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Montana - Compensation & Benefit Legislation

MONTANA - AASHOWME

Demonstrates www.BenefitsReview.com™ site. Illustrates insurance carriers' coverages within the State.

 

MONTANA - ADOPTED CHILD HEALTH CARE MANDATE

OBRA 1993 (Federal) requires group health plans to honor medical and child support orders. Also, plans must treat adopted children like biological children covered by the plan, and plans are precluded from applying pre-existing condition exclusions to an adopted child where no such exclusion applies to a newborn biological child. Health plans that covered the cost of pediatric vaccines as of May 1, 1993, and fail to continue that level of coverage, will be subject to an excise tax penalty applicable to plans that fail to meet the health care continuation coverage requirements under OBRA 1993.

 

Mandatory coverage of adopted children is included in state's newborn health care mandate.

 

Preventive care for children: Yes, through age 2.

 

(Montana Code. Ann. Sections 33-22-130, 33-22-504, 33-22-506, 33-22-512)

 

MONTANA - ALCOHOLISM & DRUG ABUSE

Mandatory coverage.

 

Minimum yearly inpatient coverage: 30 days per year for mental health coverage and substance abuse treatment combined; and $4,000 per 24 months for substance abuse (alcoholism and drug abuse) treatment.

 

Minimum yearly outpatient coverage: $1,000 for mental health coverage and substance abuse treatment combined.

 

Minimum lifetime coverage: $8,000 for substance abuse.

 

(Montana Code. Ann. Section 33-22-703)

 

MONTANA - CAFETERIA PLAN TAX LAWS

State income tax, unemployment insurance tax on salary reduction: State Unemployment Insurance law has no specific provision relating to cafeteria plan benefits, but employer contributions toward health and accident benefits are not taxable, even if provided under a cafeteria plan. Employer contributions toward other cafeteria plan benefits and all employee salary reductions are Unemployment Insurance taxable. For state Unemployment Insurance purposes, the total amount of employees' salary reductions and any cash that the employee has the option to receive (whether or not the employee chooses the cash option) must be treated as wages.

 

MONTANA - CONTINUATION OF COVERAGE CONVERSIONS

Events Triggering Continuation of Coverage:

 

MONTANA - COORDINATION OF BENEFITS

Requires use of the birthday rule if coordinating benefits. Based on 1986 National Association of Insurance Commissioner Rules model. (Montana Code Ann. Sections 33-22-225, 33-22-226)

 

MONTANA - COST-OF-LIVING

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian cost-of-living data and U.S. Automobile Cost Survey.

 

MONTANA - DRUG TESTING AND EMPLOYEE ASSISTANCE BENEFITS

Who is Covered by Statute: All employers, employees, and applicants. Written policy is required, and must be made available to employees at least 60 days prior to testing program's initiation.

 

Applicant Testing: Applicant testing is prohibited except for jobs in hazardous environments or those involving security, public safety, or fiduciary responsibility. Applicants for jobs involving intrastate commercial transportation are subject to testing.

 

Employee Testing: Employee testing is allowed if reasonable suspicion exists. Employees may also be tested if they are involved in an accident causing damage in excess of $1,500 or causing personal injury.

 

How Test Results are Used: Test results may be used to screen out drug-using applicants or to discharge or discipline employees. Adverse action may not be taken against a testee who presents a reasonable explanation for a medical opinion on the test results.

 

Enforcement of Statutes: State pursues violation of statute.

 

Employee Remedies: State has no statutory requirements.

 

Employer Penalties: Employer violations are misdemeanors.

 

Who Pays for Testing: Testing is at employer's expense and all employees must be compensated at their regular rate for time attributable to the testing program.

 

Employee Assistance Benefits: State has no statutory requirements.

 

Other Requirements: Drug testing for continuing employees in jobs involving intrastate commercial motor carrier transportation is permitted during biennial physical.

 

(Montana Code Ann. Sections 39-2-205-39-2-211.))

 

MONTANA - GROUP HEALTH CODE ADDITIONS (MANDATED)

Adopted Children: Coverage for adopted children must be to the same extent as for natural children of the insured, including coverage of an adopted child's conditions that existed prior to the date of placement in the adoptive home. Coverage must be effective from the date of placement for the purpose of adoption and must continue unless the placement is disrupted prior to legal adoption and the child is removed from placement (Montana Code Ann. Sections 33-22-130, 33-30-1016, 33-31-114.)

 

Alcoholism, Drug Abuse and Mental Health: Group accident and health policies must cover treatment under terms no less favorable than those for other illnesses. Policies must cover at least 30 inpatient days per year with the aggregate maximum for alcoholism and drug abuse treatment of $4,000 in any 24 month period and $8,000 in lifetime benefit for mental illness or equal to that for physical illnesses generally. Major medical policies may set co-insurance at 50 percent or the same as for physical illness generally, whichever is greater, with the aggregate minimum for mental illness, alcoholism and drug abuse treatment of $1,000 per year. (Montana Code Ann. Section 33-22-703.)

 

Coverage Continuation and Conversion: Disability policies must provide continuation or conversion rights to dependents who cease to be eligible family members due to death of the insured or dissolution of marriage. (Montana Code Ann. Sections 33-22-306, 33-22-311.) Group disability policies must provide continuation rights to employees whose work hours are reduced. (Montana Code Ann. Section 33-22-507.) Group disability policies must provide conversion rights to employees terminating employment or no loner covered because of termination of business or policy for themselves and their dependents. (Montana Code Ann. Section 33-22-508.) Group hospital or medical service plans issued or renewed by a health service corporation must provide conversion rights to employees terminating their employment or coverage because of termination of business or policy for themselves and their dependents. (Montana Code Ann. Section 33-30-1007.)

 

Disclosure: Requires insurance producers and health maintenance organizations to disclose the meanings of certain terms and provide an explanation of charges. (S177, 1995) Gag Clauses: Health policies or managed care plans must not by oral or written contract, by oral or written direction or requirement, or by financial inducement or penalty prohibit a provider from communicating medical information to an insured individual. (27, 1997) (Montana Code Sections 33-31-111, MCA.)

 

Domestic Abuse: Health care insurers (HMOs included) must not deny coverages or claims; refuse to issue or renew policies; restrict or exclude benefits: add premium differentials; or exclude or limit coverage for losses on the basis that individuals have been victims of domestic abuse. (S234, 1997)

 

Handicapped Dependents: Coverage for dependent children cannot be terminated while a child is incapable of employment due to mental retardation or physical handicap and chiefly dependent on the insured. (Montana Code Ann. Sections 22-22-304, 33-22-506.)

 

Health Maintenance Organizations: PPO Option: Effective January 1, 2000, an HMO which has at least 10,000 members must offer a PPO option benefit plan to each purchaser of health care services; a purchaser may accept or reject a PPO option (H46, 1997) (Montana Code Ann. Section 33-31-102 MCA.) Disclosure of Terms: Effective January 1, 1998, HMOs must issue evidence of coverage statements which must contain clear and concise information on health care services provisions, including limitations on services; deductibles or co-payments; maximum amounts of payments; methods for resolving complaints; definitions of geographical service areas; descriptions of emergency care services; and immediate coverage requirements. Mental Illness, Alcoholism and Drug Abuse: Effective January 1, 1998, HMO members, who have been referred by primary care physicians for ancillary services for mental illness, alcoholism, or drug addiction, may not be limited to care supplied by HMO providers. Mental illness and substance abuse services by non-HMO providers must be limited to the scope of the referral in order for payments to be made by HMOs. Payments made to non-HMO providers for services rendered are not to exceed an amount which an HMO would pay to one of its network providers. (S34, 1997) (Montana Code Ann. Sections 33-31-301 MCA.)

 

Home Health Care: Insurers must make available to group policyholders coverage for home health care. (Montana Code Ann. Section 33-22-1002.)

 

Mammography Screening: Each certificate of insurance in the state that provides coverage for a family member of the insured must provide minimum mammography examination coverage. This coverage must include one baseline mammogram for women 35 to 40 years old; a mammogram every two years for women 40 years of age and under 50 or more frequently if recommended by the woman's physician; and a mammogram each year for women 50 year of age or older. The terms of the applicable certificate of insurance may not be less favorable than for physical illness. A minimum $70 payment must be made for each mammography examination performed. (Montana Code Ann. Sections 33-22-132, 33-31-102; 53-6-101.)

 

Mastectomy: Post-mastectomy Care: Effective January 1, 1998, group health plans (HMOs included) must provide coverage following a mastectomy, lumpectomy, or a lymph node dissection for the treatment of cancer. Post-mastectomy coverage must include medically necessary inpatient hospital care for a period of time as determined appropriate by the attending physician or primary care physician in consultation with the patient. Reconstructive Breast Surgery: Group policies (HMOs included) must cover reconstructive breast surgery on the non-diseased breast in order to establish symmetry. Disclosure: Information concerning breast cancer treatment alternatives; advantages, disadvantages, risks, and descriptions of procedures and treatments; and aspects of recovery must be disclosed to patients. Patients must submit a written consent for treatment, stating that disclosure of relevant information has been made. (S324, 1997) (Montana Code Ann. Sections 33-22-101, 33-22-1827, 33-31-111 MCA.)

 

Maternity: Effective January 1, 1998, health care policies which provide coverage for maternity care, including benefits for childbirth, must provide at least 48 hours of inpatient hospital care following a vaginal delivery and at least 96 hours of inpatient hospital care following a Caesarean section for a mother an a newborn infant. An attending health care provider and mother may make a decision to allow a shorter maternity hospitalization stay than those previously mentioned. Health benefit plans must not terminate the services of attending health care providers or penalize or otherwise provide them with financial disincentives for providing inpatient maternity care which is consistent with legal provisions. Health care policies must supply covered individuals with written notices of required maternity coverages. (S34, 1997) (Montana Code Ann. Section 33-31-301.)

 

Phenylketonuria: Disability policies providing family coverage must cover costs of treatment of phenylketonuria. (Montana Code Ann. Sections 33-22-131, 33-31-101.)

 

Policies for Small Employers: Standard Benefit Plan: Minimum benefits in a standard benefit plan must be equal to 75 percent of the covered expenses in excess of the annual deductible that does not exceed $500 per person or $1,000 per family. The coverage must include a limitation of $2,000 per person or $4,000 per family on the total out-of-pocket expenses for services covered. The coverage may be subject to a maximum lifetime benefit of not less than $1 million. If the standard benefit plan is provided by an HMO or restricted network, then the plan must include a comparable level of benefits as determined by the benefit value. (Montana Code Ann. Section 33-22-1828.) Small employers are those organizations which are actively engaged in business and which have employed at least 3 but not more than 25 employees on at least 50 percent of the working days during the preceding calendar quarter. (H131, 1997) (Montana Code Ann. Section 33-22-1803.)

 

Prescription Drugs: Out of state mail service pharmacies must register with the state, but do not have to be licensed. (H536, 1995)

 

Providers: Physicians, certified physician assistants, dentists, osteopaths, acupuncturists, chiropractors, optometrists, podiatrists, psychologists, licensed social workers, licensed professional counselors, and nurse specialists: Costs for services must be covered if the provider is licensed, the service is with the provider's scope of services, and the services are covered by the policy. (Montana Code Ann. Sections 33-22-111, 33-22-114.) State institutions: Disability policies must cover the costs for services if the provider is licensed, the service is within the provider's scope of services, and the service is covered by the policy. (Montana Code Ann. Section 33-22-112.) Obstetricians or Gynecologists: Effective January 1, 1998, health benefit plans, which provide coverage for primary, obstetrical, or gynecological care, must allow obstetricians or gynecologists to participate as primary care physicians. Obstetricians or gynecologists are not required to accept a classification of primary care physician; however, those who accept this classification must have the same credentials generally required of other primary care physicians. Health benefit plans must permit covered individuals to exercise self-referrals to those participating obstetricians or gynecologists who are classified as primary care physicians. (S144, 1977) (Montana Code Ann. Sections 33-22-1041, 33-31-111 MCA.)

 

Uniform Health Benefits: Group policies that provide insured individuals with uniform health benefits and services must pay 50 percent of covered expenses in excess of annual deductibles; these deductibles must not exceed $1,000 per person or $2,000 per family. Group plans also must include limitations on individual's total annual out of pocket expenses of $5,000 per person or $7,500 per family with a $1 million lifetime maximum. (S381, 1997) (Montana Code Ann. Section 33-22-522 MCA.)

 

Well Child Care: Disability policies providing family coverage must provide well child care coverage for children from the moment of birth through two years of age. This coverage is exempt from any deductible provisions in force in the policy. Coverage must include a history; physical examination; developmental assessment; anticipatory guidance; laboratory tests according to the schedule of visits adopted under the early and periodic screening; diagnosis; and treatment services program provided for in 53-6-101; and routine immunizations recommended by the immunization practices advisory committee of the U.S. Department of Health and Human Services. Minimum benefits may be limited to one visit payable to one provider for all services provided at each visit. (Montana Code Ann. Sections. 33-22-301, 33-22-303, 33-22-504, 33-22-1521, 33-30-1001, 33-30-1521, 33-31-102.)

 

MONTANA - GROUP HEALTH FOR SMALL EMPLOYERS

For insurance plans offered to small employers:

 

MONTANA - GROUP LIFE CODE ADDITIONS

Employer required to pay part of premium: Yes.

 

Percent of employees who must elect coverage (if employees pay part of premium): 75%.

 

Percent of employees who must be covered if employer pays all of premium: 100%.

 

Minimum number of employees in group plan: 10.

 

Employer prohibited as beneficiary: Yes.

 

Grace period (days): 31.

 

Mandatory conversion: Yes.

 

Other provisions: None.

 

(Montana Code Ann. Sections 33-20-1101, 33-20-1202, 33-20-1210)

 

MONTANA - HOLIDAYS

January 1, Washington's Birthday (or 3rd Monday in February), Memorial Day (or last Monday in May), July 4, Labor Day (or 1st Monday in September), Veterans Day, and December 25 are state holidays in all 50 states and in the District of Columbia. Other holidays under State law include: Martin Luther King's birthday (or 3rd Monday in January), Columbus Day (or 2nd Monday in October), Thanksgiving, Sunday. Other: If any holiday (except Sunday) falls on Sunday, following Monday is a holiday. (Montana Code Ann. Sections 1-1-216, 1-1-225)

 

MONTANA - IMMIGRATION (PREVAILING WAGE POLICY)

See U.S. Federal General Administrative Letter 1-2000

 

MONTANA - JURY DUTY & WITNESS TIME OFF

Employer Restriction For Discharging Employee For Taking Leave For Jury Service: Yes.

 

Remedies and Penalties: State reports no statutory requirements.

 

Other Requirements: Applies only to public employees. Juror fees to be applied against amount due the employee from the employer unless employee elects to use annual leave for jury duty. Employer may request the court to excuse an employee who performs a needed function. (Montana Code Ann. Section 2-18-619.)

 

Employer Restriction For Discharging Employee For Taking Leave to be a Witness: Yes.

 

Remedies and Penalties: Applies only to public employees. Witness fees to be applied against amount due the employee from the employer unless employee elects to use annual leave to comply with subpoena.

 

Other Requirements: None reported.

 

MONTANA - LEAVES OF ABSENCE

Employers Subject to Leave Laws: All employers.

 

Criteria for Eligibility: Applies to all female employees.

 

Maximum length of leave: Reasonable leave.

 

Paid Leave: State does not require paid leave.

 

Acceptable Reasons for Leave: Pregnancy.

 

Employment Guarantees After Leave: Entitled to reinstatement in the position held prior to the leave or equivalent position, unless a change in circumstances makes it impossible or unreasonable for employer to do so.

 

Use of Vacation or other Time-off Benefits: State has no statutory requirements.

 

Certification Required: Employer may require certification of disabling condition due to pregnancy.

 

Effect Of Leave on Other Benefits: Fringe benefits employee had prior to leave must be restored when employee returns to work, unless a change in circumstances makes it impossible or unreasonable for employer to do so.

 

Effect of Seniority Accrual During Leave: Seniority benefits accrue during leave.

 

Minimum Requirements for Notification to Employer: State reports no statutory requirements.

 

Conditions for Denial of a Request For Leave: State reports no statutory requirements.

 

(Montana Code Ann. Sections 49-2-310, 49-2-311.)

 

See U.S. Federal Family and Medical Leave Act

 

MONTANA - LONG TERM DISABILITY CODE ADDITIONS

State does not require employer to provide long term disability benefits; although many employers do in order to remain competitive in hiring/retention of employees.

 

See LEAVES OF ABSENCE (above), WORKERS' COMPENSATION (below) and U.S. Federal Americans With Disabilities Act

 

MONTANA - MANDATED PROVIDERS

Optometrists, chiropractors, dentists, psychologists, podiatrists, social workers, and nurse specialists. Mandatory coverage for physician assistants, osteopaths, acupuncturists, licensed professional counselors, and denturists. (Montana Code Ann. Sections 33-22-11, 37-29-104)

 

MONTANA - MENTAL HEALTH CARE

Mandatory coverage.

 

Minimum yearly inpatient coverage: 21 days for mental health and substance abuse treatment combined.

 

Minimum yearly outpatient coverage: $2,000 for mental health and substance abuse treatment combined.

 

Minimum lifetime coverage: No less than lifetime maximum for physical illness.

 

(Montana Code Ann. Section 33-22-703)

 

MONTANA - MINIMUM WAGE

Refer to the Federal minimum wage: $5.15 per hour (effective September 1, 1997).

 

$4.00 per hour for employers with annual gross of less than $110,000.00.

 

Exemptions: Certain professionals, agriculture workers, domestics, outside sales, students, apprentices, and handicapped workers in special environments. (Montana Code Ann. Sections 39-3-404, 39-3406, 39-3-409)

 

See U.S. Minimum Wage

 

MONTANA - NEW HIRE REPORTING

Who is required to report: All employers.

 

Who must be reported: All employees and rehires.

 

Exempt from reporting: No exemptions.

 

Form(s) to file: W-4, state provided form, or any other form with the required information.

 

Filing deadline: Within 20 days of hire.

 

Employer information to be included: Name, address, and EIN.

 

Employee information to be included: Name, physical street address (not a P.O. Box), SSN, and date of hire. Employer may also provide employee’s home phone number, date of birth, and insurance information.

 

Penalty for failure to report: N/A/

 

(Mont. Code. Ann. Section 40-5-922)

 

MONTANA - NEWBORN CARE MANDATE

Mandated coverage.

 

Preventive care for children: Yes, through age 2. (Montana Code. Ann. Sections 33-22-130, 33-22-504, 33-22-506, 33-22-512)

 

MONTANA - PARENTAL LEAVE

See U.S. Federal Family and Medical Leave Act

 

MONTANA - PRE-EXISTING CONDITIONS

State reports no statutory requirements.

 

See U.S. Federal Health Insurance Portability & Accountability Act

 

MONTANA - PROTECTED CLASSIFICATIONS

Age:  Yes.

Race:  Yes.

Color: Yes.

National Origin: Yes.

Ancestry:  No specific law. State has expressed policy against discrimination.

Religion:  Yes.

Sex:  Yes.

Pregnancy: Yes.

Sexual Harassment: Yes. Statute specifically mentions public employment only.

 

(Montana Code Ann. Sections 49-2-101, 49-2-102, 49-2-303, 49-2-308-49-2-311, Mont. Const. art. II, Section 4.)

 

MONTANA - SALARY SURVEY

ERI's Relocation Assessor™ is a recommended source for U.S./Canadian wages & salaries (covering 3,000 positions).

 

MONTANA - SHORT TERM DISABILITY CODE ADDITIONS

State does not require employer or employee participation in short term disability plans.

 

MONTANA - TERMINATION & SEVERANCE PAY

Date pay is due if employee is discharged: Immediately.

 

Date due if employee resigns: Within 3 days.

 

Wages: Yes.

 

Vacation Pay: No.

 

Holiday: No.

 

Sick leave: No.

 

Severance: No.

 

( Montana Code Ann. Sections 39-3-201)

 

MONTANA - UNEMPLOYMENT TAX

Employer Contributions:

 

 

Voluntary Contribution Provision: No.

 

(Montana Code Ann. Sections 39-51-301, 39-51-603, 39-51-1218.)

 

MONTANA - VACATION PAY

State reports no statutory requirements.

 

MONTANA - VOTING TIME OFF

State reports no statutory requirements.

 

MONTANA - WORKERS' COMPENSATION

Private Employers: Mandatory as to all employments. Partners and sole proprietors may apply for an exemption.

 

Public Employers: Mandatory as to all public employments, including public contractors and volunteer rescue workers.

 

Exceptions: Domestic and casual employment; family members; employers covered by federal law; person performing services for aid and sustenance only; officials at amateur athletic events; real estate brokers and salesperson; direct sellers of consumer goods; dependent member of employer's family for whom the employer may claim as a exemption under the federal tax code; newspaper carriers and free-lance correspondents, cosmetologists, and barbers.

 

Special Coverage Provisions: Coverage is mandatory for partner or sole proprietor who is independent contractor, but may apply for personal exemptions. Voluntary as to exempt employments.

 

(U.S. Chamber of Commerce, 1994 Analysis of Workers' Compensation Laws.)