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1 SENATE BILL NO. 244
2 INTRODUCED BY M. YAKAWICH
3
4 A BILL FOR AN ACT ENTITLED: “AN ACT REQUIRING HEALTH INSURANCE TO PROVIDE COVERAGE
5 FOR BEHAVIORAL HEALTH SCREENING ASSESSMENTS; INCLUDING THE COVERAGE IN MANDATORY
6 PROVISIONS OF THE STATE EMPLOYEE GROUP BENEFIT PLANS; REQUIRING COVERAGE FOR THE
7 ASSESSMENTS IN DISABILITY INSURANCE OFFERED IN THE STATE AND IN SELF-FUNDED MULTIPLE
8 WELFARE EMPLOYMENT ARRANGEMENTS; AMENDING SECTIONS 2-18-704 AND 33-35-306, MCA; AND
9 PROVIDING A DELAYED EFFECTIVE DATE AND AN APPLICABILITY DATE.”
10
11 BE IT ENACTED BY THE LEGISLATURE OF THE STATE OF MONTANA:
12
13 NEW SECTION. Section 1. An
14 individual disability policy, certificate of insurance, or membership contract that is delivered, issued for delivery,
15 renewed, extended, or modified in this state must provide coverage for behavioral health screening
16 assessments that utilize a standardized, evidence-based instrument at no out-of-pocket cost to the insured or
17 the subscriber.
18
19 Section 2-18-704, MCA, is amended to read:
20 "2-18-704. (1) An insurance contract or plan issued under this part must
21 contain provisions that permit:
22 (a) the member of a group who retires from active service under the appropriate retirement
23 provisions of a defined benefit plan provided by law or, in the case of the defined contribution plan provided in
24 Title 19, chapter 3, part 21, a member with at least 5 years of service and who is at least age 50 while in
25 covered employment to remain a member of the group until the member becomes eligible for medicare under
26 the federal Health Insurance for the Aged Act, 42 U.S.C. 1395, unless the member is a participant in another
27 group plan with substantially the same or greater benefits at an equivalent cost or unless the member is
28 employed and, by virtue of that employment, is eligible to participate in another group plan with substantially the ****
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1 same or greater benefits at an equivalent cost;
2 (b) the surviving spouse of a member to remain a member of the group as long as the spouse is
3 eligible for retirement benefits accrued by the deceased member as provided by law unless the spouse is
4 eligible for medicare under the federal Health Insurance for the Aged Act or unless the spouse has or is eligible
5 for equivalent insurance coverage as provided in subsection (1)(a);
6 (c) the surviving children of a member to remain members of the group as long as they are eligible
7 for retirement benefits accrued by the deceased member as provided by law unless they have equivalent
8 coverage as provided in subsection (1)(a) or are eligible for insurance coverage by virtue of the employment of
9 a surviving parent or legal guardian.
10 (2) An insurance contract or plan issued under this part must contain the provisions of subsection
11 (1) for remaining a member of the group and also must permit:
12 (a) the spouse of a retired member the same rights as a surviving spouse under subsection (1)(b);
13 (b) the spouse of a retiring member to convert a group policy as provided in 33-22-508; and
14 (c) continued membership in the group by anyone eligible under the provisions of this section,
15 notwithstanding the person's eligibility for medicare under the federal Health Insurance for the Aged Act.
16 (3) (a) A state insurance contract or plan must contain provisions that permit a legislator to remain
17 a member of the state's group plan until the legislator becomes eligible for medicare under the federal Health
18 Insurance for the Aged Act if the legislator:
19 (i) terminates service in the legislature and is a vested member of a state retirement system
20 provided by law; and
21 (ii) notifies the department of administration in writing within 90 days of the end of the legislator's
22 legislative term.
23 (b) A former legislator may not remain a member of the group plan under the provisions of
24 subsection (3)(a) if the person:
25 (i) is a member of a plan with substantially the same or greater benefits at an equivalent cost; or
26 (ii) is employed and, by virtue of that employment, is eligible to participate in another group plan
27 with substantially the same or greater benefits at an equivalent cost.
28 (c) A legislator who remains a member of the group under the provisions of subsection (3)(a) and ****
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1 subsequently terminates membership may not rejoin the group plan unless the person again serves as a
2 legislator.
3 (4) (a) A state insurance contract or plan must contain provisions that permit continued
4 membership in the state's group plan by a member of the judges' retirement system who leaves judicial office
5 but continues to be an inactive vested member of the judges' retirement system as provided by 19-5-301. The
6 judge shall notify the department of administration in writing within 90 days of the end of the judge's judicial
7 service of the judge's choice to continue membership in the group plan.
8 (b) A former judge may not remain a member of the group plan under the provisions of this
9 subsection (4) if the person:
10 (i) is a member of a plan with substantially the same or greater benefits at an equivalent cost;
11 (ii) is employed and, by virtue of that employment, is eligible to participate in another group plan
12 with substantially the same or greater benefits at an equivalent cost; or
13 (iii) becomes eligible for medicare under the federal Health Insurance for the Aged Act.
14 (c) A judge who remains a member of the group under the provisions of this subsection (4) and
15 subsequently terminates membership may not rejoin the group plan unless the person again serves in a
16 position covered by the state's group plan.
17 (5) A person electing to remain a member of the group under subsection (1), (2), (3), or (4) shall
18 pay the full premium for coverage and for that of the person's covered dependents.
19 (6) An insurance contract or plan issued under this part that provides for the dispensing of
20 prescription drugs by an out-of-state mail service pharmacy, as defined in 37-7-702:
21 (a) must permit any member of a group to obtain prescription drugs from a pharmacy located in
22 Montana that is willing to match the price charged to the group or plan and to meet all terms and conditions,
23 including the same professional requirements that are met by the mail service pharmacy for a drug, without
24 financial penalty to the member; and
25 (b) may only be with an out-of-state mail service pharmacy that is registered with the board under
26 Title 37, chapter 7, part 7, and that is registered in this state as a foreign corporation.
27 (7) An insurance contract or plan issued under this part must include coverage for:
28 (a) treatment of inborn errors of metabolism, as provided for in 33-22-131; ****
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1 (b) therapies for Down syndrome, as provided in 33-22-139;
2 (c) treatment for children with hearing loss as provided in 33-22-128(1) and (2);
3 (d) fertility preservation services as required under 33-22-2103;
4 (e) the care and treatment of mental illness in accordance with the provisions of Title 33, chapter
5 22, part 7;
6 (f) telehealth services, as provided for in 33-22-138; and
7 (g) refills of prescription eyedrops as provided in 33-22-154.
8 (8) (a) An insurance contract or plan issued under this part that provides coverage for an individual
9 in a member's family must provide coverage for well-child care for children from the moment of birth through 7
10 years of age. Benefits provided under this coverage are exempt from any deductible provision that may be in
11 force in the contract or plan.
12 (b) Coverage for well-child care under subsection (8)(a) must include:
13 (i) a history, physical examination, developmental assessment, anticipatory guidance, and
14 laboratory tests, according to the schedule of visits adopted under the early and periodic screening, diagnosis,
15 and treatment services program provided for in 53-6-101; and
16 (ii) routine immunizations according to the schedule for immunization recommended by the
17 advisory committee on immunization practices of the U.S. department of health and human services.
18 (c) Minimum benefits may be limited to one visit payable to one provider for all of the services
19 provided at each visit as provided for in this subsection (8).
20 (d) For purposes of this subsection (8):
21 (i) "developmental assessment" and "anticipatory guidance" mean the services described in the
22 Guidelines for Health Supervision II, published by the American academy of pediatrics; and
23 (ii) "well-child care" means the services described in subsection (8)(b) and delivered by a
24 physician or a health care professional supervised by a physician.
25 (9) Upon renewal, an insurance contract or plan issued under this part under which coverage of a
26 dependent terminates at a specified age must continue to provide coverage for any dependent, as defined in
27 the insurance contract or plan, until the dependent reaches 26 years of age. For insurance contracts or plans
28 issued under this part, the premium charged for the additional coverage of a dependent, as defined in the ****
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1 insurance contract or plan, may be required to be paid by the insured and not by the employer.
2 (10) Prior to issuance of an insurance contract or plan under this part, written informational
3 materials describing the contract's or plan's cancer screening coverages must be provided to a prospective
4 group or plan member.
5 (11) The state employee group benefit plans and the Montana university system group benefits
6 plans must provide coverage for hospital inpatient care for a period of time as is determined by the attending
7 physician and, in the case of a health maintenance organization, the primary care physician, in consultation
8 with the patient to be medically necessary following a mastectomy, a lumpectomy, or a lymph node dissection
9 for the treatment of breast cancer.
10 (12) (a) (i) The state employee group benefit plans and the Montana university system group
11 benefits plans must provide coverage for medically necessary and prescribed outpatient self-management
12 training and education for the treatment of diabetes. Any education must be provided by a licensed health care
13 professional with expertise in diabetes. At a minimum, the benefit must consist of:
14 (A) 20 visits of training and education in diabetes self-management provided in either an individual
15 or group setting if the person has not received the training and education previously; and
16 (B) 12 visits of followup diabetes self-management training and education services in subsequent
17 years for an insured who has previously received and exhausted the initial 20 visits of education.
18 (ii) For the purposes of this subsection (12)(a), the term "visit" refers to a period of 30 minutes.
19 (b) The state employee group benefit plans and the Montana university system group benefits
20 plans must provide coverage for diabetic equipment and supplies that at a minimum includes insulin, syringes,
21 injection aids, devices for self-monitoring of glucose levels (including those for the visually impaired), test strips,
22 visual reading and urine test strips, one insulin pump for each warranty period, accessories to insulin pumps,
23 one prescriptive oral agent for controlling blood sugar levels for each class of drug approved by the United
24 States food and drug administration, and glucagon emergency kits.
25 (c) Nothing in subsection (12)(a) or (12)(b) prohibits the state or the Montana university group
26 benefit plans from providing a greater benefit or an alternative benefit of substantially equal value, in which
27 case subsection (12)(a) or (12)(b), as appropriate, does not apply.
28 (d) Annual copayment and deductible provisions are subject to the same terms and conditions ****
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1 applicable to all other covered benefits within a given policy.
2 (e) The state employee group benefit plans and the Montana university system group benefits
3 plans must provide coverage for behavioral health screening assessments that utilize a standardized, evidence-
4 based instrument at no out-of-pocket cost to the insured or the subscriber.
5 (e)(f) This subsection (12) does not apply to disability income, hospital indemnity, medicare
6 supplement, accident-only, vision, dental, specific disease, or long-term care policies offered by the state or the
7 Montana university system as benefits to employees, retirees, and their dependents.
8 (13) (a) Except as provided in subsection (16), the state employee group benefit plans and the
9 Montana university system group benefits plans that provide coverage to the spouse or dependents of a peace
10 officer as defined in 45-2-101, a game warden as defined in 19-8-101, a firefighter as defined in 19-13-104, or a
11 volunteer firefighter as defined in 19-17-102 shall renew the coverage of the spouse or dependents if the peace
12 officer, game warden, firefighter, or volunteer firefighter dies within the course and scope of employment.
13 Except as provided in subsection (13)(b), the continuation of the coverage is at the option of the spouse or
14 dependents. Renewals of coverage under this section must provide for the same level of benefits as is
15 available to other members of the group. Premiums charged to a spouse or dependent under this section must
16 be the same as premiums charged to other similarly situated members of the group. Dependent special
17 enrollment must be allowed under the terms of the insurance contract or plan. The provisions of this subsection
18 (13)(a) are applicable to a spouse or dependent who is insured under a COBRA continuation provision.
19 (b) The state employee group benefit plans and the Montana university system group benefits
20 plans subject to the provisions of subsection (13)(a) may discontinue or not renew the coverage of a spouse or
21 dependent only if:
22 (i) the spouse or dependent has failed to pay premiums or contributions in accordance with the
23 terms of the state employee group benefit plans and the Montana university system group benefits plans or if
24 the plans have not received timely premium payments;
25 (ii) the spouse or dependent has performed an act or practice that constitutes fraud or has made
26 an intentional misrepresentation of a material fact under the terms of the coverage; or
27 (iii) the state employee group benefit plans and the Montana university system group benefits
28 plans are ceasing to offer coverage in accordance with applicable state law. ****
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1 (14) The state employee group benefit plans and the Montana university system group benefits
2 plans must comply with the provisions of 33-22-153.
3 (15) An insurance contract or plan issued under this part and a group benefits plan issued by the
4 Montana university system must provide mental health coverage that meets the provisions of Title 33, chapter
5 22, part 7.
6 (16) The employing state agency of a law enforcement officer as defined in 2-15-2040 who is
7 covered under the state employee group benefit plan shall:
8 (a) if the officer is catastrophically injured in the line of duty as defined in 2-15-2040, enroll the
9 officer and the officer's covered spouse or dependent children in COBRA continuation coverage when that
10 officer is terminated from employment as a result of the catastrophic injury. The officer and the officer's spouse
11 or dependent children may opt out of COBRA continuation coverage within 60 days of enrollment.
12 (b) enroll the officer's covered spouse or dependent children in COBRA continuation coverage if
13 the officer dies in the line of duty as defined in 2-15-2040. The officer's spouse or dependent children may opt
14 out of COBRA coverage within 60 days of the date of enrollment.
15 (c) pay the COBRA premium for 4 months of COBRA continuation coverage for the officer and the
16 officer's covered spouse or dependent children enrolled in COBRA continuation coverage pursuant to
17 subsections (16)(a) or (16)(b), after which time the officer and the officer's spouse or dependent children shall
18 pay the COBRA premium. (See compiler's comments for contingent termination of certain text.)"
19
20 Section 33-35-306, MCA, is amended to read:
21 "33-35-306. (1) In addition to this chapter, self-
22 funded multiple employer welfare arrangements are subject to the following provisions:
23 (a) 33-1-111;
24 (b) Title 33, chapter 1, part 4, but the examination of a self-funded multiple employer welfare
25 arrangement is limited to those matters to which the arrangement is subject to regulation under this chapter;
26 (c) Title 33, chapter 1, part 7;
27 (d) Title 33, chapter 2, parts 23 and 24;
28 (e) 33-3-308; ****
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1 (f) Title 33, chapter 7;
2 (g) Title 33, chapter 18, except 33-18-242;
3 (h) Title 33, chapter 19;
4 (i) 33-22-107, 33-22-114, 33-22-128, 33-22-129, 33-22-131, 33-22-134, 33-22-135, 33-22-138,
5 33-22-139, 33-22-141, 33-22-142, and 33-22-152 through 33-22-155, and [section 1];
6 (j) 33-22-316;
7 (k) 33-22-512, 33-22-515, 33-22-525, and 33-22-526;
8 (l) Title 33, chapter 22, parts 7 and 21; and
9 (m) 33-22-707.
10 (2) Except as provided in this chapter, other provisions of Title 33 do not apply to a self-funded
11 multiple employer welfare arrangement that has been issued a certificate of authority that has not been
12 revoked."
13
14 NEW SECTION. Section 4. [Section 1] is intended to be codified as an
15 integral part of Title 33, chapter 22, and the provisions of Title 33, chapter 22, apply to [section 1].
16
17 NEW SECTION. Section 5. [This act] is effective January 1, 2026.
18
19 NEW SECTION. Section 6. [This act] applies to applies to policies, certificates, and
20 contracts issued or renewed on or after January 1, 2026.
21 - END -