33-22-526. Group health discrimination prohibited. - Montana Statutes

     33-22-526. Group health discrimination prohibited. (1) (a) A group health plan or a health insurance issuer offering group health insurance coverage may not establish rules for eligibility, including continued eligibility, of any individual to enroll under the terms of the group health plan based on any of the following health status-related factors of the individual or a dependent of the individual:
     (i) health status;
     (ii) medical condition, including both physical and mental illnesses;
     (iii) claims experience;
     (iv) receipt of health care;
     (v) medical history;
     (vi) genetic information;
     (vii) evidence of insurability, including conditions arising out of acts of domestic violence; or
     (viii) disability.
     (b) This subsection does not:
     (i) require a group health plan or group health insurance coverage to provide particular benefits other than those provided under the terms of the group health plan or group health insurance coverage; or
     (ii) prevent the group health plan or group health insurance coverage from establishing limitations or restrictions on the amount, level, extent, or nature of the benefits or coverage for similarly situated individuals enrolled in the group health plan or group health insurance coverage.
     (c) For purposes of subsection (1)(a), rules for eligibility to enroll under a group health plan include rules defining an applicable waiting period for the enrollment.
     (2) (a) A group health plan and a health insurance issuer offering health insurance coverage in connection with a group health plan may not require an individual, as a condition of enrollment or continued enrollment under the group health plan, to pay a premium or contribution that is greater than the premium or contribution for a similarly situated individual enrolled in the group health plan on the basis of any health status-related factor of the individual or of an individual enrolled under the plan as a dependent of the individual.
     (b) This subsection (2) does not:
     (i) restrict the amount that an employer may be charged for coverage under a group health plan; or
     (ii) prevent a group health plan and a health insurance issuer offering group health insurance coverage from establishing premium discounts or modifying otherwise applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.

     History: En. Sec. 44, Ch. 416, L. 1997.