Bill > HB544

This bill addresses two key aspects of health insurance regulation in Montana. First, it prohibits health insurance issuers from retroactively denying coverage for a service that was previously approved, with exceptions for cases of fraud, misrepresentation, nonpayment of premiums, exhaustion of benefits, or situations where the covered person was not actually covered when the service was provided. Second, the bill establishes guidelines for prescribing biologic therapies to minors, allowing healthcare providers to prescribe FDA-approved adult biologic treatments for children and adolescents under 18 years old, provided the treatments are medically necessary and supported by peer-reviewed medical literature demonstrating safety and effectiveness for specific age ranges. The bill also amends an existing law related to state employee group benefit plans, requiring them to comply with the new provisions on retroactive denials and biologic prescriptions. The new regulations will apply to health insurance policies issued or renewed on or after January 1, 2026, giving insurers time to adjust their practices to meet the new requirements.

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https://bills.legmt.gov/#/laws/bill/2/LC1961