and

(C) similar supplemental coverage provided to coverage under a group health plan.

(4) "Employee welfare benefit plan" means a plan, fund, or program of employee benefits as defined in 29 USC section 1002 (Employee Retirement Income Security Act).

(5) "Insolvency" means when an issuer, licensed to transact the business of insurance in this state, has had a final order of liquidation entered against it with a finding of insolvency by a court of competent jurisdiction in the issuer's state of domicile.

(6) "MACRA" means the Medicare Access and CHIP Reauthorization Act of 2015.

(7) "Medicare advantage plan" means a plan of coverage for health benefits under Medicare Part C as defined in 42 USC 1395w-28(b)(1), and includes:

(a) coordinated care plans which provide health care services, including but not limited to health maintenance organization plans (with or without a point-of-service option), plans offered by provider-sponsored organizations, and preferred provider organization plans;

(b) medical savings account plans coupled with a contribution into a Medicare advantage plan medical savings account; and

(c) Medicare advantage private fee-for-service plans.

(8) "Medicare supplement policy" has the meaning provided for in 33-22-903, MCA, except that "Medicare supplement policy" does not include Medicare advantage plans established under Medicare Part C, outpatient prescription drug plans established under Medicare Part D, or any health care prepayment plan (HCPP) that provides benefits pursuant to an agreement under section 1833(a)(1)(A) of the Social Security Act.

(9) ″MMA″ means the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

(10) "Pre-standardized Medicare supplement benefit plan," "pre-standardized benefit plan," or "pre-standardized plan" means a group or individual policy of Medicare supplement insurance issued prior to July 16, 1993.

(11) "Secretary" means the secretary of the United States Department of Health and Human Services.

(12) "1990 standardized Medicare supplement benefit plan," "1990 standardized benefit plan," or "1990 plan" means a group or individual policy of Medicare supplement insurance issued on or after July 16, 1993, and with an effective date for coverage prior to June 1, 2010, and includes Medicare supplement insurance policies and certificates renewed on or after that date which are not replaced by the issuer at the request of the insured.

(13) "2010 standardized Medicare supplement benefit plan," "2010 standardized benefit plan," or "2010 plan" means a group or individual policy of Medicare supplement insurance issued with an effective date for coverage on or after June 1, 2010.

(2) The following definitions are in addition to those in 33-22-903, MCA:

(a) "Accident," "accidental injury," or "accidental means" must be defined to employ "result" language and may not include words which establish an accidental means test or use words such as "external, violent, visible wounds" or similar words of description or characterization.

(i) The definition may not be more restrictive than the following: "injury or injuries for which benefits are provided means accidental bodily injury sustained by the insured person that is the direct result of an accident, independent of disease or bodily infirmity or any other cause, and occurs while insurance coverage is in force."

(ii) The definition may provide that injuries may not include injuries for which benefits are provided or available under any workers' compensation, employer's liability or similar law, or motor vehicle no-fault plan, unless prohibited by law.

(b) "Benefit period" or "medicare benefit period" may not be defined more restrictively than as defined in the medicare program.

(c) "Convalescent nursing home," "extended care facility," or "skilled nursing facility" must not be described more restrictively than as defined in the medicare program.

(d) "Health care expenses" means, for purposes of ARM 6.6.508, expenses of health maintenance organizations associated with the delivery of health care services, which expenses are analogous to incurred losses of insurers.

(e) "Hospital" must be defined in relation to its status, facilities, and available services or to reflect its accreditation by the joint commission on accreditation of hospitals, but not more restrictively than as defined in the medicare program.

(f) "Medicare" shall be defined in the policy and certificate.  Medicare may be substantially defined as "The Health Insurance for the Aged Act, Title XVIII of the Social Security Amendments of 1965 as then constituted or later amended."

(g) "Medicare eligible expenses" means expenses of the kinds covered by medicare parts A and B, to the extent recognized as reasonable by medicare.

(h) "Physician" must not be defined more restrictively than as defined in the medicare program.

(i) "Sickness" must not be defined more restrictively than the following:  "Sickness means illness or disease of an insured person."  The definition may be further modified to exclude sicknesses or diseases for which benefits are provided under any workers' compensation, occupational disease, employer's liability, or similar law.

(1) Except for permitted preexisting condition clauses as described in ARM 6.6.507(1)(a)(i) and 6.6.507D(1)(a)(i), no policy or certificate may be advertised, solicited, or issued for delivery in this state as a Medicare supplement policy if such policy or certificate contains limitations or exclusions on coverage that are more restrictive than those of Medicare.

(2) No Medicare supplement policy or certificate may use waivers to exclude, limit, or reduce coverage or benefits for specifically named or described preexisting diseases or physical conditions.

(3) No Medicare supplement policy or contract or certificate in force in the state of Montana shall contain benefits which duplicate benefits provided by Medicare.

(4) Subject to ARM 6.6.507(1)(a)(iv) and (v):

(a) a Medicare supplement policy or certificate with benefits for outpatient prescription drugs in existence prior to January 1, 2006, must be renewed for current policyholders or certificateholders who do not enroll in Part D at the option of the policyholder or certificateholder;

(b) a Medicare supplement policy or certificate with benefits for outpatient prescription drugs may not be issued after December 31, 2005; and

(c) after December 31, 2005, a Medicare supplement policy or certificate with benefits for outpatient prescription drugs may not be renewed after the policyholder or certificateholder enrolls in Medicare Part D unless:

(i) the policy or certificate is modified to eliminate outpatient drugs incurred after the effective date of the individual's coverage under a Part D plan; and

(ii) premiums are adjusted to reflect the elimination of outpatient prescription drug coverage at the time of Medicare Part D enrollment, accounting for any claims paid, if applicable.

(1) The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage prior to June 1, 2010. No policy or certificate may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit standards.

(a) the following standards are in addition to all other requirements of this subchapter and Title 33, chapter 22, part 9, MCA, Medicare Supplement Insurance Minimum Standards:

(i) a Medicare supplement policy or certificate shall not exclude or limit benefits for a loss incurred more than six months from the effective date of coverage because it involves a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage;

(ii) a Medicare supplement policy or certificate must not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents;

(iii) A Medicare supplement policy or certificate must provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes;

(iv) no Medicare supplement policy or certificate may provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured other than the nonpayment of premium;

(v) each Medicare supplement policy shall be guaranteed renewable and:

(A) the issuer shall not cancel or nonrenew the policy solely on the ground of health status of the individual; and

(B) the issuer shall not cancel or nonrenew the policy for any reason other than nonpayment of premium or material misrepresentation;

(vi) if the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under (1)(a)(viii), the issuer must offer certificateholders an individual Medicare supplement policy which (at the option of the certificateholder):

(A) provides for continuation of the benefits contained in the group policy; or

(B) provides for such benefits as are required to meet the minimum standards as defined in 6.6.507D(4)];

(vii) if an individual is a certificateholder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:

(A) offer the certificateholder the conversion opportunity described in (1)(a)(vi);

(B) at the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy;

(viii) if a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the succeeding issuer shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy must not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced; and

(ix) if a Medicare supplement policy or certificate eliminates an outpatient prescription drug benefit as a result of requirements imposed by the Medicare Prescription Drug, Improvement and Modernization Act of 2003 (MMA), the modified policy or certificate shall be deemed to satisfy the guaranteed renewal requirements of this rule.

(2) Termination of a Medicare supplement policy or certificate must be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(3) A Medicare supplement policy or certificate must provide that benefits and premiums under the policy or certificate must be suspended at the request of the policyholder or certificateholder for the period (not to exceed 24 months) in which the policyholder or certificateholder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificateholder notifies the issuer of such policy or certificate within 90 days after the date the individual becomes entitled to such assistance. Upon receipt of timely notice, the issuer must either return to the policyholder or certificateholder that portion of the premium attributable to the period of Medicaid eligibility, or provide coverage to the end of the term for which premiums were paid, at the option of the insured, subject to adjustment for paid claims.

(a) If such suspension occurs and if the policyholder or certificateholder loses entitlement to such medical assistance, such policy or certificate must be automatically reinstituted effective as of the date of termination of such entitlement if the policyholder or certificateholder provides notice of loss of such entitlement within 90 days after the date of such loss and pays the premium attributable to the period.

(b) Each Medicare supplement policy shall provide that benefits and premiums under the policy shall be suspended (for any period that may be provided by federal regulation) at the request of the policyholder if the policyholder is entitled to benefits under 226(b) of the Social Security Act and is covered under a group health plan (as defined in 1862(b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or certificateholder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder provides notice of loss of coverage within 90 days after the date of loss;

(c) Reinstitution of coverages as described in (3)(a) and (b); must

(i) not provide for any limitation period with respect to treatment of preexisting conditions;

(ii) provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension. If the suspended Medicare supplement policy or certificate provided coverage for outpatient prescription drugs, reinstitution of the policy or certificate for Medicare Part D enrollees must be without coverage for outpatient prescription drugs and must otherwise provide substantially equivalent coverage to the coverage in effect before the date of suspension; and

(iii) provide for classification of premiums on terms at least as favorable to the policyholder or certificateholder as the premium classification terms that would have applied to the policyholder or certificateholder had the coverage not been suspended.

(4) If an issuer makes a written offer to the Medicare supplement policyholders or certificateholders of one or more of its plans, to exchange during a specified period from his or her pre-standardized plan or 1990 standardized plan to a 2010 standardized plan as described in ARM 6.6.507E, the offer and subsequent exchange shall comply with the following requirements:

(a) An issuer need not provide justification to the commissioner if the insured replaces a pre-standardized plan or a 1990 standardized policy or certificate with an issue age rate 2010 standardized policy or certificate at the insured's original issue age and duration. If an insured's policy or certificate to be replaced is priced on an issue age rate schedule at the time of such offer, the rate charged to the insured for the new exchanged policy shall recognize the policy reserve buildup, due to the pre-funding inherent in the use of an issue age rate basis, for the benefit of the insured. The method proposed to be used by an issuer must be filed with the commissioner for approval as part of the rate filing;

(b) The rating class of the new policy or certificate shall be the class closest to the insured's class of the replaced coverage;

(c) An issuer may not apply new preexisting condition limitations or a new incontestability period to the new policy for those benefits contained in the exchanged pre-standardized plan or 1990 standardized policy or certificate of the insured, but may apply preexisting condition limitations of no more than six months to any added benefits contained in the new 2010 standardized policy or certificate not contained in the exchanged policy; and

(d) The new policy or certificate shall be offered to all policyholders or certificateholders within a given plan, except where the offer or issue would be in violation of state or Federal law.

(5) Standards for basic ("core") benefits common to benefit Plans A through J include the following:

(a) every issuer shall make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare supplement insurance benefit plans in addition to the basic "core" package, but not in lieu thereof:

(i) coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(ii) coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(iii) upon exhaustion of the Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for the balance;

(iv) coverage under Medicare Parts A and B for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations;

(v) coverage for the coinsurance amount (or in the case of hospital outpatient department services under a prospective payment system, the co-payment amount) of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible.

(b) The following additional benefits must be included in Medicare supplement benefit Plans B through J only as provided by ARM 6.6.507A:

(i) coverage for all of the Medicare Part A inpatient hospital deductible amount per benefit period;

(ii) coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A;

(iii) coverage for all of the Medicare Part B deductible amount per calendar year regardless of hospital confinement;

(iv) coverage for 80% of the difference between the actual Medicare Part B charges as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge;

(v) coverage for all of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge;

(vi) coverage for 50% of outpatient prescription drug charges, after a $250.00 calendar year deductible, to a maximum of $1,250.00 in benefits received by the insured per calendar year, to the extent not covered by Medicare. The outpatient prescription drug benefit may be included for sale or issuance in a Medicare supplement policy or certificate until January 1, 2006;

(vii) coverage for 50% of outpatient prescription drug charges, after a $250.00 calendar year deductible to a maximum of $3,000.00 in benefits received by the insured per calendar year, to the extent not covered by Medicare. The outpatient prescription drug benefit may be included for sale or issuance in a Medicare supplement policy or certificate until January 1, 2006;

(viii) coverage to the extent not covered by Medicare for 80% of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first 60 consecutive days of each trip outside the United States, subject to a calendar year deductible of $250.00, and a lifetime maximum benefit of $50,000.00. For purposes of this benefit, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset; and

(ix) coverage for the following preventive health services not covered by Medicare:

(A) an annual clinical preventive medical history and physical examination that may include tests and services from (4)(b)(ix)(B) and patient education to address preventive health care measure;

(B) preventive screening tests or preventive services, the selection and frequency of which is determined to be medically appropriate by the attending physician;

(C) reimbursement shall be for the actual charges up to 100% of the Medicare-approved amount for each service, as if Medicare were to cover the service as identified in American Medical Association Current Procedural Terminology (AMA CPT) codes, to a maximum of $120.00 annually under this benefit. This benefit must not include payment for any procedure covered by Medicare;

(x) coverage for services to provide short term, at-home assistance with activities of daily living for those recovering from an illness, injury or surgery.

(A) for purposes of this benefit, the following definitions apply:

(I) "activities of daily living" include, but are not limited to bathing, dressing, personal hygiene, transferring, eating, ambulating, assistance with drugs that are normally self-administered, and changing bandages or other dressings;

(II) "care provider" means a duly qualified or licensed home health aide/homemaker, personal care aide or nurse provided through a licensed home health care agency or referred by a licensed referral agency or licensed nurses registry;

(III) "home" means any place used by the insured as a place of residence, provided that such place would qualify as a residence for home health care services covered by Medicare. A hospital or skilled nursing facility shall not be considered the insured's place of residence; and

(IV) "at-home recovery visit" means the period of a visit required to provide at-home recovery care, without limit on the duration of the visit, except each consecutive four hours in a 24-hour period of services provided by a care provider is one visit;

(B) for the purposes of this benefit, the following coverage requirements apply:

(I) at-home recovery services provided must be primarily services which assist in activities of daily living.

(II) the insured's attending physician shall certify that the specific type and frequency of at-home recovery services are necessary because of a condition for which a home care plan of treatment was approved by Medicare.

(C) coverage is limited to:

(I) no more than the number and type of at-home recovery visits certified as necessary by the insured's attending physician. The total number of at-home recovery visits shall not exceed the number of Medicare approved home health care visits under a Medicare approved home care plan of treatment;

(II) the actual charges for each visit up to a maximum reimbursement of $40.00 per visit;

(III) $1,600.00 per calendar year;

(IV) seven visits in any one week;

(V) care furnished on a visiting basis in the insured's home;

(VI) services provided by a care provider as defined in this rule;

(VII) at-home recovery visits while the insured is covered under the policy or certificate and not otherwise excluded; and

(VIII) at-home recovery visits received during the period the insured is receiving Medicare approved home care services or no more than eight weeks after the service date of the last Medicare approved home health care visit;

(D) coverage is excluded for:

(I) home care visits paid for by Medicare or other government programs; and

(II) care provided by family members, unpaid volunteers or providers who are not care providers.

(c) the following are the standards for plans K and L:

(i) Standardized Medicare Supplement Benefit Plan K must consist of the following benefits:

(A) coverage of 100% of the Part A hospital coinsurance amount for each day used from the 61st through the 90th day in any Medicare benefit period;

(B) coverage of 100% of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

(C) upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable PPS rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(D) coverage for 50% of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in (4)(c)(i)(J);

(E) coverage for 50% of the coinsurance amount for each day used from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in (4)(c)(i)(J);

(F) coverage for 50% of cost sharing for all Part A Medicare eligible expenses for hospice and respite care until the out-of-pocket limitation is met as described in (4)(c)(i)(J);

(G) coverage for 50%, under Medicare Part A or B, of the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under federal regulations) unless replaced in accordance with federal regulations until the out-of-pocket limitation is met as described in (4)(c)(i)(J);

(H) except for coverage provided in (4)(c)(i)(I), coverage for 50% of the cost sharing otherwise applicable under Medicare Part B after the policyholder pays the Part B deductible until the out-of-pocket limitation is met as described in (4)(c)(i)(J);

(I) coverage of 100% of the cost sharing for Medicare Part B preventive services after the policyholder pays the Part B deductible; and

(J) coverage of 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4,000.00 in 2006, indexed each year by the appropriate inflation adjustment specified by the secretary of the U.S. department of health and human services;

(ii) Standardized Medicare Supplement Benefit Plan L must consist of the following:

(A) the benefits described in (4)(c)(i)(A), (B), (C) and (I);

(B) the benefits described in (4)(c)(i)(D), (E), (F), (G) and (H), but substituting 75% for 50%; and

(C) the benefits described in (4)(c)(i)(J), but substituting $2,000.00 for $4,000.00.

(1) An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic "core" benefits, as established in ARM 6.6.507.

(2) No groups, packages or combinations of Medicare supplement benefits other than those listed in this rule shall be offered for sale in this state, except as may be permitted in (7) and Medicare select policies or certificates.

(3) Benefit plans must be uniform in structure, language, designation and format to the standard benefit Plans A through L listed in this rule and conform to the definitions in 33-22-903, MCA, and ARM 6.6.505. Each benefit shall be structured in accordance with the format provided in ARM 6.6.507(4)(a), (b), and (c) and list the benefits in the order shown in this rule. For purposes of this section, "structure, language, and format" means style, arrangement and overall content of a benefit.

(4) An issuer may use, in addition to the benefit plan designations required in (3), other designations to the extent permitted by law.

(5) The following descriptions detail the contents of the standardized benefit Plans A through J:

(a) Standardized Medicare Supplement Benefit Plan A must be limited to the basic ("core") benefits common to all benefit plans, as established in ARM 6.6.507(5).

(b) Standardized Medicare Supplement Benefit Plan B must include only the core benefit as established in ARM 6.6.507(5), plus the Medicare Part A deductible as established in ARM 6.6.507(5)(b)(i).

(c) Standardized Medicare Supplement Benefit Plan C must include only the core benefit, as established in ARM 6.6.507(5), plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, and medically necessary emergency care in a foreign country as established in ARM 6.6.507(5)(b)(i), (ii), (iii), and (viii) , respectively.

(d) Standardized Medicare Supplement Benefit Plan D must include only the core benefit, as established in ARM 6.6.507(5), plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country, and the at-home recovery benefit as established in ARM 6.6.507(5)(b)(i), (ii), (viii), and (x), respectively.

(e) Standardized Medicare Supplement Benefit Plan E must include only the core benefit as established in ARM 6.6.507(5), plus the Medicare Part A deductible, skilled nursing facility care, medically necessary emergency care in a foreign country, and preventive medical care as defined in ARM 6.6.507(5)(b)(i), (ii), (viii), and (ix), respectively.

(f) Standardized Medicare Supplement Benefit Plan F must include only the core benefit as established in ARM 6.6.507(5), plus the Medicare Part A deductible, the skilled nursing facility care, the Part B deductible, 100% of the Medicare Part B excess charges and medically necessary emergency care in a foreign country as established in ARM 6.6.507(5)(b)(i), (ii), (iii), (v), and (viii), respectively.

(g) Standardized Medicare Supplement Benefit High Deductible Plan F shall include only 100% of covered expenses following the payment of the annual High Deductible Plan F deductible.

(i) The covered expenses are the core benefit as defined in ARM 6.6.507(5), plus the Medicare Part A deductible, skilled nursing facility care, the Medicare Part B deductible, 100% of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in ARM 6.6.507(5)(b)(i), (ii), (iii), (v), and (viii), respectively.

(ii) The annual High Deductible Plan F deductible must consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement Plan F policy, and must be in addition to any other specific benefit deductibles. The annual High Deductible Plan F deductible will be $1500.00 for 1998 and 1999, must be based on the calendar year, and will be adjusted annually thereafter by the secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.00.

(h) Standardized Medicare Supplement Benefit Plan G must include only the core benefit as established in ARM 6.6.507(5) plus the Medicare Part A deductible, the skilled nursing facility care, 80% of the Medicare Part B excess charges, medically necessary emergency care in a foreign country, and the at-home recovery benefit as established in ARM 6.6.507(5)(b)(i), (ii), (iv), (viii), and (x), respectively.

(i) Standardized Medicare Supplement Benefit Plan H must include only the core benefit as established in ARM 6.6.507(5), plus the Medicare Part A deductible, the skilled nursing facility care, basic prescription drug benefit, and medically necessary emergency care in a foreign country as established in ARM 6.6.507(5)(b)(i), (ii), (vi), and (viii), respectively. However, the outpatient prescription drug benefit may not be included in a Medicare supplement policy or certificate sold after December 31, 2005.

(j) Standardized Medicare Supplement Benefit Plan I must include only the core benefit as established in ARM 6.6.507(5), plus the Medicare Part A deductible, the skilled nursing facility care, 100% of the Medicare Part B excess charges, basic prescription drug benefit, medically necessary emergency care in a foreign country, and at-home recovery benefit as established in ARM 6.6.507(5)(b)(i), (ii), (v), (vi), (viii), and (x), respectively. However, the outpatient prescription drug benefit may not be included in a Medicare supplement policy or certificate sold after December 31, 2005.

(k) Standardized Medicare supplement benefit plan J must include only the core benefit as established in ARM 6.6.507(5), plus the Medicare Part A deductible, the skilled nursing facility care, Medicare Part B deductible, 100% of the Medicare Part B excess charges, extended prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care, and at-home recovery benefit as established in ARM 6.6.507(5)(b)(i), (ii), (iii), (v), (vii), (viii), (ix), and (x), respectively. However, the outpatient prescription drug benefit shall not be included in a Medicare supplement policy or certificate sold after December 31, 2005.

(l) Standardized Medicare Supplement Benefit High Deductible Plan J shall consist of 100% of covered expenses following the payment of the annual High Deductible Plan J deductible.

(i) The covered expenses must be only the core benefit as defined in ARM 6.6.507(5), plus the Medicare Part A deductible, skilled nursing facility care, Medicare Part B deductible, 100% of the Medicare Part B excess charges, extended outpatient prescription drug benefit, medically necessary emergency care in a foreign country, preventive medical care benefit, and at-home recovery benefit as defined in ARM 6.6.507(5)(b)(i), (ii), (iii), (v), (vii), (viii), (ix), and (x), respectively. However, the outpatient prescription drug benefit may not be included in a Medicare supplement policy or certificate sold after December 31, 2005.

(ii) The annual High Deductible Plan J deductible must consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement Plan J policy, and must be in addition to any other specific benefit deductibles. The annual deductible will be $1500.00 for 1998 and 1999, must be based on a calendar year, and will be adjusted annually thereafter by the secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.00.

(6) The following descriptions detail the contents of two Medicare supplement plans mandated by the MMA:

(a) standardized Medicare Supplement Benefit Plan K must consist of only those benefits described in ARM 6.6.507(5)(c)(i); and

(b) standardized Medicare Supplement Benefit Plan L must consist of only those benefits described in ARM 6.6.507(5)(c)(ii).

(7) An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits in addition to the benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits may include benefits that are appropriate to Medicare supplement insurance, new or innovative, not otherwise available, cost-effective, and offered in a manner which is consistent with the goal of simplification of Medicare supplement policies. After December 31, 2005, the innovative benefit may not include an outpatient prescription drug benefit.

(1) No issuer may deny or condition the issuance or effectiveness of any Medicare supplement policy or certificate available for sale in this state, nor discriminate in the pricing of a policy or certificate because of the health status, claims experience, receipt of health care, or medical condition of an applicant where an application for a policy or certificate is submitted prior to or during the six-month period beginning with the first day of the first month in which an individual is both 65 years of age or older and is enrolled for benefits under Medicare Part B.

(2) Each Medicare supplement policy or certificate currently available from an issuer must be made available to all applicants who qualify under this rule without regard to age:

(a) If an applicant qualifies under ARM 6.6.507B(1) submits an application during either time period referenced in (1) and, as of the date of application, has had a continuous period of creditable coverage of at least six months, the issuer shall not exclude benefits based on a preexisting condition; and

(b) If the applicant qualifies under ARM 6.6.507B(1) and submits an application during either time period referenced in (1) and, as of the date of application, has had a continuous period of creditable coverage that is less than six months, the issuer shall reduce the period of any preexisting condition exclusion by the aggregate of the period of creditable coverage applicable to the applicant as of the enrollment date. The secretary shall specify the manner of the reduction under this rule.

(3) This rule must not be construed as preventing the exclusion of benefits under a policy, except as provided in (2)(a) and (2)(b), ARM 6.6.507C, and 6.6.522 during the first six months, based on a preexisting condition for which the policyholder or certificateholder received treatment or was otherwise diagnosed during the six months before it became effective.

(1) The following are general provisions relating to guaranteed issue:

(a) Eligible persons are those individuals described in (2) who enroll under the policy during the period specified in (3) and who submit evidence of the date of termination, disenrollment, or Medicare part D enrollment with the application for a Medicare supplement policy.

(b) with respect to eligible persons, an issuer shall not:

(i) deny or condition the issuance or effectiveness of a Medicare supplement policy described in (5) that is offered and is available for issuance to new enrollees by the issuer;

(ii) discriminate in the pricing of such a Medicare supplement policy because of health status, claims experience, receipt of health care, or medical condition; or

(iii) impose an exclusion of benefits based on a preexisting condition under such a Medicare supplement policy.

(c) if an eligible person who originally purchased an issue-age rated plan applies for another issue-age plan from any issuer on a guaranteed issue basis, then that issuer must rate the replacement policy or certificate using the age at which the original policy or certificate was rated.

(2) An eligible person is an individual described in any of the following paragraphs:

(a) The individual is enrolled under an employee welfare benefit plan that:

(i) provides health benefits that supplement the benefits under Medicare, and the plan terminates, or the plan ceases to provide some or all such supplemental health benefits to the individual; or

(ii) is primary to Medicare and the plan terminates or the plan ceases to provide some or all health benefits to the individual because the individual leaves the plan;

(b) the individual is enrolled with a Medicare advantage organization under a Medicare advantage plan under Part C of Medicare, and any of the following circumstances apply, or the individual is 65 years of age or older and is enrolled with a Program of All-inclusive Care for the Elderly (PACE) provider under section 1894 of the Social Security Act, and there are circumstances similar to those described below that would permit discontinuance of the individual's enrollment with such provider if such individual were enrolled in a Medicare advantage plan:

(i) the organization's or plan's certification has been terminated or the organization has terminated or otherwise discontinued providing the plan in the area in which the individual resides;

(ii) the individual is no longer eligible to elect the plan because of a change in the individual's place of residence or other change in circumstances specified by the secretary, but not including termination of the individual's enrollment on the basis described in section 1851(g)(3)(B) of the federal Social Security Act (where the individual has not paid premiums on a timely basis or has engaged in disruptive behavior as specified in standards under section 1856), or the plan is terminated for all individuals within a residence area;

(iii) the individual demonstrates, in accordance with guidelines established by the secretary, that:

(A) the organization offering the plan substantially violated a material provision of the organization's contract under this part in relation to the individual, including the failure to provide an enrollee on a timely basis medically necessary care for which benefits are available under the plan or the failure to provide such covered care in accordance with applicable quality standards; or

(B) the organization, or agent or other entity on the organization's behalf, materially misrepresented the plan's provisions in marketing the plan to the individual; or

(C) the individual meets such other exceptional conditions as the secretary may provide.

(c) The individual:

(i) is enrolled with one of the following organizations:

(A) an eligible organization under a contract under section 1876 of the Social Security Act (Medicare cost);

(B) a similar organization operating under demonstration project authority, effective for periods before April 1, 1999;

(C) an organization under an agreement under section 1833(1)(A) of the Social Security Act (health care prepayment plan); or

(D) an organization under a Medicare select policy; and

(ii) the enrollment ceases under the same circumstance that would permit discontinuance of an individual's election of coverage under (2)(b).

(d) The individual is enrolled under a Medicare supplement policy and the enrollment ceases because:

(i) of the insolvency of the issuer or bankruptcy of the non-issuer organization;

(ii) of other involuntary termination of coverage or enrollment under the policy;

(iii) the issuer of the policy substantially violated a material provision of the policy; or

(iv) the issuer, or an agent or other entity acting on the issuer's behalf, materially misrepresented the policy's provisions in marketing the policy to the individual.

(e) The individual was enrolled under a Medicare supplement policy and terminates enrollment and:

(i) subsequently enrolls, for the first time, with any Medicare advantage organization under a Medicare advantage plan under Part C of Medicare, any eligible organization under a contract under section 1876 of the Social Security Act (Medicare risk or cost), any similar organization operating under demonstration project authority, any PACE provider under section 1894 of the Social Security Act, an organization under an agreement under section 1833(a)(1)(A) (health care prepayment plan), or a Medicare select policy; and

(ii) the subsequent enrollment under (2)(e) is terminated by the enrollee during any period within the first 12 months of such subsequent enrollment (during which the enrollee is permitted to terminate such subsequent enrollment under section 1851(e) of the Federal Social Security Act).

(f) the individual, upon first becoming eligible for benefits under Medicare part A at age 65, enrolls in a Medicare advantage plan under Part C of Medicare, or with a PACE provider under section 1894 of the Social Security Act, and disenrolls from the plan or program by not later than 12 months after the effective date of enrollment.

(g) the individual enrolls in a Medicare Part D plan during the initial enrollment period and, at the time of enrollment in part D, was enrolled under a Medicare supplement policy that covers outpatient prescription drugs and the individual terminates enrollment in the Medicare supplement policy and submits evidence of enrollment in Medicare Part D along with the application for a policy described in (5)(e).

(h) the individual, upon first becoming eligible for benefits under Medicare Part A and B is enrolled in the Qualified Medicare Beneficiary Program as defined in section 6408(d)(2) of the Federal Omnibus Budget Reconciliation Act of 1989, Public Law 101-239, or full Medicaid (ARM 37.83.802), and no longer qualifies due to income or eligibility changes; or

(i) the individual becomes eligible for benefits under Medicare Part A and B by reason of disability.

(3) The guaranteed issue time period:

(a) for an individual described in (2)(a):

(i) begins on the later of:

(A) the date the individual receives a notice of termination or cessation of some or all supplemental health benefits (or, if a notice is not received, notice that a claim has been denied because of such a termination or cessation); or

(B) the date that the applicable coverage terminates or ceases;

(ii) ends 63 days after the applicable notice;

(b) for an individual described in (2)(b), (c), (e), (f), or (h), whose enrollment is terminated involuntarily, begins on the date that the individual receives a notice of termination and ends 63 days after the date the applicable coverage is terminated;

(c) for an individual described in (2)(d)(i) or (ii):

(i) begins on the earlier of:

(A) the date that the individual receives a notice of termination, a notice of the issuer's bankruptcy or insolvency, or other similar notice if any; or

(B) the date that the applicable coverage is terminated;

(ii) and ends on the date that is 63 days after the date the coverage is terminated;

(d) for an individual described in (2)(b), (d)(iii), (e), or (f) who disenrolls voluntarily, begins on the date that is 60 days before the effective date of the disenrollment and ends on the date that is 63 days after the effective date;

(e) for an individual described in (2)(g), begins on the date the individual receives notice pursuant to section 1882(v)(2)(B) of the Social Security Act from the Medicare supplement issuer during the 60-day period immediately preceding the initial Part D enrollment period and ends on the date that is 63 days after the effective date of the individual's coverage under Medicare Part D;

(f) for an individual described in (2) but not described in the preceding provisions of (3), begins on the effective date of disenrollment and ends on the day that is 63 days after the effective date; and

(g) for an individual described in (2)(i), begins on the date the individual is informed of the individual's eligibility for Medicare by reason of disability and end 63 days after that date.

(4) An individual is entitled to an extension of the guarantee issue time periods for Medicare supplement and Medicare select access if there is an interrupted trial period, as follows:

(a) if an individual described in (2)(e) (or deemed to be so described, pursuant to this subsection) whose enrollment with an organization or provider described in (2)(e)(i) is involuntarily terminated within the first 12 months of enrollment, and who, without an intervening enrollment, enrolls with another such organization or provider, then the subsequent enrollment shall be deemed to be an initial enrollment described in (2)(e);

(b) if an individual described in (2)(f) (or deemed to be so described, pursuant to this subsection) whose enrollment with a plan or in a program described in (2)(f) is involuntarily terminated within the first 12 months of enrollment, and who, without an intervening enrollment, enrolls in another such plan or program, then the subsequent enrollment shall be deemed to be an initial enrollment described in (2)(f); and

(c) for purposes of (2)(e) and (f), no enrollment of an individual with an organization or provider described in (2)(e)(i), or with the plan or in a program described in (2)(f), may be deemed to be an initial enrollment under this subsection after the two-year period beginning on the date on which the individual first enrolled with such an organization, provider, plan or program.

(5) The following describe the type of Medicare supplement policy which must be issued to an eligible person:

(a) an eligible person defined in (2)(a), (b), (c), or (d) is entitled to the issuance of a Medicare supplement policy which has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K, or L offered by any issuer;

(b) subject to (5)(c), an eligible person defined in (2)(e) is entitled to the issuance of the same Medicare supplement policy in which the eligible person was most recently enrolled, if available from the issuer, or, if not so available, a policy described in (5)(a);

(c) after December 31, 2005, an individual who was most recently enrolled in a Medicare supplement policy with an outpatient prescription drug benefit and who elects to enroll in Part D, is entitled to the issuance of a Medicare supplement policy described as follows:

(i) the same policy from the same issuer but modified to remove outpatient prescription drug coverage; or

(ii) at the election of the policyholder, an A, B, C, F (including F with high deductible), K, or L policy that is offered by any issuer;

(d) an eligible person defined in (2)(f), (h), or (i)�is entitled to the issuance of any Medicare supplement policy offered by any issuer;

(e) An eligible person defined in (2)(g) is entitled to the issuance of a Medicare supplement policy that has a benefit package classified as Plan A, B, C, F (including F with a high deductible), K, or L, and that is offered and is available for issuance to new enrollees by the same issuer that issued the individual's Medicare supplement policy with outpatient prescription drug coverage. However, if the eligible person wishes to enroll in an A, B, C, F (including high deductible F), K, or L and that issuer does not offer that plan, then the eligible person is entitled to have that plan issued by any issuer who makes it available for sale to new enrollees in Montana.

(6) The following establish standards for notification upon termination and disenrollment:

(a) at the time of an event described in (2) because of which an individual loses coverage or benefits due to the termination of a contract or agreement, policy, or plan, the organization that terminates the contract or agreement, the issuer terminating the policy, or the administrator of the plan being terminated, respectively, shall notify the individual of his or her rights under this rule, and of the obligations of issuers of Medicare supplement policies under (1). Such notice shall be communicated contemporaneously with the notification of termination.

(b) at the time of an event described in (2) because of which an individual ceases enrollment under a contract or agreement, policy, or plan, the organization that offers the contract or agreement, regardless of the basis of the cessation of enrollment, the issuer offering the policy, or the administrator of the plan, respectively, shall notify the individual of his or her rights under this rule, and of the obligations of issuers of Medicare supplement policies under (1). Such notice shall be communicated within ten working days of the issuer receiving notification of disenrollment.

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(1) The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate with an effective date for coverage on or after June 1, 2010, unless it complies with these benefit standards. No issuer may offer any 1990 Standardized Medicare Supplement Benefit Plan for sale on or after June 1, 2010. Benefit standards applicable to Medicare supplement policies and certificates issued with an effective date for coverage before June 1, 2010, remain subject to the requirements of ARM 6.6.507 and other applicable rules and statutes contained in this subchapter and Title 33, chapter 22, part 9, MCA.

(a) The following standards are in addition to all other requirements of this subchapter and Title 33, chapter 22, part 9, MCA, Medicare Supplement Insurance Minimum Standards:

(i) a Medicare supplement policy or certificate must not exclude or limit benefits for a loss incurred more than six months from the effective date of coverage because it involves a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than a condition for which medical advice was given or treatment was recommended by or received from a physician within six months before the effective date of coverage;

(ii) a Medicare supplement policy or certificate must not indemnify against losses resulting from sickness on a different basis than losses resulting from accidents;

(iii) a Medicare supplement policy or certificate must provide that benefits designed to cover cost sharing amounts under Medicare will be changed automatically to coincide with any changes in the applicable Medicare deductible copayment, or coinsurance amounts. Premiums may be modified to correspond with such changes;

(iv) no Medicare supplement policy or certificate may provide for termination of coverage of a spouse solely because of the occurrence of an event specified for termination of coverage of the insured other than the nonpayment of premium;

(v) each Medicare supplement policy shall be guaranteed renewable and:

(A) the issuer shall not cancel or nonrenew the policy solely on the ground of health status of the individual; and

(B) the issuer shall not cancel or nonrenew the policy or certificate for any reason other than nonpayment of premium or material misrepresentation.

(vi) if the Medicare supplement policy is terminated by the group policyholder and is not replaced as provided under (1)(a)(viii), the issuer must offer certificateholders an individual Medicare supplement policy which (at the option of the certificateholder):

(A) provides for continuation of the benefits contained in the group policy; or

(B) provides for such benefits that meet the requirements of this subsection.

(vii) if an individual is a certificateholder in a group Medicare supplement policy and the individual terminates membership in the group, the issuer shall:

(A) offer the certificateholder the conversion opportunity described in (1)(a)(vi); or

(B) at the option of the group policyholder, offer the certificateholder continuation of coverage under the group policy.

(viii) if a group Medicare supplement policy is replaced by another group Medicare supplement policy purchased by the same policyholder, the issuer of the replacement policy shall offer coverage to all persons covered under the old group policy on its date of termination. Coverage under the new policy must not result in any exclusion for preexisting conditions that would have been covered under the group policy being replaced.

(2) Termination of a Medicare supplement policy or certificate must be without prejudice to any continuous loss which commenced while the policy was in force, but the extension of benefits beyond the period during which the policy was in force may be conditioned upon the continuous total disability of the insured, limited to the duration of the policy benefit period, if any, or payment of the maximum benefits. Receipt of Medicare Part D benefits will not be considered in determining a continuous loss.

(3) A Medicare supplement policy or certificate must provide that benefits and premiums under the policy or certificate must be suspended at the request of the policyholder or certificateholder for the period (not to exceed 24 months) in which the policyholder or certificateholder has applied for and is determined to be entitled to medical assistance under Title XIX of the Social Security Act, but only if the policyholder or certificateholder notifies the issuer of such policy or certificate within 90 days after the date the individual becomes entitled to such assistance. Upon receipt of timely notice, the issuer must either return to the policyholder or certificateholder that portion of the premium attributable to the period of Medicaid eligibility, or provide coverage to the end of the term for which premiums were paid, at the option of the insured, subject to adjustment for paid claims:

(a) if such suspension occurs and if the policyholder or certificateholder loses entitlement to such medical assistance, such policy or certificate must be automatically reinstituted effective as of the date of termination of such entitlement if the policyholder or certificateholder provides notice of loss of such entitlement within 90 days after the date of such loss and pays the premium attributable to the period, effective as of the date of the termination of entitlement;

(b) each Medicare supplement policy or certificate must provide that benefits and premiums under the policy must be suspended (for any period that may be provided by Federal regulation) at the request of the policyholder or certificateholder if the policyholder or certificateholder is entitled to benefits under 226(b) of the Social Security Act and is covered under a group health plan (as defined in 1862(b)(1)(A)(v) of the Social Security Act). If suspension occurs and if the policyholder or certificateholder loses coverage under the group health plan, the policy shall be automatically reinstituted (effective as of the date of loss of coverage) if the policyholder or certificateholder provides notice of loss of coverage within 90 days after the date of loss of coverage;

(c) reinstitution of coverages as described in (3)(a) and (b) must:

(i) not provide for any limitation with respect to treatment of preexisting conditions;

(ii) provide for resumption of coverage that is substantially equivalent to coverage in effect before the date of suspension; and

(iii) provide for classification of premiums on terms at least as favorable to the policyholder or certificateholder as the premium classification terms that would have applied to the policyholder or certificateholder had the coverage not been suspended.

(4) Standards for basic ("core") benefits common to benefit Plans A, B, C, D, F, F with High Deductible, G, M, and N include the following:

(a) every issuer shall make available a policy or certificate including only the following basic "core" package of benefits to each prospective insured. An issuer may make available to prospective insureds any of the other Medicare supplement insurance benefit plans in addition to the basic "core" package, but not in lieu thereof:

(i) coverage of Part A Medicare eligible expenses incurred for hospitalization to the extent not covered by Medicare from the 61st day through the 90th day in any Medicare benefit period;

(ii) coverage of Part A Medicare eligible expenses for hospitalization to the extent not covered by Medicare for each Medicare lifetime inpatient reserve day used;

(iii) upon exhaustion of the Medicare hospital inpatient coverage, including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for any balance;

(iv) coverage under Medicare Parts A and B for the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under Federal regulations) unless replaced in accordance with Federal regulations;

(v) coverage for the coinsurance amount (or in the case of hospital outpatient department services paid under a prospective payment system, the copayment amount) of Medicare eligible expenses under Part B regardless of hospital confinement, subject to the Medicare Part B deductible; and

(vi) coverage of cost sharing for all Part A Medicare eligible hospice care and respite care expenses.

(b) The following additional benefits must be included in Medicare Supplement Benefit Plans B, C, D, F, and F with High Deductible, G, M, and N as provided by ARM 6.6.507E:

(i) coverage for 100% of the Medicare Part A inpatient hospital deductible amount per benefit period;

(ii) coverage for 50% of the Medicare Part A inpatient hospital deductible amount per benefit period;

(iii) coverage for the actual billed charges up to the coinsurance amount from the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A;

(iv) coverage for all of the Medicare Part B deductible amount per calendar year regardless of hospital confinement;

(v) coverage for all of the difference between the actual Medicare Part B charge as billed, not to exceed any charge limitation established by the Medicare program or state law, and the Medicare-approved Part B charge; and

(vi) coverage to the extent not covered by Medicare for 80% of the billed charges for Medicare-eligible expenses for medically necessary emergency hospital, physician and medical care received in a foreign country, which care would have been covered by Medicare if provided in the United States and which care began during the first 60 consecutive days of each trip outside the United States, subject to a calendar year deductible of $250, and a lifetime maximum benefit of $50,000. For purposes of this benefit, "emergency care" shall mean care needed immediately because of an injury or an illness of sudden and unexpected onset.

(1) The following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state with an effective date for coverage on or after June 1, 2010. No policy or certificate may be advertised, solicited, delivered or issued for delivery in this state as a Medicare supplement policy or certificate unless it complies with these benefit plan standards. Benefit plan standards applicable to Medicare supplement policies and certificates with an effective date for coverage before June 1, 2010, remain subject to the requirements of ARM 6.6.507A.

(2) An issuer shall make available to each prospective policyholder and certificateholder a policy form or certificate form containing only the basic "core" benefits, as established in ARM 6.6.507D(4).

(3) If an issuer makes available any of the additional benefits described in ARM 6.6.507D(4)(b) or offers standardized benefits Plans K or L (as described in ARM 6.6.507E(8)(a) and (b) of this subchapter), then the issuer shall make available to each prospective policyholder and certificateholder, in addition to a policy form or certificate form with only the basic core benefits as described in (2), a policy form or certificate form containing either Standardized Benefit Plan C (as described in ARM 6.6.507E(7)(c) of this subchapter) or Standardized Benefit Plan F (as described in ARM 6.6.507E(7)(e) of this subchapter).

(4) No groups, packages, or combinations of Medicare supplement benefits other than those listed in this rule shall be offered for sale in this state, except as may be permitted in ARM 6.6.507E(11) and ARM 6.6.601-614 of these rules.

(5) Benefit plans must be uniform in structure, language, designation and format to the standard benefit plans listed in this rule and conform to the definitions in 33-22-903, MCA, and ARM 6.6.505. Each benefit shall be structured in accordance with the format provided in ARM 6.6.507D(4)(a) and (b); or in the case of Plans K or L, in ARM 6.6.507E(8)(a) and (b), and list the benefits in the order shown in this rule. For purposes of this rule, "structure, language, and format" means style, arrangement and overall content of a benefit.

(6) An issuer may use, in addition to the benefit plan designations required in (5), other designations to the extent permitted by law.

(7) The following descriptions detail the contents of the 2010 standardized benefit plans:

(a) Standardized Medicare Supplement Benefit Plan A must be limited to the basic ("core") benefits common to all benefit plans, as established in ARM 6.6.507D(4)(a);

(b) Standardized Medicare Supplement Benefit Plan B must include only the core benefit as established in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible as established in ARM 6.6.507D(4)(b)(i).

(c) Standardized Medicare Supplement Benefit Plan C must include only the core benefit, as established in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing facility care, 100% of the Medicare Part B deductible, and medically necessary emergency care in a foreign country as established in ARM 6.6.507D(4)(b)(i), (iii), (iv), and (vi), respectively.

(d) Standardized Medicare Supplement Benefit Plan D must include only the core benefit, as established in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country, as established in ARM 6.6.507D(4)(b)(i), (iii), and (vi), respectively.

(e) Standardized Medicare Supplement Benefit regular Plan F must include only the core benefit as established in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing facility care, 100% of the Medicare Part B deductible, 100% of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country, established in ARM 6.6.507D(4)(b)(i), (iii), (iv), (v), and (vi), respectively.

(f) Standardized Medicare Supplement Benefit High Deductible Plan F shall include only 100% of covered expenses following the payment of the annual High Deductible Plan F deductible.

(i) ″Covered expenses″ for this subsection are the core benefit as defined in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing facility care, 100% of the Medicare Part B deductible, 100% of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as defined in ARM 6.6.507D(4)(b)(i), (iii), (iv), (v), and (vi), respectively.

(ii) The ″annual high deductible Plan F deductible″ must consist of out-of-pocket expenses, other than premiums, for services covered by the Medicare supplement regular Plan F policy, and must be in addition to any other specific benefit deductibles. The basis for the deductible will be $1500 and will be adjusted annually from 1999 by the Secretary to reflect the change in the consumer price index for all urban consumers for the 12-month period ending with August of the preceding year, and rounded to the nearest multiple of $10.

(g) Standardized Medicare Supplement Benefit Plan G must include only the core benefit as established in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing facility care, 100% of the Medicare Part B excess charges, and medically necessary emergency care in a foreign country as established in ARM 6.6.507D(4)(b)(i), (iii), (v), and (vi), respectively. Effective January 1, 2020, the standardized benefit plans described in ARM 6.6.507F(2)(d) (Redesignated Plan G High Deductible) may be offered to any individual who was eligible for Medicare prior to January 1, 2020.

(8) The following descriptions detail the contents of two Medicare supplement plans authorized by the MMA:

(a) Standardized Medicare Supplement Benefit Plan K must consist of only the following benefits:

(i) coverage of 100% of the Part A hospital coinsurance amount for each day used from the 61st day through the 90th day in any Medicare benefit period;

(ii) coverage of 100% of the Part A hospital coinsurance amount for each Medicare lifetime inpatient reserve day used from the 91st through the 150th day in any Medicare benefit period;

(iii) upon exhaustion of the Medicare hospital inpatient coverage including the lifetime reserve days, coverage of 100% of the Medicare Part A eligible expenses for hospitalization paid at the applicable prospective payment system (PPS) rate, or other appropriate Medicare standard of payment, subject to a lifetime maximum benefit of an additional 365 days. The provider shall accept the issuer's payment as payment in full and may not bill the insured for the balance;

(iv) coverage for 50% of the Medicare Part A inpatient hospital deductible amount per benefit period until the out-of-pocket limitation is met as described in (x);

(v) coverage for 50% of the coinsurance amount for each day used for the 21st day through the 100th day in a Medicare benefit period for post-hospital skilled nursing facility care eligible under Medicare Part A until the out-of-pocket limitation is met as described in (x);

(vi) coverage for 50% of cost sharing for all Part A Medicare eligible expenses and respite care until the out-of-pocket limitation is met as described in (x);

(vii) coverage for 50%, under Medicare Part A or B of the reasonable cost of the first three pints of blood (or equivalent quantities of packed red blood cells, as defined under Federal regulations) unless replaced in accordance with Federal regulations until the out-of-pocket limitation is met as described in (x);

(viii) except for coverage provided in (ix) of this subsection, coverage for 50% of the cost sharing otherwise applicable under Medicare Part B after the policyholder or certificateholder pays the Part B deductible until the out-of-pocket limitation is met as described in (x);

(ix) coverage of 100% of the cost sharing for Medicare Part B preventative services after the policyholder pays the Part B deductible; and

(x) coverage of 100% of all cost sharing under Medicare Parts A and B for the balance of the calendar year after the individual has reached the out-of-pocket limitation on annual expenditures under Medicare Parts A and B of $4000 in 2006, indexed each year by the appropriate inflation adjustment specified by the Secretary.

(b) Standardized Medicare Supplement Benefit Plan L must consist of only the following benefits:

(i) the benefits described in (8)(a)(i), (ii), (iii), and (ix);

(ii) the benefit described in (8)(a)(iv), (v), (vi), (vii) and (viii), but substituting 75% for 50%; and

(iii) the benefit described in (8)(a)(x), but substituting $2000 for $4000.

(9) Standardized Medicare Supplement Plan M shall include only the basic (core) benefit as defined in ARM 6.6.507D(4)(a), plus 50% of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country, as defined in ARM 6.6.507D(4)(b)(ii), (iii), and (vi), respectively.

(10) Standardized Medicare Supplement Plan N shall include only the basic (core) benefit as defined in ARM 6.6.507D(4)(a), plus 100% of the Medicare Part A deductible, skilled nursing facility care, and medically necessary emergency care in a foreign country, as defined in ARM 6.6.507D(4)(b)(i), (iii), and (vi), respectively, with copayments in the following amounts:

(a) the lesser of $20 or the Medicare Part B coinsurance or copayment for each covered health care provider office visit (including visits to medical specialist); and

(b) the lesser of $50 or the Medicare Part B coinsurance or copayment for each covered emergency room visit, however, the copayment shall be waived if the insured is admitted to any hospital and the emergency visit is subsequently covered as a Medicare Part A expense.

(11) An issuer may, with the prior approval of the commissioner, offer policies or certificates with new or innovative benefits in addition to the standardized benefits provided in a policy or certificate that otherwise complies with the applicable standards. The new or innovative benefits must include only benefits that are appropriate to Medicare supplement insurance, are new or innovative, are not otherwise available, are cost-effective, and are offered in a manner which is consistent with the goal of simplification of Medicare supplement policies. New or innovative benefits must not include an outpatient prescription drug benefit. New or innovative benefits may not be used to change or reduce benefits, including a change of any cost-sharing provision, in any standardized plan.

(1) The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) requires that the following standards are applicable to all Medicare supplement policies or certificates delivered or issued for delivery in this state to individuals newly eligible for Medicare on or after January 1, 2020. No policy or certificate that provides coverage of the Medicare part B deductible may be advertised, solicited, delivered, or issued for delivery in this state as a Medicare supplement policy or certificate to individuals newly eligible for Medicare on or after January 1, 2020. All policies must comply with the following benefit standards. Benefit plan standards applicable to Medicare supplement policies and certificates issued to individuals eligible for Medicare before January 1, 2020, remain subject to the requirements of the appropriate rules of this subchapter.

(2) The standards and requirements of ARM 6.6.507E shall apply to all Medicare supplement policies or certificates delivered or issued for delivery to individuals newly eligible for Medicare on or after January 1, 2020, with the following exceptions:

(a) Standardized Medicare supplement benefit Plan C is redesignated as Plan D and shall provide the benefits contained in ARM 6.6.507E(7)(c) but shall not provide coverage for 100% or any portion of the Medicare Part B deductible.

(b) Standardized Medicare supplement benefit Plan F is redesignated as Plan G and shall provide the benefits contained in ARM 6.6.507E(7)(e) but shall not provide coverage for 100% or any portion of the Medicare Part B deductible.

(c) Standardized Medicare supplement benefit Plans C, F, and F with High Deductible may not be offered to individuals newly eligible for Medicare on or after January 1, 2020.

(d) Standardized Medicare supplement benefit Plan F With High Deductible is redesignated as Plan G With High Deductible and shall provide the benefits contained in ARM 6.6.507E(7)(g) but shall not provide coverage for 100% or any portion of the Medicare Part B deductible. However, the Medicare Part B deductible paid by the beneficiary shall be considered an out-of-pocket expense in meeting the annual high deductible.

(e) The reference to Plans C or F contained in ARM 6.6.507E(3) is deemed a reference to Plans D or G for purposes of this rule.

(3) This rule applies to only individuals that are newly eligible for Medicare on or after January 1, 2020:

(a) by reason of attaining age 65 on or after January 1, 2020; or

(b) by reason of entitlement to benefits under part A pursuant to section 226(b) or 226A of the Social Security Act, or who is deemed to be eligible for benefits under section 226(a) of the Social Security Act on or after January 1, 2020.

(4) For purposes of ARM 6.6.507C, in the case of any individual newly eligible for Medicare on or after January 1, 2020, any reference to a Medicare supplement policy C or F (including F With High Deductible) shall be deemed to be a reference to Medicare supplement policy D or G (including G With High Deductible), respectively, that meet the requirements of this rule.

(5) In the case of a State described in Section 1882(p)(6) of the Social Security Act (″waivered″ alternative simplification states) MACRA prohibits the coverage of the Medicare Part B deductible for any Medicare supplement policy sold or issued to an individual that is newly eligible for Medicare on or after January 1, 2020.

(6) On or after January 1, 2020, the standardized benefit plans described in (2)(d) may be offered to any individual who was eligible for Medicare prior to January 1, 2020, in addition to the standardized plans described in ARM 6.6.507E(7).

(1) A Medicare supplement policy form or certificate form must not be delivered or issued for delivery unless the policy form or certificate form can be expected, as estimated for the entire period for which rates are computed to provide coverage, to return to policyholders and certificateholders in the form of aggregate benefits (not including anticipated refunds or credits) provided under the policy form or certificate form:

(a) at least 75% of the aggregate amount of premiums earned in the case of group policies; or

(b) at least 65% of the aggregate amount of premiums earned in the case of individual policies.

(2) For purposes of (1), the loss ratio must be calculated on the basis of incurred claims experience or incurred health care expenses where coverage is provided by a health maintenance organization on a service rather than reimbursement basis and earned premiums for the period and in accordance with accepted actuarial principles and practices. Incurred health care expenses where coverage is provided by a health maintenance organization must not include:

(a) home office and overhead costs;

(b) advertising costs;

(c) commissions and other acquisition costs;

(d) taxes;

(e) capital costs;

(f) administrative costs; or

(g) claims processing costs.

(3) All filings of rates and rating schedules must demonstrate that expected claims in relation to premiums comply with the requirements of this rule when combined with actual experience to date. Filings of rate revisions must also demonstrate that the anticipated loss ratio over the entire future period for which the revised rates are computed to provide coverage can be expected to meet the appropriate loss ratio standards.

(4) The experience used to calculate an expected loss ratio must be the separate experience of any plan. However, if there is more than one Plan H, I, or J because of the requirements of the MMA, the experience of each plan issued before September 9, 2005, and of each H, I, or J Plan issued on or after September 9, 2005, must be combined for the purpose of determining the expected loss ratio. The experience must also be provided separately for each of these plans for the department's records.

(5) For policies issued prior to September 30, 1993, expected claims in relation to premiums shall meet:

(a) the originally filed anticipated loss ratio when combined with the actual experience since inception;

(b) the appropriate loss ratio requirement from (1)(a) and (b) when combined with actual experience beginning with June 21, 1996 to date; and

(c) the appropriate loss ratio requirement from (1)(a) and (b) over the entire future period for which the rates are computed to provide coverage.

(6) Annual reporting and refund or credit calculations must conform to the following requirements:

(a) an issuer shall collect and file with the commissioner by May 31 of each year the data contained in the reporting form contained in ARM 6.6.524 for each type in a standard Medicare supplement benefit plan;

(b) if, on the basis of the experience as reported, the benchmark ratio since inception (ratio 1) exceeds the adjusted experience ratio since inception (ratio 3), then a refund or credit calculation is required. The refund calculation (see ARM 6.6.524) must be done on a statewide basis for each type in a standard Medicare Supplement Benefit Plan. For purposes of the refund or credit calculation, experience on policies issued within the reporting year shall be excluded;

(c) for the purposes of this subsection, for policies or certificates issued prior to September 30, 1993, the issuer shall make the refund or credit calculation separately for all individual policies combined and all group policies combined for experience after February 13, 2004; and

(d) a refund or credit must be made only when the benchmark loss ratio exceeds the adjusted experience loss ratio and the amount to be refunded or credited exceeds a de minimis level. The refund shall include interest from the end of the calendar year to the date of the refund or credit at a rate specified by the secretary, but in no event shall it be less than the average rate of interest for 13-week treasury notes. A refund or credit against premiums due shall be made by September 30 following the experience year upon which the refund or credit is based.

(7) An issuer of Medicare supplement policies and certificates issued before or after the effective date of these rules in this state must file annually its rates, rating schedule, and supporting documentation including ratios of incurred losses to earned premiums by policy duration for approval by the commissioner in accordance with the filing requirements and procedures prescribed by the commissioner, demonstrating that it is in compliance with the foregoing. The supporting documentation must also demonstrate in accordance with actuarial standards of practice using reasonable assumptions that the appropriate loss ratio standards can be expected to be met over the entire period for which rates are computed. Such demonstration must exclude active life reserves. An expected third-year loss ratio which is greater than or equal to the applicable percentage shall be demonstrated for policies or certificates in force less than three years.

(8) As soon as practicable, but prior to the effective date of enhancements in Medicare benefits, every issuer of Medicare supplement policies or certificates in the state must file with the commissioner, in accordance with the applicable filing procedures of this state:

(a) appropriate premium adjustments necessary to produce loss ratios as anticipated for the current premium for the applicable policies or certificates; and

(b) any appropriate riders, endorsements, or policy forms needed to accomplish the Medicare supplement policy or certificate modifications necessary to eliminate benefit duplications with Medicare. The riders, endorsements, or policy forms shall provide a clear description of the Medicare supplement benefits provided by the policy or certificate.

(9) As required by (9), an issuer must make such premium adjustments necessary to produce an expected loss ratio under the policy or certificate to conform with minimum loss ratio standards for Medicare supplement policies and which are expected to result in a loss ratio at least as great as that originally anticipated in the rates used to produce current premiums by the issuer for the Medicare supplement policies or certificates. No premium adjustment which would modify the loss ratio experience under the policy, other than the adjustments described in this rule, should be made with respect to a policy at any time other than upon its renewal date or anniversary date. Any premium adjustment filings must include all necessary supporting documents to justify the adjustment.

(10) If an issuer fails to make premium adjustments acceptable to the commissioner, the commissioner may order premium adjustments, refunds, or premium credits deemed necessary to achieve the loss ratio required by this rule.

(11) The commissioner may conduct a public hearing to gather information concerning a request by an issuer for an increase in a rate for a policy form or certificate form issued before or after the effective date of this rule if the experience of the form for the previous reporting period is not in compliance with the applicable loss ratio standard. Any determination of compliance should be made without consideration of any refund or credit for the reporting period. Public notice of the hearing shall be furnished in a manner deemed appropriate by the commissioner.

(1) An issuer may not deliver, or issue for delivery, a policy or certificate to a resident of this state unless the policy form or certificate has been filed with and approved by the commissioner in accordance with filing requirements and procedures prescribed by the commissioner.

(a) An issuer's name must be as prominently displayed as the name of the association, tradename, or other sponsoring organization.

(b) The policy and certificate must be identified by the proper plan designation letter which must be included anywhere in the form number for the policy.

(2) An issuer must file any riders or amendments to policy or certificate forms to delete outpatient prescription drug benefits as required by the MMA with the commissioner in the state in which the policy or certificate was issued.

(3) An issuer shall not use or change premium rates for a Medicare supplement policy or certificate unless the rates, rating schedule, and supporting documentation, together with the outline of coverage, have been filed with and approved by the commissioner in accordance with the filing requirements and procedures adopted by the commissioner.

(4) Except as provided in (4)(a), an issuer shall not file for approval more than one form of a policy or certificate of each type for each standard Medicare supplement benefit plan.

(a) An issuer may offer, with the approval of the commissioner, up to four additional policy forms or certificate forms of the same type for the same standard Medicare supplement benefit plan, one for each of the following cases:

(i) the inclusion of new or innovative benefits;

(ii) the addition of either direct response or agent marketing methods;

(iii) the addition of either guaranteed issue or underwritten coverage; or

(iv) the offering of coverage to individuals eligible for Medicare by reason of disability.

(b) For the purposes of this rule, a "type" means an individual policy, a group policy, an individual Medicare select policy, or a group Medicare select policy.

(5) Except as provided in (5)(a), an issuer shall continue to make available for purchase any policy form or certificate form issued after the effective date of this rule that has been approved by the commissioner. A policy form or certificate form shall not be considered to be available for purchase unless the issuer has actively offered it for sale in the previous 12 months.

(a) An issuer may discontinue the availability of a policy form or certificate form if the issuer provides to the commissioner in writing its decision at least 30 days prior to discontinuing the availability of the form of the policy or certificate. After receipt of the notice by the commissioner, the issuer shall no longer offer for sale the policy form or certificate form in this state.

(b) An issuer that discontinues the availability of a policy form or certificate form pursuant to (5)(a) may not file for approval a new policy form or certificate form of the same type for the same standard Medicare supplement benefit plan as the discontinued form for a period of five years after the issuer provides notice to the commissioner of the discontinuance. The period of discontinuance may be reduced if the commissioner determines that a shorter period is appropriate.

(c) The sale or other transfer of Medicare supplement business to another issuer shall be considered a discontinuance for the purposes of this subsection.

(d) Any change in the rating structure or methodology shall be considered a discontinuance under (5) unless the issuer complies with the following requirements:

(i) the issuer provides an actuarial memorandum, in a form and manner prescribed by the commissioner, describing the manner in which the revised rating methodology and resultant rates differ from the existing rating methodology and existing rates; and

(ii) the issuer does not subsequently put into effect a change of rates or rating factors that would cause the percentage differential between the discontinued and subsequent rates as described in the actuarial memorandum to change. The commissioner may approve a change to the differential which is in the public interest.

(6) The experience of all policy forms or certificate forms of the same type in a standard Medicare supplement benefit plan must be combined for purposes of the refund or credit calculation prescribed in ARM 6.6.508, except that forms assumed under an assumption reinsurance agreement shall not be combined with the experience of other forms for purposes of the refund or credit calculation.

(7) An issuer may not file a rate structure for its Medicare supplement policies and certificates after January 1, 2006, based upon a structure or methodology with any groupings of attained ages greater than one year for each year the rate increases. The rate change may be flat at the beginning and end of the rate structure, but otherwise the ratio between rates for successive ages must exhibit a smooth pattern as age increases. For example, the commissioner may allow a rate structure that has the same rate for policyholders younger than 68, a rate that smoothly increases some percentage each successive year through age 90, and then maintains the same rate for policyholders older than 90.

(8) An issuer has the option of offering Medicare supplement policies on an attained age basis, issue age basis, or a dual rating basis. Only one of those rating methodologies may be chosen per Medicare supplement benefit policy form, except as provided in (4)(a).

(a) Regardless of the rating methodology chosen, an issuer must provide adequate information to consumers so they may make informed decisions on their Medicare supplement purchases.

(b) If an issuer elects to offer dual rating, the issuer must:

(i) provide a choice between an issue age or attained age rating methodology to individual policyholders, for individual policies, or to group policyholders (not certificate holders) for group policies;

(ii) develop materials which disclose both rating methodologies, including how the methodologies differ in the near term and the long term;

(iii) provide the same commission for both methodologies;

(iv) allow consumers to switch from an attained age rating methodology to an issue age rating methodology; and

(v) prohibit consumers from switching from an issue age rating methodology to an attained age rating methodology.

(1) Medicare supplement policies and certificates must include a renewal or continuation provision.  The language or specifications of the provision must be consistent with the type of contract to be issued.  The provision must be appropriately captioned, must appear on the first page of the policy, and must include any reservation by the issuer of the right to change premiums and any automatic renewal premium increases based on the policyholder's age.

(2) Except for riders or endorsements by which the issuer effectuates a request made in writing by the insured or exercises a specifically reserved right under a Medicare supplement policy, or is required to reduce or eliminate benefits to avoid duplication of Medicare benefits, all riders or endorsements added to a Medicare supplement policy after date of issue or at reinstatement or renewal which reduce or eliminate benefits or coverage in the policy must require a signed acceptance by the insured.  After the date of policy or certificate issue, any rider or endorsement that increases benefits or coverage with a concomitant increase in premium during the policy term must be agreed to in writing and signed by the insured, unless the increased benefits or coverage are required by the minimum standards for Medicare supplement policies, or if the increased benefits or coverage is required by law.  If a separate additional premium is charged for benefits provided in connection with riders or endorsements, the premium charge must be set forth in the policy.

(3) Medicare supplement policies or certificates must not provide for the payment of benefits based on standards described as "usual and customary," "reasonable and customary," or words of similar import.

(4) If a Medicare supplement policy or certificate contains any limitations with respect to preexisting conditions, the limitations must appear as a separate paragraph of the policy and be labeled as "Preexisting Condition Limitations".

(5) Medicare supplement policies and certificates must have notices prominently printed on the first page of the policy or certificate or attached thereto stating in substance that the policyholder or certificateholder shall have the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if, after examination of the policy or certificate the insured person is not satisfied for any reason.

(6) Issuers of accident and sickness policies or certificates or subscriber contracts that provide hospital or medical expense coverage on an expense incurred or indemnity basis to persons eligible for Medicare must provide to such applicants a Medicare supplement "buyer's guide".  This may be the pamphlet entitled "Guide to Health Insurance for People with Medicare," developed jointly by the national association of insurance commissioners and the center for Medicaid and Medicare services (CMS) of the U.S. Department of Health and Human Services, or any reproduction or official revision of that pamphlet in a type size no smaller than 12 point type.  The "buyer’s guide" must conform to the language, format, type size, type proportional spacing, bold character, and line spaces as specified in Appendix C of the NAIC Model Regulation (see ARM 6.6.526).

(a) Delivery of the "buyer's guide" must be made whether or not such policies or certificates are advertised, solicited, or issued as Medicare supplement policies or certificates as defined in this rule.  Except in the case of direct response issuers, delivery of the "buyer's guide" must be made to the applicant at the time of application and acknowledgment of receipt of the "buyer's guide" must be obtained by the issuer.  Direct response issuers must deliver the "buyer's guide" to the applicant upon request but not later than at the time the policy is delivered.

(7) As soon as practicable, but no later than 30 days prior to the annual effective date of any Medicare benefit changes, an issuer shall notify its policyholders and certificateholders of modifications it has made to Medicare supplement insurance policies or certificates in a format acceptable to the commissioner.  Such notice must:

(a) include a description of revisions to the Medicare program and a description of each modification made to the coverage provided under the Medicare supplement policy or certificate; and

(b) inform each policyholder or certificateholder as to when any premium adjustment is to be made due to changes in Medicare;

(c) The notice of benefit modifications and any premium adjustments shall be in outline form and in clear and concise terms so as to facilitate comprehension; and

(d) Such notices must not contain, or be accompanied by, any solicitation.

(8) Issuers shall comply with any notice requirements of the MMA.

(9) Issuers shall provide an outline of coverage to each applicant at the time application is presented to the prospective applicant and, except for direct response policies, shall obtain an acknowledgment of receipt of such outline from the applicant:

(a) If an outline of coverage is provided at the time of application and the Medicare supplement policy or certificate is issued on a basis which would require revision of the outline, a substitute outline of coverage properly describing the policy or certificate must accompany such policy or certificate when it is delivered and contain the following statement, in no less than 12 point bold type, immediately above the company name:

            "NOTICE:  Read this outline of coverage carefully.  It is not identical to the outline of coverage provided upon application and the coverage originally applied for has not been issued."

(b) The outline of coverage provided to applicants consists of a cover page, premium information, disclosure pages, and charts displaying the features of each benefit plan offered by the issuer.  The outline of coverage must be in the language and format prescribed below in no less than 12 point type.  All plans must be shown on the cover page, and the plans that are offered by the issuer must be prominently identified.  Premium information for plans that are offered must be shown on the cover page or immediately following the cover page and must be prominently displayed.  The premium and mode shall be stated for all plans that are offered to the prospective applicant.  All possible premiums for the prospective applicant must be illustrated.

(10) The CSI adopts and incorporates by reference the National Association of Insurance Commissioners (NAIC) Model Regulation to Implement the NAIC Medicare Supplement Insurance Minimum Standards Model Act (MDL-651), page 651-42 through page 651-84, which was last adopted in 2023.   Specifically, those pages of the NAIC MDL-651 set forth benefit charts, disclosures to insureds, and outlines of coverage for 2010 or 2020 Medicare supplement plans, as applicable, that must be included in the outline of coverage provided to the consumer in the same order as set forth in NAIC MDL-651, except that asterisks can be represented numerically and asterisked text appearing at the top or beginning of a document can instead appear at the bottom or end of the document. Copies of the NAIC MDL-651 (2023) are available for public inspection online at http://www.naic.org/prod_serv_model_laws.htm and at the Office of the Commissioner of Securities and Insurance, Montana State Auditor, Legal Department, 840 Helena Avenue, Helena, Montana 59601. Persons obtaining a copy of these forms must pay the cost of providing such copies.

(11) Any accident and sickness insurance policy or certificate, other than a Medicare supplement policy; or a policy issued pursuant to a contract under section 1876 or section 1833 of the Federal Social Security Act (42 USC Sec. 1395, et seq.), disability income policy; basic, catastrophic, or major medical expense policy; single premium nonrenewable policy or other policy identified in ARM 6.6.503(2) issued for delivery in this state to persons eligible for Medicare by reason of age must be accompanied by a notice to the insureds under the policy that the policy is not a Medicare supplement policy or certificate. The notice must either be printed on or attached to the first page of the outline of coverage delivered to insureds under the policy, or if no outline of coverage is delivered, to the first page of the policy or certificate delivered to insureds. The notice must be in no less than 12 point type and must contain the following language: "THIS (POLICY OR CERTIFICATE) IS NOT A MEDICARE SUPPLEMENT (POLICY OR CERTIFICATE). If you are eligible for Medicare, review the Medicare Supplement Buyers Guide available from the company."

(12) Applications provided to persons eligible for Medicare for the health insurance policies or certificates described in this rule shall disclose, using the applicable statement in Appendix C of the NAIC Model Regulation, which was incorporated by reference in ARM 6.6.519, the extent to which the policy duplicates Medicare. The disclosure statement shall be provided as a part of, or together with, the application for the policy or certificate.

(1) Application forms must include the following questions designed to elicit information as to whether, as of the date of application, the applicant currently has Medicare supplement, Medicare advantage, Medicaid coverage, or another health policy or certificate in force or whether a Medicare supplement policy or certificate is intended to replace any other accident and sickness policy or certificate presently in force. A supplementary application or other form to be signed by the applicant and producer containing such questions and statements as the following may be used.

�

(STATEMENTS)

�

������� (1) You do not need more than one Medicare supplement policy.

�

������� (2) If you purchase this policy, you may want to evaluate your existing health coverage and decide if you need multiple coverages.

�

������� (3) You may be eligible for benefits under Medicaid and may not need a Medicare supplement policy.

�

������� (4) If, after purchasing this policy, you become eligible for Medicaid, the benefits and premiums under your Medicare supplement policy must be suspended if requested during your entitlement to benefits under Medicaid for 24 months. You must request this suspension within 90 days of becoming eligible for Medicaid. Upon receipt of timely notice, the issuer must either return to the policyholder or certificateholder that portion of the premium attributable to the period of Medicaid eligibility or provide coverage to the end of the term for which premiums were paid, at the option of the insured, subject to adjustment for paid claims. If you are no longer entitled to Medicaid, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstated if requested within 90 days of losing Medicaid eligibility. If the Medicare supplement policy provided coverage for outpatient prescription drugs and you enrolled in Medicare part D while your policy was suspended, the reinstated policy will not have outpatient prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of the suspension.

�

������� (5) If you are eligible for and have enrolled in a Medicare supplement policy by reason of disability and you later become covered by an employer or union-based group health plan, the benefits and premiums under your Medicare supplement policy can be suspended, if requested, while you are covered under the employer or union-based group health plan. If you suspend your Medicare supplement policy under these circumstances, and later lose your employer or union-based group health plan, your suspended Medicare supplement policy (or, if that is no longer available, a substantially equivalent policy) will be reinstated if requested within 90 days of losing your employer or union-based group health plan. If the Medicare supplement policy provided coverage for outpatient prescription drugs and you enrolled in Medicare part D while your policy was suspended, the reinstated policy will not have prescription drug coverage, but will otherwise be substantially equivalent to your coverage before the date of suspension.

�

������� (6) Counseling services may be available in your state to provide advice concerning your purchase of Medicare supplement insurance and concerning medical assistance through the state Medicaid program, including benefits as a Qualified Medicare Beneficiary (QMB) and a Specified Low-Income Medicare Beneficiary (SLMB).

�

(QUESTIONS)

�

If you lost or are losing other health insurance coverage and received a notice from your prior insurer saying you were eligible for guaranteed issue of a Medicare supplement policy, or that you had certain rights to buy such a policy, you may be guaranteed acceptance in one or more of our Medicare supplement plans. Please include a copy of the notice from your prior insurer with your application. PLEASE ANSWER ALL QUESTIONS.

�

[Please mark Yes or No below with an ″X″]

�

To the best of your knowledge:

�

������� (1)(a) Did you turn age 65 in the last 6 months?

YES _____ NO _____

�

������� (b) Did you enroll in Medicare Part B in the last 6 months?

YES _____ NO _____

�

������� (c) If yes, what is the effective date? ___________

�

������� (2)�Are you covered for medical assistance through the state Medicaid program?

[NOTE TO APPLICANT: If you are participating in a ″spend-down″ program and have not met your ″share of cost,″ please answer NO to this question.]

YES _____ NO _____

�

If yes,

������� (a)�Will Medicaid pay your premiums for this Medicare supplement policy?

YES _____ NO _____

�

������� (b) Do you receive any benefits from Medicaid other than payments toward your Medicare Part B premium?

YES _____ NO _____

�

������� (3)(a) If you had coverage from any Medicare plan other than original Medicare within the past 63 days (for example, a Medicare advantage plan, or a Medicare HMO or PPO), fill in your start and end dates below. If you are still covered under this plan, leave ″END″ blank.

Start /�� �/���� End /��� /

�

������� (b) If you are still covered under the Medicare plan, do you intend to replace your current coverage with this new Medicare supplement policy?

YES _____ NO _____

�

������� (c) Was this your first time in this type of Medicare plan?

YES _____ NO _____

�

������� (d) Did you drop a Medicare supplement policy to enroll in the Medicare plan?

YES _____ NO _____

�

������� (4)(a) Do you have another Medicare supplement policy in force?

YES _____ NO _____

�

������� (b) If so, with what company, and what plan do you have [optional for direct mailers]?

_____________________________________________________________

�

������� (c) If so, do you intend to replace your current Medicare supplement policy with this policy?

YES _____ NO _____

�

������� (5) Have you had coverage under any other health insurance within the past 63 days? (For example, an employer, union, or individual plan.)

YES _____ NO _____

�

������� (a) If so, with what company and what kind of policy?

__________________________________________________________________________________________________________________________________________________________________________________________

�

������� (b) What are your dates of coverage under the other policy?

Start /��� /��� �End /�� �/

(If you are still covered under the other policy, leave ″end″ blank.)

�

[End Statements and Questions Form]

�

(2) Producers shall list any other health insurance policies they have sold to the applicant, including:

(a) Policies sold which are still in force; and

(b) Policies sold in the past five years which are no longer in force.

(3) In the case of a direct response issuer, a copy of the application or supplemental form, signed by the applicant, and acknowledged by the insurer, shall be returned to the applicant by the insurer upon delivery of the policy.

(4) Upon determining that a sale will involve replacement of medicare supplement coverage, and prior to the issuance or delivery of the medicare supplement policy or certificate, an issuer, other than a direct response insurer, or its producer must furnish the applicant a notice regarding replacement of medicare supplement coverage. One copy of the notice signed by the applicant and the producer, except where coverage is sold without a producer, must be provided to the applicant and an additional signed copy must be retained by the issuer for three years. A direct response issuer shall deliver to the applicant at the time of the issuance of the policy the notice regarding replacement of medicare supplement coverage.

(5) The notice required by (4) for an issuer must be in substantially the same form as below and be in no less than 12 point type:

�

�

NOTICE TO APPLICANT REGARDING REPLACEMENT

OF MEDICARE SUPPLEMENT INSURANCE

OR MEDICARE ADVANTAGE

�

(Insurance Company's Name and Address)

�

SAVE THIS NOTICE! IT MAY BE IMPORTANT TO YOU IN THE FUTURE.

�

According to (your application) (information you have furnished), you intend to terminate existing Medicare or Medicare advantage supplement insurance and replace it with a policy to be issued by (Company Name). Your new policy will provide 30 days within which you may decide without cost whether you desire to keep the policy.

�

You should review this new coverage carefully. Compare it with all accident and sickness coverage you now have. Terminate your present policy only if, after due consideration, you find that purchase of this Medicare supplement or Medicare advantage coverage is a wise decision.

�

STATEMENT TO APPLICANT BY ISSUER, OR PRODUCER:

�

I have reviewed your current medical or health insurance coverage. To the best of my knowledge, this Medicare supplement policy will not duplicate your existing Medicare supplement or, if applicable, Medicare advantage coverage because you intend to terminate your existing Medicare supplement coverage or leave your Medicare advantage plan. The replacement policy is being purchased for the following reason(s) (check one):

�

Additional benefits.

�

No change in benefits, but lower premiums.

�

Fewer benefits and lower premiums.

�

My plan has outpatient prescription drug coverage and I am enrolling in part D.

�

Disenrollment from a Medicare advantage plan. Please explain reason for disenrollment. [optional only for direct mailers.]

�

Other. (please specify) ________________________________________________________________________________________________________________

�

1. Note: If the issuer of the Medicare supplement policy being applied for does not, or is otherwise prohibited from imposing pre-existing condition limitations, please skip to statement (2) below. Health conditions which you may presently have (pre-existing conditions) may not be immediately or fully covered under the new policy. This could result in denial or delay of a claim for benefits under the new policy, whereas a similar claim might have been payable under your present policy.

�

2. State law provides that your replacement policy or certificate may not contain new preexisting conditions, waiting periods, elimination periods or probationary periods. The insurer will waive any time periods applicable to preexisting conditions, waiting periods, elimination periods, or probationary periods in the new policy (or coverage) for similar benefits to the extent such time was spent (depleted) under the original policy.

�

3. If you still wish to terminate your present policy and replace it with new coverage, be certain to truthfully and completely answer all questions on the application concerning your medical/health history. Failure to include all material medical information on an application may provide a basis for the company to deny any future claims and to refund your premium as though your policy had never been in force. After the application has been completed and before you sign it, review it carefully to be certain that all information has been properly recorded. [If the policy or certificate is guaranteed issue, this paragraph need not appear.]

�

Do not cancel your present policy until you have received your new policy and are sure that you want to keep it.

�

�

�

(Signature of Producer or Other Representative)*

�

�

�

[Typed Name and Address of Issuer or Producer]

�

The above ″Notice to Applicant″ was delivered to me on:

�

�

(Date)

�

�

(Applicant's Signature)

�

*Signature not required for direct response sales.

�

[END OF NOTICE FORM]

�

(6) Paragraphs 1. and 2. of the replacement notice, above (applicable to preexisting conditions) may be deleted by an issuer if the replacement does not involve application of a new preexisting condition limitation.

�

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

This rule has been repealed.

(a) Accepting a notice from a medicare carrier on dually assigned claims submitted by participating physicians and suppliers as a claim form otherwise required and making a payment determination on the basis of the information contained in that notice;

(b) Notifying the participating physician or supplier and the beneficiary of the payment determination;

(c) Paying the participating physician or supplier directly;

(d) Furnishing, at the time of enrollment, each enrollee with a card listing the policy name, number and a central mailing address to which notices from a medicare carrier may be sent;

(e) Paying user fees for claim notices that are transmitted electronically or otherwise. Any cost may not be passed on to the insured as a separate distinguishable charge and the charge may not be separated from the premium; and

(f) Providing to the secretary of health and human services, at least annually, a central mailing address to which all claims may be sent by medicare carriers.

(2) Compliance with the above requirements must be certified on the medicare supplement insurance experience reporting form.

This rule has been repealed.

(1) An issuer or other entity may provide commission or other compensation to a producer for the sale of a Medicare supplement policy or certificate only if the first year commission or other first year compensation is no more than 200% of the commission or other compensation paid for selling or servicing the policy or certificate in the second year or period.

(2) The commission or other compensation provided in subsequent (renewal) years must be the same as that provided in the second year or period and must be provided for no fewer than five renewal years.

(3) No issuer or other entity shall provide compensation to its producers, and no producer shall receive, compensation greater than the renewal compensation payable by the replacing issuer on renewal policies or certificates if an existing policy or certificate is replaced.

(4) For purposes of this rule, "compensation" includes pecuniary or non-pecuniary remuneration of any kind relating to the sale or renewal of the policy or certificate including but not limited to bonuses, gifts, prizes, awards and service and finders fees.

(5) As part of the annual filing under ARM 6.6.508(7), the entity providing Medicare supplement policies shall provide copies of commission schedules.

(a) An issuer must provide reasonable compensation, as provided under the plan of operation of the program, to a producer, if any, for the sale of a Medicare supplement insurance policy or certificate. For purposes of this rule, "reasonable compensation" shall be at least 3% of the premium paid for the policy or certificate.

(b) An issuer may not vary the commission paid on the sale or renewal of a Medicare supplement insurance policy or certificate due to any factor other than the first year or renewal status of the policy or certificate. For example, issuers may not vary the commission based on the plan marketed or the age, health status, location, or claims experience of the insured. Issuers may pay a different commission on a policy transferred to a different producer for servicing purposes following the initial sale, or on a policy sold over the internet, so long as there is no other variation in the commission for any other reason.

This rule has been repealed.

(1) An issuer directly or through its producers shall:

(a) establish marketing procedures to assure that any comparison of policies by its producers will be fair and accurate;

(b) establish marketing procedures to assure excessive insurance is not sold or issued;

(c) establish marketing procedures which set forth a mechanism or formula for determining whether a replacement policy or certificate contains benefits greater than the benefits under the replaced policy;

(d) display prominently by type, stamp or other appropriate means, on the first page of the policy the following: "Notice to buyer: This policy may not cover all of your medical expenses;"

(e) inquire and otherwise make every reasonable effort to identify whether a prospective applicant or enrollee for Medicare supplement insurance already has accident and sickness insurance and the types and amounts of any such insurance;

(f) establish auditable procedures for verifying compliance with this rule; and

(g) provide to the enrollee an appropriate disclosure statement if the enrollee has accident and sickness insurance. These statements must be identical to the disclosure statements in ARM 6.6.526.

(2) In addition to the practices prohibited in Title 33, chapter 18, MCA, the following acts and practices are prohibited:

(a) knowingly making any misleading representation or incomplete or fraudulent comparison of any insurance policies or insurers for the purpose of inducing, or tending to induce, any person to lapse, forfeit, surrender, terminate, retain, pledge, assign, borrow on, or convert any insurance policy or to take out a policy of insurance with another insurer;

(b) employing any method of marketing having the effect of or tending to induce the purchase of insurance through force, fright, threat, whether explicit or implied, or undue pressure to purchase or recommend the purchase of insurance; and

(c) making use directly or indirectly of any method of marketing which fails to disclose in a conspicuous manner that a purpose of the method of marketing is solicitation of insurance and that contact will be made by an insurance producer or issuer.

(3) The terms "medicare supplement," "medigap," "medicare wrap-around," "medicare select," and words of similar import must not be used unless the policy or certificate is issued in compliance with applicable administrative rules and statutes.

(2) Any sale of medicare supplement policy or certificate that will provide an individual more than one medicare supplement policy or certificate is prohibited.

(3) An issuer may not issue a medicare supplement policy or certificate to an individual enrolled in medicare part C unless the effective date of the coverage is after the termination date of the individual's part C coverage.

(1) On or before March 1 of each year, every issuer shall report, on the form contained in ARM 6.6.525, information for every individual resident of this state for which the issuer has in force more than one Medicare supplement insurance policy or certificate. The following information must be reported:

(a) policy and certificate number; and

(b) date of issuance.

(2) The items set forth above must by grouped by individual policyholder.

(2) If a medicare supplement policy or certificate replaces another medicare supplement policy or certificate which has been in effect for at least six months, the replacing policy must not provide any time period applicable to preexisting conditions, waiting periods, elimination periods and probationary periods.

(1) This is the appendix referred to in ARM 6.6.508(2) and (3) .

�

MEDICARE SUPPLEMENT REFUND CALCULATION FORM

FOR CALENDAR YEAR ______

�

TYPE¹ _____________________________ SMSBP² _________________________

For the State of ______________________ Company Name ____________________

NAIC Group Code ____________________�NAIC Company Code ________________

Address ___________________________ �Person Completing Exhibit ____________

Title _______________________________ Telephone Number __________________

�

�

�

�

�

1. Individual, Group, Individual Medicare Select, or Group Medicare Select Only.
2. "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for prestandardized plans.
3. Includes Modal Loadings and Fees Charged
4. Excludes Active Life Reserves
5. This is to be used as "Issue Year Earned Premium" for Year 1 of next year's "Worksheet for Calculation of Benchmark Ratios"

�

If Ratio 3 is more than Benchmark Ratio (Ratio 1) , a refund or credit to premium is not required.

�

If Ratio 3 is less than the Benchmark Ratio, then proceed.

�

�

If the amount on line 13 is less than .005 times the annualized premium in force as of December 31 of the reporting year, then no refund is made.� Otherwise, the amount on line 13 is to be refunded or credited, and a description of the refund or credit against premiums to be used must be attached to this form.

�

�

����������������������� ___________________________________

�������������������������������������� Signature

����������������������� ___________________________________

�������������������������������������� Name - Please Type

����������������������� ___________________________________

�������������������������������������� Title - Please Type

����������������������� ___________________________________

�������������������������������������� Date

�

�

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR GROUP POLICIES

FOR CALENDAR YEAR ____________

�

����������������� TYPE¹ ________________________________��� SMSBP² _____________________________

����������������� For the State of �� _________________���� Company Name _______________________

����������������� NAIC Group Code _____________________���� NAIC Company Code___________________

����������������� Address _____________________________���� Person Completing Exhibit___________

����������������� Title _______________________________���� Telephone Number ___________________

�

(a)3	(b)4	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(j)	(o)5
� Year	Earned Premium	� Factor	� (b)x(c)	Cumulative Loss Ratio	� (d)x(e)	� Factor	� (b)x(g)	Cumulative Loss Ratio	� (h)x(i)	Policy Year Loss Ratio
1	�	2.770	�	0.507	�	0.000	�	0.000	�	0.46
2	�	4.175	�	0.567	�	0.000	�	0.000	�	0.63
3	�	4.175	�	0.567	�	1.194	�	0.759	�	0.75
4	�	4.175	�	0.567	�	2.245	�	0.771	�	0.77
5	�	4.175	�	0.567	�	3.170	�	0.782	�	0.80
6	�	4.175	�	0.567	�	3.998	�	0.792	�	0.82
7	�	4.175	�	0.567	�	4.754	�	0.802	�	0.84
8	�	4.175	�	0.567	�	5.445	�	0.811	�	0.87
9	�	4.175	�	0.567	�	6.075	�	0.818	�	0.88
10	�	4.175	�	0.567	�	6.650	�	0.824	�	0.88
11	�	4.175	�	0.567	�	7.176	�	0.828	�	0.88
12	�	4.175	�	0.567	�	7.655	�	0.831	�	0.88
13	�	4.175	�	0.567	�	8.093	�	0.834	�	0.89
14	�	4.175	�	0.567	�	8.493	�	0.837	�	0.89
15+6	�	4.175	�	0.567	�	8.684	�	0.838	�	0.89
Total	�	�	(k):	�	(l):	�	(m):	�	(n):	�

Benchmark Ratio Since Inception (1 + n)/(k + m): ____________

¹Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

² "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for pre-standardized plans

³ Year 1 is the current calendar year - 1.�Year 2 is the current calendar year - 2 (etc). (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

⁴ For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

⁵ These loss ratios are not explicitly used in computing the benchmark loss ratios.�They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet.�They are shown here for informational purposes only.

⁶ To include the earned premium for all years prior to as well as the 15th year prior to the current year.

�

�

REPORTING FORM FOR THE CALCULATION OF BENCHMARK RATIO SINCE INCEPTION FOR INDIVIDUAL POLICIES

FOR CALENDAR YEAR ____________

�

����������������� TYPE¹ ______________________________�SMSBP² _____________________________

����������������� For the State of ___________________ Company Name _______________________

����������������� NAIC Group Code ____________________ NAIC Company Code __________________

����������������� Address ____________________________�Person Completing Exhibit __________

����������������� Title ______________________________�Telephone Number ___________________

�

(a)3	(b)4	(c)	(d)	(e)	(f)	(g)	(h)	(i)	(j)	(o)5
� Year	Earned Premium	� Factor	� (b)x(c)	Cumulative Loss Ratio	� (d)x(e)	� Factor	� (b)x(g)	Cumulative Loss Ratio	� (h)x(i)	Policy Year Loss Ratio
1	�	2.770	�	0.442	�	0.000	�	0.000	�	0.40
2	�	4.175	�	0.493	�	0.000	�	0.000	�	0.55
3	�	4.175	�	0.493	�	1.194	�	0.659	�	0.65
4	�	4.175	�	0.493	�	2.245	�	0.669	�	0.67
5	�	4.175	�	0.493	�	3.170	�	0.678	�	0.69
6	�	4.175	�	0.493	�	3.998	�	0.686	�	0.71
7	�	4.175	�	0.493	�	4.754	�	0.695	�	0.73
8	�	4.175	�	0.493	�	5.445	�	0.702	�	0.75
9	�	4.175	�	0.493	�	6.075	�	0.708	�	0.76
10	�	4.175	�	0.493	�	6.650	�	0.713	�	0.76
11	�	4.175	�	0.493	�	7.176	�	0.717	�	0.76
12	�	4.175	�	0.493	�	7.655	�	0.720	�	0.77
13	�	4.175	�	0.493	�	8.093	�	0.723	�	0.77
14	�	4.175	�	0.493	�	8.493	�	0.725	�	0.77
15+6	�	4.175	�	0.493	�	8.684	�	0.725	�	0.77
Total	�	�	(k):	�	(l):	�	(m):	�	(n):	�

Benchmark Ratio Since Inception (1 + n)/(k + m): ____________

¹Individual, Group, Individual Medicare Select, or Group Medicare Select Only.

² "SMSBP" = Standardized Medicare Supplement Benefit Plan - Use "P" for pre-standardized plans

³ Year 1 is the current calendar year - 1.�Year 2 is the current calendar year - 2 (etc). (Example: If the current year is 1991, then: Year 1 is 1990; Year 2 is 1989, etc.)

⁴ For the calendar year on the appropriate line in column (a), the premium earned during that year for policies issued in that year.

⁵ These loss ratios are not explicitly used in computing the benchmark loss ratios.�They are the loss ratios, on a policy year basis, which result in the cumulative loss ratios displayed on this worksheet.�They are shown here for informational purposes only.

⁶ To include the earned premium for all years prior to as well as the 15th year prior to the current year.

(1) This is the appendix referred to in ARM 6.6.521.

�

FORM FOR REPORTING MEDICARE SUPPLEMENT POLICIES

�

Company Name:������� ____________________________

�

Address:���������������������____________________________

�

�������������������������������������____________________________

�

Phone Number:����������____________________________

�

Due March 1, annually

�

The purpose of this form is to report the following information on each resident of this state who has in force more than one Medicare supplement policy or certificate.� The information is to be grouped by individual policyholder.

�

�������������������������������Policy and���������������������������������������������������������������������������Date of

�������������������������������Certificate #������������������������������������������������������������������������Issuance

�

�

�

�

�

�

�

_______________________________

�����������������������������������������������������������������������������������������������������������������������������Signature

�

_______________________________

�����������������������������������������������������������������������������������������������������������������Name and Title (please type)

�

_______________________________

�����������������������������������������������������������������������������������������������������������������������������Date

�

(1) This is the appendix referred to in ARM 6.6.509(6) .

Instructions for Use of the Disclosure Statements for Health Insurance Policies Sold to Medicare Beneficiaries that Duplicate Medicare

(1) Section 1882(d) of the federal Social Security Act (42 U.S.C. 1395ss) prohibits the sale of a health insurance policy (the term policy includes certificate) to Medicare beneficiaries that duplicates Medicare benefits unless it will pay benefits without regard to a beneficiary's other health coverage and it includes the prescribed disclosure statement on or together with the application for the policy.

(2) All types of health insurance policies that duplicate Medicare shall include one of the attached disclosure statements, according to the particular policy type involved, on the application or together with the application.  The disclosure statement may not vary from the attached statements in terms of language or format (type size, type proportional spacing, bold character, line spacing, and usage of boxes around text) .

(3) State and federal law prohibits insurers from selling a Medicare supplement policy to a person that already has a Medicare supplement policy except as a replacement policy.

(4) Property/casualty and life insurance policies are not considered health insurance.

(5) Disability income policies are not considered to provide benefits that duplicate Medicare.

(6) Long-term care insurance policies that coordinate with Medicare and other health insurance are not considered to provide benefits that duplicate Medicare.

(7) The federal law does not preempt state laws that are more stringent than the federal requirements.

(8) The federal law does not preempt existing state form filing requirements.

(9) Section 1882 of the federal Social Security Act was amended in Subsection (d) (3) (A) to allow for alternative disclosure statements.  The disclosure statements already in Appendix C remain.  Carriers may use either disclosure statement with the requisite insurance product.  However, carriers should use either the original disclosure statements or the alternative disclosure statements and not use both simultaneously.

(a) [Original disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]

This is not Medicare Supplement Insurance.

This insurance provides limited benefits, if you meet the policy conditions, for hospital or medical expenses that result from accidental injury.  It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when it pays:

• hospital or medical expenses up to the maximum stated in the policy

Medicare generally pays for most or all of these expenses.

Medicare pays extensive benefits for medically necessary services regardless of the reason you need them.  These include:

• hospitalization
• physician services
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check for coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(b) [Original disclosure statement for policies that provide benefits for specified limited services.]

This is not Medicare Supplement Insurance.

This insurance provides limited benefits, if you meet the policy conditions, for expenses relating to the specific services listed in the policy.  It does not pay your Medicare deductibles or coinsurance and is not a substitute for Medicare Supplement insurance.

This insurance duplicates Medicare benefits when:

• any of the services covered by the policy are also covered by Medicare

Medicare pays extensive benefits for medically necessary services regardless of the

reason you need them.  These include:

• hospitalization
• physician services
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(c) [Original disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments.  This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]

• hospital or medical expenses up to the maximum stated in the policy

• hospitalization
• physician services
• hospice
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(d) [Original disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments.  This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]

• hospitalization
• physician services
• hospice
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(e) [Original disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]

• any of the services covered by the policy are also covered by Medicare

• hospitalization
• physician services
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• hospice
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(f) [Original disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]

• any expenses or services covered by the policy are also covered by Medicare; or
• it pays the fixed dollar amount stated in the policy and Medicare covers the same event

• hospitalization
• physician services
• hospice care
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(g) [Original disclosure statement for other health insurance policies not specifically identified in the preceding statements.]

• the benefits stated in the policy and coverage for the same event is provided by Medicare

• hospitalization
• physician services
• hospice
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(h) [Alternative disclosure statement for policies that provide benefits for expenses incurred for an accidental injury only.]

• hospitalization
• physician services
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(i) [Alternative disclosure statement for policies that provide benefits for specified limited services.]

• hospitalization
• physician services
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(j) [Alternative disclosure statement for policies that reimburse expenses incurred for specified diseases or other specified impairments.  This includes expense-incurred cancer, specified disease and other types of health insurance policies that limit reimbursement to named medical conditions.]

• hospitalization
• physician services
• hospice
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(k) [Alternative disclosure statement for policies that pay fixed dollar amounts for specified diseases or other specified impairments.  This includes cancer, specified disease, and other health insurance policies that pay a scheduled benefit or specific payment based on diagnosis of the conditions named in the policy.]

• hospitalization
• physician services
• hospice
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

This policy must pay benefits without regard to other health benefit coverage to which you may be entitled under Medicare or other insurance.

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(l) [Alternative disclosure statement for indemnity policies and other policies that pay a fixed dollar amount per day, excluding long-term care policies.]

• hospitalization
• physician services
• hospice
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(m) [Alternative disclosure statement for policies that provide benefits upon both an expense-incurred and fixed indemnity basis.]

• hospitalization
• physician services
• hospice care
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(n) [Alternative disclosure statement for other health insurance policies not specifically identified in the preceding statements.]

• hospitalization
• physician services
• hospice care
• [outpatient prescription drugs if you are enrolled in Medicare Part D]
• other approved items and services

• Check the coverage in all health insurance policies you already have.
• For more information about Medicare and Medicare Supplement insurance, review the "Guide to Health Insurance for People with Medicare," available from the insurance company.
• For help in understanding your health insurance, contact your state insurance department or state [health] insurance [assistance] program [SHIP].

(a)  deny or condition the issuance or effectiveness of the policy or certificate (including the imposition of any exclusion of benefits under the policy based on a preexisting condition) on the basis of the genetic information with respect to such individual; and

(b)  discriminate in the pricing of the policy or certificate (including the adjustment of premium rates) of an individual on the basis of the genetic information with respect to such individual.

(2)  Nothing in (1) shall be construed to limit the ability of an issuer, to the extent otherwise permitted by law, from:

(a)  denying or conditioning the issuance or effectiveness of the policy or certificate or increasing the premium for a group based on the manifestation of a disease or disorder of an insured or applicant; or

(b)  increasing the premium for any policy issued to an individual based on the manifestation of a disease or disorder of an individual who is covered under the policy (in such case, the manifestation of a disease or disorder in one individual cannot also be used as genetic information about other group members and to further increase the premium for the group).

(3)  An issuer of a Medicare supplement policy or certificate shall not request or require an individual or a family member of such individual to undergo a genetic test.

(4)  Section (3) shall not be construed to preclude an issuer of a Medicare supplement policy or certificate from obtaining and using the results of a genetic test in making a determination regarding payment (as defined for the purposes of applying the regulations promulgated under Part C of Title XI and section 264 of the Health Insurance Portability and Accountability Act of 1996, as may be revised from time to time) and consistent with (1).

(5)  For purposes of carrying out (4), an issuer of a Medicare supplement policy or certificate may request only the minimum amount of information necessary to accomplish the intended purpose.

(6)  Notwithstanding (3), an issuer of a Medicare supplement policy may request, but not require, that an individual or a family member of such individual undergo a genetic test if each of the following conditions is met:

(a)  The request is made pursuant to research that complies with part 46 of Title 45, Code of Federal Regulations, or equivalent Federal regulations, and any applicable state or local law or regulations for the protection of human subjects in research.

(b)  The issuer clearly indicates to each individual, or in the case of a minor child, to the legal guardian of such child, to whom the request is made that:

(i)  compliance with the request is voluntary; and

(ii)  noncompliance will have no effect on enrollment status or premium or contribution amounts.

(c)  No genetic information collected or acquired under this subsection shall be used for underwriting, determination of eligibility to enroll or maintain enrollment status, premium rates, or the issuance, renewal, or replacement of a policy or certificate.

(d)  The issuer notifies the Secretary in writing that the issuer is conducting activities pursuant to the exception provided for under this subsection, including a description of the activities conducted.

(e)  The issuer complies with such other conditions as the Secretary may by regulation require for activities conducted under this subsection.

(7)  An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information for underwriting purposes.

(8)  An issuer of a Medicare supplement policy or certificate shall not request, require, or purchase genetic information with respect to any individual prior to such individual's enrollment under the policy in connection with such enrollment.

(9)  If an issuer of a Medicare supplement policy or certificate obtains genetic information incidental to the requesting, requiring, or purchasing of other information concerning any individual, such request, requirement, or purchase shall not be considered a violation of (8) if such request, requirement, or purchase is not in violation of (7).

(10)  For the purposes of this section only:

(a)  "Issuer of a Medicare supplement policy or certificate" includes third-party administrator, or other person acting for or on behalf of such issuer;

(b)  "Family member" means, with respect to an individual, any other individual who is a first-degree, second-degree, third-degree, or fourth-degree relative of such individual;

(c)  "Genetic information" means, with respect to any individual, information about such individual's genetic tests, the genetic tests of family members of such individual, and the manifestation of a disease or disorder in family members of such individual.  Such term includes, with respect to any individual, any request for, or receipt of, genetic services, or participation in clinical research which includes genetic services, by such individual or any family member of such individual.  Any reference to genetic information concerning an individual or family member of an individual who is a pregnant woman, includes genetic information of any fetus carried by such pregnant woman, or with respect to an individual or family member utilizing reproductive technology, includes genetic information of any embryo legally held by an individual or family member.  The term "genetic information" does not include information about the sex or age of any individual;

(d)  "Genetic services" means a genetic test, genetic counseling (including obtaining, interpreting, or assessing genetic information), or genetic education;

(e)  "Genetic test" means an analysis of human DNA, RNA, chromosomes, proteins, or metabolites, that detect genotypes, mutations, or chromosomal changes.  The term "genetic test" does not mean an analysis of proteins or metabolites that does not detect genotypes, mutations, or chromosomal changes; or an analysis of proteins or metabolites that is directly related to a manifested disease, disorder, or pathological condition that could reasonably be detected by a health care professional with appropriate training and expertise in the field of medicine involved;

(f)  "Underwriting purposes" means:

(i)  rules for, or determination of, eligibility (including enrollment and continued eligibility) for benefits under the policy;

(ii)  the computation of premium or contribution amounts under the policy;

(iii)  the application of any preexisting condition exclusion under the policy; and

(iv)   other activities related to the creation, renewal, or replacement of a contract of health insurance or health benefits.

apply to medicare select policies and certificates, as defined

in ARM 6.6.601 through 6.6.614.

(2) No policy or certificate may be advertised as a medicare select policy or certificate unless it meets the requirements of ARM 6.6.601 through 6.6.614.

(1) "Complaint" means any dissatisfaction expressed by an individual concerning a medicare select issuer or its network providers.

(2) "Grievance" means dissatisfaction expressed in writing by an individual insured under a medicare select policy or certificate with the administration, claims practices, or provision of services concerning a medicare select issuer or its network providers.

(3) "Medicare select issuer" means an issuer offering, or seeking to offer, a medicare select policy or certificate.

(4) "Medicare select policy" or "medicare select certificate" mean respectively a medicare supplement policy or certificate that contains restricted network provisions.

(5) "Network provider" means a provider of health care, or a group of providers of health care, which has entered into a written agreement with the issuer to provide benefits insured under a medicare select policy.

(6) "Restricted network provision" means any provision which conditions the payment of benefits, in whole or in part, on the use of network providers.

(7) "Service area" means the geographic area approved by the commissioner within which an issuer is authorized to offer a medicare select policy.

commissioner may authorize an issuer to offer a medicare

select policy or certificate, pursuant to ARM 6.6.601 through

6.6.614 and section 4358 of the Omnibus Budget Reconciliation

Act (OBRA) of 1990, if the commissioner finds that the issuer

has satisfied all of the requirements of ARM 6.6.601 through

6.6.614 and at the discretion of the commissioner has met the requirements of 33-22-901 through 33-22-924 , MCA and ARM 6.6.501 through 6.6.522.

(a) evidence that all covered services that are subject to restricted network provisions are available and accessible through network providers, including a demonstration that:

(i) such services can be provided by network providers with reasonable promptness with respect to geographic location, hours of operation and after-hour care. The hours of operation and availability of after-hour care shall reflect usual practice in the local area. Geographic availability shall reflect the usual travel times within the community;

(ii) the number of network providers in the service area is sufficient, with respect to current and expected policyholders, either:

(A) to deliver adequately all services that are subject to a restricted network provision; or

(B) to make appropriate referrals;

(iii) there are written agreements with network providers describing specific responsibilities;

(iv) emergency care is available 24 hours per day and 7 days per week;

(v) in the case of covered services that are subject to a restricted network provision and are provided on a prepaid basis, there are written agreements with network providers prohibiting such providers from billing or otherwise seeking reimbursement from or recourse against any individual insured under a medicare select policy or certificate. (1) (a) (v) shall not apply to supplemental charges or coinsurance amounts as stated in the medicare select policy or certificate;

(b) a statement or map providing a clear description of the service area;

(c) a description of the grievance procedure to be utilized;

(d) a description of the quality assurance program, including:

(i) the formal organizational structure;

(ii) the written criteria for selection, retention and removal of network providers; and

(iii) the procedures for evaluating quality of care provided by network providers, and the process to initiate corrective action when warranted;

(e) a list and description, by specialty, of the network providers;

(f) copies of the written information proposed to be used by the issuer to comply with (1) ; and

(g) any other information requested by the commissioner.

(2) An updated list of network providers shall be filed with the commissioner at least quarterly.

(a) the services are for symptoms requiring emergency care or are immediately required for an unforeseen illness, injury or a condition; and

(b) it is not reasonable to obtain such services through a network provider.

(2) A medicare select policy or certificate must provide payment for full coverage under the policy for covered services that are not available through network providers.

(1) A medicare select issuer shall make full and fair disclosure in writing of the provisions, restrictions, and limitations of the medicare select policy or certificate to each applicant. This disclosure shall include at least the following:

(a) an outline of coverage sufficient to permit the applicant to compare the coverage and premiums of the medicare select policy or certificate with:

(i) other medicare supplement policies or certificates offered by the issuer; and

(ii) other medicare select policies or certificates;

(b) a description (including address, telephone number and hours of operation) of the network providers, including primary care physicians, specialty physicians, hospitals and other providers;

(c) a description of the restricted network provisions, including payments for coinsurance and deductibles, when providers other than network providers are utilized. Except to the extent specified in the policy or certificate, expenses incurred when using out-of-network providers do not count toward the out-of-pocket annual limit contained in plans K and L;

(d) a description of coverage for emergency and urgently needed care and other out-of-service area coverage;

(e) a description of limitations on referrals to restricted network providers and to other providers;

(f) a description of the policyholder's rights to purchase any other medicare supplement policy or certificate otherwise offered by the issuer; and

(g) a description of the medicare select issuer's quality assurance program and grievance procedure.

(1) Prior to the sale of a medicare select policy or certificate, a medicare select issuer shall obtain from the applicant a signed and dated form stating that the applicant has received the information provided pursuant to ARM 6.6.608 and that the applicant understands the restrictions of the medicare select policy or certificate.

(2) The grievance procedure shall be described in the policies and certificates and in the outline of coverage.

(3) At the time the policy or certificate is issued, the issuer shall provide detailed information to the policyholder describing how a grievance may be registered with the issuer.

(4) Grievances shall be considered in a timely manner and shall be transmitted to appropriate decision-makers who have authority to fully investigate the issue and take corrective action.

(5) If a grievance is found to be valid, corrective action shall be taken promptly.

(6) All concerned parties shall be notified about the results of a grievance.

(7) The issuer shall report no later than each March 31 to the commissioner regarding its grievance procedure. The report shall be in a format prescribed by the commissioner and shall contain the number of grievances filed in the past year and a summary of the subject, nature and resolution of such grievances.

(2) For the purpose of this rule, a medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the medicare select policy or certificate being replaced. For the purpose of (2) , a significant benefit means coverage for the medicare part A deductible, coverage for at-home recovery services, or coverage for part B excess charges.

(2) Each medicare select issuer shall make available to each individual insured under a medicare select policy or certificate the opportunity to purchase any medicare supplement policy or certificate offered by the issuer which has comparable or lesser benefits and which does not contain a restricted network provision. The issuer shall make such policies and certificates available without requiring evidence or insurability.

(3) For the purpose of this rule, a medicare supplement policy or certificate will be considered to have comparable or lesser benefits unless it contains one or more significant benefits not included in the medicare select policy or certificate being replaced. For the purpose of (3) , a significant benefit means coverage for the medicare part A deductible, coverage for at-home recovery services, or coverage for part B excess charges.

(4) In the event of the discontinuance of the medicare select insurance program by an entity, (including but not limited to the federal government, an insurer, an insurance company, health maintenance organization or health service corporation) the insured will have the option to continue medicare supplement insurance. The insured may select from any of the medicare supplement insurance plans then currently available with no restrictions or limitations.

(a) variable life insurance;

(b) individual and group annuity contracts;

(c) credit life insurance; or

(d) life insurance policies with no illustrated death benefits on any individual exceeding $10,000.

(1) " Actuarial Standards Board" means the board established by the American academy of actuaries to develop and promulgate standards of actuarial practice.

(2) " Contract premium" means the gross premium that is required to be paid under a fixed premium policy, including the premium for a rider for which benefits are shown in the illustration.

(3) "Currently payable scale" means a scale of non-guaranteed elements in effect for a policy form as of the preparation date of the illustration or declared to become effective within the next 95 days.

(4) "Disciplined current scale " means a scale of non-guaranteed elements constituting a limit on illustrations currently being illustrated by an insurer that is based on actual recent historical experience, as certified annually by an illustration actuary designated by the insurer.   Further guidance in determining the disciplined current scale as contained in standards established by the actuarial standards board may be relied upon if the standards:

(a) are consistent with all provisions of this subchapter;

(b) limit a disciplined current scale to reflect only actions that have already been taken or events that have already occurred;

(c) do not permit a disciplined current scale to include any projected trends of improvements in experience or any assumed improvements in experience beyond the illustration date; and

(d) do not permit assumed expenses to be less than minimum assumed expenses.

(5) "Generic name" means a short title descriptive of the policy being illustrated such as "whole life," "term life" or " flexible premium adjustable life."

(6) "Guaranteed elements" means the premiums, benefits, values, credits or charges under a policy of life insurance that are guaranteed and determined at issue.

(7) "Illustrated scale" means a scale of non-guaranteed elements currently being illustrated that is not more favorable to the policy owner than the lesser of:

(a) the disciplined current scale; or

(b) the currently payable scale.

(8) "Illustration" means a presentation or depiction that includes non-guaranteed elements of a policy of life insurance over a period of years and that is one of the three types defined below:

(a) "basic illustration" means a ledger or proposal used in the sale of a life insurance policy that shows both guaranteed and non-guaranteed elements;

(b) "supplemental illustration" means an illustration furnished in addition to a basic illustration that meets the applicable requirements of this subchapter, and that may be presented in a format differing from the basic illustration, but may only depict a scale of non-guaranteed elements that is permitted in a basic illustration;

(c) " in force illustration " means an illustration furnished at any time after the policy that it depicts has been in force for one year or more.

(9) " Illustration actuary " means an actuary meeting the requirements of ARM 6.6.715 who certifies to illustrations based on the standard of practice promulgated by the Actuarial Standards Board.

(10) "Lapse-supported illustration" means an illustration of a policy form failing the test of self-supporting as defined in this subchapter, under a modified persistency rate assumption using persistency rates underlying the disciplined current scale for the first five years and 100% policy persistency thereafter.

(11) " Minimum assumed expenses" means the minimum expenses that may be used in the calculation of the disciplined current scale for a policy form.  The insurer may choose to designate each year the method of determining assumed expenses for all policy forms from the following:

(a) fully allocated expenses;

(b) a generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies and approved by the commissioner;

(c) marginal expenses which may be used only if greater than a generally recognized expense table.  If no generally recognized expense table is approved, fully allocated expenses must be used.

(12) "Non-guaranteed elements" means the premiums, benefits, values, credits or charges under a policy of life insurance that are not guaranteed or not determined at issue.

(13) " Non-term group life" means a group policy or individual policies of life insurance issued to members of an employer group or other permitted group where:

(a) every plan of coverage was selected by the employer or other group representative;

(b) some portion of the premium is paid by the group or through payroll deduction; and

(c) group underwriting or simplified underwriting is used.

(14) "Policy owner" means the owner named in the policy or the certificate holder in the case of a group policy.

(15) "Premium outlay" means the amount of premium assumed to be paid by the policy owner or other premium payer out-of-pocket.

(16) " Self-supporting illustration" means an illustration of a policy form for which it can be demonstrated that, when using experience assumptions underlying the disciplined current scale, for all illustrated points in time on or after the fifteenth policy anniversary or the twentieth policy anniversary for second-or-later-to-die policies (or upon policy expiration if sooner) , the accumulated value of all policy cash flows equals or exceeds the total policy owner value available.   For this purpose, policy owner value will include cash surrender values and any other illustrated benefit amounts available at the policy owner's election.

(17) "Terminal dividends " means dividends paid when a policy terminates.

(2) If the insurer identifies a policy form as one to be marketed without an illustration, any use of an illustration for any policy using that form prior to the first policy anniversary is prohibited.

(3) If a policy form is identified by the insurer as one to be marketed with an illustration, a basic illustration prepared and delivered in accordance with this subchapter is required, except that a basic illustration need not be provided to individual members of a group or to individuals insured under multiple lives coverage issued to a single applicant unless the coverage is marketed to these individuals.   The illustration furnished an applicant for a group life insurance policy or policies issued to a single applicant on multiple lives may be either an individual or composite illustration representative of the coverage on the lives of members of the group or the multiple lives covered.

(4) Potential enrollees of non-term group life subject to this subchapter shall be furnished a quotation with the enrollment materials.   The quotation shall show potential policy values for sample ages and policy years on a guaranteed and non-guaranteed basis appropriate to the group and the coverage.   This quotation shall not be considered an illustration for purposes of this subchapter, but all information provided shall be consistent with the illustrated scale.   A basic illustration shall be provided at delivery of the certificate to enrollees for non-term group life who enroll for more than the minimum premium necessary to provide pure death benefit protection.   In addition, the insurer shall make a basic illustration available to any non-term group life enrollee who requests it.

(1) An illustration used in the sale of a life insurance policy shall satisfy the applicable requirements of this subchapter, be clearly labeled "life insurance illustration" and contain the following basic information:    

(a) name of insurer;            

(b) name and business address of producer or insurer's authorized representative, if any;

(c) name, age, and sex (if sex is used in underwriting) of proposed insured, except where a composite illustration is permitted under this subchapter;

(d) underwriting or rating classification upon which the illustration is based;

(e) generic name of policy, the company product name, if different, and form number;

(f) initial death benefit; and

(g) dividend option election or application of non-guaranteed elements, if applicable.

(2) When using an illustration in the sale of a life insurance policy, an insurer or its producers or other authorized representatives shall not:

(a) represent the policy as anything other than a life insurance policy;

(b) use or describe non-guaranteed elements in a manner that is misleading or has the capacity or tendency to mislead;

(c) state or imply that the payment or amount of non-guaranteed elements is guaranteed;

(d) use an illustration that does not comply with the requirements of this subchapter;

(e) use an illustration that at any policy duration depicts policy performance more favorable to the policy owner than that produced by the illustrated scale of the insurer whose policy is being illustrated;

(f) provide an applicant with an incomplete illustration;

(g) represent in any way that premium payments will not be required for each year of the policy in order to maintain the illustrated death benefits, unless that is the fact;

(h) use the term "vanish" or "vanishing premium," or a similar term that implies the policy becomes paid up, to describe a plan for using non-guaranteed elements to pay a portion of future premiums;

(i) except for policies that can never develop nonforfeiture values, use an illustration that is "lapse-supported;" or

(j) use an illustration that is not "self-supporting."

(3) If an interest rate used to determine the illustrated non-guaranteed elements is shown, it shall not be greater than the earned interest rate underlying the disciplined current scale.

(1) A basic illustration shall conform with the following requirements:  

(a) the illustration shall be labeled with the date on which it was prepared;            

(b) each page, including any explanatory notes or pages, shall be numbered and show its relationship to the total number of pages in the illustration (e.g., the fourth page of a seven-page illustration shall be labeled " page 4 of 7 pages");

(c) the assumed dates of payment receipt and benefit pay-out within a policy year shall be clearly identified;

(d) if the age of the proposed insured is shown as a component of the tabular detail, it shall be issue age plus the numbers of years the policy is assumed to have been in force;

(e) the assumed payments on which the illustrated benefits and values are based shall be identified as premium outlay or contract premium, as applicable.  For policies that do not require a specific contract premium, the illustrated payments shall be identified as premium outlay;

(f) guaranteed death benefits and values available upon surrender, if any, for the illustrated premium outlay or contract premium shall be shown and clearly labeled guaranteed;

(g) if the illustration shows any non-guaranteed elements, they cannot be based on a scale more favorable to the policy owner than the insurer's illustrated scale at any duration.  These elements shall be clearly labeled non-guaranteed;

(h) the guaranteed elements, if any, shall be shown before corresponding non-guaranteed elements and shall be specifically referred to on any page of an illustration that shows or describes only the non-guaranteed elements (e.g., "see page one for guaranteed elements");

(i) the account or accumulation value of a policy, if shown, shall be identified by the name this value is given in the policy being illustrated and shown in close proximity to the corresponding value available upon surrender;                                      

(j) the value available upon surrender shall be identified by the name this value is given in the policy being illustrated and shall be the amount available to the policy owner in a lump sum after deduction of surrender charges, policy loans and policy loan interest, as applicable;

(k) illustrations may show policy benefits and values in graphic or chart form in addition to the tabular form;

(l) any illustration of non-guaranteed elements shall be accompanied by a statement indicating that:

(i) the benefits and values are not guaranteed;

(ii) the assumptions on which they are based are subject to change by the insurer; and

(iii) actual results may be more or less favorable.

(m) if the illustration shows that the premium payer may have the option to allow policy charges to be paid using non-guaranteed values, the illustration must clearly disclose that a charge continues to be required and that, depending on actual results, the premium payer may need to continue or resume premium outlays.   Similar disclosure shall be made for premium outlay of lesser amounts or shorter durations than the contract premium.   If a contract premium is due, the premium outlay display shall not be left blank or show zero unless accompanied by an asterisk or similar mark to draw attention to the fact that the policy is not paid up;

(n) if the applicant plans to use dividends or policy values, guaranteed or non-guaranteed, to pay all or a portion of the contract premium or policy charges, or for any other purpose, the illustration may reflect those plans and the impact on future policy benefits and values.

(a) a brief description of the policy being illustrated, including a statement that it is a life insurance policy;

(b) a brief description of the premium outlay or contract premium, as applicable, for the policy.   For a policy that does not require payment of a specific contract premium, the illustration shall show the premium outlay that must be paid to guarantee coverage for the term of the contract, subject to maximum premiums allowable to qualify as a life insurance policy under the applicable provisions of the Internal Revenue Code;

(c) a brief description of any policy features, riders or options, guaranteed or non-guaranteed, shown in the basic illustration and the impact they may have on the benefits and values of the policy;

(d) identification and a brief definition of column headings and key terms used in the illustration; and

(e) a statement containing in substance the following:

(i) "this illustration assumes that the currently illustrated non-guaranteed elements will continue unchanged for all years shown. This is not likely to occur, and actual results may be more or less favorable than those shown. "

(2) This summary shall be shown for at least policy years five, 10 and 20 and at age 70, if applicable, on the three bases shown below.   For multiple life policies the summary shall show policy years five, 10, 20 and 30:

(a) policy guarantees;

(b) insurer's illustrated scale;

(c) insurer's illustrated scale used but with the non-guaranteed elements reduced as follows:

(i) dividends at 50% of the dividends contained in the illustrated scale used;

(ii) non-guaranteed credited interest at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used; and

(iii) all non-guaranteed charges, including but not limited to, term insurance charges, mortality and expense charges, at rates that are the average of the guaranteed rates and the rates contained in the illustrated scale used.

(3) In addition, if coverage would cease prior to policy maturity or age 100, the year in which coverage ceases shall be identified for each of the three bases.

(1) Statements substantially similar to the following shall be included on the same page as the numeric summary and signed by the applicant, or the policy owner in the case of an illustration provided at time of delivery, as required in this rule.

(2) A statement to be signed and dated by the applicant or policy owner reading as follows: "I have received a copy of this illustration and understand that any non-guaranteed elements illustrated are subject to change and could be either higher or lower.   The agent has told me they are not guaranteed. "

(3) A statement to be signed and dated by the insurance producer or other authorized representative of the insurer reading as follows: "I certify that this illustration has been presented to the applicant and that I have explained that any non-guaranteed elements illustrated are subject to change.   I have made no statements that are inconsistent with the illustration. "

(a) the premium outlay and mode the applicant plans to pay and the contract premium, as applicable;

(b) the corresponding guaranteed death benefit, as provided in the policy; and

(c) the corresponding guaranteed value available upon surrender, as provided in the policy.

(2) For a policy that provides for a contract premium, the guaranteed death benefit and value available upon surrender shall correspond to the contract premium.

(3) Non-guaranteed elements may be shown if described in the contract.   In the case of an illustration for a policy on which the insurer intends to credit terminal dividends, they may be shown if the insurer's current practice is to pay terminal dividends.   If any non-guaranteed elements are shown they must be shown at the same durations as the corresponding guaranteed elements, if any.   If no guaranteed benefit or value is available at any duration for which a non-guaranteed benefit or value is shown, a zero shall be displayed in the guaranteed column.

(1) A supplemental illustration may be provided so long as:

(a) it is appended to, accompanied by, or preceded by a basic illustration that complies with this subchapter;

(b) the non-guaranteed elements shown are not more favorable to the policy owner than the corresponding elements based on the scale used in the basic illustration;

(c) it contains the same statement required of a basic illustration that non-guaranteed elements are not guaranteed; and

(d) for a policy that has a contract premium, the contract premium underlying the supplemental illustration is equal to the contract premium shown in the basic illustration. For policies that do not require a contract premium, the premium outlay underlying the supplemental illustration shall be equal to the premium outlay shown in the basic illustration.

(2) The supplemental illustration shall include a notice referring to the basic illustration for guaranteed elements and other important information.

(1) If a basic illustration is used by an insurance producer or other authorized representative of the insurer in the sale of a life insurance policy and the policy is applied for as illustrated, a copy of that illustration, signed in accordance with this subchapter, shall be submitted to the insurer at the time of policy application. � A copy also shall be provided to the applicant.

(2) If the policy is issued other than as applied for, a revised basic illustration conforming to the policy as issued shall be sent with the policy. � The revised illustration shall conform to the requirements of this subchapter, shall be labeled "revised illustration" and shall be signed and dated by the applicant or policy owner and producer or other authorized representative of the insurer no later than the time the policy is delivered. � A copy shall be provided to the insurer and the policy owner.

(3) If no illustration is used by an insurance producer or other authorized representative in the sale of a life insurance policy or if the policy is applied for other than as illustrated, the producer or representative shall certify to that effect in writing on a form provided by the insurer. � On the same form the applicant shall acknowledge that no illustration conforming to the policy applied for was provided and shall further acknowledge an understanding that an illustration conforming to the policy as issued will be provided no later than at the time of policy delivery. � This form shall be submitted to the insurer at the time of policy application.

(4) If the policy is issued, a basic illustration conforming to the policy as issued shall be sent with the policy and signed no later than the time the policy is delivered. � A copy shall be provided to the insurer and the policy owner:

(a) if the basic illustration or revised illustration is sent to the applicant or policy owner by mail from the insurer, it shall include instructions for the applicant or policy owner to sign the duplicate copy of the numeric summary page of the illustration for the policy issued and return the signed copy to the insurer. � The insurer's obligation under this subsection shall be satisfied if it can demonstrate that it has made a diligent effort to secure a signed copy of the numeric summary page. � The requirement to make a diligent effort shall be deemed satisfied if the insurer includes in the mailing a self-addressed postage prepaid envelope with instructions for the return of the signed numeric summary page;

(b) a copy of the basic illustration and a revised basic illustration, if any, signed as applicable, along with any certification that either no illustration was used or that the policy was applied for other than as illustrated, shall be retained by the insurer until five years after the policy is no longer in force. � A copy need not be retained if no policy is issued.

�

(1) In the case of a policy designated as one for which illustrations will be used, the insurer shall provide each policy owner with an annual report on the status of the policy that shall contain at least the following information:

(a) for universal life policies, the report shall include the following:

(i) the beginning and end date of the current report period;

(ii) the policy value at the end of the previous report period and at the end of the current report period;

(iii) the total amounts that have been credited or debited to the policy value during the current report period, identifying each by type (e.g., interest, mortality, expense and riders) ;

(iv) the current death benefit at the end of the current report period on each life covered by the policy;

(v) the net cash surrender value of the policy as of the end of the current report period;

(vi) the amount of outstanding loans, if any, as of the end of the current report period; and

(b) for fixed premium policies, if, assuming guaranteed interest, mortality and expense loads and continued scheduled premium payments, the policy's net cash surrender value is such that it would not maintain insurance in force until the end of the next reporting period, a notice to this effect shall be included in the report; or

(c) for flexible premium policies, if, assuming guaranteed interest, mortality and expense loads, the policy's net cash surrender value will not maintain insurance in force until the end of the next reporting period unless further premium payments are made, a notice to this effect shall be included in the report;

(d) for all other policies, where applicable:

(i) current death benefit;

(ii) annual contract premium;

(iii) current cash surrender value;

(iv) current dividend;

(v) application of current dividend; and

(vi) amount of outstanding loan;

(e) insurers writing life insurance policies that do not build nonforfeiture values shall only be required to provide an annual report with respect to these policies for those years when a change has been made to non-guaranteed policy elements by the insurer.

(2) If the annual report does not include an in force illustration, it shall contain the following notice displayed prominently: "IMPORTANT POLICY OWNER NOTICE:   You should consider requesting more detailed information about your policy to understand how it may perform in the future.   You should not consider replacement of your policy or make changes in your coverage without requesting a current illustration.   You may annually request, without charge, such an illustration by calling [insurer's phone number], writing to [insurer's name] at [insurer's address] or contacting your agent. If you do not receive a current illustration of your policy within 30 days from your request, you should contact your state insurance department." The insurer may vary the sequential order of the methods for obtaining an in force illustration.

(3) Upon the request of the policy owner, the insurer shall furnish an in force illustration of current and future benefits and values based on the insurer's present illustrated scale.   This illustration shall comply with the requirements of ARM 6.6.706(1) and (2) , 6.6.707 and 6.6.711.   No signature or other acknowledgment of receipt of this illustration shall be required.

(4) If an adverse change in non-guaranteed elements that could affect the policy has been made by the insurer since the last annual report, the annual report shall contain a notice of that fact and the nature of the change prominently displayed.

(2) The illustration actuary shall certify that the disciplined current scale used in illustrations is in conformity with the Actuarial Standard of Practice for Compliance with the NAIC model regulation on life insurance illustrations promulgated by the Actuarial Standards Board and that the illustrated scales used in insurer-authorized illustrations meet the requirements of this subchapter.

(3) The illustration actuary shall:

(a) be a member in good standing of the American Academy of Actuaries;

(b) be familiar with the standard of practice regarding life insurance policy illustrations;

(c) not have been found by the commissioner, following appropriate notice and hearing to have:

(i) violated any provision of, or any obligation imposed by, the insurance law or other law in the course of his or her dealings as an illustration actuary;

(ii) been found guilty of fraudulent or dishonest practices;

(iii) demonstrated his or her incompetence, lack of cooperation, or untrustworthiness to act as an illustration actuary; or

(iv) resigned or been removed as an illustration actuary within the past five years as a result of acts or omissions indicated in any adverse report on examination or as a result of a failure to adhere to generally acceptable actuarial standards.

(d) not fail to notify the commissioner of any action taken by a commissioner of another state similar to that under (3) above;

(e) disclose in the annual certification whether, since the last certification, a currently payable scale applicable for business issued within the previous five years and within the scope of the certification has been reduced for reasons other than changes in the experience factors underlying the disciplined current scale.   If non-guaranteed elements illustrated for new policies are not consistent with those illustrated for similar in force policies, this must be disclosed in the annual certification.   If non-guaranteed elements illustrated for both new and in force policies are not consistent with the non-guaranteed elements actually being paid, charged or credited to the same or similar forms, this must be disclosed in the annual certification; and

(f) disclose in the annual certification the method used to allocate overhead expenses for all illustrations:

(i) fully allocated expenses;

(ii) marginal expenses; or

(iii) a generally recognized expense table based on fully allocated expenses representing a significant portion of insurance companies and approved by the NAIC or by the commissioner.

(4) The illustration actuary shall file a certification with the board and with the commissioner:

(a) annually for all policy forms for which illustrations are used; and

(b) before a new policy form is illustrated.

(5) If an error in a previous certification is discovered, the illustration actuary shall notify the board of directors of the insurer and the commissioner promptly.

(6) If an illustration actuary is unable to certify the scale for any policy form illustration the insurer intends to use, the actuary shall notify the board of directors of the insurer and the commissioner promptly of his or her inability to certify.

(7) A responsible officer of the insurer, other than the illustration actuary, shall certify annually:

(a) that the illustration formats meet the requirements of this subchapter and that the scales used in insurer-authorized illustrations are those scales certified by the illustration actuary; and

(b) that the company has provided its agents with information about the expense allocation method used by the company in its illustrations and disclosed as required in (3) (f) .

(8) The annual certifications shall be provided to the commissioner each year by a date determined by the insurer.

(9) If an insurer changes the illustration actuary responsible for all or a portion of the company's policy forms, the insurer shall notify the commissioner of that fact promptly and disclose the reason for the change.

(1) This subchapter applies to all annuity contracts and certificates except:

(a) registered or nonregistered variable annuities or other registered contracts;

(b) immediate and deferred annuities that contain no nonguaranteed elements;

(c) annuities used to fund:

(i) an employee pension plan which is covered by the Employee Retirement Income Security Act (ERISA);

(ii) a plan described by section 401(a), 401(k), 403(b) of the Internal Revenue Code (IRC), where the plan, for purposes of ERISA, is established or maintained by an employer;

(iii) a governmental or church plan defined in section 414, IRC, or a deferred compensation plan of a state or local government or tax exempt organization under section 457, IRC; or

(iv) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor.

(d) Notwithstanding (c), this rule shall apply to annuities used to fund a plan or arrangement that is funded solely by contributions an employee elects to make whether on a pretax or after-tax basis, and where the insurance company has been notified that plan participants may choose from among two or more fixed annuity providers and there is a direct solicitation of an individual employee by a producer for the purchase of an annuity contract. As used in this rule, direct solicitation shall not include any meeting held by a producer solely for the purpose of educating or enrolling employees in the plan or arrangement;

(e) structured settlement annuities;

(f) charitable gift annuities; and

(g) funding agreements.

(1) "Charitable gift annuity" means a transfer of cash or other property by a donor to a charitable organization in return for an annuity payable over one or two lives, under which the actuarial value of the annuity is less than the value of the cash or other property transferred and the difference in value constitutes a charitable deduction for federal tax purposes, but does not include a charitable remainder trust or a charitable lead trust or other similar arrangement where the charitable organization does not issue an annuity and incur a financial obligation to guarantee annuity payments.

(2) "Contract owner" means the owner named in the annuity contract or certificate holder in the case of a group annuity contract.

(3) "Determinable elements" means elements that are derived from processes or methods that are guaranteed at issue and not subject to company discretion, but where the values or amounts cannot be determined until some point after issue. These elements include the premiums, credited interest rates (including any bonus), benefits, values, noninterest based credits, charges or elements of formulas used to determine any of these. These elements may be described as guaranteed but not determined at issue. An element is considered determinable if it was calculated from underlying determinable elements only, or from both determinable and guaranteed elements.

(4) "Funding agreement" means an agreement for an insurer to accept and accumulate funds and to make one or more payments at future dates in amounts that are not based on mortality or morbidity contingencies.

(5) "Generic name" means a short title descriptive of the annuity contract being applied for or illustrated such as "single premium deferred annuity".

(6) "Guaranteed elements" means the premiums, credited interest rates (including any bonus), benefits, values, noninterest based credits, charges or elements of formulas used to determine any of these, that are guaranteed and determined at issue. An element is considered guaranteed if all of the underlying elements that go into its calculation are guaranteed.

(7) "Nonguaranteed elements" means the premiums, credited interest rates (including any bonus), benefits, values, noninterest based credits, charges or elements of formulas used to determine any of these, that are subject to company discretion and are not guaranteed at issue. An element is considered nonguaranteed if any of the underlying nonguaranteed elements are used in its calculation.

(8) "Structured settlement annuity" means a "qualified funding asset" as defined in section 130(d) of the Internal Revenue Code or an annuity that would be a qualified funding asset under section 130(d) but for the fact that it is not owned by an assignee under a qualified assignment.

(a) Where the application for an annuity contract is taken by means other than in a face-to-face meeting, the applicant shall be sent both the disclosure document and the Buyer's Guide no later than five business days after the completed application is received by the insurer.

(i) With respect to an application received as a result of a direct solicitation through the mail:

(A) Providing a Buyer's Guide in a mailing inviting prospective applicants to apply for an annuity contract shall be deemed to satisfy the requirement that the Buyer's Guide be provided no later than five business days after receipt of the application.

(B) Providing a disclosure document in a mailing inviting a prospective applicant to apply for an annuity contract shall be deemed to satisfy the requirement that the disclosure document be provided no later than five business days after receipt of the application.

(ii) With respect to an application received via the internet:

(A) Taking reasonable steps to make the Buyer's Guide available for viewing and printing on the insurer's web site shall be deemed to satisfy the requirement that the Buyer's Guide be provided no later than five business days of receipt of the application.

(B) Taking reasonable steps to make the disclosure document available for viewing and printing on the insurer's web site shall be deemed to satisfy the requirement that the disclosure document be provided no later than five business days after receipt of the application.

(iii) A solicitation for an annuity contract provided in other than a face-to-face meeting shall include a statement that the proposed applicant may contact the insurance department of the state for a free annuity Buyer's Guide. In lieu of the foregoing statement, an insurer may include a statement that the prospective applicant may contact the insurer for a free annuity Buyer's Guide.

(b) Where the Buyer's Guide and disclosure document are not provided at or before the time of application, a free look period of no less than 15 days shall be provided for the applicant to return the annuity contract without penalty. This free look shall run concurrently with any other free look provided under state law or regulation.

(2) The State Auditor's Office hereby adopts and incorporates by reference the appendix titled "Buyer's Guide" including the section title "Equity-indexed Annuities," which is contained in the National Association of Insurance Commissioners' Annuity Disclosure Model Regulation, adopted April 1999. Copies of this appendix are available for public inspection at the office of the Commissioner of Insurance, 840 Helena Avenue, Helena, MT 59601. A copy of this appendix may be obtained by writing to the State Auditor's Office, Legal Department, 840 Helena Avenue, Helena, Montana 59601.

(3) At a minimum, the following information shall be included in the disclosure document required to be provided under this rule:

(a) the generic name of the contract, the company product name, if different, and form number, and the fact that it is an annuity;

(b) the insurer's name and address;

(c) a description of the contract and its benefits, emphasizing its long-term nature, including examples where appropriate:

(i) the guaranteed, nonguaranteed and determinable elements of the contract, and their limitations, if any, and an explanation of how they operate;

(ii) an explanation of the initial crediting rate, specifying any bonus or introductory portion, the duration of the rate and the fact that rates may change from time to time and are not guaranteed;

(iii) periodic income options both on a guaranteed and nonguaranteed basis;

(iv) any value reductions caused by withdrawals from or surrender of the contract;

(v) how values in the contract can be accessed;

(vi) the death benefit, if available and how it will be calculated;

(vii) a summary of the federal tax status of the contract and any penalties applicable on withdrawal of values from the contract; and

(viii) impact of any rider, such as long term care rider.

(d) specific dollar amount or percentage charges and fees shall be listed with an explanation of how they apply; and

(e) information about the current guaranteed rate for new policies that contains a clear notice that the rate is subject to change.

(4) Insurers shall define terms used in the disclosure statement in language that facilitates the understanding by a typical person within the segment of the public to which the disclosure statement is directed.

(a) the beginning and end date of the current report period;

(b) the accumulation and cash surrender value, if any, at the end of the previous report period and at the end of the current report period;

(c) the total amounts, if any, that have been credited, charged to the contract value or paid during the current report period; and

(d) the amount of outstanding loans, if any, as of the end of the current report period.

(1) �The purpose of these rules is to provide:

(a) �model forms for mandatory disclosures to consumers prior to the recommendation or sale of an annuity and for documenting certain events at the time of a recommendation or sale of an annuity; and

(b) �the process for approving, and certifying compliance with, training courses necessary to educate insurance producers prior to engaging in the recommendation or sale of an annuity.�

�

(1)  For purposes of the model forms to be provided by the insurance department under 33-20-805(4), MCA, the commissioner adopts and incorporates by reference Appendices A through C of the National Association of Insurance Commissioners (NAIC) Model Regulation No. 275, Suitability In Annuity Transactions, published Spring 2020, which set forth a model form for an insurance agent or producer's disclosure prior to the recommendation or sale of an annuity, a model form for use when a consumer refuses to provide certain information, and a model form for use when a consumer decides to purchase an annuity that is not based on a producer's recommendation.  A copy of Appendices A through C of NAIC Model Act No. 275 may be obtained from the Commissioner of Securities and Insurance, Office of the Montana State Auditor, at 840 Helena Ave., Helena, MT 59601. 

(2)  As used in Appendix A, "cash compensation" has the same meaning set forth in the definition found at 33-20-804, MCA.

(3) As used in Appendix B, "consumer profile information" has the same meaning set forth in the definition found at 33-20-804, MCA.

(1)  The commissioner will approve training on the subject of the suitability of annuities using the process for review and approval of continuing education courses set forth at 33-17-1201 et seq., MCA.  

(2)  A training course intended to fulfill the requirements of 33-20-807, MCA, must be submitted for review to and recommendation by the Continuing Education Course Advisory Council established at 33-17-1204(2), MCA. Except as stated in (3), for purposes of this rule, the commissioner adopts and incorporates by reference ARM 6.6.4201 through 4213 (as in effect on October 1, 2021), which sets forth the rules for Continuing Education Program for Insurance Producers and Consultants. A copy of the rules may be obtained from the Commissioner of Securities and Insurance, Office of the Montana State Auditor, at 840 Helena Ave., Helena, MT 59601.

(3) The commissioner's adoption and incorporation by reference of the rules identified in (2) is done with the following exceptions and additions specific to the training requirements of 33-20-807, MCA:

(a)  The definition of "Biennial cycle" found at ARM 6.6.4202(3) does not apply to this rule.

(b) In addition to the rules for course submissions found at ARM 6.6.4203, the submission must demonstrate the following:

(i)  In the case of any submission for a one-time, four-credit course:

(A) that the course contains information on at least the following topics: 

(I) the types of annuities and various classifications of annuities;

(II) identification of the parties to an annuity;

(III)  how product-specific annuity contract features affect consumers;

(IV) the application of income taxation of qualified and nonqualified annuities;

(V) the primary uses of annuities; and

(VI)  appropriate standard of conduct, sales practices, replacement, and disclosure requirements.

(B)  that the course does not include any information on marketing, sales techniques, or the specific aspects of a particular insurer's products. 

(ii)  In the case of any submission for a one-time, one-credit course:

(A)  that the course contains information on at least appropriate sales practices and replacement and disclosure requirements; and

(B)  that the course does not include any information on marketing, sales techniques, or the specific aspects of a particular insurer's products. 

(c)  The following revisions apply to the rule for nonresident licensees found at ARM 6.6.4208: 

(i) The requirements for nonresident licensees found at ARM 6.6.4208(1) do not apply unless the home state or designated home state in which the nonresident licensee is licensed has adopted a law substantially similar to the Montana Suitability in Annuity Transactions Act found at 33-20-801 et seq., MCA.

(ii) In addition to the requirements for nonresident licensees found at ARM 6.6.4208(2), the licensee shall submit to this state proof of course completion demonstrating compliance with 33-20-807, MCA.

(d)  In addition to the conditions for nonresident sponsoring organizations found at ARM 6.6.4213, reciprocity may only be afforded for courses intended to fulfill the requirements of 33-20-807, MCA, if the resident state has adopted a law substantially similar to the Montana Suitability in Annuity Transactions Act found at 33-20-801 et seq., MCA. 

(e) The rule concerning extensions found at ARM 6.6.4214 is not adopted. 

(1)  An insurer's obligation to verify that a producer has completed the training requirements of 33-20-807, MCA, can be accomplished by either:  

(a)  obtaining certificate(s) of completion of a commissioner-approved training course; or

(b)  obtaining reports from a database system that either reflects on the face of the report information establishing that the training includes at least the requirements set forth in ARM 6.6.812, as applicable, or can be queried to provide that information if requested by the commissioner.

(1)  A producer may submit a written request to the commissioner to evaluate a training course or courses with components substantially similar to those required, and prohibited, by 33-20-807(2), MCA.  

(2)  The written request must:

(a)  be made within 12 months of the producer attending the course or courses to be considered;

(b)  be accompanied by a time-stamped syllabus or similar material that:

(i)  shows the content of the course or courses; and

(ii)  establishes the minimum length of training under 33-20-807(2)(b), (f)(i), or (f)(ii), MCA, as applicable;

(c)  include a narrative description, annotated syllabus, or similar cross-reference showing where each of the topics required by ARM 6.6.812(3)(b), as applicable to the producer, were addressed in the course or courses; and

(d)  contain a sworn statement that the course or courses did not include any information on marketing, sales techniques, or the specific aspects of a particular insurer's products.

(3) The commissioner will approve or deny the request within 60 days. 

(2) Nothing herein may be construed to create or imply a private cause of action for a violation of this rule.

(a) credit insurance;

(b) group life insurance or group annuities where there is no in-person, face-to-face solicitation of individuals by an insurance producer or where the contract or certificate does not include a side fund;

(c) an application to the existing insurer that issued the existing policy or contract when a contractual change or a conversion privilege is being exercised; or, when the existing policy or contract is being replaced by the same insurer pursuant to a program filed with and approved by the commissioner; or, when a term conversion privilege is exercised among corporate affiliates;

(d) individual stand-alone health policies, including disability income policies;

(e) contracts offered by Servicemembers' Group Life Insurance (SGLI) or Veterans' Group Life Insurance (VGLI), as authorized by 38 U.S.C. Section 1965 et seq.;

(f) life insurance contracts offered through or by a nonprofit military association, qualifying under section 501(c)(23) of the Internal Revenue Code (IRC), and which are not underwritten by an insurer; or

(g) contracts used to fund:

(i) an employee pension or welfare benefit plan that is covered by the Employee Retirement and Income Security Act (ERISA);

(ii) a plan described by sections 401(a), 401(k), 403(b), 408(k), or 408(p) of the IRC, as amended, if established or maintained by an employer;

(iii) a government or church plan defined in section 414 of the IRC, a government or church welfare benefit plan, or a deferred compensation plan of a state or local government or tax exempt organization under section 457 of the IRC;

(iv) a nonqualified deferred compensation arrangement established or maintained by an employer or plan sponsor;

(v) settlements of or assumptions of liabilities associated with personal injury litigation or any dispute or claim resolution process; or

(vi) prearranged funeral contracts.

(2) Nothing herein shall be construed to abrogate the ability of nonprofit organizations (and/or other organizations) to educate members of the United States Armed Forces in accordance with Department of Defense DoD Instruction 1344.07 "Personal Commercial Solicitation on DoD Installations" or successor directive.

(3) For purposes of this rule, general advertisements, direct mail and internet marketing shall not constitute "solicitation." Telephone marketing shall not constitute "solicitation" provided the caller explicitly and conspicuously discloses that the product concerned is life insurance and makes no statements that avoid a clear and unequivocal statement that life insurance is the subject matter of the solicitation. Provided however, nothing in this rule shall be construed to exempt an insurer or insurance producer from this regulation in any in-person, face-to-face meeting established as a result of the "solicitation" exemptions identified in this rule.

(1) "Active duty" means full-time duty in the active military service of the United States and includes members of the reserve component (National Guard and Reserve) while serving under published orders for active duty or full-time training. The term does not include members of the reserve component who are performing active duty or active duty for training under military calls or orders specifying periods of less than 31 calendar days.

(2) "Department of Defense (DoD) personnel" means all active duty service members and all civilian employees, including nonappropriated fund employees and special government employees, of the Department of Defense.

(3) "Door to door" means a solicitation or sales method whereby an insurance producer proceeds randomly or selectively from household to household without prior specific appointment.

(4) "General advertisement" means an advertisement having as its sole purpose the promotion of the reader's or viewer's interest in the concept of insurance, or the promotion of the insurer or the insurance producer.

(5) "Insurer" means an insurance company required to be licensed under the laws of this state to provide life insurance products, including annuities.

(6) "Insurance producer" means a person required to be licensed under the laws of this state to sell, solicit, or negotiate life insurance, including annuities.

(7) "Known" or "knowingly" means, depending on its use herein, the insurance producer or insurer had actual awareness, or in the exercise of ordinary care should have known, at the time of the act or practice complained of, that the person solicited:

(a) is a service member; or

(b) is a service member with a pay grade of E-4 or below.

(8) "Life insurance" means insurance coverage on human lives including benefits of endowment and annuities, and may include benefits in the event of death or dismemberment by accident and benefits for disability income and unless otherwise specifically excluded, includes individually issued annuities.

(9) "Military installation" means any federally owned, leased, or operated base, reservation, post, camp, building, or other facility to which service members are assigned for duty, including barracks, transient housing, and family quarters.

(10) "MyPay" is a Defense Finance and Accounting Service (DFAS) web-based system that enables service members to process certain discretionary pay transactions or provide updates to personal information data elements without using paper forms.

(11) "Service member" means any active duty officer (commissioned and warrant) or enlisted member of the United States Armed Forces.

(12) "Side fund" means a fund or reserve that is part of or otherwise attached to a life insurance policy (excluding individually issued annuities) by rider, endorsement, or other mechanism which accumulates premium or deposits with interest or by other means. The term does not include:

(a) accumulated value or cash value or secondary guarantees provided by a universal life policy;

(b) cash values provided by a whole life policy which are subject to standard nonforfeiture law for life insurance; and

(c) a premium deposit fund which:

(i) contains only premiums paid in advance which accumulate at interest;

(ii) imposes no penalty for withdrawal;

(iii) does not permit funding beyond future required premiums;

(iv) is not marketed or intended as an investment; and

(v) does not carry a commission, either paid or calculated.

(13) "Specific appointment" means a prearranged appointment agreed upon by both parties and definite as to place and time.

(14) "United States Armed Forces" means all components of the Army, Navy, Air Force, Marine Corps, and Coast Guard.

(a) knowingly soliciting the purchase of any life insurance product "door to door" or without first establishing a specific appointment for each meeting with the prospective purchaser;

(b) soliciting service members in a group or "mass" audience or in a "captive" audience where attendance is not voluntary;

(c) knowingly making appointments with or soliciting service members during their normally scheduled duty hours;

(d) making appointments with or soliciting service members in barracks, day rooms, unit areas, or transient personnel housing or other areas where the installation commander has prohibited solicitation;

(e) soliciting the sale of life insurance without first obtaining permission from the installation commander or the commander's designee;

(f) posting unauthorized bulletins, notices, or advertisements;

(g) failing to present DD Form 2885, "Personal Commercial Solicitation Evaluation," to service members solicited or encouraging service members solicited not to complete or submit a DD Form 2885; or

(h) knowingly accepting an application for life insurance or issuing a policy of life insurance on the life of an enlisted member of the United States Armed Forces without first obtaining for the insurer's files a completed copy of any required form which confirms that the applicant has received counseling or fulfilled any other similar requirement for the sale of life insurance established by regulations, directives, or rules of the DoD or any branch of the Armed Forces.

(2) The following acts or practices when committed on a military installation by an insurer or insurance producer constitute corrupt practices, improper influences, or inducements and are declared to be false, misleading, deceptive, or unfair:

(a) using DoD personnel, directly or indirectly, as a representative or agent in any official or business capacity with or without compensation with respect to the solicitation or sale of life insurance to service members; or

(b) using an insurance producer to participate in any United States Armed Forces sponsored education or orientation program.

(a) submitting, processing, or assisting in the submission or processing of any allotment form or similar device used by the United States Armed Forces to direct a service member's pay to a third party for the purchase of life insurance. The foregoing includes, but is not limited to, using or assisting in using a service member's "MyPay" account or other similar internet or electronic medium for such purposes. This rule does not prohibit assisting a service member by providing insurer or premium information necessary to complete any allotment form; or

(b) knowingly receiving funds from a service member for the payment of premium from a depository institution with which the service member has no formal banking relationship. For purposes of this rule, a formal banking relationship is established when the depository institution:

(i) provides the service member a deposit agreement and periodic statements and makes the disclosures required by the Truth in Savings Act, 12 U.S.C. section 4301 et seq., and the regulations promulgated thereunder; and

(ii) permits the service member to make deposits and withdrawals unrelated to the payment or processing of insurance premiums.

(c) employing any device or method or entering into any agreement whereby funds received from a service member by allotment for the payment of insurance premiums are identified on the service member's Leave and Earnings Statement or equivalent or successor form as "savings" or "checking" and where the service member has no formal banking relationship as defined in (1)(b);

(d) entering into any agreement with a depository institution for the purpose of receiving funds from a service member whereby the depository institution, with or without compensation, agrees to accept direct deposits from a service member with whom it has no formal banking relationship;

(e) using DoD personnel, directly or indirectly, as a representative or agent in any official or unofficial capacity with or without compensation with respect to the solicitation or sale of life insurance to service members who are junior in rank or grade, or to the family members of such personnel;

(f) offering or giving anything of value, directly or indirectly, to DoD personnel to procure their assistance in encouraging, assisting, or facilitating the solicitation or sale of life insurance to another service member;

(g) knowingly offering or giving anything of value to a service member with a pay grade of E-4 or below for his or her attendance to any event where an application for life insurance is solicited; and

(h) advising a service member with a pay grade of E-4 or below to change his or her income tax withholding or state of legal residence for the sole purpose of increasing disposable income to purchase life insurance.

(2) The following acts or practices by an insurer or insurance producer lead to confusion regarding source, sponsorship, approval, or affiliation and are declared to be false, misleading, deceptive, or unfair:

(a) making any representation, or using any device, title, descriptive name, or identifier that has the tendency or capacity to confuse or mislead a service member into believing that the insurer, insurance producer, or product offered is affiliated, connected, or associated with, endorsed, sponsored, sanctioned, or recommended by the U.S. Government, the United States Armed Forces, or any state or federal agency or government entity. Examples of prohibited insurance producer titles include, but are not limited to, "Battalion Insurance Counselor," "Unit Insurance Advisor," "Servicemen's Group Life Insurance Conversion Consultant," or "Veteran's Benefits Counselor."

(i) Nothing herein shall be construed to prohibit a person from using a professional designation awarded after the successful completion of a course of instruction in the business of insurance by an accredited institution of higher learning. Such designations include, but are not limited to, Chartered Life Underwriter (CLU), Chartered Financial Consultant (ChFC), Certified Financial Planner (CFP), Master of Science In Financial Services (MSFS), or Masters of Science Financial Planning (MS); or

(b) soliciting the purchase of any life insurance product through the use of or in conjunction with any third party organization that promotes the welfare of or assists members of the United States Armed Forces in a manner that has the tendency or capacity to confuse or mislead a service member into believing that either the insurer, insurance producer, or insurance product is affiliated, connected, or associated with, endorsed, sponsored, sanctioned, or recommended by the U.S. Government, or the United States Armed Forces.

(3) The following acts or practices by an insurer or insurance producer lead to confusion regarding premiums, costs, or investment returns and are declared to be false, misleading, deceptive, or unfair:

(a) using or describing the credited interest rate on a life insurance policy in a manner that implies that the credited interest rate is a net return on premium paid; and

(b) excluding individually issued annuities, misrepresenting the mortality costs of a life insurance product, including stating or implying that the product "costs nothing" or is "free."

(4) The following acts or practices by an insurer or insurance producer regarding SGLI or VGLI are declared to be false, misleading, deceptive, or unfair:

(a) making any representation regarding the availability, suitability, amount, cost, exclusions, or limitations to coverage provided to a service member or dependents by SGLI or VGLI, which is false, misleading, or deceptive;

(b) making any representation regarding conversion requirements, including the costs of coverage, or exclusions or limitations to coverage of SGLI or VGLI to private insurers which is false, misleading, or deceptive; or

(c) suggesting, recommending, or encouraging a service member to cancel or terminate his or her SGLI policy or issuing a life insurance policy which replaces an existing SGLI policy unless the replacement shall take effect upon or after the service member's separation from the United States Armed Forces.

(5) The following acts or practices by an insurer and or insurance producer regarding disclosure are declared to be false, misleading, deceptive, or unfair:

(a) deploying, using or contracting for any lead generating materials designed exclusively for use with service members that do not clearly and conspicuously disclose that the recipient will be contacted by an insurance producer, if that is the case, for the purpose of soliciting the purchase of life insurance;

(b) failing to disclose that a solicitation for the sale of life insurance will be made when establishing a specific appointment for an in-person, face-to-face meeting with a prospective purchaser;

(c) excluding individually issued annuities, failing to clearly and conspicuously disclose the fact that the product being sold is life insurance;

(d) failing to make, at the time of sale or offer to an individual known to be a service member, the written disclosures required by section 10 of the "Military Personnel Financial Services Protection Act," Pub. L. No. 109-290, p.16; and

(e) excluding individually issued annuities, when the sale is conducted in-person face-to-face with an individual known to be a service member, failing to provide the applicant at the time the application is taken:

(i) an explanation of any free look period with instructions on how to cancel if a policy is issued; and

(ii) either a copy of the application or a written disclosure. The copy of the application or the written disclosure shall clearly and concisely set out the type of life insurance, the death benefit applied for and its expected first year cost. A basic illustration that meets the requirements of 33-20-604 , MCA (2005) and ARM 6.6.303 shall be deemed sufficient to meet this requirement for a written disclosure.

(6) The following acts or practices by an insurer or insurance producer with respect to the sale of certain life insurance products are declared to be false, misleading, deceptive, or unfair:

(a) excluding individually issued annuities, recommending the purchase of any life insurance product which includes a side fund to a service member in pay grades E-4 and below unless the insurer has reasonable grounds for believing that the life insurance death benefit, standing alone, is suitable; and

(b) offering for sale or selling a life insurance product which includes a side fund to a service member in pay grades E-4 and below who is currently enrolled in SGLI, is presumed unsuitable unless, after the completion of a needs assessment, the insurer demonstrates that the applicant's SGLI death benefit, together with any other military survivor benefits, savings and investments, survivor income, and other life insurance are insufficient to meet the applicant's insurable needs for life insurance:

(i) "insurable needs" are the risks associated with premature death taking into consideration the financial obligations and immediate and future cash needs of the applicant's estate and/or survivors or dependents; and

(ii) "other military survivor benefits" include, but are not limited to: the Death Gratuity, Funeral Reimbursement, Transition Assistance, Survivor and Dependents' Educational Assistance, Dependency and Indemnity Compensation, TRICARE Healthcare benefits, Survivor Housing Benefits and Allowances, Federal Income Tax Forgiveness, and Social Security Survivor Benefits.

(c) excluding individually issued annuities, offering for sale or selling any life insurance contract which includes a side fund:

(i) unless interest credited accrues from the date of deposit to the date of withdrawal and permits withdrawals without limit or penalty;

(ii) unless the applicant has been provided with a schedule of effective rates of return based upon cash flows of the combined product. For this disclosure, the effective rate of return will consider all premiums and cash contributions made by the policyholder and all cash accumulations and cash surrender values available to the policyholder in addition to life insurance coverage. This schedule will be provided for at least each policy year from one to ten and for every fifth policy year thereafter ending at age 100, policy maturity, or final expiration; and

(iii) which by default diverts or transfers funds accumulated in the side fund to pay, reduce, or offset any premiums due.

(d) excluding individually issued annuities, offering for sale or selling any life insurance contract which after considering all policy benefits, including but not limited to endowment, return of premium or persistency, does not comply with standard nonforfeiture law for life insurance; and

(e) selling any life insurance product to an individual known to be a service member that excludes coverage if the insured's death is related to war, declared or undeclared, or any act related to military service except for an accidental death coverage, e.g., double indemnity, which may be excluded.

(1) The purpose of these rules is to establish specific rules to regulate funeral insurance, including but not limited to the licensing of producers, form review, financial reporting, and consumer protection.

(1) These rules shall apply to:

(a) all life insurance policy forms delivered or issued for delivery, marketed, or designated as intended for use in this state as funeral insurance;

(b) any solicitation, negotiation, or sale of funeral insurance occurring within this state;

(c) reporting by funeral insurance issuers; and

(d) the licensing of specialized funeral insurance producers.

(1) Funeral insurance is defined in 33-20-1501, MCA, as a type of life insurance, and all rules pertaining to life insurance shall apply to funeral insurance unless funeral insurance is specifically exempted. In the event of any inconsistency between these rules and other rules pertaining to life insurance, these rules shall govern.

(1) "Excess beneficiary" means the person designated in the funeral insurance policy or certificate to receive any amount of the funeral insurance proceeds that exceed the cost of the funeral goods and services provided to the insured. Payment to the excess beneficiary may be subject to recovery by Medicaid pursuant to 33-20-1501, MCA.

(2) "Funeral goods and services" means personal property sold, or provided, and services provided in connection with a funeral or at the final disposition of human remains.

(3) "Funeral insurance" is a type of life insurance as defined in 33-20-1501, MCA. Funeral insurance may be purchased by making a one time payment of premium or by paying premium in installments. Funeral insurance may be issued on a group or individual basis. Annuity contracts and viatical settlement agreements are not funeral insurance and may not be marketed or designated as intended for use as funeral insurance.

(4) "Funeral insurance policy forms" means every policy, certificate, enrollment form, application form, printed rider, endorsement form, disclosure form, policy summary, or other document which purports to grant funeral insurance or effect a transaction of funeral insurance.

(5) "Funeral insurance proceeds" means the amount payable as stated in the funeral insurance policy forms upon the death of the insured. Funeral insurance proceeds are also known as the death benefit.

(6) "Insurable interest" has the same meaning as in 33-15-201, MCA.

(7) "One-time payment of premium" means a single premium payment is made and the funeral insurance is fully paid up with no further premium payments required.

(8) "Person" means an individual or a business entity including a corporation, association, partnership, limited liability company, limited liability partnership, or other legal entity.

(9) "Preneed funeral arrangement" means an arrangement made with a person licensed under Title 37, chapter 19, parts 3 and 4, MCA, by the intended recipient of the funeral goods and services on that individual's own behalf, or by an authorized individual on behalf of the intended recipient, prior to the death of the individual. Preneed funeral arrangements are governed by Title 37, chapter 19, MCA, and the rules promulgated to implement that chapter.

(10) "Primary beneficiary" means the person designated in the funeral insurance to receive the funeral insurance proceeds intended by the applicant or insured, if not one in the same, to fund a preneed funeral arrangement or to pay for funeral goods and services for the insured. The primary beneficiary may, but need not, be a person licensed under Title 37, chapter 19, parts 3 and 4, MCA. Payment to the primary beneficiary may be subject to recovery by Medicaid pursuant to 33-20-1501, MCA.

(11) "Specialized funeral insurance producer" means a person who holds a current specialized funeral insurance producer license.

(12) "Specialized funeral insurance producer license" means a life insurance producer license that is issued only to persons also licensed under Title 37, chapter 19, parts 3 and 4, MCA.

(1) No person shall solicit, negotiate, or sell funeral insurance unless that person is properly licensed and appointed as a life insurance producer or as a specialized funeral insurance producer.

(2) Any person applying for a specialized funeral insurance producer license shall apply in a form approved by the commissioner. The commissioner may require a supplement to a standardized license application, or a separate license application for persons also licensed under Title 37, chapter 19, parts 3 and 4, MCA.

(3) Any person who wishes to obtain a specialized funeral insurance producer license shall disclose to the commissioner whether the person is currently licensed as funeral director, undertaker, mortician, or mortuary under Title 37, chapter 19, parts 3 and 4, MCA. Additionally, applicants shall disclose whether they have ever had such an application denied, or whether a disciplinary action has ever been taken against such a license, and the outcome of the disciplinary proceeding.

(4) Any nonresident applicant who holds a funeral director, undertaker, mortician, mortuary, or similar license, by whatever name called, in another jurisdiction must first become licensed as a funeral director, undertaker, mortician, or mortuary under Title 37, chapter 19, parts 3 and 4, MCA, before the commissioner will consider an application for a specialized funeral insurance producer license.

(5) If the Board of Funeral Service, provided for in 2-15-1743, MCA, suspends, revokes, or terminates the license of a funeral director, undertaker, mortician, or mortuary, the specialized funeral insurance producer license and any appointments will automatically terminate. The funeral director, undertaker, mortician, or mortuary must notify the commissioner within ten days after a suspension, revocation, or license termination by the Board of Funeral Service.

(1) The commissioner may require a funeral insurance issuer to file a supplement to the annual statement. The supplement will be in a form approved by the commissioner.

(1) In addition to the filing and approval requirements in statute and rule for life insurance policy forms, funeral insurance issuers must file the following with the commissioner for review and prior approval:

(a) solicitation materials; and

(b) disclosure forms.

(2) In addition to complying with the rules governing life insurance, funeral insurance policy forms must clearly and conspicuously:

(a) be identified as funeral insurance;

(b) list any and all exclusions or other conditions under which the funeral insurance will not pay the death benefit; and

(c) contain beneficiary designation provisions as set out in ARM 6.6.1012.

(1) Funeral insurance policy forms must clearly and conspicuously:

(a) allow the insured, or applicant, if the applicant has an insurable interest in the life of the insured, to designate a primary beneficiary and an excess beneficiary;

(b) state that funeral insurance proceeds may be subject to recovery by Medicaid pursuant to 33-20-1501, MCA; and

(c) subject to (1)(b), provide that if the primary beneficiary is a funeral director, mortician, mortuary, or undertaker:

(i) any funeral insurance proceeds that exceed the cost of funeral goods and services provided will be paid in accordance with the term of the funeral insurance, such as an excess beneficiary designation or provision regarding a failed beneficiary designation; and

(ii) under no circumstance may any funeral insurance proceeds be paid to the primary beneficiary that exceed the cost of funeral goods and services provided.

(1) Each funeral insurance policy and certificate delivered or issued for delivery in this state must clearly and conspicuously provide to the insured the right to return the policy or certificate to the funeral insurance issuer within 30 days of delivery of the policy or certificate and to receive an unconditional full refund of all premium and other consideration paid on it.

(2) The funeral insurance issuer must refund the premium and other consideration paid within 30 days of receiving the refund request.

(3) A funeral insurance policy or certificate returned pursuant to this rule is void from the beginning.

(1) Each issuer offering funeral insurance with premium payable in installments shall, as a protection against unintentional lapse, comply with the following:

(a) No funeral insurance policy or certificate shall be issued until the issuer has received from the applicant either a written designation of at least one individual who is to receive notice of lapse or termination of the policy or certificate for nonpayment of premium, or a written waiver dated and signed by the applicant electing not to designate an additional individual to receive notice. The applicant has the right to designate at least one individual who is to receive the notice of termination in addition to the insured. Designation shall not constitute acceptance of any liability by the third party for any goods or services provided to the insured. The form used for the written designation must clearly and conspicuously provide space for listing at least one individual. The designation shall include each individual's full name and home address. In the case of an applicant who elects not to designate an additional individual, the waiver shall state:

(i) "Protection against unintended lapse. I understand that I have the right to designate at least one individual other than myself to receive notice of lapse, or termination of this funeral insurance policy or certificate for nonpayment of premium. I understand that notice will not be given until 30 days after a premium is due and unpaid. I do not elect to designate an individual to receive this notice."

(b) No funeral insurance policy or certificate shall lapse or be terminated for nonpayment of premium unless the issuer, at least 30 days before the effective date of the lapse or termination, has given notice to those individuals designated pursuant to (1) at the address provided for purposes of receiving notice of lapse or termination.

(1) In addition to any disclosures required for life insurance by statute or rule, the funeral insurance issuer shall develop clear and conspicuous written disclosures regarding the following information:

(a) the information contained in 33-20-1501(3), MCA;

(b) whether the cumulative premium paid may exceed the face amount of the funeral insurance policy or certificate and, if so, the length of time until the cumulative premium paid exceeds the face amount of the policy or certificate;

(c) the nature of the relationship among the soliciting producer, the provider of the funeral goods and services, and any other person identified in a preneed funeral arrangement who will or may profit from the transaction;

(d) whether a sales commission, or other form of compensation, is being paid in connection with the sale of the funeral insurance and the identity of the persons to whom it will be paid;

(e) that the funeral insurance issuer, insurance producer, or specialized funeral insurance producer may not require that the applicant, or insured, designate a specific beneficiary, including, but not limited to a funeral director, mortician, mortuary, or undertaker;

(f) the relationship of the funeral insurance to the funding of the preneed funeral arrangement and the nature and existence of any guarantees in relation to the preneed funeral arrangement;

(g) an itemized list of the funeral goods and services which are applied or contracted for in the preneed funeral arrangement and all relevant information concerning the price of the same and whether the price is guaranteed or to be determined at the time of need;

(h) the impact on the preneed funeral arrangement of:

(i) changes in the funeral insurance policy, including, but not limited to, changes in the assignment, beneficiary designation, or use of the proceeds;

(ii) penalties to be incurred by the policyholder as a result of failure to make premium payments; and

(iii) penalties to be incurred or monies to be received as a result of cancellation or surrender of the funeral insurance.

(i) an explanation of any entitlements or obligations which arise if there is a difference between the funeral insurance proceeds and the amount actually needed to fund the preneed funeral arrangement;

(j) any penalties or restrictions, regarding either geographic restrictions, or the inability of the provider of the funeral goods and services identified in the preneed funeral arrangement to perform, on the delivery of funeral goods and services, or the guaranteed elements in the preneed funeral arrangement;

(k) if known, whether the provider of funeral goods and services making or entering a preneed funeral arrangement will accept assignments of funeral insurance and preneed funeral arrangements sold by any other properly licensed person;

(l) that after the death of an individual who at any time received Medicaid benefits, a funeral director, mortician, mortuary, undertaker, or other person, including but not limited to the decedent's spouse, heir, devisee, or personal representative, who is the beneficiary of funeral insurance in excess of $5,000 in value designated to pay for the disposition of the Medicaid recipient's remains and for related expenses shall, after paying for the disposition and related expenses, pay all remaining funds to the Department of Public Health and Human Services within 30 days following the receipt of the funeral insurance death benefit. The funds must be paid to the Department of Public Health and Human Services regardless of any provision in a written contract, insurance policy, or other agreement entered into on or after January 1, 2008, directing a different disposition of the funds. Funds paid to the department under these rules are not considered to be property of the deceased Medicaid recipient's estate, and the provisions of 53-6-167, MCA, do not apply to recovery of the funds by the department;

(m) that the funeral goods and services may also be purchased prior to death by making payment directly to a provider of funeral goods and services, licensed under Title 37, chapter 19, MCA, who would hold the funds in trust for the benefit of the purchaser under Title 37, chapter 19, MCA;

(n) that a discount from the price of funeral goods and services will not be offered, or provided, as an inducement to purchase or assign funeral insurance; and

(o) that cancellation of a preneed funeral arrangement will not cancel, or otherwise invalidate the funeral insurance policy.

(2) If any of the disclosures in (1) cannot be determined until the time of application, the life insurance producer or specialized funeral insurance producer shall complete the disclosure information specific to that funeral insurance transaction.

(3) The funeral insurance issuer will provide the disclosures in (1) to the applicant at the time application is made and prior to accepting any premium. Receipt of these disclosures must be acknowledged in writing by the applicant.

(4) The disclosures and a copy of the written acknowledgment must also be provided when the funeral insurance policy or certificate is delivered.

(1) The sale of funeral insurance may not be conditioned on:

(a) the applicant or insured agreeing to assign the funeral insurance proceeds to a funeral director, mortician, mortuary, or undertaker; or

(b) the applicant or insured making or entering a preneed funeral arrangement.

(2) Prohibited inducements under 33-18-208, MCA, include, but are not limited to, discounts from the price of funeral goods and services.

(1) Except as may otherwise be provided in this subchapter, the following rates for credit life insurance may be considered "prima facie acceptable rates" for purposes of 33-21-205, MCA.� Rates which are filed by any company for the indicated coverage will be considered acceptable without substantiating data if they do not exceed these premium rates:

(a) If premiums are payable on a monthly outstanding balance basis the rate is $.80 per month per $1,000 of outstanding insured debt on single life and $1.40 per month per $1,000 of outstanding insured debt on joint life.

(b) If the premium is charged on a single premium basis, the rate must be computed according to the following formula or according to a forumla approved by the commissioner which produces a rate which is substantially the same as the rate produced by the following formula:

�

�

�

�

S_p = Single premium rate per $100 of initial credit life insurance coverage.

�

O_p = $.80, the prima facie credit life insurance premium rate for monthly outstanding balance coverage from (1).

�

I_t = The scheduled amount of insurance for month t.

�

I_i = Initial amount of insurance.� For a net insurance policy, I_i equals the initial principal balance of the loan.

�

dis = .0036, representing an annual discount rate of 4% for the interest plus .4% for mortality.

�

n = The number of months in the term of the insurance.

�

(c) The premium rate for joint credit life coverage must not exceed 1.75 times the permitted single credit life rate.

�

(2) An insurer may at any time charge a rate which is less than the basic maximum rate set forth above.

(1) The rates provided by ARM 6.6.1101 are presumed to produce reasonable benefits in relation to premium only if:

(a) The credit life insurance contract contains no exclusion other than for suicide committed within two years of the effective date of the insurance; and

(b) The contract contains no age restrictions more severe than those making ineligible for coverage debtors older than the applicable age limit, which must not be less than attained age 65 years if such limit applies to the age when the insurance attaches, or not less than attained age 66 if such limit applies to the age on the scheduled maturity date of the debt.

(i) If the insurer used ages 70 and 71, or higher ages, instead of ages 65 or 66, the prima facie rates in-ARM 6.6.1101(1) may be increased by 5%.

(ii) If the insurer imposes no age limit, the prima facie rates may be increased by 10%.

(2) If a debtor exceeds the eligibility age, has correctly stated his age in writing, or otherwise, and a certificate or policy is issued to him in error, the insurer has the right within 60 days from the date of the loan or extension of credit to terminate coverage and refund any premiums paid. Failure on the part of the insurer to act in a timely manner will subject it to the full risk regardless of the age.

(a) If the debtor dies within the 60 day period before the insurer terminates coverage, the insurer will be liable for the amount of the debtor's insurance at death.

(3) If the policy is issued beyond the age limits established in the policy due to misstatement of age of the debtor, an equitable adjustment of premiums or of benefits must be made as provided by the policy.

(4) The contract may require submission of evidence of insurability.

(1) Except as may otherwise be provided in this sub-chapter, the rates provided in this rule for credit disability insurance may be considered as "prima facie acceptable rates" for the purposes of 33-21-205, MCA. Rates which are filed by any company for the indicated coverage will be considered acceptable without substantiating data if they do not exceed these premium rates.

(2) If premiums are paid in one sum for the entire duration of the indebtedness, the following rates for $100 of initial indebtedness repayable in the indicated number of installments are applicable.

�

��

Number of months in which indebtedness	Nonretroactive � Elimination Period�			Retroactive Benefits � Waiting Period
is repayable	7-day	14-day�	30-day	7-day	14-day	30-day
�6 or less	$1.55	$1.03	$0.41	$2.16	$1.85	$1.34
7	� 1.61	� 1.09	��0.47	� 2.22	� 1.91	� 1.40
8	� 1.67	� 1.15	� 0.53	� 2.28	� 1.97	� 1.46
9	� 1.73	� 1.21	� 0.59	� 2.34	��2.03	� 1.52
10	� 1.79	� 1.27	� 0.65	� 2.40	� 2.09	� 1.58
11	� 1.85	� 1.33	� 0.71	� 2.46	� 2.15	� 1.64
12	� 1.91	� 1.39	� 0.77	� 2.52	� 2.21	� 1.70
13	� 1.96	� 1.45	� 0.83	� 2.58	� 2.27	� 1.76
14	� 2.01	� 1.51	� 0.89	� 2.64	� 2.33	� 1.82
15	� 2.06	� 1.57	� 0.95	� 2.70	� 2.39	� 1.88
16	� 2.11	� 1.63	� 1.01	� 2.76	� 2.45	� 1.94
17	� 2.16	� 1.69	� 1.07	� 2.82	� 2.51	� 2.00
18	� 2.21	� 1.75	� 1.13	� 2.88	� 2.58	� 2.06
19	� 2.27	� 1.81	� 1.19	� 2.94	� 2.64	� 2.11
20	� 2.32	� 1.87	� 1.25	� 3.00	� 2.70	� 2.16
21	� 2.37	� 1.93	� 1.31	� 3.06	� 2.76	� 2.21
22	� 2.42	� 1.99	� 1.37	� 3.12	� 2.82	� 2.27
23	� 2.47	� 2.05	� 1.43	� 3.18	� 2.88	� 2.32
24	� 2.52	� 2.11	� 1.49	� 3.24	� 2.94	� 2.37
25	� 2.58	� 2.17	� 1.55	� 3.30	� 2.99	� 2.42
26	� 2.63	� 2.23	� 1.61	� 3.36	� 3.04	� 2.47
27	� 2.68	� 2.29	� 1.67	� 3.42	� 3.09	� 2.52
28	� 2.73	� 2.35	� 1.73	� 3.48	� 3.14	� 2.58
29	� 2.78	� 2.41	� 1.79	� 3.54	� 3.19	� 2.63
30	� 2.83	� 2.47	� 1.85	� 3.61	� 3.24	� 2.68
31	� 2.88	� 2.53	� 1.91	� 3.66	� 3.30	��2.73
32	� 2.94	� 2.59	� 1.96	� 3.71	� 3.35	� 2.78
33	� 2.99	� 2.65	� 2.01	� 3.76	� 3.40	� 2.83
34	� 3.04	� 2.71	� 2.06	� 3.81	� 3.45	� 2.88

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