MT HB544

Health insurers are prohibited from retroactively denying coverage for services that received prior approval, except in cases of fraud, misrepresentation, nonpayment of premium, benefit exhaustion, or if the patient was not covered or received a different service than approved.

Providers may prescribe FDA-approved biologic therapies to patients under 18, even without pediatric FDA approval, if the treatment is medically necessary and supported by at least two peer-reviewed journals demonstrating safety and effectiveness for the patient's age group (infancy, childhood, or adolescence).

State employee group benefit plans and Montana university system group benefits plans must comply with these new retroactive denial and biologic therapy provisions.

Effective January 1, 2026, applying to health insurance policies issued or renewed on or after that date.