Montana Health Insurance Policy Requirements

Montana has comprehensive health insurance regulations that work alongside federal requirements. The Montana Mental Health Parity Act provides additional protections.

Regulatory Structure

Montana health coverage is regulated by the Commissioner of Securities and Insurance (CSI):

Health Insurance Marketplace

Montana uses the federal HealthCare.gov marketplace:

• Federally facilitated marketplace
• Provides access to qualified health plans (QHPs)
• Premium tax credits available for eligible residents
• Open enrollment and special enrollment periods apply

Metal Tier Plans

Pre-Existing Condition Protections

Montana prohibits pre-existing condition exclusions in ACA-compliant plans:

Guaranteed Issue and Renewal

Montana requires:

Guaranteed Issue

• Insurers must accept all applicants for ACA-compliant plans
• Cannot deny coverage based on health status
• Applies to individual and small group markets

Guaranteed Renewal

• Insurers cannot cancel coverage except for:
  • Non-payment of premium
  • Fraud or misrepresentation
  • Plan discontinuation (with proper notice)

Montana Mental Health Parity Act

Montana has its own Mental Health Parity Act under MCA 33-22, Part 7:

Coverage Requirements

Montana law requires health insurance to provide coverage for:

• Mental health conditions
• Substance use disorders
• Psychiatric collaborative care model
• Primary care behavioral health model

Parity Compliance Records (MCA 33-22-707)

Health insurers must submit reports to the Commissioner that comply with federal mental health parity requirements under 42 U.S.C. 300gg-26(a)(8).

Red Flag Violations

The CSI has identified examples of parity violations:

• Requiring new treatment plans for mental health therapy every 90 days
• Requiring reauthorization of inpatient mental health stays every 5 days
• Refusing out-of-state treatment for mental illness
• Denying therapy because progress hasn't been "proven"

Enforcement Actions

The CSI has taken enforcement action against insurers for parity violations, including ordering payment of unpaid claims and imposing fines.

Essential Health Benefits

All individual and small group plans must cover:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorders
6. Prescription drugs
7. Rehabilitative services
8. Laboratory services
9. Preventive and wellness services
10. Pediatric services (including dental and vision)

Consumer Complaints

Consumers can file mental health parity complaints with the CSI:

• Phone: (406) 444-2040
• Toll-free: (800) 332-6148
• Email: CSI.marketconduct@mt.gov

The CSI will investigate and has enforcement powers if violations are found.