24-A M.R.S. § 471 — ME Code / Title 24-A / Chapter 5 / Section 471
24-A §471. Proclamation by Governor
Status: in_force

Whenever it appears to the Governor that the welfare of the State or any section thereof, or the welfare and security of insurers under the supervision of the superintendent or their insureds or beneficiaries require, the Governor may proclaim that an insurance emergency exists and this subchapter shall thereupon become effective. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 2430 — ME Code / Title 24-A / Chapter 27 / Section 2430
24-A §2430. Exemption of proceeds, group insurance
Status: in_force

1. A policy of group life insurance or group health insurance or the proceeds thereof payable to the individual insured or to the beneficiary thereunder, is not liable, either before or after payment, to be applied by any legal or equitable process to pay any debt or liability of such insured individual or the individual's beneficiary or of any other person having a right under the policy. [RR 2021, c. 1, Pt. B, §220 (COR).]

2. This section does not apply to group insurance issued pursuant to this Title to a creditor covering the creditor's debtors, to the extent that such proceeds are applied to payment of the obligation for the purpose of which the insurance was so issued. [RR 2021, c. 1, Pt. B, §220 (COR).]
24-A M.R.S. § 1481-A — ME Code / Title 24-A / Chapter 16 / Section 1481-A
24-A §1481-A. Applicability of subchapter
Status: in_force

1. Applicability. This subchapter applies to licensed producers and licensed consultants. [PL 1997, c. 592, §44 (NEW).]

2. Exceptions. Except for limited licenses for the sale of annuities, this subchapter does not apply to persons holding only limited licenses under section 1416 . [PL 1997, c. 592, §44 (NEW).]
24-A M.R.S. § 222 — ME Code / Title 24-A / Chapter 3 / Section 222
24-A §222. Registration, regulation, supervision and examination of holding company systems, agents, promoters and others
Status: in_force

1. Examination. [PL 2013, c. 238, Pt. A, §2 (RP); PL 2013, c. 238, Pt. A, §34 (AFF).]

1-A. Examination. For purposes of ascertaining compliance with law, or relationships and transactions between any person as defined hereafter and any insurer or proposed insurer subject to this section, the superintendent may as often as the superintendent determines to be advisable examine the accounts, records, documents and transactions pertaining to or affecting the insurance affairs or proposed insurance affairs, or transactions of the insurer or proposed insurer as may be in the possession of any holding company, its subsidiaries or affiliates as is necessary to ascertain the financial condition, including the enterprise risk to the insurer by the ultimate controlling party, or legality of conduct of the insurer or proposed insurer or the insurance holding company system as a whole or any combination of entities within the insurance holding company system and to verify the accuracy of any information provided or required to be provided to the superintendent pursuant to this section. A. The superintendent's investigatory and examination authority under this subsection extends to the examination of: (1) Any business entity structured to hold the stock of an insurance company, or person holding the shares of voting stock or policyholder proxies of an insurer as voting trustee or otherwise, for the purpose of controlling the management thereof; (2) Any insurance producer, adjuster or consultant or other insurance or reinsurance representative or intermediary or any person acting as or purporting to be any of the foregoing; (3) Any person having a contract giving that person by its terms or in fact the exclusive or dominant right to manage or control the insurer; and (4) Any person in this State engaged in or proposing to be engaged in or acting as or purporting to be so engaged or proposing to be engaged in the business of insurance or in this State assisting in the promotion, formation or financing of an insurer or insurance holding corporation or corporation or other group financing an insurer or the production of its business. [PL 2013, c. 238, Pt. A, §3 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B. Subject to the limitations contained in this subsection and in addition to the powers that the superintendent has under section 221 and sections 223 to 228 relating to the examination of insurers, the superintendent may order an insurer registered under subsection 8 to produce records, books or papers in the possession of the insurer or affiliates as may be necessary to verify the accuracy of the information required to be provided to the superintendent under this section and any additional information pertinent to transactions between the insurer and affiliates. The books, records, papers and information are subject to examination in the same manner as prescribed in this chapter for an examination conducted under section 221 , except that expenses incurred by the superintendent in examining an affiliate that is not an insurer must be borne by the registered insurer subject to the limitations of section 228, subsection 1 . The superintendent may issue subpoenas, administer oaths and examine any person under oath for purposes of determining compliance with this subsection. [PL 2013, c. 238, Pt. A, §3 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] C. A member of an insurer's insurance holding company system shall comply fully and accurately with a request by the insurer to provide it with information necessary to respond to an examination request by the superintendent pursuant to this section. [PL 2013, c. 238, Pt. A, §3 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] D. The superintendent may order an insurer registered under subsection 8 to produce information not in the possession of the insurer if the insurer can obtain access to the information pursuant to contractual relationships, statutory obligations or any other lawful method. If the insurer cannot obtain the information requested by the superintendent, the insurer shall provide the superintendent a written objection with a detailed explanation of the reason that the insurer cannot obtain the information and the identity of the holder of the information. It is a violation of this section to submit an objection to production of information without a reasonable basis or to fail to produce information on the basis of an objection that the superintendent has denied after notice and opportunity for hearing. [PL 2013, c. 238, Pt. A, §3 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2013, c. 238, Pt. A, §3 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).]

2. Definitions. As used in this section, unless the context otherwise requires, the following words shall have the following meanings. A. Affiliate. "Affiliate" of, or a person "affiliated" with, a specific person means a person who directly or indirectly controls, or is controlled by, or is under common control with the person specified. [PL 1975, c. 356, §1 (RPR).] A-1. Beneficial owner. "Beneficial owner" of a voting security, voting insurance policy or guaranty capital share means any person or group of persons acting in concert who, directly or indirectly, through any contract, arrangement, proxy appointment, understanding, relationship or otherwise, has or shares: (1) Voting power over the security, policy or guaranty capital share, including the power to vote or to direct the voting of the security, policy or share; or (2) Investment power over the security, policy or share, including the power to dispose or to direct the disposition of the security, policy or share. The superintendent may determine that persons are acting in concert, either on the superintendent's own initiative or upon application of an interested person, based upon evidence that actions taken by those persons, if consummated, may permit the exercise of common control, directly or indirectly, over the domestic insurer. The absence of a determination by the superintendent that persons are acting in concert shall not be construed to exempt those persons from compliance with the requirements of this section. [PL 1989, c. 385, §1 (NEW).] A-2. "Continuing director" means: (1) Any member of a domestic insurer's board of directors, while that person is a member of the board of directors, who was a member of that board of directors prior to the time that any person acquires control of the domestic insurer or any person controlling the insurer; and (2) Any successor of a continuing director, while the successor is a member of the board of directors, who is recommended or elected to succeed a continuing director by a number of continuing directors equal to a majority of continuing directors in office immediately preceding the acquisition of control. [PL 1991, c. 37, §1 (NEW).] B. Control. (1) "Control," including "controlling," "controlled by" and "under common control with," means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is solely the result of an official position with or a corporate office held by the person. Control is presumed to exist if any person is the beneficial owner of 10% or more of the voting securities or guaranty capital shares, if applicable, or has the right to cast 10% or more of the votes in the election of directors or other governing body of any other person. A beneficial owner may rely in determining the amount of voting securities of any person outstanding upon information set forth in that person's most recent quarterly or annual report filed with the Securities and Exchange Commission pursuant to the Exchange Act unless the beneficial owner knows or has reason to believe that the information contained in the quarterly or annual report is inaccurate. Two or more domestic mutual insurance companies that have restricted their licensed territories to the State are not considered subject to this section merely because those insurance companies commonly share facilities, incurred expenses or personnel services or otherwise utilize cost allocations based on generally accepted accounting principles including pro rata sharing of assumed risks. A person may have more than one controlling person, even if those controlling persons are not acting in concert. (2) Notwithstanding the presumption of control contained in subparagraph (1), the superintendent, upon application of the insurance company, may determine that the insurer is not controlled by the person presumed to control it. In addition, the superintendent, after notice and an opportunity to be heard, may determine, notwithstanding the absence of the presumption in subparagraph (1), that a person does control an insurance company or companies. (3) The presumption of control contained in subparagraph (1) does not apply to a securities broker-dealer holding, in the usual and customary broker's function, less than 20% of the voting securities of another person. [PL 2013, c. 238, Pt. A, §4 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] B-1. Exchange Act. "Exchange Act" means the federal Securities Act of 1933, 15 United States Code, Chapter 2‑A, Subchapter 1 and the federal Securities Exchange Act of 1934, 15 United States Code, Chapter 2‑B. [PL 2013, c. 238, Pt. A, §5 (RPR); PL 2013, c. 238, Pt. A, §34 (AFF).] B-2. Enterprise risk. "Enterprise risk" means an activity, circumstance, event or series of events involving one or more affiliates of an insurer that, if not remedied promptly, is likely to have a material adverse effect upon the financial condition or liquidity of the insurer, or of its insurance holding company system as a whole, including, but not limited to, anything that would cause or exacerbate a risk-based capital event as described in sections 6453 to 6456 or would cause the insurer to be in unsound or hazardous financial condition as determined by the superintendent. [PL 2013, c. 238, Pt. A, §6 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B-3. "Groupwide supervisor" means the regulatory official who is determined or acknowledged by the superintendent under subsection 7‑C to have the authority to engage in conducting and coordinating groupwide supervision activities over an internationally active insurance group or other insurance group that has requested groupwide supervision. [PL 2017, c. 169, Pt. B, §2 (NEW).] B-4. “Group capital calculation” means a method for insurance groups to assess the financial condition of the group, including noninsurance entities within the group, in order to identify and quantify potential risks. [PL 2021, c. 521, §5 (NEW).] B-5. “Group capital calculation instructions” means the group capital calculation instructions as adopted by the NAIC and as amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. [PL 2021, c. 521, §6 (NEW).] C. Insurance holding company system. "Insurance holding company system" shall consist of 2 or more affiliated persons, one or more of whom is an insurer. [PL 1975, c. 356, §1 (RPR).] D. Insurer. "Insurer" has the same meaning as in section 4 and includes a fraternal benefit society required to be licensed under section 4124 or 4125 . [PL 2013, c. 238, Pt. A, §7 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] D-1. [PL 1993, c. 313, §7 (RP).] D-2. "Net gain from operations" means: (1) For life insurers, the net income or loss after dividends to policyholders and federal income taxes but before the inclusion of net realized capital gains or losses; and (2) For nonlife insurers, the net income or loss after dividends to policyholders and federal income taxes and net realized capital gains or losses. [PL 2017, c. 169, Pt. B, §3 (AMD).] D-3. Own risk and solvency assessment or ORSA. "Own risk and solvency assessment" or "ORSA" means a confidential internal assessment that is conducted by an insurer or insurance holding company system of the material and relevant risks associated with its current business plan and the sufficiency of its capital resources to support those risks and that is appropriate to the nature, scale and complexity of the operations of the insurer or insurance holding company system. [PL 2013, c. 238, Pt. A, §8 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] D-4. ORSA guidance manual. "ORSA guidance manual" means the NAIC Own Risk and Solvency Assessment (ORSA) Guidance Manual, as amended from time to time. A change in the ORSA guidance manual is effective with regard to this State on January 1st following the calendar year in which the change has been adopted by the National Association of Insurance Commissioners. [PL 2013, c. 238, Pt. A, §8 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] D-5. ORSA summary report. "ORSA summary report" means a confidential high-level summary of an insurer's or insurance holding company system's own risk and solvency assessment and includes a combination of separate reports that collectively meet the requirements of the ORSA guidance manual. [PL 2013, c. 238, Pt. A, §8 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] D-6. "Internationally active insurance group" means an insurance holding company system that meets the following criteria: (1) The group has premiums written in at least 3 countries; (2) The percentage of gross premiums written outside the United States is at least 10% of the insurance holding company system's total gross written premiums; and (3) Based on a 3-year rolling average, the total assets of the insurance holding company system are at least $50,000,000,000 or the total gross written premiums of the insurance holding company system are at least $10,000,000,000. [PL 2017, c. 169, Pt. B, §4 (NEW).] D-7. "Liquidity stress test" means a method for insurance groups to assess the potential effects of liquidity risk to the insurer and to the financial markets. [PL 2021, c. 521, §7 (NEW).] D-8. “NAIC Liquidity Stress Test Framework” means the NAIC publication that includes the applicable scope criteria and liquidity stress test instructions and reporting templates, as adopted by the NAIC and amended from time to time in accordance with the procedures adopted by the NAIC. [PL 2021, c. 521, §8 (NEW).] E. Person. "Person" shall mean an individual, a corporation, a corporation which, pursuant to Title 24, chapter 19 , maintains and operates nonprofit hospital service plans, nonprofit medical service plans or nonprofit health care plans or any combination thereof, a partnership, an association, a joint stock company, a business trust, an unincorporated organization or any similar entity, or any combination of the foregoing acting in concert. [PL 1975, c. 356, §1 (RPR).] E-1. “Scope criteria” means the designated exposure bases and minimum magnitudes, as detailed in the NAIC Liquidity Stress Test Framework, used to establish a preliminary list of insurers that are presumptively within the scope of the NAIC Liquidity Stress Test Framework. [PL 2021, c. 521, §9 (NEW).] F. "Subsidiary" of a specified person means an affiliate controlled by that person directly or through one or more intermediaries. [PL 2001, c. 72, §4 (AMD).] G. "Surplus regarding policyholders" means admitted assets less all liabilities. [PL 1993, c. 313, §9 (NEW).] H. "Unassigned funds" means the undistributed and unappropriated amount of surplus remaining on the balance sheet date as the result of all operations of an insurance company from its commencement of business. [PL 1993, c. 313, §9 (NEW).] I. "Voting security" means any security with voting rights or any security convertible into or evidencing a right to acquire a security with voting rights. [PL 1999, c. 113, §10 (NEW).] [PL 2021, c. 521, §§5-9 (AMD).]

3. Subsidiaries of insurers; investments to acquire interest. This subsection pertains to insurers and their subsidiaries and affiliates. A. Any domestic insurer may invest in or otherwise acquire one or more subsidiaries as authorized in section 1115 or section 1157 . [PL 1987, c. 399, §1 (AMD).] A-1. A domestic insurer shall notify the superintendent in writing within 30 days after any investment by the insurer or any of its affiliates in any one corporation if the insurer has invested in that corporation and the total investment in that corporation by the insurance holding company system exceeds 10% of the corporation's voting securities. [PL 1991, c. 828, §4 (AMD).] B. If an insurer ceases to control a subsidiary, it shall dispose of any investment therein made pursuant to this section within 3 years from the time of the cessation of control or within such further time as the superintendent may prescribe, unless at any time after the investment was made, the investment met the requirements for investment under any other section of this Title and the insurer has notified the superintendent thereof. [PL 1991, c. 828, §4 (AMD).] [PL 1991, c. 828, §4 (AMD).]

4. Tender offers. [PL 1989, c. 385, §4 (RP).]

4-A. Tender offers. [PL 2013, c. 238, Pt. A, §9 (RP); PL 2013, c. 238, Pt. A, §34 (AFF).]

4-B. Application for approval. [PL 2013, c. 238, Pt. A, §10 (RP); PL 2013, c. 238, Pt. A, §34 (AFF).]

4-C. Acquisitions; tender offers; divestitures. The following provisions apply to a transaction or proposed transaction that results or might result in the change of direct or indirect control of a domestic insurer. A. Except as provided in paragraph B , a person other than the issuer may not make a tender offer for, or a request or invitation for tenders of, or an agreement to exchange securities for, or otherwise acquire any voting security, or any security convertible into a voting security, of a domestic insurer or of any person controlling a domestic insurer if, as a result of the consummation thereof, the person making the tender offer, request or agreement would, directly or indirectly, acquire actual or presumptive control of the insurer or controlling person, and a person may not enter into an agreement to merge with or otherwise acquire actual or presumptive control of a domestic insurer or its controlling person, unless: (1) The person has filed with the superintendent and has sent the domestic insurer an application containing the information required by paragraph C ; (2) The offer, request, invitation, agreement or acquisition has been approved by the superintendent in the manner prescribed in subsection 7 ; and (3) Ten days has elapsed from the date of approval by the superintendent and no injunction or other court order precludes consummation of the offer, request, invitation, agreement or acquisition. [PL 2013, c. 238, Pt. A, §11 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B. A controlling person of a domestic insurer seeking to divest its controlling interest in the domestic insurer in any manner, including any partial divestiture that would cause that person to cease to be a controlling person, shall file with the superintendent, with a copy to the insurer, confidential notice of its proposed divestiture at least 30 days before the cessation of control, unless the divestiture transaction consists of the transfer of the divesting person's interest to one or more acquiring persons, all of whom have reported their respective acquisitions pursuant to paragraph A . Unless the superintendent grants an exemption under paragraph D , the divesting person shall file an application substantially similar to the application required under paragraph C , with such modifications as the superintendent determines to be appropriate based on the nature of the transaction. The superintendent shall decide whether to approve the application using the criteria in subsection 7, paragraph A and may hold a public hearing if the superintendent determines that a hearing is in the interests of policyholders or the public. If 20 days has elapsed after the superintendent's receipt of a notice filed under this paragraph and the superintendent has not disapproved the proposed divestiture or postponed its effective date pending further review, the superintendent is deemed to have granted an exemption under paragraph D , subparagraph (2). [PL 2013, c. 238, Pt. A, §11 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] C. An application required by paragraph A must contain the following information as applicable, made under oath or affirmation, except that if the proposed transaction is subject to regulation under the Exchange Act or Title 32, chapter 135 , the superintendent may accept the relevant documents filed with the United States Securities and Exchange Commission or the Department of Professional and Financial Regulation, Office of Securities in lieu of some or all of the documents required by this paragraph: (1) The name and address of each person by whom or on whose behalf the merger or other acquisition of control is to be effected and: (a) If the person acquiring control is an individual, the person's principal occupation and all offices and positions held during the past 5 years and any convictions for crimes other than minor traffic violations; and (b) If the person acquiring control is not an individual, a report of the nature of its business operations during the past 5 years or for a lesser period the person and any predecessors have been in existence; an informative description of the business intended to be done by the person and the person's subsidiaries; and a list of all individuals who are or who have been selected to become directors or executive officers of the person or who perform or will perform functions appropriate to such positions. The list must include the information required by division (a) for each individual listed; (2) The source, nature and amount of the consideration used or to be used in effecting the merger or other acquisition of control, a description of any transaction through which funds were or are to be obtained for any such purpose, including any pledge of the insurer's stock or the stock of any of its subsidiaries or controlling affiliates, and the identity of persons furnishing consideration. If a source of consideration is a loan made in the lender's ordinary course of business, the identity of the lender is confidential if the person filing the application so requests; (3) Fully audited financial information as to the earnings and financial condition of each acquiring person for the preceding 5 fiscal years, or for a lesser period if the acquiring person and any predecessors have been in existence for less than 5 years, and similar unaudited information as of a date not earlier than 90 days before the filing of the application; (4) Any plans or proposals that each acquiring person may have to liquidate the insurer, to sell its assets or merge or consolidate it with any person or to make any other material change in its business or corporate structure or management; (5) The number of shares of any security referred to in paragraph A that each acquiring person proposes to acquire, the terms of the offer, request, invitation, agreement or acquisition referred to in paragraph A and a statement as to the method by which the fairness of the proposal was arrived at; (6) The amount of each class of any security referred to in paragraph A that is beneficially owned or concerning which there is a right to acquire beneficial ownership by each acquiring person; (7) A full description of any contracts, arrangements or understandings with respect to any security referred to in paragraph A in which any acquiring person is involved, including but not limited to transfer of any of the securities, joint ventures, loan or option arrangements, puts or calls, guarantees of loans, guarantees against loss or guarantees of profits, division of losses or profits or the giving or withholding of proxies. The description must identify the persons with whom the contracts, arrangements or understandings have been entered into; (8) A description of the purchase by any acquiring person of any security referred to in paragraph A during the 12 calendar months preceding the filing of the application, including the dates of purchase, names of the purchasers and consideration paid or agreed to be paid; (9) A description of any recommendations to purchase any security referred to in paragraph A made during the 12 calendar months preceding the filing of the application by any acquiring person or by anyone based upon interviews with or at the suggestion of the acquiring person; (10) Copies of all tender offers for, requests or invitations for tenders of, exchange offers for and agreements to acquire or exchange any securities referred to in paragraph A and copies of any additional related soliciting material that has been distributed; (11) The terms of any agreement, contract or understanding made or proposed to be made with any broker-dealer as to solicitation of securities referred to in paragraph A for tender and the amount of any fees, commissions or other compensation to be paid to broker-dealers with regard to the solicitation of securities referred to in paragraph A ; (12) An agreement by the person required to file the application to provide the annual enterprise risk report required by subsection 8, paragraph B‑1 , subparagraph (1)for as long as control by the person exists; (13) An acknowledgement by the person required to file the application that the person and all subsidiaries within its control in the insurance holding company system will provide information to the superintendent upon request as necessary to evaluate enterprise risk to the insurer; (14) A statement as to whether or not the proposed transaction will result in an increase in market share in this State in any line of insurance as specified in the annual statement required to be filed under section 423 for one or more insurers with combined market share greater than 5% and, if so, such further information on the competitive impact of the proposed transaction as the superintendent requires by rule or order; and (15) Such additional information as the superintendent may prescribe by rule or order. [PL 2021, c. 521, §10 (AMD).] D. The superintendent may exempt a person otherwise subject to the requirements of this subsection and subsection 7 from some or all of those requirements if the person demonstrates to the satisfaction of the superintendent that an exemption will not be detrimental to the interests of policyholders in the State or the public and that the transaction satisfies at least one of the following criteria: (1) The interests of the State in regulating the transaction are minimal relative to the interests of other jurisdictions or are minimal relative to the impact of the transaction as a whole; (2) The person proposes a divestiture of control under paragraph B and the superintendent determines that the prior approval process is not necessary in the circumstances of the transaction; (3) A party proposing to acquire presumed control submits a disclaimer fully disclosing all material relationships and bases for affiliation with the insurer and demonstrating to the satisfaction of the superintendent that the person will not be acquiring actual control. As a condition of granting an exemption under this subparagraph, the superintendent may require the person to agree to reasonable restrictions on the exercise of rights or powers that might otherwise tend to result in control; (4) The superintendent elects to participate in a consolidated approval proceeding conducted under the laws of one or more other states pursuant to subsection 7‑A, paragraph E ; and (5) The transaction involves the control of a person that is not primarily engaged in the business of insurance, directly or through its affiliates, and there will be no material impact on the management or operations of a domestic insurer. A person requesting an exemption under this paragraph must agree to provide additional information if needed by the superintendent and to postpone the effective date of the transaction if ordered by the superintendent while the request for exemption is pending. [PL 2013, c. 238, Pt. A, §11 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] E. A broker-dealer that is exempt from the requirements of this section pursuant to subsection 2, paragraph B , subparagraph (3) shall disclose to the superintendent the identity of any person, or group of persons the broker-dealer knows or reasonably believes to be acting in concert, on whose behalf the broker-dealer knows or reasonably believes that the broker-dealer holds 5% or more of the voting securities of a domestic insurer or of any entity the broker-dealer knows or reasonably believes to be a controlling person of a domestic insurer. A broker-dealer shall disclose to the superintendent on request the beneficial owners of any securities held by the broker-dealer of any entity that is, or that the superintendent believes might be or might become, a member of the insurance holding company system of an insurer subject to registration under subsection 8 . [PL 2013, c. 238, Pt. A, §11 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2021, c. 521, §10 (AMD).]

5. Tender offer material. All requests or invitations for tenders or advertisements making a tender offer or requesting or inviting tenders of such voting securities for control of a domestic insurer or its controlling person made by or on behalf of any such person must contain any information specified in subsection 4‑C as the superintendent may prescribe and must be filed with the superintendent at the time that material is first published or sent or given to security holders. Copies of any additional material soliciting or requesting such tender offers subsequent to the initial solicitation or request must contain the information that the superintendent may prescribe as necessary or appropriate in the public interest or for the protection of policyholders and must be filed with the superintendent at the time copies of that material are first published or sent or given to security holders. [PL 2013, c. 238, Pt. A, §12 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).]

6. Information as to applicant. If a person required to file an application under subsection 4‑C is a partnership, limited partnership, syndicate or other group, the superintendent may require that the information called for by subsection 4‑C must be given with respect to each partner of the partnership or limited partnership, each member of the syndicate or group and each person who controls any such partner or member. If a person required to file an application under subsection 4‑C is a corporation, the superintendent may require that the information called for by subsection 4‑C must be given with respect to the corporation and each officer and director thereof and each person who is directly or indirectly the beneficial owner of more than 10% of the outstanding securities of the corporation. [PL 2013, c. 238, Pt. A, §13 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).]

7. Approval, disapproval of proposed change of control. A. The superintendent shall hold a hearing in accordance with the procedures set forth in section 231 and Title 5, chapter 375, subchapter 4 , within 30 days after the application required by subsection 4‑C has been filed with the superintendent. The superintendent shall make a determination within 30 days after the conclusion of that hearing. The superintendent shall approve any purchase, exchange, merger or other change of control referred to in subsection 4‑C unless the superintendent finds that: (1) After the change of control, the domestic insurer could not satisfy the requirements for the issuance of a certificate of authority according to requirements in force at the time of the issuance or last renewal or continuation of its certificate of authority to do the insurance business that it intends to transact in this State; (2) The effect of the purchases, exchanges, merger of a controlling person of the insurer or other changes of control may be substantially to lessen competition in insurance in this State or tend to create a monopoly in this State or would violate the laws of this State or of the United States relating to monopolies or restraints of trade; (3) The financial condition of an acquiring person would jeopardize the financial stability of the insurer or prejudice the interest of its policyholders; (4) The plans or proposals that the acquiring or divesting person has to liquidate the insurer, to sell its assets or to merge it with any person, or to make any other major change in its business or corporate structure or management, are unfair or prejudicial to policyholders; (5) The competence, experience and integrity of those persons who would control the operation of the insurer indicate that it would not be in the interest of policyholders or the public to permit them to do so; (6) Any merger of a domestic insurer does not comply with section 3474 ; or (7) The change of control would tend to affect adversely the contractual obligations of the domestic insurer or its ability and tendency to render service in the future to its policyholders and the public. [PL 2021, c. 16, §3 (AMD).] B. Paragraph A , subparagraphs (3) to (7) do not apply to any change of control if and to the extent that the superintendent, by rule or by order, exempts the change of control from the provisions of those subparagraphs as not included within the purpose of this subsection. [PL 2013, c. 238, Pt. A, §14 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] C. Merger, consolidation or bulk reinsurance as to a domestic insurer may be effectuated only pursuant to the applicable provisions of chapter 47, subchapter 4 and sections 3875 , 4108 and 4109 , as related to organization and powers of insurers. [PL 2013, c. 238, Pt. A, §14 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] D. Violation. (1) Failure to file the application required under subsection 4‑C constitutes a violation of this section. (2) Effectuation of or any attempt to effectuate an acquisition of control of, divestiture of control of or merger with a domestic insurer earlier than 30 days after the filing of the application required by subsection 4‑C , before the superintendent's decision if a hearing is held or after disapproval by the superintendent of the acquisition, divestiture or merger, constitutes a violation of this section. [PL 2013, c. 238, Pt. A, §14 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2021, c. 16, §3 (AMD).]

7-A. Consolidated proceedings. If a proposed change of control requires, or is part of a series of related transactions that require, the approval of the insurance regulators of more than one state, a person filing an application under subsection 4‑C with respect to the change of control may file a request for a consolidated approval proceeding with the National Association of Insurance Commissioners. A. The applicant shall file a copy of the application made under subsection 4‑C with the National Association of Insurance Commissioners within 5 days after making the request for a consolidated approval proceeding. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B. Within 10 days after receiving notice from the National Association of Insurance Commissioners of a request for a consolidated approval proceeding, the superintendent shall issue an order, with notice to the applicant and to the National Association of Insurance Commissioners, specifying whether the superintendent elects to participate in the consolidated proceeding or to opt out of the consolidated proceeding. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] C. If the superintendent opts out of the consolidated approval proceeding pursuant to paragraph B , the superintendent shall hold a public hearing under subsection 7 unless the superintendent grants an exemption under subsection 4‑C, paragraph D . Opting out of the consolidated proceeding does not preclude or limit the superintendent’s authority to coordinate a proceeding conducted under subsection 7 with the consolidated proceeding or with other parallel proceedings in other states. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] D. With the agreement of the other participating insurance regulators, the superintendent may initiate a consolidated approval proceeding under this paragraph to render decisions on all applications within the scope of the order of consolidation issued by the superintendent. A consolidated approval proceeding convened under this paragraph is a public adjudicatory proceeding. Except as provided in this paragraph, the proceeding must be conducted in the same manner as a proceeding under subsection 7 . (1) A person who would have the right to participate in a proceeding on any of the consolidated applications held under subsection 7 or substantially similar laws of other states has the right to participate in the proceeding. (2) The chief insurance regulator of a participating state has the right to participate in making the decision or in designating a decision-making panel. (3) The proceeding is public to the same extent as a proceeding conducted under subsection 7 , except that deliberations of a decision-making panel are not public proceedings and communications in the course of those deliberations among panel members and their advisers, other than the decision itself, are not public records. (4) The proceeding may be held in any state with a significant connection to the subject transactions or in a nearby location in an adjacent state. Sessions may be held in different states. Provision must be made for parties, witnesses, insurance regulators and members of the public to attend and participate in the proceeding by telecommunication. (5) The superintendent, decision-making panel or presiding officer may vary the applicable procedural requirements under this Title and Title 5 to the extent the superintendent, panel or presiding officer determines to be reasonably necessary for the fair and effective administration of a consolidated multistate proceeding. (6) The decision is subject to judicial review in the same manner as a final agency action of the superintendent. [PL 2021, c. 16, §4 (AMD).] E. The superintendent may participate, including serving as a decision maker or member of a decision-making panel, in a consolidated approval proceeding conducted under the laws of one or more other states if the consolidated proceeding provides for a public hearing with substantially similar rights of participation and judicial review as a proceeding conducted pursuant to paragraph D . If the superintendent elects under this paragraph to participate in a consolidated proceeding that is conducted under the laws of one or more other states, the application is exempt from further review under this section pursuant to subsection 4‑C, paragraph D , subparagraph (4) and the consolidated proceeding, notwithstanding the superintendent's participation, is not subject to any provisions of the law of this State governing adjudicatory proceedings, judicial review, public records or public meetings. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2021, c. 16, §4 (AMD).]

7-B. Supervisory colleges. In order to assess the business strategy, financial position, legal and regulatory position, risk exposure including enterprise risk, risk management and governance processes of a domestic insurer that is part of an insurance holding company system with international operations, the superintendent may participate in a supervisory college with other regulators charged with supervision of the insurer or its affiliates, including other state, federal and international regulatory agencies. A supervisory college may be convened as either a temporary or permanent forum for communication and cooperation among the regulators charged with the supervision of the insurer or its affiliates. A. The superintendent's powers with respect to supervisory colleges include, but are not limited to: (1) Initiating the establishment of a supervisory college or participating in a supervisory college initiated by one or more other regulators; (2) Entering into agreements providing the basis for cooperation between the superintendent and the other participating regulators and for the activities of the supervisory college, including but not limited to agreements for sharing confidential information under section 216, subsection 5 ; (3) Obtaining and providing assistance in examinations conducted under subsection 1‑A or under the examination authority of other participating jurisdictions; (4) Clarifying the membership and participation of other regulators in the supervisory college; (5) Clarifying the functions of the supervisory college and the role of other regulators, including the designation of the superintendent or another member of the supervisory college as a group-wide supervisor; (6) Coordinating the ongoing activities of the supervisory college, including planning meetings, supervisory activities and processes for information sharing; and (7) Establishing a crisis management plan. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B. A domestic insurer whose activities are subject to this subsection is liable for and shall pay the reasonable expenses of the superintendent's participation in a supervisory college, including reasonable travel expenses. The superintendent may establish a regular assessment to the insurer for the payment of these expenses. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] C. This section may not be construed to delegate to a supervisory college the authority of the superintendent to regulate or supervise an insurer or its affiliates within this State. [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2013, c. 238, Pt. A, §15 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).]

7-C. Groupwide supervision. This subsection governs groupwide supervision. A. The superintendent is authorized to act as the groupwide supervisor in accordance with the provisions of this subsection for any internationally active insurance group, or any other insurance holding company system that has requested the identification of a groupwide supervisor pursuant to this subsection, or to acknowledge another regulatory official as the groupwide supervisor if the insurance group: (1) Does not have substantial insurance operations in the United States; (2) Has substantial insurance operations in the United States, but not in this State; or (3) Has substantial insurance operations in the United States and this State, but the superintendent has determined pursuant to the factors set forth in paragraphs B and G that the other regulatory official is the appropriate groupwide supervisor. [PL 2017, c. 169, Pt. B, §6 (NEW).] B. In cooperation with other state, federal and international regulatory agencies, and in consultation with the insurance group, the superintendent shall identify a single groupwide supervisor for each internationally active insurance group that includes an insurer registered under subsection 8 and has the discretion to identify a single groupwide supervisor for any other insurance holding company system that has requested that the superintendent identify a groupwide supervisor. The superintendent may determine that the superintendent is the appropriate groupwide supervisor for an insurance group that conducts substantial insurance operations concentrated in this State or may acknowledge that a regulatory official from another jurisdiction is the appropriate groupwide supervisor for the insurance group. The superintendent shall consider the following factors when making a determination or acknowledgment under this paragraph and shall reconsider that determination or acknowledgment if the superintendent finds that there has been a material change in the following factors: (1) The place of domicile of the insurers within the insurance group that hold the largest share of the group's written premiums, assets or liabilities; (2) The place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the insurance group; (3) The location of the executive offices or largest operational offices of the insurance group; (4) The recommendation made by a regulatory official who is a candidate for designation under the criteria in this paragraph but has notified the superintendent that a different regulatory official would be a more appropriate groupwide supervisor; (5) Whether another regulatory official is acting or is seeking to act as the groupwide supervisor under a regulatory system that the superintendent determines to be: (a) Substantially similar to the system of regulation provided under the laws of this State; or (b) Otherwise sufficient in terms of providing for groupwide supervision, enterprise risk analysis and cooperation with other regulatory officials; and (6) Whether another regulatory official acting or seeking to act as the groupwide supervisor provides the superintendent with reasonably reciprocal recognition and cooperation. [PL 2017, c. 169, Pt. B, §6 (NEW).] C. If another regulatory official is acting as the groupwide supervisor of an insurance group subject to groupwide supervision under this subsection, the superintendent shall acknowledge that regulatory official as the groupwide supervisor and may not consider designating the superintendent as the groupwide supervisor under paragraph B unless there is a material change in the insurance group that results in: (1) The insurance group's insurers domiciled in this State holding the largest share of the group's premiums, assets or liabilities; or (2) This State being the place of domicile of the top-tiered insurer or insurers in the insurance holding company system of the insurance group. [PL 2017, c. 169, Pt. B, §6 (NEW).] D. If more than one regulatory official is acting as the groupwide supervisor of an insurance group, the superintendent is authorized to cooperate with any of them under paragraph G . [PL 2017, c. 169, Pt. B, §6 (NEW).] E. Pursuant to subsection 1‑A , the superintendent is authorized to collect from any insurer registered pursuant to subsection 8 all information necessary to determine whether the superintendent should act as the groupwide supervisor of an insurance group or whether the superintendent should acknowledge another regulatory official to act as the groupwide supervisor. Before issuing a determination that an insurance group is subject to groupwide supervision by the superintendent, the superintendent shall notify the insurer registered pursuant to subsection 8 and the ultimate controlling person within the insurance group. The insurance group has no less than 30 days to provide the superintendent with additional information pertinent to the pending determination. The superintendent shall publish on the bureau's publicly accessible website the identity of all insurance groups that the superintendent has determined are subject to groupwide supervision by the superintendent. [PL 2017, c. 169, Pt. B, §6 (NEW).] F. If the superintendent is the groupwide supervisor for an insurance group, the superintendent is authorized to engage in any of the following groupwide supervision activities: (1) Assess the enterprise risks within the insurance group to ensure that: (a) The material financial condition and liquidity risks to the members of the insurance group that are engaged in the business of insurance are identified by management; and (b) Reasonable and effective mitigation measures are in place; (2) Request, from any member of the insurance group, information necessary and appropriate to assess enterprise risk, including, but not limited to, information about the members of the insurance group regarding: (a) Governance, risk assessment and management; (b) Capital adequacy; and (c) Material intercompany transactions; (3) Coordinate and, through the authority of the regulatory officials of the jurisdictions where members of the insurance group are domiciled, compel development and implementation of reasonable measures designed to ensure that the insurance group is able to promptly recognize and mitigate enterprise risks to members of the insurance group that are engaged in the business of insurance; (4) Communicate with other state, federal and international agencies that regulate members of the insurance group and share relevant information subject to the confidentiality provisions of subsection 13‑A , through supervisory colleges as set forth in subsection 7‑B or otherwise; (5) Enter into agreements with or obtain documentation from any insurer registered under subsection 8 , any member of the insurance group and any other state, federal and international regulatory agencies for members of the insurance group, providing the basis for or otherwise clarifying the superintendent's role as groupwide supervisor, including provisions for resolving disputes with other regulatory officials. Such agreements or documentation may not serve as evidence in any proceeding that any insurer or person within an insurance holding company system not domiciled or incorporated in this State is doing business in this State or is otherwise subject to jurisdiction in this State; and (6) Other groupwide supervision activities, consistent with the authorities and purposes set out in subparagraphs (1) to (5), as considered necessary by the superintendent. [PL 2017, c. 169, Pt. B, §6 (NEW).] G. If the superintendent acknowledges that another regulatory official from a jurisdiction that is not accredited by the National Association of Insurance Commissioners is the groupwide supervisor, the superintendent is authorized to cooperate reasonably, through supervisory colleges or otherwise, with groupwide supervision undertaken by the groupwide supervisor, as long as: (1) The superintendent's cooperation is in compliance with the laws of this State; and (2) The regulatory official acknowledged as the groupwide supervisor also recognizes and cooperates with the superintendent's activities as a groupwide supervisor for other insurance groups as applicable. When such recognition and cooperation is not reasonably reciprocal, the superintendent is authorized to refuse recognition and cooperation. [PL 2017, c. 169, Pt. B, §6 (NEW).] H. The superintendent is authorized to enter into agreements with or obtain documentation from any insurer registered under subsection 8 , any affiliate of the insurer and other state, federal and international regulatory agencies for members of the insurance group in order to provide the basis for or otherwise clarify a regulatory official's role as groupwide supervisor. [PL 2017, c. 169, Pt. B, §6 (NEW).] I. The superintendent may adopt rules necessary for the administration of this subsection. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2017, c. 169, Pt. B, §6 (NEW).] J. A registered insurer subject to this subsection is liable for and shall pay the reasonable expenses of the superintendent's participation in the administration of this subsection, including the engagement of attorneys, actuaries and any other professionals and all reasonable travel expenses. [PL 2017, c. 169, Pt. B, §6 (NEW).] [PL 2017, c. 169, Pt. B, §6 (NEW).]

8. Registration of holding company system insurers. A. An insurer that is authorized to do business in this State and that is a member of an insurance holding company system shall register with the superintendent, except that these requirements do not apply to a foreign insurer domiciled in a jurisdiction that in the opinion of the superintendent has adopted by statute or regulation disclosure statements and standards substantially similar to those contained in this section. An insurer domiciled in a jurisdiction that has not adopted by statute or regulation disclosure requirements and standards substantially similar to those contained in this section may be treated as a domestic insurer for purposes of this section. Each insurer that is subject to registration under this subsection shall register within 15 days after it becomes subject to registration, and annually thereafter by May 1st, unless the superintendent, for good cause shown, extends the time for registration and then an insurer shall register within that extended time. This section does not prohibit the superintendent from requesting any authorized insurer that is a member of an insurance holding company system and not subject to registration under this section to provide a copy of the registration statement or other information filed by such insurer with the insurance regulatory authority of its state of domicile. Upon request of the insurer or of the insurance regulatory authority of another jurisdiction in which the insurer is authorized to transact insurance, the superintendent at the insurer's expense shall furnish a copy of the registration statement or other information filed by a domestic insurer with the superintendent pursuant to this section; [PL 2013, c. 238, Pt. A, §16 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] B. An insurer subject to registration shall file a registration statement with the superintendent on a form and in a format prescribed by the National Association of Insurance Commissioners. The registration statement must contain current information about: (1) The capital structure, general financial condition, ownership and management of the insurer and of any person controlling the insurer; (1-A) The identity and relationship of every member of the insurance holding company system; (2) The following transactions currently outstanding between the insurer and its affiliates: (a) Loans and other investments, and purchases, sales or exchanges of securities of the affiliate by the insurer or of the insurer by its affiliates; (b) Purchases, sales or exchanges of assets; (c) Transactions not in the ordinary course of business; (d) Guarantees or undertakings for the benefit of an affiliate that result in an actual contingent exposure of the insurer's assets to liability, other than insurance contracts entered into in the ordinary course of the insurer's business; (e) All management and service contracts and all cost-sharing arrangements, other than cost allocation arrangements based upon generally accepted accounting principles; (f) Reinsurance agreements; (g) Dividends and other distributions to shareholders; and (h) Consolidated tax allocation agreements; (2-A) Any pledge of the insurer's stock, including stock of any subsidiary or controlling affiliate, for a loan made to any member of the insurance holding company system; (2-B) If requested by the superintendent, financial statements of or within the insurance holding company system, including all affiliates. The required financial statements may include but are not limited to annual audited financial statements filed with the United States Securities and Exchange Commission pursuant to the Exchange Act. An insurer required to file financial statements pursuant to this subparagraph may satisfy the request by providing the superintendent with the most recently filed parent corporation financial statements that have been filed with the United States Securities and Exchange Commission; (3) Other matters concerning transactions between the insurer and any affiliate as may be required by the superintendent; and (4) Any other information required by the superintendent by rule; [PL 2013, c. 238, Pt. A, §17 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] B-1. The controlling person with ultimate control of an insurer subject to registration shall file an annual enterprise risk report in accordance with subparagraph (1) and, if applicable, shall file any additional reports required by this paragraph. The reports must be filed with the lead state regulator of the insurance holding company system as determined by the procedures within the NAIC Financial Analysis Handbook or successor publication. (1) The enterprise risk report must be appropriate to the nature, scale and complexity of the operations of the insurance holding company system and must, to the best of the controlling person’s knowledge and belief, identify the material risks within the insurance holding company system, if any, that could pose enterprise risk to the insurer. (2) Except as otherwise provided in this subparagraph, the ultimate controlling person of an insurer subject to registration shall file an annual group capital calculation concurrently with the registration required by paragraph A . The report must be completed as directed by the lead state regulator in accordance with the group capital calculation instructions, which may permit the lead state regulator to allow a controlling person that is not the ultimate controlling person to file the group capital calculation. (a) An insurance holding company is exempt from filing the group capital calculation if it has only one insurer within its holding company structure and that insurer is not licensed outside this State to transact insurance, does not write business outside this State and does not assume reinsurance from any other insurer. (b) An insurance holding company is exempt from filing the group capital calculation if it is required to perform a group capital calculation specified by the Board of Governors of the Federal Reserve System and the lead state regulator has obtained the current group capital calculation from the board of governors. If this State is the insurance holding company system’s lead state, the superintendent shall request the calculation from the board of governors under the terms of information sharing agreements in effect. (c) An insurance holding company is exempt from filing the group capital calculation if its groupwide supervisor is located within a non-United States jurisdiction that the superintendent has designated as a reciprocal jurisdiction pursuant to section 731‑B, subsection 1, paragraph B‑3 , subparagraph (1), division (b) and that recognizes the United States system of group supervision and group capital regulation. (d) An insurance holding company is exempt from filing the group capital calculation if its groupwide supervisor is located in a non-United States jurisdiction and: (i) The lead state regulator meets the requirements for accreditation under the NAIC financial standards and accreditation program and the insurance holding company system provides information to the lead state regulator, either directly or indirectly through the groupwide supervisor, that the lead state regulator has determined to be satisfactory to allow the lead state to comply with the NAIC group supervision approach, as detailed in the NAIC Financial Analysis Handbook or successor publication; and (ii) The groupwide supervisor recognizes and accepts the group capital calculation as the worldwide group capital assessment for United States insurance groups that operate in that non-United States jurisdiction, consistent with criteria specified by the superintendent by rule. (e) Notwithstanding divisions (c) and (d), a non-United States-based insurance holding company system shall file a group capital calculation limited to its United States operations if its lead state regulator determines, after any necessary consultation with other supervisors or officials, that requiring a United States group capital calculation is appropriate for prudential oversight and solvency monitoring purposes or for ensuring the competitiveness of the insurance marketplace. (f) If this State is an insurance holding company system’s lead state, the superintendent may exempt the ultimate controlling person from filing an annual group capital calculation or may accept a limited group capital filing or report in accordance with criteria specified by the superintendent by rule. An exemption or modification granted under a substantially similar law of another jurisdiction that is the lead state of an insurance holding company system that includes a domestic insurer applies to a filing otherwise required by this subparagraph. (g) If the lead state regulator determines that an insurance holding company system no longer meets one or more of the requirements for an exemption from filing the group capital calculation under this subparagraph, the insurance holding company system shall file the group capital calculation at the next annual filing date unless given an extension by the lead state regulator based on reasonable grounds shown. (3) The ultimate controlling person of an insurer subject to registration shall file the results of a liquidity stress test for each data year for which the insurer’s insurance holding company system is within the scope of that year’s NAIC Liquidity Stress Test Framework, as determined by the lead state regulator. (a) If this State is the lead state, the determination that an insurer is within scope or out of scope must be based on whether the insurer or its insurance holding company system meets at least one threshold in the applicable scope criteria, unless the superintendent determines, in consultation with the NAIC Financial Stability Task Force or its successor organization, that there is good cause to exclude an insurer or insurance holding company system that meets one or more thresholds or to include an insurer or insurance holding company system that does not meet any of the thresholds. In making that determination, the superintendent shall consider the goal of providing a stable experience base and avoiding insurers moving in and out of scope frequently. (b) A liquidity stress test under this subparagraph must be performed, and its results must be filed, in accordance with the NAIC Liquidity Stress Test Framework’s instructions and reporting templates for that data year. (c) For the purposes of this subparagraph, any change to the NAIC Liquidity Stress Test Framework, including the data to be used in applying the scope criteria, is effective on January 1st of the year following the calendar year when the change is adopted by the NAIC. [PL 2021, c. 521, §11 (AMD).] B-2. An insurer subject to registration shall file statements confirming that the insurer's board of directors oversees corporate governance and internal controls and that the insurer's officers or senior management have approved and implemented and continue to maintain and monitor corporate governance and internal control procedures; [PL 2013, c. 238, Pt. A, §18 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B-3. A domestic insurer that is subject to registration, and has annual premium of $500,000,000 or more or is a member of an insurance holding company system with annual premium of $1,000,000,000 or more, shall conduct an own risk and solvency assessment in accordance with the requirements of this paragraph and the ORSA guidance manual at least annually, and also at any time when there are significant changes to the risk profile of the insurer or its insurance holding company system, except as otherwise provided in subparagraph (1). For purposes of this paragraph, "premium" means direct written and unaffiliated assumed premium, including international direct and assumed premium but excluding premiums reinsured with the Federal Crop Insurance Corporation within the United States Department of Agriculture, Risk Management Agency and with the National Flood Insurance Program within the United States Department of Homeland Security, Federal Emergency Management Agency. (1) This paragraph does not apply if: (a) The insurer is an agency, authority or instrumentality of the United States, its possessions and territories, the Commonwealth of Puerto Rico, the District of Columbia or a state or political subdivision of a state; (b) The insurer and its insurance holding company system did not meet either of the minimum premium criteria of this paragraph in the financial statements immediately preceding their most recent financial statements and the superintendent has not required compliance with this paragraph under subparagraph (2); or (c) The superintendent has granted a waiver from the requirements of this paragraph based upon unique circumstances. In deciding whether to grant a waiver, the superintendent may consider the type and volume of business written by the insurer, the ownership and organizational structure of the insurer and its insurance holding company system and any other factor the superintendent considers relevant to the insurer or the insurer's insurance holding company system. If the insurer's insurance holding company system includes insurers domiciled in more than one state, the superintendent shall coordinate with the lead regulator and with other domiciliary regulators in considering whether to grant the insurer's request for a waiver. (2) The superintendent may require an insurer that does not meet either of the minimum premium criteria of this paragraph to comply with the requirements of this paragraph if: (a) The superintendent determines that the insurer should be subject to this paragraph due to unique circumstances, including, but not limited to, the type and volume of business written by the insurer, the ownership and organizational structure of the insurer and its insurance holding company system, federal agency requests and international supervisor requests; (b) The insurer is subject to a corrective order or required to adopt a risk-based capital plan under sections 6453 to 6456 ; (c) The superintendent has determined in accordance with rules adopted by the superintendent that the insurer is in hazardous financial condition; or (d) The superintendent has determined that the insurer otherwise exhibits qualities of a troubled insurer. (3) If an insurer's insurance holding company system has annual premium of $1,000,000,000 or more, the assessment and reporting required by this paragraph must be conducted for each insurer within the insurance holding company system, either on a systemwide basis or separately for insurers or combinations of insurers within the insurance holding company system. (4) An insurer subject to this paragraph shall maintain a risk management framework to assist the insurer with identifying, assessing, monitoring, managing and reporting on its material and relevant risks. An insurer may satisfy this requirement by participating in an applicable risk management framework maintained by the insurance holding company system of which the insurer is a member. (5) An insurer subject to this paragraph shall prepare and submit regular ORSA summary reports that satisfy the requirements of this subparagraph and shall provide additional information to the superintendent upon request. (a) Beginning no later than 2015, the ORSA summary report must be prepared at least annually, on a timetable consistent with the insurer's internal strategic planning processes, and submitted to the lead regulator of the insurer's insurance holding company system, as determined by the procedures within the NAIC Financial Analysis Handbook or successor publication. If the superintendent is not the lead regulator, the insurer shall submit the insurer's or insurance holding company system's most recent ORSA summary report to the superintendent on request. (b) The ORSA summary report must be prepared consistent with the ORSA guidance manual. Documentation and supporting information must be maintained and made available upon examination by or upon request of the superintendent. (c) The insurer's or insurance holding company system's chief risk officer, or other executive having responsibility for the oversight of the insurer's enterprise risk management process, shall sign the ORSA summary report attesting to the best of the signer's belief and knowledge that the insurer applies the enterprise risk management process described in the ORSA summary report and that a copy of the report has been provided to the insurer's board of directors or the appropriate committee of the board. (d) An insurer may comply with this paragraph by providing the most recent ORSA summary report and a report or reports that are substantially similar to the ORSA summary report that are provided by the insurer or another member of its insurance holding company system to the insurance commissioner of another state or to an insurance supervisor or regulator of a foreign jurisdiction if that report provides information that is comparable to the information described in the ORSA guidance manual. Any report in a language other than English must be accompanied by an English translation. (6) The superintendent's review of the ORSA summary report, and any additional requests for information, must be consistent with accepted regulatory procedures for the analysis and examination of multistate or global insurers and insurance groups. [PL 2021, c. 521, §12 (AMD).] C. An insurer does not need to disclose on the registration statement filed pursuant to this subsection information that is not material to the purposes of this section. Sales, purchases, exchanges, loans or extensions of credit or investments involving 1/2 of 1% or less of an insurer's admitted assets as of December 31st immediately preceding are not material for purposes of this section, except: (1) For purposes of the group capital calculation and liquidity stress test in accordance with paragraph B‑1 , subparagraphs (2) and (3); (2) When the instructions for a specific filing specify a different materiality threshold or specify that no materiality threshold applies; or (3) As the superintendent otherwise provides by rule or order. [PL 2021, c. 521, §13 (AMD).] D. Each registered insurer shall keep current the information required to be disclosed in its registration statement by reporting on forms provided by the superintendent all material changes or additions on or before the 15th day of the month following that in which it learns of each such change or addition; [PL 1975, c. 356, §1 (NEW).] E. The superintendent shall terminate the registration of any insurer which demonstrates that it is no longer a member of an insurance holding company system; [PL 1975, c. 356, §1 (NEW).] F. Two or more affiliated insurers subject to registration hereunder may file a consolidated registration statement or consolidated reports amending their respective consolidated statements or their individual registration statements so long as such consolidated filings correctly reflect the condition of and transactions between such persons; [PL 1975, c. 356, §1 (NEW).] G. The superintendent may allow or require any insurer, which is authorized to do business in this State and which is part of an insurance holding company system, to register on behalf of any affiliated insurer which is required to register under paragraph A and to file all information and material required to be filed under this section; [PL 1975, c. 356, §1 (NEW).] H. This section shall not apply to any insurer, information or transaction if and to the extent that the superintendent by rule, regulation or order shall exempt the same from the provisions of this section as not comprehended within the purposes thereof; [PL 1975, c. 356, §1 (NEW).] I. Any person may file with the superintendent a disclaimer of affiliation with any authorized insurer. A disclaimer of affiliation may be filed by the insurer or any member of an insurance holding company system. The disclaimer must fully disclose all material relationships and bases for affiliation between the disclaiming person and the insurer as well as the bases for disclaiming affiliation. (1) An approved disclaimer relieves the disclaiming person of the duty to register under this section. (2) A disclaimer is deemed approved unless the superintendent, within 30 days after receipt of a complete disclaimer, including any additional information required by the superintendent, either disallows the disclaimer or notifies the disclaiming person that a hearing will be held on the disclaimer. (3) The superintendent may condition the approval of a disclaimer on terms and conditions reasonably designed to ensure that the disclaiming person will not exercise actual control or acquire the right to actual control over the insurer without triggering the prior approval process under subsections 4‑C and 7 . (4) If the superintendent takes action on a disclaimer without hearing, including the imposition of conditions not agreed to by the disclaiming person, an aggrieved person has the right to a hearing. (5) The superintendent may rescind the approval of a disclaimer, after notice and opportunity for hearing, on the basis of new information or changed circumstances demonstrating the existence of control over the insurer. [PL 2013, c. 238, Pt. A, §20 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2021, c. 521, §§11-13 (AMD).]

9. Transactions with affiliates; standards. Transactions by insurers subject to registration with their affiliates are subject to the following standards. A. The terms, including any charges or fees for services performed, must be fair and reasonable. [PL 1991, c. 828, §5 (AMD).] A-1. Agreements for management services and cost sharing must include any provisions required by the superintendent by rule. [PL 2017, c. 169, Pt. B, §7 (AMD).] B. The books, accounts and records of each party must be so maintained as to disclose clearly and accurately the nature and details of the transaction, including all accounting information necessary to support the reasonableness of any charges or fees. [PL 1991, c. 828, §5 (AMD).] C. The insurer's surplus to policyholders following any dividends or distributions to stockholder affiliates must be reasonable in relation to the insurer's outstanding liabilities and adequate to its financial needs. [PL 1991, c. 548, Pt. B, §3 (AMD).] D. Expenses incurred and payment received must be allocated to the insurer in conformity with customary insurance accounting practices consistently applied. [PL 1991, c. 828, §5 (NEW).] D-1. If an insurer subject to this Title is determined by the superintendent to be in hazardous financial condition as defined by rule or a condition that would be grounds for a delinquency proceeding under chapter 57 , the superintendent may require the insurer to secure and maintain either a deposit, held by the Treasurer of State on behalf of the superintendent, or a bond, as determined by the insurer at the insurer’s discretion, for the protection of the insurer for the duration of a contract or agreement or the duration of the condition for which the superintendent required the deposit or the bond. In determining whether a deposit or a bond is required, the superintendent shall consider whether concerns exist with respect to the affiliated person’s ability to fulfill all of its contracts or agreements if the insurer were to be put into liquidation. If the insurer is determined to be in hazardous financial condition or in a condition that would be grounds for a delinquency proceeding, and a deposit or bond is required, the superintendent has discretion to determine the amount of the deposit or bond, not to exceed the aggregate value in any one year of all contracts or agreements secured by the deposit or bond, and whether the deposit or bond should be required for a single contract, multiple contracts or a contract with a specific person. [PL 2021, c. 521, §14 (NEW).] D-2. All records and data of the insurer held by an affiliate are and remain the property of the insurer, must be subject to control of the insurer, must be identifiable and must be segregated or readily capable of segregation, at no additional cost to the insurer, from all other persons’ records and data. This includes all records and data that are otherwise the property of the insurer, in whatever form maintained, including, but not limited to, claims and claim files, policyholder lists, application files, litigation files, premium records, rate books, underwriting manuals, personnel records, financial records and similar records within the possession, custody or control of the affiliate. At the request of the insurer or its receiver, the affiliate shall allow the insurer or receiver to obtain a complete set of all records of any type that pertain to the insurer’s business and obtain access to the electronic operating systems on which the data is maintained or software that runs those systems either through assumption of licensing agreements or otherwise and shall restrict the use of the data by the affiliate if it is not operating the insurer’s business. The affiliate shall provide a waiver of any landlord lien or other encumbrance to give the insurer access to all records and data in the event of the affiliate’s default under a lease or other agreement. [PL 2021, c. 521, §15 (NEW).] D-3. Premiums or other funds belonging to the insurer that are collected by or held by an affiliate are the exclusive property of the insurer and are subject to the control of the insurer. Any offset in the event that an insurer is placed into receivership is subject to section 4381 . [PL 2021, c. 521, §16 (NEW).] E. A domestic insurer shall notify the superintendent in writing at least 30 days in advance, unless the superintendent authorizes a shorter period, before entering into or materially amending or modifying any of the following kinds of transactions with any member of its holding company system: (1) Sales, purchases, exchanges, loans or extensions of credit, guarantees or investments that are equal to or exceed: (a) With respect to nonlife insurers, the lesser of 3% of the insurer's admitted assets as of December 31st of the preceding year and 25% of surplus to policyholders; (b) With respect to life insurers, 3% of the insurer's admitted assets as of December 31st of the preceding year; or (c) With respect to nonprofit hospital and medical service organizations and their 100% controlled affiliates that operate as monoline health insurers or health maintenance organizations, the lesser of 5% of the entity's admitted assets as of December 31st of the preceding year and 25% of surplus to policyholders; (2) Loans or extensions of credit to any person who is not an affiliate, if the insurer makes the loan or extension of credit with the agreement or understanding that the proceeds in whole or in substantial part are to be used to make loans or extensions of credit to, purchase assets of or make investments in any affiliate of the insurer if the loan, extension of credit, purchase or investment is equal to or exceeds: (a) With respect to nonlife insurers, the lesser of 3% of the insurer's admitted assets as of December 31st of the preceding year and 25% of surplus to policyholders; (b) With respect to life insurers, 3% of the insurer's admitted assets as of December 31st of the preceding year; or (c) With respect to nonprofit hospital and medical service organizations and their 100% controlled affiliates that operate as monoline health insurers or health maintenance organizations, the lesser of 5% of the entity's admitted assets as of December 31st of the preceding year and 25% of surplus to policyholders; (3) All reinsurance pooling agreements, and all reinsurance agreements in which the reinsurance premium or a change in the insurer's liabilities, or the projected reinsurance premium or a projected change in the insurer's liabilities in any of the next 3 years, equals or exceeds 5% of the insurer's surplus to policyholders, as of December 31st of the preceding year, including those agreements that may require as consideration the transfer of assets from an insurer to a nonaffiliate if an agreement or understanding exists between the insurer and nonaffiliate that any portion of the assets will be transferred to one or more affiliates of the insurer; (4) All management agreements, cost-sharing arrangements, tax allocation agreements, service contracts and guaranties, with the exception of guaranties that are quantifiable in amount and do not exceed, in the aggregate, the lesser of 0.5% of admitted assets and 10% of surplus as regards policyholders as of December 31st of the preceding year; (5) Any transactions that are part of a plan or series of like transactions with persons within the holding company system if the transactions when aggregated over any 12-month period exceed the reporting thresholds of this paragraph. If the superintendent determines that those separate transactions were entered into for the purpose of avoiding regulatory review by circumventing statutory reporting requirements, that determination is a sufficient basis for disapproving the transactions under this subsection; and (6) Any other material transactions specified by rule that the superintendent has determined may adversely affect the interests of the insurer's policyholders. A notice of amendment or modification of a transaction must include the reasons for the change and the financial impact on the domestic insurer. The insurer shall notify the superintendent within 30 days after terminating an agreement previously reported under this paragraph. The superintendent shall disapprove a transaction that is subject to this paragraph if the transaction violates the standards of this section or other applicable law or adversely affects the interests of policyholders. The superintendent's failure to make a determination on a proposed transaction within 30 days after it has been submitted for review has the effect of an approval, unless the superintendent has issued a notice of adjudicatory hearing on the proposal in accordance with section 230 . [PL 2017, c. 169, Pt. B, §8 (AMD).] Any violation of this subsection, in addition to the penalties contained in subsection 14 , renders the transactions voidable at the initiative of the superintendent or otherwise under applicable law. The superintendent's approval of a transaction in accordance with this section, whether actual or by acquiescence, may not override any applicable law and does not operate to authorize any transaction that would be contrary to law if it involved an insurer not a member of the same holding company system. [PL 2021, c. 521, §§14-16 (AMD).]

10. Insurer's surplus; adequacy factors. For the purposes of this section, in determining whether an insurer's surplus to policyholders is reasonable in relation to the insurer's outstanding liabilities and adequate to its financial needs, the following factors, among others, may be considered: A. The size of the insurer as measured by its assets, capital and surplus, reserves, premium writings, insurance in force and other appropriate criteria; [PL 1975, c. 356, §1 (NEW).] B. The extent to which the insurer's business is diversified among the several lines of insurance; [PL 1975, c. 356, §1 (NEW).] C. The number and size of the risks insured in each line of business; [PL 1975, c. 356, §1 (NEW).] D. The extent of the geographical dispersion of the insurer's insured risks; [PL 1975, c. 356, §1 (NEW).] E. The nature and extent of the insurer's reinsurance program; [PL 1975, c. 356, §1 (NEW).] F. The quality, diversification and liquidity of the insurer's investment portfolio; [PL 1975, c. 356, §1 (NEW).] G. The recent past and projected future trend in the size of the insurer's surplus as regards policyholders; [PL 1993, c. 313, §10 (AMD).] H. The quality and liquidity of investments in subsidiaries or affiliates. The department may discount any such investment or treat any investment as a nonadmitted asset for purposes of determining the adequacy of surplus as regards policyholders whenever the investment so warrants; [PL 1993, c. 313, §10 (AMD).] I. The adequacy of the insurer's reserves; [PL 1993, c. 313, §10 (AMD).] J. The surplus as regards policyholders maintained by other comparable insurers in respect of the factors set out in this subsection; and [PL 1993, c. 313, §10 (AMD).] K. The quality of the company's earnings and the extent to which the reported earnings include extraordinary items. [PL 1993, c. 313, §10 (NEW).] [PL 2013, c. 238, Pt. A, §22 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).]

11. Dividends and distributions. [PL 1993, c. 313, §11 (RP).]

11-A. Extraordinary dividends. [PL 2009, c. 511, Pt. A, §3 (RP).]

11-B. All other dividends and distributions. [PL 2009, c. 511, Pt. A, §4 (RP).]

11-C. Dividends and distributions. The superintendent shall review all dividends and distributions declared or paid by any insurer registered under subsection 8 at least annually. A. An insurer shall notify the superintendent within 5 days after the declaration of any dividend or distribution. If the dividend or distribution is not disapproved pursuant to paragraph B and is not an extraordinary dividend as defined in paragraph C , the insurer may pay the dividend or distribution once the superintendent has approved the payment or 10 days have elapsed after the superintendent’s receipt of notice. [PL 2009, c. 511, Pt. A, §5 (NEW).] B. The superintendent shall issue an order restricting or disallowing the payment of dividends and distributions if the superintendent determines that the insurer's surplus would not be reasonable in relation to the insurance company's outstanding liabilities, that the insurer's surplus would be inadequate to that company's financial needs, that the insurer's financial condition would constitute a condition hazardous to policyholders, claimants or the public or that a violation of subsection 4‑C prevents the superintendent from sufficiently understanding the enterprise risk to the insurer posed by its affiliates or by its insurance holding company system. [PL 2013, c. 238, Pt. A, §23 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] C. An extraordinary dividend may not be paid until affirmatively approved by the superintendent or until at least 60 days after the superintendent has received a request to pay an extraordinary dividend. (1) For purposes of this subsection, "extraordinary dividend" means any dividend or distribution, other than a pro rata distribution of a class of the insurer’s own securities, that: (a) When aggregated with all other dividends and distributions paid or proposed to be paid by the insurer less than a full year before the payment date, exceeds the greater of 10% of the insurer's surplus to policyholders as of December 31st of the preceding year and the net gain from operations for the preceding calendar year; (b) Is declared within 5 years after any acquisition of control of a domestic insurer or of any person controlling that insurer, unless it has been approved by a number of continuing directors equal to a majority of the directors in office immediately preceding that acquisition of control; or (c) Is not paid entirely from unassigned funds. For purposes of this division, 50% of the net of unrealized capital gains and unrealized capital losses, reduced, but not to less than zero, by that portion of the asset valuation reserve attributable to equity investments, must be excluded from the calculation of unassigned funds. (2) An insurer may declare an extraordinary dividend on a conditional basis, subject to the superintendent’s approval. A declaration pursuant to this subparagraph does not confer any rights upon stockholders until the superintendent has approved the payment or the 60-day review period has elapsed. [PL 2017, c. 169, Pt. B, §9 (AMD).] [PL 2017, c. 169, Pt. B, §9 (AMD).]

12. Verification of information. [PL 2013, c. 238, Pt. A, §24 (RP); PL 2013, c. 238, Pt. A, §34 (AFF).]

13. Confidential communications. [PL 2013, c. 238, Pt. A, §25 (RP); PL 2013, c. 238, Pt. A, §34 (AFF).]

13-A. Confidential information. This section applies to holding company information that is in the possession or control of the superintendent or that is in the possession or control of the National Association of Insurance Commissioners as a result of a filing under this section or as a result of information sharing by the superintendent as authorized by this section. A. For purposes of this subsection, "holding company information" means any of the following documents, materials and other information if the document, material or other information has not specifically and expressly been designated as a public record by other applicable law: (1) Information obtained by the superintendent pursuant to an examination or investigation pursuant to subsection 1‑A to the same extent as the information would have been confidential if obtained in an examination or investigation conducted under section 220 or 221 ; (2) A registration statement or report filed under subsection 8 , including all supporting information; (2-A) Any group capital calculation or liquidity stress test, including all supporting information, conducted under the authority of a non-United States financial supervisor or the Board of Governors of the Federal Reserve System; (3) A report filed under subsection 9 , including all supporting information; (4) A notice of proposed divestiture filed under subsection 4‑C, paragraph B , until the divestiture transaction has occurred; (5) A disclosure of the beneficial owner of securities made by a broker-dealer pursuant to subsection 4‑C, paragraph E ; (6) The identity of a lender that is to finance a proposed transaction if declared confidential under subsection 4‑C, paragraph C , subparagraph (2); (7) Information filed in support of any required attestation of risk management or internal controls under subsection 4‑C, paragraph C , subparagraph (12) or (13); (8) A competitive impact statement filed under subsection 4‑C, paragraph C , subparagraph (14), including all supporting information; (8-A) Groupwide supervision information reported or provided to the superintendent under subsection 7‑C ; (9) Information obtained under an information-sharing agreement entered into pursuant to this section to the extent that it is protected by the confidentiality provisions of the agreement; (10) Information obtained pursuant to this section from a jurisdiction other than this State to the extent that it is confidential under the laws of the jurisdiction in which it is normally maintained; and (11) Information obtained under this section to the extent that it is confidential under other applicable law, including, but not limited to, section 216 , section 225 and Title 1, section 402, subsection 3 . [PL 2021, c. 521, §17 (AMD).] B. Except as otherwise provided by paragraphs D and E or specifically and expressly provided by other applicable law, holding company information is confidential, is not a public record, is not subject to a subpoena, is not subject to discovery or admissible as evidence in any private civil action and may not be made public by the superintendent without prior written consent of the relevant insurer. The privilege provided under this paragraph does not supersede any other applicable privilege or confidentiality protection, nor does disclosure of confidential holding company information to the superintendent constitute a waiver of any such privilege or protection. Neither the superintendent nor any person who received holding company information from or under the authority of the superintendent under this section may be permitted or required to testify in any private civil action concerning holding company information that is confidential under this subsection. [PL 2013, c. 238, Pt. A, §26 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] C. The superintendent may share holding company information that is confidential under this subsection only in accordance with the requirements of section 216, subsection 5 and the following additional requirements. (1) The recipient of the information must agree in writing to maintain the same level of confidentiality as is available under Maine law. This requirement may be satisfied through a multilateral confidentiality agreement to which both the superintendent and the recipient are parties. (2) The superintendent may not share confidential holding company information with or through the National Association of Insurance Commissioners except in accordance with an information-sharing agreement entered into in accordance with section 216, subsection 5, paragraph C . (3) If the recipient of the information is in the United States, the recipient's state must have statutes or rules that expressly protect holding company information at a level at least equivalent to the protections provided by this subsection and section 216, subsection 5 . (4) ORSA-related information subject to subsection 8, paragraph B‑3 may, with the written consent of the insurer, be shared with a person under contract with the superintendent pursuant to section 208 . In addition, any agreement for sharing ORSA-related information with the person under the contract with the superintendent or with the National Association of Insurance Commissioners must further provide that: (a) The recipient of the information agrees in writing to maintain the confidentiality and privileged status of the ORSA-related information and has verified in writing the legal authority to maintain confidentiality; and (b) Any preauthorization granted under the agreement for further sharing of information provided by the superintendent must be limited to only the domiciliary regulators of other insurers in the same insurance holding company system. (5) If the superintendent authorizes a contractor to have access to liquidity stress test information provided pursuant to subsection 8, paragraph B‑1 , subparagraph (3), the superintendent shall disclose the identity of the contractor to the applicable insurers. [PL 2021, c. 521, §§18, 19 (AMD).] D. This subsection does not prohibit the superintendent from using holding company information in the furtherance of any regulatory or legal action brought as a part of the superintendent's official duties. [PL 2013, c. 238, Pt. A, §26 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] E. Unless otherwise provided by applicable law, the superintendent may, after giving notice and opportunity for hearing to the insurer and any affiliates, controlling person or other persons that would be affected, order one or more items of holding company information, other than ORSA-related information, to be made a public record in its entirety or in redacted form if the superintendent determines that public disclosure will be in the interest of policyholders, shareholders or the public. [PL 2013, c. 238, Pt. A, §26 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] F. Except as otherwise required under this section, directly or indirectly publicly disseminating a statement in print or electronically regarding a group capital calculation required under subsection 8, paragraph B‑1 , subparagraph (2) or its resulting group capital ratio, a liquidity stress test required under subsection 8, paragraph B‑1 , subparagraph (3) or its results or supporting disclosures of any insurer or any insurance group or of any component derived in the calculation by any insurer, producer or other person engaged in any manner in the insurance business is prohibited. The insurer may publish in a written publication an announcement the sole purpose of which is to rebut any materially false statement or inappropriate comparison if the materially false statement or inappropriate comparison relating to a group capital calculation, group capital ratio, liquidity stress test or test results or supporting disclosures is published in any written publication and the insurer is able to demonstrate to the superintendent with substantial proof the falsity of that statement or the inappropriateness, as the case may be. [PL 2021, c. 521, §20 (NEW).] G. A group capital calculation required under subsection 8, paragraph B‑1 , subparagraph (2) or its resulting group capital ratio or a liquidity stress test required under subsection 8, paragraph B‑1 , subparagraph (3) or its results and supporting disclosures is not a means to rank any insurers or insurance holding company systems. [PL 2021, c. 521, §21 (NEW).] [PL 2021, c. 521, §§17-21 (AMD).]

14. Penalties. A. Any person who willfully violates any of the provisions of this section, or the rules and regulations promulgated by the superintendent under authority thereof, or any person who willfully, in a filing pursuant to subsection 4‑C or a registration pursuant to subsection 8, paragraph B , makes any untrue statement of a material fact or omits to state any material fact required to be stated therein or necessary to make the statements therein not misleading, must upon conviction be fined not more than $1,000 or imprisoned not more than 3 years, or both; [PL 2013, c. 238, Pt. A, §27 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).] B. Any person who is found, after notice and opportunity to be heard, to have willfully violated any of the provisions of this section or any rule or regulations promulgated by the superintendent under the authority thereof, shall, in addition to any other penalty provided by law, forfeit to this State the sum of $50 for a first violation and an additional sum of $25 for each day such violation shall continue; [PL 1975, c. 356, §1 (NEW).] C. In addition to other remedies and penalties provided in this section or otherwise available under the laws of this State, any violation of this section is hereby declared to be an unfair method of competition or an unfair or deceptive act and practice in the business of insurance subject to the provisions of chapter 23 and in addition, the superintendent may, after notice and hearing: (1) Refuse to issue, refuse to renew or reissue, revoke or suspend for a period not exceeding one year any license or certificate of authority issued or to be issued to any person found to have violated any of the provisions of this section; (2) Impose civil penalties in accordance with section 12‑A for each such violation and for each day's continuance thereof; (4) Issue such administrative orders to require compliance with this section, including the filing of evidence of compliance and periodic reporting as to such compliance, enforceable by such revocation, suspension or refusal to issue, renew or reissue of any such license or licenses or otherwise pursuant to the laws of this State; or (5) Any or all of the foregoing; [PL 2025, c. 348, §§2-4 (AMD).] D. The superintendent may proceed in a court of competent jurisdiction within or without this State for an injunction to prevent a violation of this section, to reverse or hold invalid any transaction made in violation of this section or in violation of a rule adopted or order issued pursuant to this section, to enforce any order issued pursuant to this section and for other equitable relief as the nature of the case and the interest of the insurer’s policyholders, creditors and shareholders or the public may require. (1) If the superintendent finds probable cause that a violation of this section constitutes grounds provided for the rehabilitation, conservatorship or liquidation of an insurer, the superintendent may initiate a delinquency proceeding under chapter 57 . (2) The Superior Court may, on the application of an insurer or the superintendent: (a) Enjoin any offer, request, invitation, agreement or acquisition made in contravention of this section or any rule adopted or order issued by the superintendent pursuant to this section; (b) Enjoin the voting of any security that is the subject of any agreement or arrangement regarding acquisition or that is acquired or to be acquired in contravention of the provisions of this section or of any rule adopted or order issued by the superintendent and, if appropriate, may void any vote of the security already cast at any meeting of shareholders; (c) Seize or sequester any voting securities of the insurer owned or controlled directly or indirectly by a person who has acquired or is proposing to acquire a voting security of the insurer in violation of this section or any rule adopted or order issued by the superintendent; and (d) Issue any other order as may be appropriate to effectuate the provisions of this section. [PL 2025, c. 348, §5 (NEW).] [PL 2025, c. 348, §§2-5 (AMD).]

14-A. Recovery. A. If an order for liquidation or rehabilitation of a domestic insurer has been entered, the receiver appointed under that order has the right to recover on behalf of the insurer: (1) From any parent corporation or holding company or person or affiliate who otherwise controlled the insurer, the amount of any distributions other than distributions of shares of the same class of stock paid by the insurer on its capital stock; or (2) Any payment in the form of a bonus, termination settlement or extraordinary lump-sum salary adjustment made by the insurer or by any subsidiary of that insurer to a director, officer or employee when the distribution or payment pursuant to this subparagraph or subparagraph (1) is made at any time during the one year preceding the petition for liquidation, conservation or rehabilitation, subject to the limitations of paragraphs B , C and D . [PL 1993, c. 313, §13 (NEW).] B. Such a distribution is not recoverable if the parent corporation or affiliate shows that when paid the distribution was lawful and reasonable and that the insurer did not know and could not reasonably have known that the distribution could adversely affect the ability of the insurer to fulfill its contractual obligations. [PL 1993, c. 313, §13 (NEW).] C. Any person who was a parent corporation or holding company or a person who otherwise controlled the insurer or affiliate at the time distributions were paid is liable up to the amount of distributions or payments under paragraph A that the person received. Any person who otherwise controlled the insurer at the time the distributions were declared is liable up to the amount of the distributions the person would have received if that person had been paid immediately. If 2 or more persons are liable for the same distributions, those persons are jointly and severally liable. [PL 1993, c. 313, §13 (NEW).] D. The maximum amount recoverable under this subsection is the amount needed in excess of all other available assets of the impaired or insolvent insurer to pay the contractual obligations of the impaired or insolvent insurer and to reimburse any guaranty funds. [PL 1993, c. 313, §13 (NEW).] E. To the extent that any person liable under paragraph C is insolvent or fails to pay claims due pursuant to paragraph C , its parent corporation or holding company or person who otherwise controlled it at the time the distribution was paid, is jointly and severally liable for any resulting deficiency in the amount recovered from the parent corporation or holding company or person who otherwise controlled it. [PL 1993, c. 313, §13 (NEW).] [PL 1993, c. 313, §13 (NEW).]

14-B. Supervision, seizure, conservatorship or receivership proceedings. This subsection governs an affiliate's obligations under supervision, seizure, conservatorship or receivership proceedings against an insurer. A. An affiliate that is party to an agreement or contract with a domestic insurer that is subject to subsection 9, paragraph E , subparagraph (4) is subject to the jurisdiction of a supervision, seizure, conservatorship or receivership proceeding against the insurer and to the authority of a supervisor, rehabilitator or liquidator for the insurer appointed pursuant to chapter 57 for the purpose of interpreting, enforcing and overseeing the affiliate’s obligations under the agreement or contract to perform services for the insurer that are: (1) An integral part of the insurer’s operations, including, but not limited to, management, administrative, accounting, data processing, marketing, underwriting, claims handling and investment functions and any other similar functions; or (2) Essential to the insurer’s ability to fulfill its obligations under insurance policies. [PL 2021, c. 521, §22 (NEW).] B. The superintendent may require that an agreement or contract subject to subsection 9, paragraph E , subparagraph (4) for the provision of services described in paragraph A , subparagraph (1) or (2) specify that the affiliate consents to jurisdiction as set forth in this subsection. [PL 2021, c. 521, §22 (NEW).] [PL 2021, c. 521, §22 (NEW).]

14-C. Prohibited voting of securities. In regard to a security that is the subject of any agreement or arrangement regarding acquisition or that is acquired or to be acquired in contravention of the provisions of this section or of any rule adopted or order issued by the superintendent, a person may not vote the security at any shareholder’s meeting or count the security for quorum purposes, and any action of shareholders requiring the affirmative vote of a percentage of shares may be taken as though the securities were not issued and outstanding. An action taken at any meeting at which a security described by this section has been voted is not invalidated by the voting of the security unless the action would materially affect control of the insurer or unless the courts of this State have so ordered. [PL 2025, c. 348, §6 (NEW).]

15. Additional powers. The powers, remedies, procedures and penalties provided in this section shall be in addition to, and not in limitation of, any other powers, remedies, procedures and penalties otherwise provided by law. [PL 1975, c. 356, §1 (NEW).]

16. Separability of provisions. If any provision of this section or the application thereof to any person or circumstance is held invalid, the invalidity shall not affect other provisions or applications of this section which can be given effect without the invalid provision or application, and for this purpose the provisions of this section are separable. [PL 1975, c. 356, §1 (NEW).]

17. Jurisdiction of courts; service of process. Any person obtaining or attempting to obtain control of a domestic insurer is subject to the jurisdiction of the courts of this State and to service of process in the manner provided in this Title. Unless a valid appointment of an agent for service of process is on file with the superintendent pursuant to another provision of this Title, the person is deemed to have appointed the superintendent as agent for service of process, and service may be made in the same manner as provided in section 2105 . [PL 1999, c. 113, §14 (AMD).]

18. Rules. The superintendent may adopt reasonable rules to carry out provisions of this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2013, c. 238, Pt. A, §28 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).]

19. Supplemental to existing provisions. This section, as to insurance holding company systems, supplements in particular those provisions contained in sections 407, subsection 2 ; 410, subsection 1, paragraph B ; 413 ; 423‑C ; 425 ; 1115 ; 1136 ; 3414 ; 3474 ; 3475 ; 3476 ; 3483 ; 3875 and 4407 ; and the provisions of this section are deemed to supersede or modify any such provisions or any other provisions of this Title to the extent inconsistent therewith. [PL 2013, c. 238, Pt. A, §29 (AMD); PL 2013, c. 238, Pt. A, §34 (AFF).]
24-A M.R.S. § 6807 — ME Code / Title 24-A / Chapter 85 / Section 6807
24-A §6807. Examinations and investigations
Status: in_force

1. Complaint. [PL 2003, c. 636, §10 (RP).]

1-A. Examinations. The superintendent may conduct examinations in accordance with this subsection. A. The superintendent may conduct an examination under this chapter of a licensee as often as the superintendent in the superintendent's sole discretion considers appropriate. [PL 2003, c. 636, §10 (NEW).] B. For purposes of completing an examination of a licensee under this chapter, subject to the provisions of section 6806 , the superintendent may examine or investigate any person, or the business of any person, insofar as the examination or investigation is, in the sole discretion of the superintendent, considered necessary or material to the examination of the licensee. [PL 2003, c. 636, §10 (NEW).] C. In lieu of an examination under this chapter of any foreign or alien licensee licensed in this State, the superintendent may, at the superintendent's discretion, accept an examination report on the licensee as prepared by the superintendent of insurance for the licensee's state of domicile or port-of-entry state. [PL 2003, c. 636, §10 (NEW).] [PL 2003, c. 636, §10 (NEW).]

2. Confidential information. [PL 2003, c. 636, §10 (RP).]

3. Records. Records of all settlement transactions must be maintained by the settlement provider licensee in accordance with this subsection. A. A settlement provider required to be licensed by this chapter shall retain for 5 years copies of all: (1) Proposed, offered or executed settlement contracts, settlement purchase agreements, underwriting documents, policy forms and applications from the date of the proposal, offer or execution of the settlement contract or settlement purchase agreement, whichever is later; (2) Checks, drafts or other evidence and documentation related to the payment, transfer, deposit or release of funds from the date of the transaction; and (3) Other records and documents related to the requirements of this chapter. [PL 2003, c. 636, §10 (NEW).] B. This subsection does not relieve a settlement provider licensee of the obligation to produce these documents to the superintendent after the retention period has expired if the person has retained the documents. [PL 2003, c. 636, §10 (NEW).] C. Subject to the provisions of section 6806 , records required to be retained by this subsection must be legible and complete and may be retained in paper, photographic, microprocess, magnetic, mechanical or electronic media or by any process that accurately reproduces or forms a durable medium for the reproduction of a record. [PL 2003, c. 636, §10 (NEW).] [PL 2003, c. 636, §10 (AMD).]

4. Immunity. A cause of action may not arise against any person for the act of communicating or delivering information or data to the superintendent or the superintendent's authorized representative or examiner pursuant to an examination made under this chapter if the act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive. This subsection does not abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by the superintendent, the superintendent's authorized representatives or any examiner appointed by the superintendent. A. A cause of action may not arise against the superintendent, the superintendent's authorized representatives or any examiner appointed by the superintendent for any statements made or conduct performed in good faith while carrying out the provisions of this chapter. [PL 2003, c. 636, §10 (NEW).] B. A cause of action may not arise against any person for the act of communicating or delivering information or data to the superintendent or the superintendent's authorized representative or examiner pursuant to an examination made under this chapter if the act of communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive. This paragraph does not abrogate or modify in any way any common law or statutory privilege or immunity heretofore enjoyed by any person identified in paragraph A . [PL 2003, c. 636, §10 (NEW).] C. A person identified in paragraph A or B is entitled to an award of attorney's fees and costs if that person is the prevailing party in a civil cause of action for libel, slander or any other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For purposes of this paragraph, a proceeding is "substantially justified" if the proceeding had a reasonable basis in law or fact at the time that it was initiated. [PL 2003, c. 636, §10 (NEW).] [PL 2003, c. 636, §10 (AMD).]

5. Conduct of examinations. The following provisions govern the conduct of examinations. A. Upon determining that an examination should be conducted, the superintendent shall issue an examination warrant appointing one or more examiners to perform the examination and instructing them as to the scope of the examination. In conducting the examination, the examiner shall observe those guidelines and procedures as the superintendent considers appropriate. [PL 2003, c. 636, §10 (NEW).] B. Every licensee or person from whom information is sought and its officers, directors and agents shall provide to the examiners timely, convenient and free access at all reasonable hours at its offices to all books, records, accounts, papers, documents, assets and computer or other recordings relating to the property, assets, business and affairs of the licensee or person being examined. The officers, directors, employees and agents of the licensee or person shall facilitate the examination and aid in the examination insofar as it is in their power to do so. The refusal of a licensee, by its officers, directors, employees or agents, to submit to examination or to comply with any reasonable written request of the superintendent is grounds for suspension or refusal of, or nonrenewal of, any license or authority held by the licensee to engage in the business of settlements or other business subject to the superintendent's jurisdiction. Any proceedings for suspension, revocation or refusal of any license or authority must be conducted pursuant to Title 5, chapter 375, subchapter 4 . [PL 2003, c. 636, §10 (NEW).] C. The superintendent has the power to issue subpoenas, to administer oaths and to examine under oath any person as to any matter pertinent to the examination. Upon the failure or refusal of a person to obey a subpoena, the superintendent may petition a court of competent jurisdiction and, upon proper showing, the court may enter an order compelling the witness to appear and testify or produce documentary evidence. Failure to obey the court order is punishable as contempt of court. [PL 2003, c. 636, §10 (NEW).] D. When making an examination under this chapter, the superintendent may retain attorneys, appraisers, independent actuaries, independent certified public accountants or other professionals or specialists as examiners, the reasonable cost of which must be borne by the licensee that is the subject of the examination. [PL 2003, c. 636, §10 (NEW).] E. This chapter may not be construed to limit the superintendent's authority to terminate or suspend an examination in order to pursue other legal or regulatory action pursuant to the insurance laws of this State. Findings of fact and conclusions made pursuant to any examination are prima facie evidence in any legal or regulatory action. [PL 2003, c. 636, §10 (NEW).] F. This chapter may not be construed to limit the superintendent's authority to use and, if appropriate, to make public any final or preliminary examination report, any examiner or licensee workpapers or other documents or any other information discovered or developed during the course of any examination in the furtherance of any legal or regulatory action that the superintendent may, in the superintendent's sole discretion, consider appropriate. [PL 2003, c. 636, §10 (NEW).] [PL 2003, c. 636, §10 (NEW).]

6. Examination reports. Examination reports may be composed only of facts appearing upon the books, records or other documents of the licensee or its agents or other persons examined or as ascertained from the testimony of its officers or agents or other persons examined concerning its affairs and of such conclusions and recommendations as the examiners find reasonably warranted from the facts. No later than 60 days following completion of the examination, the examiner in charge shall file under oath with the superintendent a verified written report of examination. Upon receipt of the verified report, the superintendent shall transmit the report to the licensee examined, together with a notice that affords the licensee examined a reasonable opportunity of not more than 30 days to make a written submission or rebuttal with respect to any matters contained in the examination report. In the event the superintendent determines that regulatory action is appropriate as a result of an examination, the superintendent may initiate any proceedings or actions provided by law. [PL 2003, c. 636, §10 (NEW).]

7. Confidentiality of examination information. The disclosure of information is governed by this subsection. A. Names and individual identification data for all viators and insured persons are considered private and confidential information and may not be disclosed by the superintendent, unless required by law. [PL 2003, c. 636, §10 (NEW).] B. Except as otherwise provided in this chapter, all examination reports, workpapers, recorded information, documents and copies thereof produced by, obtained by or disclosed to the superintendent or any other person in the course of an examination made under this chapter, or in the course of analysis or investigation by the superintendent of the financial condition or market conduct of a licensee, are confidential by law and privileged, are not subject to subpoena and are not subject to discovery or admissible in evidence in any private civil action. The superintendent is authorized to use the documents, materials or other information in the furtherance of any regulatory or legal action brought as part of the superintendent's official duties. For the purposes of this paragraph and paragraph C , "chapter" includes the law of another state or jurisdiction that is substantially similar to this chapter. [PL 2003, c. 636, §10 (NEW).] C. Documents, materials or other information, including, but not limited to, all workpapers and copies thereof, in the possession or control of the National Association of Insurance Commissioners, or its successor organization, and its affiliates and subsidiaries are confidential by law and privileged, are not subject to subpoena and are not subject to discovery or admissible in evidence in any private civil action if they are: (1) Created, produced or obtained by or disclosed to the National Association of Insurance Commissioners, or its successor organization, and its affiliates and subsidiaries in the course of assisting an examination made under this chapter or assisting a superintendent in the analysis or investigation of the financial condition or market conduct of a licensee; or (2) Disclosed to the National Association of Insurance Commissioners, or its successor organization, and its affiliates and subsidiaries under paragraph D by a superintendent. [PL 2003, c. 636, §10 (NEW).] D. The superintendent and any person that receives documents, material or other information while acting under the authority of the superintendent, including the National Association of Insurance Commissioners, or its successor organization, and its affiliates and subsidiaries, may not testify in any private civil action concerning any confidential documents, materials or information subject to paragraph A . [PL 2003, c. 636, §10 (NEW).] E. In order to assist in the performance of the superintendent's duties, the superintendent: (1) May share documents, materials or other information, including the confidential and privileged documents, materials or information subject to paragraph A , with other state, federal and international regulatory agencies, with the National Association of Insurance Commissioners, or its successor organization, and its affiliates and subsidiaries and with state, federal and international law enforcement authorities, as long as the recipient agrees to maintain the confidentiality and privileged status of the documents, materials, communication or other information; and (2) May receive documents, materials, communications or information, including otherwise confidential and privileged documents, materials or information, from the National Association of Insurance Commissioners, or its successor organization, and its affiliates and subsidiaries and from regulatory and law enforcement officials of foreign or other domestic jurisdictions and shall maintain as confidential or privileged any document, material or information received with notice or the understanding that it is confidential or privileged under the laws of the jurisdiction that is the source of the document, material, or information. [PL 2003, c. 636, §10 (NEW).] F. A waiver of any applicable privilege or claim of confidentiality in the documents, materials or information does not occur as a result of disclosure to the superintendent under this section or as a result of sharing as authorized in paragraph E . [PL 2003, c. 636, §10 (NEW).] G. A privilege established under the law of any state or jurisdiction that is substantially similar to the privilege established under this subsection is available and enforced in any proceeding in, and in any court of, this State. [PL 2003, c. 636, §10 (NEW).] H. This chapter may not prevent or be construed as prohibiting the superintendent from disclosing the content of an examination report or preliminary examination report or results, or any matter relating thereto, to the superintendent of insurance of any other state or country or to law enforcement officials of this State or any other state or an agency of the Federal Government at any time or to the National Association of Insurance Commissioners, or its successor organization, as long as such agency or office receiving the report or matters relating thereto agrees in writing to hold it confidential and in a manner consistent with this chapter. [PL 2003, c. 636, §10 (NEW).] [PL 2003, c. 636, §10 (NEW).]

8. Conflict of interest. The following provisions apply. A. An examiner may not be appointed by the superintendent if the examiner, either directly or indirectly, has a conflict of interest or is affiliated with the management of or owns a pecuniary interest in any person subject to examination under this chapter. This section may not be construed to automatically preclude an examiner from being: (1) A viator; (2) An insured in an insurance policy acquired pursuant to a settlement contract; or (3) A beneficiary in an insurance policy that is proposed to be acquired pursuant to a settlement contract. [PL 2003, c. 636, §10 (NEW).] B. Notwithstanding the requirements of this subsection, the superintendent may retain from time to time, on an individual basis, qualified actuaries, certified public accountants or similar individuals who are independently practicing their professions, even though these persons may from time to time be similarly employed or retained by persons subject to examination under this chapter. [PL 2003, c. 636, §10 (NEW).] [PL 2003, c. 636, §10 (NEW).]

9. Investigative authority of superintendent. In addition to the authority granted pursuant to section 220 , the superintendent may investigate persons engaged in the business of settlements and persons suspected of engaging in fraudulent viatical or life settlement acts. [PL 2003, c. 636, §10 (NEW).]
24-A M.R.S. § 3409 — ME Code / Title 24-A / Chapter 47 / Section 3409
24-A §3409. Vouchers for expenditures
Status: in_force

1. No insurer shall make any disbursement of $50 or more, unless such disbursement is evidenced by a voucher or other document correctly describing the consideration for the payment and supported by a check or receipt endorsed or signed by or on behalf of the person receiving the money, or made through an electronic or wire funds transfer system supported by accurate records identifying the payor, payee, date of electronic or wire transfer payment, and the nature of the disbursement so made. [PL 1981, c. 501, §47-A (AMD).]

2. If the disbursement is for services and reimbursement, the voucher or other document, or some other writing referred to therein, shall describe the services and itemize the expenditures. [PL 1969, c. 132, §1 (NEW).]

3. If in a particular instance a required voucher cannot be obtained, the expenditure must be supported by an affidavit executed by an officer of the insurer stating the reasons for such inability and the particulars of such expenditure as otherwise required in this section. [PL 1981, c. 501, §47-A (AMD).]
24-A M.R.S. § 4202-A — ME Code / Title 24-A / Chapter 56 / Section 4202-A
24-A §4202-A. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 1991, c. 709, §2 (NEW).]

1. Basic health care services. "Basic health care services" means health care services that an enrolled population might reasonably require in order to be maintained in good health and includes, at a minimum, emergency care, inpatient hospital care, inpatient physician services, outpatient physician services, ancillary services such as x-ray services and laboratory services and all benefits mandated by statute and mandated by rule applicable to health maintenance organizations. The superintendent may adopt rules defining "basic health care services" to be provided by health maintenance organizations. In adopting such rules, the superintendent shall consider the coverages that have traditionally been provided by health maintenance organizations; the need for flexibility in the marketplace; and the importance of providing multiple options to employers and consumers. The superintendent shall permit reasonable, but not excessive or unfairly discriminatory, variations in the copayment, coinsurance, deductible and other features of coverage, except that these features must meet or exceed those required in benefits mandated by statute. The superintendent shall permit deductible, coinsurance and copayment levels consistent with the deductible levels permitted for policies issued pursuant to chapter 33 or 35 . Rules adopted pursuant to this subsection are major substantive rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2011, c. 90, Pt. F, §4 (AMD).]

2. Capitated basis. "Capitated basis" has the following meanings. A. "Capitated basis" means fixed per-member, per-month payments or percentage-of-premium payments pursuant to which the provider assumes full risk for the cost of contracted services without regard to the type, value or frequency of services provided. For purposes of this definition, capitated basis includes the cost associated with operating staff model facilities. [PL 1991, c. 709, §2 (NEW).] B. "Capitated basis," in the context of a point-of-service option plan, means prepayment that considers provision of in-plan covered services as described in paragraph A and that considers out-of-plan indemnity benefits reimbursed pursuant to the terms of a point-of-service product approved pursuant to section 4207‑A . [PL 1991, c. 709, §2 (NEW).] [PL 1991, c. 709, §2 (NEW).]

3. Carrier. "Carrier" means a health maintenance organization, an insurer, a nonprofit hospital, a medical service corporation or any other entity responsible for the payment of benefits or provision of services under a group contract. [PL 1991, c. 709, §2 (NEW).]

4. Copayment. "Copayment" means an amount an enrollee must pay in order to receive a specific service that is not fully prepaid. [PL 1991, c. 709, §2 (NEW).]

5. Deductible. "Deductible" means the amount an enrollee is responsible to pay out of pocket before a health maintenance organization begins to pay the costs associated with treatment. [PL 1991, c. 709, §2 (NEW).]

6. Enrollee. "Enrollee" means an individual who is enrolled in a health maintenance organization. [PL 1991, c. 709, §2 (NEW).]

7. Evidence of coverage. "Evidence of coverage" means any certificate, agreement or contract issued to a group contract holder or an enrollee setting out the coverage to which an enrollee is entitled. [PL 1991, c. 709, §2 (NEW).]

8. Group contract holder. "Group contract holder" means an entity or person that has purchased coverage from a health maintenance organization that provides, at a minimum, basic health care services to enrollees. [PL 1991, c. 709, §2 (NEW).]

9. Health care services. "Health care services" means any services included in the furnishing of medical care, dental care or hospitalization to an individual, or any services incident to the furnishing of that care or hospitalization, as well as the furnishing of any other services to an individual to prevent, alleviate, cure or heal human illness or injury. [PL 1991, c. 709, §2 (NEW).]

10. Health maintenance organization. "Health maintenance organization" means a public or private organization that is organized under the laws of the Federal Government, this State, another state or the District of Columbia or a component of such an organization, and that: A. Provides, arranges or pays for, or reimburses the cost of, health care services, including, at a minimum, basic health care services to enrolled participants, except that health maintenance organizations contracting with the State Government or the Federal Government to service Medicaid or Medicare populations may limit the services they provide under the contracts consistent with the terms of those contracts if such basic health care services are provided to those populations by other means; [PL 1995, c. 673, Pt. D, §1 (AMD).] B. Is compensated, except for reasonable copayments, for basic health care services to enrolled participants solely on a predetermined periodic rate basis, except that the organization is not prohibited from having a provision in a group contract allowing an adjustment of premiums based upon the actual health services utilization of the enrollees covered under the contract, and except that such a contract may not be sold to an eligible group subject to the community rating requirements of section 2808‑B ; [PL 1993, c. 645, Pt. A, §5 (AMD).] C. Provides physicians' services primarily directly through physicians who are either employees or partners of that organization or through arrangements with individual physicians or one or more groups of physicians organized on a group-practice or individual-practice basis under which those physicians or groups are provided effective incentives to avoid unnecessary or unduly costly utilization, regardless of whether a physician is individually compensated primarily on a fee-for-service basis or otherwise. The organization may discharge its obligation through a point-of-service option product by reimbursing out-of-plan providers pursuant to the terms contained in the group contract holder's group contract. Receipt of out-of-plan covered services by an enrollee does not obligate the organization for an enrollee's responsibilities to meet copayments or deductibles; and [PL 1991, c. 709, §2 (NEW).] D. Ensures the availability, accessibility and quality, including effective utilization, of the health care services that it provides or makes available through clearly identifiable focal points of legal and administrative responsibility. [PL 1991, c. 709, §2 (NEW).] Nothing in this subsection prevents a health maintenance organization from providing fee-for-service health care services as well as health maintenance organization services. A health care provider or affiliated entity that does not offer health insurance or health benefit plans may not be or become a health maintenance organization subject to this chapter solely by reason of arrangements with insurers or hospital or medical service organizations for reimbursement in whole or in part on a capitated basis, the financial risk to the provider or affiliated entity associated with reimbursement arrangements with such 3rd-party payors or the furnishing by the provider or affiliated entity of utilization or case management services. [PL 1995, c. 673, Pt. D, §1 (AMD).]

11. In-plan covered services. "In-plan covered services" means covered health care services obtained from providers who are employed by, under contract with, referred by or otherwise affiliated with the health maintenance organization. "In-plan covered services" includes emergency services. [PL 1991, c. 709, §2 (NEW).]

12. Nonprofit hospital or medical service organization. "Nonprofit hospital or medical service organization" means any organization defined in and authorized to act under Title 24, chapter 19 . [PL 1991, c. 709, §2 (NEW).]

12-A. NCQA accreditation survey report. "NCQA accreditation survey report" means the unpublished, detailed survey report to a health maintenance organization by the National Committee for Quality Assurance upon completion of NCQA's accreditation survey of the health maintenance organization. [PL 1999, c. 256, Pt. Q, §1 (NEW).]

13. Out-of-plan covered services. "Out-of-plan covered services" means nonemergency, covered health care services obtained without a referral from providers who are not otherwise employed by, under contract with or otherwise affiliated with the health maintenance organization or from affiliated specialists. [PL 1991, c. 709, §2 (NEW).]

14. Participating provider. "Participating provider" means a provider as defined in subsection 18 that, under an express or implied contract with a health maintenance organization, has agreed to provide health care services to enrollees with an expectation of receiving payment, other than copayment, directly or indirectly from the health maintenance organization. [PL 1991, c. 709, §2 (NEW).]

15. Person. "Person" means an individual, firm, partnership, corporation, association, syndicate, organization, society, business trust, attorney-in-fact or any legal entity. [PL 1991, c. 709, §2 (NEW).]

16. Point-of-service option. "Point-of-service option" means a health maintenance organization product that allows an enrollee to select either the comprehensive health care benefits of the health maintenance organization or care from a provider of the enrollee's choice outside the health maintenance organization network with traditional indemnity benefits. A point-of-service option in which the risk for out-of-plan covered services of a health maintenance organization is shared with a reinsurer must meet the requirements of this chapter applicable to the indemnity benefits provided by a health maintenance organization. [PL 1991, c. 709, §2 (NEW).]

17. Point-of-service product. "Point-of-service product" means a product that includes both in-plan covered services and out-of-plan covered services. [PL 1991, c. 709, §2 (NEW).]

18. Provider. "Provider" means a physician, hospital or person that is licensed or otherwise authorized in this State to furnish health care services. [PL 1991, c. 709, §2 (NEW).]

19. Superintendent. "Superintendent" means the Superintendent of Insurance. [PL 1991, c. 709, §2 (NEW).]

20. Uncovered expenditures. "Uncovered expenditures" means costs to a health maintenance organization for health care services that are the obligation of the health maintenance organization for which an enrollee may also be liable. [PL 1991, c. 709, §2 (NEW).]
24-A M.R.S. § 2761 — ME Code / Title 24-A / Chapter 33 / Section 2761
24-A §2761. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
Status: in_force

All individual health insurance policies, contracts and certificates must make available coverage for breast reduction surgery and symptomatic varicose vein surgery determined to be medically necessary health care as defined in section 4301‑A, subsection 10‑A . [PL 2005, c. 128, §2 (NEW); PL 2005, c. 128, §5 (AFF).]
24-A M.R.S. § 2550 — ME Code / Title 24-A / Chapter 29 / Section 2550
24-A §2550. Inclusion of lapse of time considerations
Status: in_force

Any paid-up annuity, cash surrender or death benefits available at any time, other than on the contract anniversary under any contract with fixed scheduled considerations, shall be calculated with allowance for the lapse of time and the payment of any scheduled considerations beyond the beginning of the contract year in which cessation of payment of considerations under the contract occurs. [PL 1979, c. 442, §4 (NEW).]
24-A M.R.S. § 2738 — ME Code / Title 24-A / Chapter 33 / Section 2738
24-A §2738. Notice as to renewability
Status: in_force

The superintendent shall have the right to make the following requirements: [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

1. When a policy has neither a brief description nor a separate statement printed on the first page and on the filing back, referring to the renewal conditions of the policy, a separately captioned provision, setting forth the conditions under which the policy may be renewed, must appear on the first page of the policy. The caption shall be clear and definite and shall be approved by the superintendent; but any one of the following captions is acceptable: "RENEWAL SUBJECT TO CONSENT OF COMPANY. RENEWAL SUBJECT TO COMPANY CONSENT. RENEWABLE AT OPTION OF COMPANY." [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. If the policy is not renewable, a separate, appropriately captioned provision on the first page of the policy shall so state. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3364 — ME Code / Title 24-A / Chapter 47 / Section 3364
24-A §3364. Contingent liability of members
Status: in_force

1. Except as provided otherwise in section 3367 with respect to nonassessable policies, each member of a domestic mutual insurer has a contingent liability, pro rata and not one for another, for the discharge of its obligations, which contingent liability may not be greater than 6 times the annual premium for the member's policy at the annual premium rate, as is specified in the insurer's articles of incorporation or bylaws. [PL 2013, c. 299, §10 (AMD).]

2. Every policy issued by the insurer shall contain a plain and legible statement of the contingent liability upon either the face or back thereof. [PL 1969, c. 132, §1 (NEW).]

3. Termination of the policy of any such member does not relieve the member of contingent liability for the member's proportion of the obligations of the insurer that accrued while the policy was in force. [RR 2021, c. 1, Pt. B, §268 (COR).]

4. Unrealized contingent liability of members does not constitute an asset of the insurer in any determination of its financial condition. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2245 — ME Code / Title 24-A / Chapter 24-A / Section 2245
24-A §2245. Prohibitions
Status: in_force

1. Prohibition against waiver. The provisions of this chapter may not be waived. [PL 1999, c. 268, §2 (NEW).]

2. Prohibition against penalty. A payee who proposes to make a transfer of structured settlement payment rights may not incur a penalty, forfeit an application fee or other payment or otherwise incur any liability to the proposed transferee based on the failure of that transfer to satisfy the conditions of section 2243 . [PL 1999, c. 268, §2 (NEW).]
24-A M.R.S. § 6601 — ME Code / Title 24-A / Chapter 81 / Section 6601
24-A §6601. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 1993, c. 688, §1 (NEW).]

1. Declaration of trust. "Declaration of trust" means a joint statement of those participating employers composing a multiple-employer welfare arrangement in which the purposes, plan of administration, rights and duties of the participants and the manner of funding obligations arising under the arrangement are established. [PL 1993, c. 688, §1 (NEW).]

2. Fund balance. "Fund balance" means the total assets in excess of total liabilities, except that assets pledged to secure debts not reflected on the books of the multiple-employer welfare arrangement are not included in the fund balance. "Fund balance" includes other contributed capital, retained earnings and subordinated debt. [PL 1993, c. 688, §1 (NEW).]

3. Funded trust. "Funded trust" means that legal entity created to receive, hold and administer contributions of employers participating in the arrangement that is composed of assets acceptable to the superintendent equal to or in excess of loss reserves and all other liabilities of the arrangement. A trust is not fully funded if any part of the corpus consists of a surety bond. [PL 1993, c. 688, §1 (NEW).]

4. Insolvent or impaired condition. A multiple-employer welfare arrangement is "insolvent" or in an "impaired condition" when the fund balance is in a deficit position. [PL 1993, c. 688, §1 (NEW).]

5. Multiple-employer welfare arrangement. "Multiple-employer welfare arrangement" or "arrangement" means an employer welfare benefit plan or any other arrangement that is established or maintained for the purpose of offering or providing health benefits to the employees of 2 or more employers or to their beneficiaries. For the purposes of this chapter only, an employer welfare benefit plan or any other arrangement that, after April 30, 1996, is established or maintained for the purpose of offering or providing health benefits to employees leased to client companies by an employee leasing company required to be registered under Title 32, chapter 125 must be treated as a multiple-employer welfare arrangement within the meaning of this chapter. "Multiple-employer welfare arrangement" does not include a plan or arrangement established or maintained before January 1, 1993 by the State, a political subdivision of the State or an association composed of political subdivisions of the State primarily to cover its employees, former employees or their dependents, nor does it include a plan or arrangement established or maintained under or pursuant to one or more agreements deemed collective bargaining agreements under the federal Employee Retirement Income Security Act of 1974, Section 3(40)(A)(i), as amended. For purposes of this chapter, 2 or more trades or businesses, whether or not incorporated, are deemed a single employer if those trades or businesses are under common ownership or within the same control group as defined under the federal Employee Retirement Income Security Act of 1974, Section 3(40)(B). For the purposes of this chapter only, each of an employee leasing company's client companies, as defined in Title 32, section 14051 , is considered a separate employer as long as it is not deemed a single employer under this subsection. [PL 1995, c. 618, §5 (AMD).]

6. Participation agreement. "Participation agreement" means the document pursuant to which an employer undertakes and agrees to fulfill the obligation of employers imposed by the declaration of trust. [PL 1993, c. 688, §1 (NEW).]

7. Qualified financial institution. "Qualified financial institution" means an institution that is organized, or in the case of a United States branch or agency office of a foreign banking organization is licensed under the laws of the United States or any state, and has been granted authority to operate with fiduciary powers and is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies. [PL 1993, c. 688, §1 (NEW).]

8. Third-party administrator. "Third-party administrator" or "administrator" means an administrator licensed pursuant to chapter 18 . [PL 1993, c. 688, §1 (NEW).]
24-A M.R.S. § 4231 — ME Code / Title 24-A / Chapter 56 / Section 4231
24-A §4231. Insolvency or withdrawal; alternative coverage
Status: in_force

1. Continuation of coverage by other carriers. In the event of an insolvency of a health maintenance organization and if satisfactory arrangements for the performance of its obligations have not been made as provided for in section 4214 , all other carriers that made an offer of coverage to any group contract holder of the insolvent health maintenance organization at the most recent purchase or renewal of coverage, upon order of the superintendent, shall offer the enrollees in the group covered by that contract a 30-day enrollment period that begins on the date of insolvency. Each carrier shall offer the group's enrollees the same coverage and rates that the carrier had offered to those enrollees at the most recent purchase or renewal of coverage prior to the insolvency, except that a successor health maintenance organization may increase the group's rate to the extent justified by including the new enrollees in a recalculation of rates using the existing method of rate calculation of the successor carrier or, if the group was covered under a multiple-year contract, to the extent justified to take into account increased health care costs, as approved by the superintendent. [PL 2001, c. 88, §8 (AMD).]

2. Allocation of enrollees. If no other carrier had offered coverage to a group contract holder in the insolvent health maintenance organization, or if the superintendent determines that the other health benefit plan or plans lack sufficient health care delivery resources to ensure that health care services will be available and reasonably accessible to all of that group's enrollees in the insolvent health maintenance organization, then the superintendent shall allocate equitably the insolvent health maintenance organization's group contracts among all health maintenance organizations that operate within a portion of the insolvent health maintenance organization's service area, taking into consideration the health care delivery resources of each health maintenance organization. Each health maintenance organization to which a group or groups are so allocated shall offer such group or groups the health maintenance organization's existing coverage that is most similar to each group's coverage with the insolvent health maintenance organization at rates determined in accordance with the successor health maintenance organization's existing rating methodology. [PL 1989, c. 842, §18 (NEW).]

3. Nongroup enrollees. [PL 1995, c. 332, Pt. O, §10 (RP).]

4. Allocation upon withdrawal. If any group contract holder of a withdrawing health maintenance organization is unable to obtain replacement coverage subsequent to a withdrawal pursuant to section 415‑A , the superintendent may allocate equitably the withdrawing health maintenance organization's group contract holders among all health maintenance organizations that operate within a portion of the withdrawing health maintenance organization's service area in accordance with subsection 2 . [PL 2001, c. 88, §9 (NEW).]
24-A M.R.S. § 15 — ME Code / Title 24-A / Chapter 1 / Section 15
24-A §15. NAIC defined
Status: in_force

As used in this Title, “NAIC” or “National Association of Insurance Commissioners” means the National Association of Insurance Commissioners or its successor organization of insurance regulators. [PL 2021, c. 521, §1 (NEW).]
24-A M.R.S. § 4304 — ME Code / Title 24-A / Chapter 56-A / Section 4304
24-A §4304. Utilization review
Status: in_force

The following requirements apply to health plans doing business in this State that require prior authorization by the plan of health care services or otherwise subject payment of health care services to review for clinical necessity, appropriateness, efficacy or efficiency. A carrier offering or renewing a health plan subject to this section that contracts with other entities to perform utilization review on the carrier's behalf is responsible for ensuring compliance with this section and chapter 34 . [PL 2007, c. 199, Pt. B, §12 (AMD).]

1. Requirements for medical review or utilization review practices. A carrier shall appoint a medical director who is responsible for reviewing and approving the carrier's policies governing the clinical aspects of coverage determinations by any health plan that it offers or renews. A carrier's medical review or utilization review practices must be governed by the standard of medically necessary health care as defined in this chapter. A carrier shall provide clear written policies and procedures to providers and enrollees on how to obtain a prior authorization. [PL 2023, c. 275, §1 (AMD).]

2. Prior authorization of nonemergency services. Except for a request in exigent circumstances as described in section 4311, subsection 1‑A, paragraph B , a request by a provider for prior authorization of a nonemergency service must be answered by a carrier within 72 hours or 2 business days, whichever is less, in accordance with this subsection. A. Both the provider and the enrollee on whose behalf the authorization was requested must be notified by the carrier of its determination. [PL 2019, c. 273, §1 (NEW).] B. If the carrier responds to a request by a provider for prior authorization with a request for additional information, the carrier shall make a decision within 72 hours or 2 business days, whichever is less, after receiving the requested information. [PL 2019, c. 273, §1 (NEW).] C. If the carrier responds that outside consultation is necessary before making a decision, the carrier shall make a decision within 72 hours or 2 business days, whichever is less, from the time of the carrier's initial response. [PL 2019, c. 273, §1 (NEW).] D. The prescription drug and prior authorization standards used by a carrier must be clear and readily available to enrollees, participating providers, pharmacists and other providers. With regard to prior authorization for prescription drugs, a carrier shall comply with the requirements set forth in subsection 2‑B . A provider must make best efforts to provide all information necessary to evaluate a request, and the carrier must make best efforts to limit requests for additional information. [PL 2021, c. 73, §1 (AMD).] E. If a covered medically necessary service cannot be delivered on the approved date of an approved prior authorization request, a carrier may not deny the claim if the covered medically necessary service is provided within 14 days before or after the approved date. [PL 2023, c. 680, Pt. A, §4 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).] F. For nonemergency services provided without a required prior authorization approval, a carrier may not deny a claim for nonemergency services that were within the scope of the enrollee's coverage pending medical necessity review and may not impose a penalty on the provider for failing to obtain a prior authorization of greater than 15% of the contractually allowed amount for the services that required prior authorization approval. [PL 2023, c. 680, Pt. A, §5 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).] If a carrier does not grant or deny a request for prior authorization within the time frames required under this subsection, the request for prior authorization by the provider is granted. [PL 2023, c. 680, Pt. A, §§4, 5 (AMD); PL 2023, c. 680, Pt. A, §10 (AFF).]

2-A. Prior authorization of medication-assisted treatment for opioid use disorder. A carrier may not require prior authorization for medication-assisted treatment for opioid use disorder for the prescription of at least one drug for each therapeutic class of medication used in medication-assisted treatment, except that a carrier may not impose any prior authorization requirements on a pregnant woman for medication-assisted treatment for opioid use disorder. For the purposes of this subsection, "medication-assisted treatment" means an evidence-based practice that combines pharmacological interventions with substance use disorder counseling. [PL 2019, c. 273, §2 (NEW).]

2-B. Electronic transmission of prior authorization requests. If a health plan provides coverage for prescription drugs, the carrier must accept and respond to prior authorization requests in accordance with subsection 2 and this subsection through a secure electronic transmission using standards recommended by a national institute for the development of fair standards and adopted by a national council for prescription drug programs for electronic prescribing transactions. For the purposes of this subsection, transmission of a facsimile through a proprietary payer portal or by use of an electronic form is not considered electronic transmission. A carrier's electronic transmission system for prior authorization requests for prescription drugs must comply with the following. A. No later than January 1, 2022, unless a waiver is granted by the superintendent, a carrier or entity under contract to a carrier shall make available to a provider in real time at the point of prescribing one or more electronic benefit tools that are capable of integrating with at least one electronic prescribing system or electronic medical record system to provide complete, accurate, timely, clinically appropriate formulary and benefit information specific to an enrollee, including, but not limited to, the estimated cost-sharing amount to be paid by the enrollee, information on any available formulary alternatives that are clinically appropriate and information about the formulary status and the utilization review and prior authorization requirements of each drug presented. Upon a carrier's request, the superintendent may grant a waiver from the requirements of this paragraph based on a demonstration of good cause. [PL 2021, c. 73, §2 (NEW).] B. No later than January 1, 2023, unless a waiver is granted by the superintendent, a carrier or entity under contract to a carrier shall make available to a provider in real time at the point of prescribing an electronic benefit tool that is capable of integrating with the provider's electronic prescribing system or electronic medical record system to provide complete, accurate, timely, clinically appropriate formulary and benefit information specific to an enrollee, including, but not limited to, the estimated cost-sharing amount to be paid by the enrollee, information on any available formulary alternatives that are clinically appropriate and information about the formulary status and the utilization review and prior authorization requirements of each drug presented. Upon a carrier's request, the superintendent may grant a waiver from the requirements of this paragraph based on a demonstration of good cause. [PL 2021, c. 73, §2 (NEW).] [PL 2021, c. 73, §2 (AMD).]

2-C. Prior authorization of prescription drugs used for assessment and treatment of serious mental illness. Notwithstanding any requirement of this section to the contrary, a carrier shall approve a prior authorization request for medication on the carrier's prescription drug formulary that is prescribed to assess or treat an enrollee's serious mental illness. If a drug shortage makes a formulary drug prescribed to assess or treat an enrollee's serious mental illness unavailable and there is no equivalent formulary drug available, the carrier shall approve an equivalent nonformulary drug prescribed to assess and treat the enrollee's serious mental illness for the period of time that a formulary drug is unavailable. For the purposes of this subsection, "serious mental illness" means a mental disorder, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, that results in serious functional impairment that substantially interferes with or limits one or more major life activities. The superintendent may adopt rules to implement this subsection. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2025, c. 473, §1 (AMD).]

3. Background information; affirmative duty of provider. A provider has an affirmative duty to submit to the carrier the background information necessary for the carrier to complete its review and render a decision within the time period required in subsection 2 . If the provider needs additional time to submit that required information, the provider must inform the carrier in a timely manner. Nothing in this section requires a provider to submit confidential information without a signed consent from the enrollee. [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).]

4. Revocation of prior authorization. When prior approval for a service or other covered item is granted, a carrier may not retrospectively deny coverage or payment for the originally approved service unless fraudulent or materially incorrect information was provided at the time prior approval for the service was granted. [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).]

5. Emergency services. When conducting utilization review or making a benefit determination for emergency services, a carrier shall provide benefits for emergency services consistent with the requirements of this subsection and any applicable bureau rule. A. Before a carrier denies benefits or reduces payment for an emergency service based on a determination of the absence of an emergency medical condition or a determination that a lower level of care was needed, the carrier shall conduct a utilization review done by a board-certified emergency physician who is licensed in this State, including a review of the enrollee's medical record related to the emergency medical condition subject to dispute. If a carrier requests records related to a potential denial of or payment reduction for an enrollee's benefits when emergency services were furnished to an enrollee, a provider has an affirmative duty to respond to the carrier in a timely manner. This paragraph does not apply when a reduction in payment is made by a carrier based on a contractually agreed upon adjustment for health care service. [PL 2019, c. 238, §2 (NEW).] B. The medical necessity of emergency services may not be based on whether those services were provided by participating or nonparticipating providers. Restrictions on coverage of emergency services provided by nonparticipating providers may not be greater than restrictions that apply when those services are provided by participating providers. [PL 2023, c. 680, Pt. A, §6 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).] C. If an enrollee receives an emergency service that requires immediate post‑evaluation or post‑stabilization services, a carrier may not require prior authorization for the post‑evaluation or post-stabilization services provided during the same encounter. If the post-evaluation or post-stabilization services require an inpatient level of care, the carrier shall make a utilization review determination within 24 hours of receiving a request for those services and the carrier is responsible for payment for those services for the duration until the carrier affirmatively notifies the provider otherwise. If the utilization review determination is not made within 24 hours, the services for which the utilization review was requested are deemed approved until the carrier affirmatively notifies the provider otherwise. [PL 2023, c. 680, Pt. A, §7 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).] [PL 2023, c. 680, Pt. A, §§6, 7 (AMD); PL 2023, c. 680, Pt. A, §10 (AFF).]

6. Notice. A notice issued by a carrier or its contracted utilization review entity in response to a request by or on behalf of an insured or enrollee for authorization of medical services that advises that the requested service has been determined to be medically necessary must also advise whether the service is covered under the policy or contract under which the insured or enrollee is covered. Nothing in this subsection requires a carrier to provide coverage for services performed when the insured or enrollee is no longer covered by the health plan. [PL 2001, c. 410, Pt. B, §6 (NEW).]

7. Requirements for an appeal of adverse health care treatment decision. An appeal of a carrier's adverse health care treatment decision must be conducted by a clinical peer. The clinical peer may not have been involved in making the initial adverse health care treatment decision unless additional information not previously considered during the initial review is provided on appeal. For the purposes of this subsection, "adverse health care treatment decision" does not include a carrier's rescission determination or a carrier's determination of initial coverage eligibility for coverage. [PL 2019, c. 171, §2 (NEW).]
24-A M.R.S. § 3609 — ME Code / Title 24-A / Chapter 51 / Section 3609
24-A §3609. New assessment plan insurers; conversion
Status: in_force

Mutual insurers organized to transact insurance on the assessment plan are not authorized to transact any kind of insurance other than property insurance or to transact insurance of any kind on the cash premium plan, unless the insurer qualifies for such authority in accordance with the requirements of domestic mutual insurers organized under chapter 47 (organization, corporate powers, procedures of domestic legal reserve stock and mutual insurers), and by appropriate amendment to its articles of incorporation converts to such a legal reserve insurer. [PL 2013, c. 299, §21 (AMD).]
24-A M.R.S. § 2808-B — ME Code / Title 24-A / Chapter 35 / Section 2808-B
24-A §2808-B. Small group health plans
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Carrier" means any insurance company, nonprofit hospital and medical service organization or health maintenance organization authorized to issue small group health plans in this State. For the purposes of this section, carriers that are affiliated companies or that are eligible to file consolidated tax returns are treated as one carrier and any restrictions or limitations imposed by this section apply as if all small group health plans delivered or issued for delivery in this State by affiliated carriers were issued by one carrier. For purposes of this section, health maintenance organizations are treated as separate organizations from affiliated insurance companies and nonprofit hospital and medical service organizations. [PL 1991, c. 861, §2 (NEW).] B. "Community rate" means the rate to be charged to all eligible groups for small group health plans prior to any adjustments pursuant to subsection 2, paragraphs C and D . [PL 1991, c. 861, §2 (NEW).] C. "Eligible employee" means an employee who works on a full-time basis, with a normal work week of 30 hours or more. "Eligible employee" includes a sole proprietor, a partner of a partnership or an independent contractor, but does not include employees who work on a temporary or substitute basis. An employer may elect to treat as eligible employees part-time employees who work a normal work week of 10 hours or more as long as at least one employee works a normal work week of 30 hours or more. An employer may elect to treat as eligible employees employees who retire from the employer's employment. [PL 1999, c. 256, Pt. P, §1 (AMD).] D. "Eligible group" means any person, firm, corporation, partnership, association or subgroup engaged actively in a business that employed an average of 50 or fewer eligible employees during the preceding calendar year. (1) If an employer was not in existence throughout the preceding calendar year, the determination must be based on the average number of employees that the employer is reasonably expected to employ on business days in the current calendar year. (2) In determining the number of eligible employees, companies that are affiliated companies or that are eligible to file a combined tax return for purposes of state taxation are considered one employer. (3) A group is not an eligible group if there is any one other state where there are more eligible employees than are employed within this State and the group had coverage in that state or is eligible for guaranteed issuance of coverage in that state. (4) An employer qualifies as an eligible group for 2-person coverage if the employer provides a carrier with the following information demonstrating that the employer's business and employees meet the minimum qualifications for group coverage in paragraph C : (a) A copy of the most recent quarterly combined filing for income tax withholding and unemployment contributions, Form 941/C1-ME; (b) For an employee claimed to be an employee eligible for group coverage whose name is not listed on Form 941/C1-ME, a copy of the employer's payroll records for the most recent 3 months showing tax withholding or a wage report from a payroll company showing wages paid to that employee for the most recent quarter with tax withholding; (c) If an employer is exempt from filing Form 941/C1-ME for group coverage, documentation of that exemption and a copy of the employer's payroll records for the most recent 3 months showing tax withholding or a wage report from a payroll company showing wages paid to that employee for the most recent quarter with tax withholding; or (d) If the name of the business owner or employee does not appear on Form 941/C1-ME, a copy of one of the following: (i) Federal income tax Form Schedule C or Schedule F; (ii) Federal income tax Form 1120S, Schedule K-1; (iii) Federal income tax Form 1065, Schedule K-1; (iv) A workers' compensation insurance audit or evidence of a waiver of benefits under Title 39‑A ; (v) A description of operations in a commercial general liability insurance policy or equivalent insurance policy providing coverage for the business; or (vi) A signature card from a financial institution or credit union authorizing the employee to sign checks on a business checking or share draft account that is at least 6 months old; a notarized affidavit from the employer describing the duties of the employee and the average number of hours worked by the employee and attesting that the employer is not defrauding the carrier and is aware of the consequences of committing fraud or making a material misrepresentation to the carrier, including a loss of coverage and benefits; and, if the group coverage is purchased through a producer, a notarized affidavit from the producer affirming the producer's belief that the employer qualifies as an eligible group for coverage. In determining if a new business or a business that adds an owner or a new employee to payroll during the course of a year qualifies as an eligible group for 2-person coverage under this subparagraph, the employer must submit an affidavit stating that all employees meet the criteria in this subparagraph and that the documentation and forms required under this subparagraph will be provided to the carrier when payroll records become available, when ownership distribution forms become available or the first renewal date of the coverage, whichever date is earlier. A false affidavit or misrepresentation on an affidavit submitted by an employer may result in the loss of group coverage and repayment of claims paid. This subparagraph may not be construed to prohibit a carrier from recognizing an employer as an eligible group if the employer has not produced the documentation required in this subparagraph. This subparagraph applies only to an employer applying for group health insurance coverage as a 2-person group from October 1, 2001 to December 31, 2013. [PL 2011, c. 364, §9 (AMD).] E. "Late enrollee" means an eligible employee or dependent who requests enrollment in a small group health plan following the initial minimum 30-day enrollment period provided under the terms of the plan, except that, an eligible employee or dependent is not considered a late enrollee if the eligible employee or dependent meets the requirements of section 2849‑B, subsection 3, paragraph A , B , C‑1 or D . [PL 1997, c. 777, Pt. B, §2 (AMD).] F. "Premium rate" means the rate charged to an eligible group or eligible individual for a small group health plan. [PL 1991, c. 861, §2 (NEW).] G. "Small group health plan" means any hospital and medical expense-incurred policy; health, hospital or medical service corporation plan contract; or health maintenance organization subscriber contract covering an eligible group. "Small group health plan" does not include the following types of insurance: (1) Accident; (2) Credit; (3) Disability; (4) Long-term care or nursing home care; (5) Medicare supplement; (6) Specified disease; (7) Dental or vision; (8) Coverage issued as a supplement to liability insurance; (9) Workers' compensation; (10) Automobile medical payment; or (11) Insurance under which benefits are payable with or without regard to fault and that is required statutorily to be contained in any liability insurance policy or equivalent self-insurance. [PL 1991, c. 861, §2 (NEW).] H. "Subgroup" means an employer with 50 or fewer employees within an association, a multiple employer trust, a private purchasing alliance or any similar subdivision of a larger group covered by a single group health policy or contract. For group policies issued to an employee leasing company as defined in Title 32, chapter 125 , each client having 50 or fewer employees is considered a separate subgroup. [PL 2009, c. 244, Pt. F, §2 (AMD).] [PL 2011, c. 364, §9 (AMD).]

2. Rating practices. The following requirements apply to the rating practices of carriers providing small group health plans. This subsection does not apply to policies issued before January 1, 1998 to eligible groups that employed, on average, 25 to 50 eligible employees until their first renewal date on or after January 1, 1998. A. [PL 2003, c. 469, Pt. E, §14 (RP).] B. A carrier may not vary the premium rate due to the gender, health status, claims experience or policy duration of the eligible group or members of the group or any other rating factor not specified in this section. [PL 2019, c. 5, Pt. A, §9 (AMD).] C. A carrier may vary the premium rate due to family membership and participation in wellness programs. The premium rate for a family must equal the sum of the premiums for each individual in the family, except that it may not be based on more than 3 dependent children who are less than 21 years of age. The superintendent may adopt rules setting forth appropriate methodologies regarding rate discounts for participation in wellness programs. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2019, c. 5, Pt. A, §10 (AMD).] C-1. A carrier may vary the premium rate due to geographic area in accordance with the limitation set out in this paragraph. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between October 1, 2011 and December 31, 2023, the rating factor used by a carrier for geographic area may not exceed 1.5. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2024, the rating factor used by a carrier for geographic area may not exceed 1.25. [PL 2021, c. 655, §2 (AMD).] D. A carrier may vary the premium rate due to age and tobacco use in accordance with the limitations set out in this paragraph. A carrier that varies the premium rate due to age must vary the premium rate according to a uniform age curve. The superintendent shall adopt rules establishing a uniform age curve that is substantially similar to the age curve in effect on January 1, 2019 under the federal Affordable Care Act. Rules adopted under this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . (1) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 15, 1993 and July 14, 1994, the premium rate may not deviate above or below the community rate filed by the carrier by more than 50%. (2) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 15, 1994 and July 14, 1995, the premium rate may not deviate above or below the community rate filed by the carrier by more than 33%. (3) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 15, 1995 and September 30, 2011, the premium rate may not deviate above or below the community rate filed by the carrier by more than 20%. (4) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between October 1, 2011 and September 30, 2012, the maximum rate differential due to age filed by the carrier as determined by ratio is 2 to 1. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (5) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between October 1, 2012 and December 31, 2013, the maximum rate differential due to age and group size filed by the carrier as determined by ratio is 2.5 to 1. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (6) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between January 1, 2014 and December 31, 2014, the maximum rate differential due to age and group size filed by the carrier as determined by ratio is 3 to 1 to the extent permitted by the federal Affordable Care Act. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (7) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between January 1, 2015 and December 31, 2015, the maximum rate differential due to age and group size filed by the carrier as determined by ratio is 4 to 1 to the extent permitted by the federal Affordable Care Act. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (8) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2016, except as provided in subparagraph (10), the maximum rate differential due to age and group size filed by the carrier as determined by ratio is 5 to 1 to the extent permitted by the federal Affordable Care Act. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (9) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between October 1, 2011 and December 31, 2022, the maximum rate differential due to tobacco use filed by the carrier as determined by ratio is 1.5 to 1, except that the carrier may not apply a rate differential pursuant to this subparagraph when the covered individual is participating in an evidence-based tobacco cessation strategy approved by the United States Department of Health and Human Services, Food and Drug Administration. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between January 1, 2023 and December 31, 2023, the maximum rate differential due to tobacco use filed by the carrier as determined by ratio is 1.25 to 1, except that the carrier may not apply a rate differential pursuant to this subparagraph when the covered individual is participating in an evidence-based tobacco cessation strategy approved by the United States Department of Health and Human Services, Food and Drug Administration. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2024, a carrier may not vary the premium rate due to tobacco use. (10) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after the effective date of this Act, the maximum rate differential due to age filed by the carrier as determined by ratio is 3 to 1 for individuals 21 years of age and older on the first day of coverage under the policy, contract or certificate. The variation in rate due to age must be actuarially justified for individuals under 21 years of age consistent with the uniform age rating curve adopted under this paragraph. [PL 2021, c. 344, §2 (AMD).] D-1. [PL 2011, c. 90, Pt. A, §9 (RP).] D-2. Notwithstanding the requirements of paragraph D , rates with respect to employees whose work site is not in this State may be based on area adjustment factors appropriate to that location. [RR 1997, c. 1, §22 (RAL).] E. The superintendent may authorize a carrier to establish a separate community rate for an association group organized pursuant to section 2805‑A or a trustee group organized pursuant to section 2806 consistent with the provisions of this paragraph and applicable federal law. (1) Association group membership or eligibility for participation in the trustee group may not be conditioned on health status, claims experience or other risk selection criteria. (2) All health plans offered by the carrier through that association or trustee group must be made available on a guaranteed issue basis to all eligible employers that are members of the association or are eligible to participate in the trustee group except that a professional association may require that a minimum percentage of the eligible professionals employed by a subgroup be members of the association in order for the subgroup to be eligible for issuance or renewal of coverage through the association. The minimum percentage must not exceed 90%. For purposes of this subparagraph, "professional association" means an association that: (a) Serves a single profession that requires a significant amount of education, training or experience or a license or certificate from a state authority to practice that profession; (b) Has been actively in existence for 5 years; (c) Has a constitution and bylaws or other analogous governing documents; (d) Has been formed and maintained in good faith for purposes other than obtaining insurance; (e) Is not owned or controlled by a carrier or affiliated with a carrier; (f) Has at least 1,000 members if it is a national association; 200 members if it is a state or local association; (g) All members and dependents of members are eligible for coverage regardless of health status or claims experience; and (h) Is governed by a board of directors and sponsors annual meetings of its members. (3) The aggregate rate charged by the carrier to the association or trustee group is considered a large group rate, and the terms of coverage are considered a large group health plan. Rates for participating employers within the group may vary only as permitted by paragraphs B to D‑2 . (4) Producers may only market association memberships, accept applications for membership or sign up members in a professional association in which the individuals are actively engaged in or directly related to the profession represented by the professional association. (5) Carriers may not be reinsured under section 3958 for coverage issued under this paragraph. (6) Except for employers with plans that have grandfathered status under the federal Affordable Care Act, this paragraph does not apply to policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2014 until December 31, 2019. To the extent permitted under the federal Affordable Care Act, this paragraph applies to policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2020. [PL 2019, c. 653, Pt. B, §3 (RPR).] F. Premium rates charged to a private purchasing alliance, as defined by chapter 18‑A , may be reduced in accordance with rules adopted pursuant to that chapter. [PL 1995, c. 673, Pt. A, §6 (NEW).] G. [PL 2003, c. 469, Pt. E, §15 (RP).] H. [PL 2019, c. 5, Pt. A, §12 (RP).] I. Except for plans that have grandfathered status under the federal Affordable Care Act, beginning January 1, 2014, a carrier shall consider all enrollees in all small group health plans offered by the carrier to be members of a single risk pool to the extent required by the federal Affordable Care Act. [PL 2011, c. 364, §14 (NEW).] [PL 2021, c. 655, §2 (AMD).]

2-A. Rate filings. A carrier offering small group health plans shall file with the superintendent the community rates for each plan and every rate, rating formula and classification of risks and every modification of any formula or classification that it proposes to use. A. Every filing must state the effective date of the filing. Every filing must be made not less than 60 days in advance of the stated effective date, unless the 60-day requirement is waived by the superintendent. The effective date may be suspended by the superintendent for a period of time not to exceed 30 days. [PL 2009, c. 244, Pt. C, §7 (AMD).] B. A filing and all supporting information, except for protected health information required to be kept confidential by state or federal statute and except for descriptions of the amount and terms or conditions or reimbursement in a contract between an insurer and a 3rd party, are public records notwithstanding Title 1, section 402, subsection 3, paragraph B and become part of the official record of any hearing held pursuant to subsection 2‑B, paragraph B or section 2792, subsection 2 . [PL 2019, c. 653, Pt. B, §4 (AMD).] C. Rates for small group health plans must be filed in accordance with this section and subsections 2‑B and 2‑C or section 2792 , as applicable, for premium rates effective on or after July 1, 2004. [PL 2023, c. 59, §5 (AMD).] [PL 2023, c. 59, §5 (AMD).]

2-B. Rate review and hearings. Except as provided in subsection 2‑C and section 2792 , rate filings are subject to this subsection. A. Rates subject to this subsection must be filed for approval by the superintendent. The superintendent shall disapprove any premium rates filed by any carrier, whether initial or revised, for a small group health plan unless it is anticipated that the aggregate benefits estimated to be paid under all the small group health plans maintained in force by the carrier for the period for which coverage is to be provided will return to policyholders at least 75% of the aggregate premiums collected for those policies, as determined in accordance with accepted actuarial principles and practices and on the basis of incurred claims experience and earned premiums. [PL 2023, c. 59, §6 (AMD).] B. If at any time the superintendent has reason to believe that a filing does not meet the requirements that rates not be excessive, inadequate or unfairly discriminatory or that the filing violates any of the provisions of chapter 23 , the superintendent shall cause a hearing to be held. Hearings held under this subsection must conform to the procedural requirements set forth in Title 5, chapter 375, subchapter 4 . The superintendent shall issue an order or decision within 30 days after the close of the hearing or of any rehearing or reargument or within such other period as the superintendent for good cause may require, but not to exceed an additional 30 days. In the order or decision, the superintendent shall either approve or disapprove the rate filing. If the superintendent disapproves the rate filing, the superintendent shall establish the date on which the filing is no longer effective, specify the filing the superintendent would approve and authorize the insurer to submit a new filing in accordance with the terms of the order or decision. [PL 2003, c. 469, Pt. E, §16 (NEW).] C. When a filing is not accompanied by the information upon which the carrier supports the filing or the superintendent does not have sufficient information to determine whether the filing meets the requirements that rates not be excessive, inadequate or unfairly discriminatory, the superintendent shall require the carrier to furnish the information upon which it supports the filing. [PL 2011, c. 364, §15 (AMD).] D. [PL 2023, c. 59, §7 (RP).] E. [PL 2009, c. 244, Pt. C, §8 (RP).] F. [PL 2009, c. 244, Pt. C, §9 (RP).] [PL 2023, c. 59, §§6, 7 (AMD).]

2-C. Guaranteed loss ratio. Notwithstanding subsection 2‑B , rate filings for a credible block of small group health plans may be filed in accordance with this subsection instead of subsection 2‑B , except as otherwise provided in section 2792 . Rates filed in accordance with this subsection are filed for informational purposes. A. A block of small group health plans is considered credible if the anticipated average number of members during the period for which the rates will be in effect meets standards for full or partial credibility pursuant to the federal Affordable Care Act. The rate filing must state the anticipated average number of members during the period for which the rates will be in effect and the basis for the estimate. If the superintendent determines that the number of members is likely to be less than needed to meet the credibility standard, the filing is subject to subsection 2‑B . [PL 2011, c. 364, §16 (AMD).] A-1. [PL 2011, c. 364, §16 (RP).] B. [PL 2011, c. 364, §16 (RP).] C. [PL 2011, c. 364, §16 (RP).] D. [PL 2011, c. 364, §16 (RP).] E. [PL 2011, c. 364, §16 (RP).] [PL 2019, c. 653, Pt. B, §7 (AMD).]

3. Coverage for late enrollees. In providing coverage to late enrollees, small group health plan carriers are allowed to exclude or limit coverage for a late enrollee subject to the limitations set forth in section 2849‑B, subsection 3 . [PL 1999, c. 256, Pt. L, §1 (AMD).]

4. Guaranteed issuance and guaranteed renewal. Carriers providing small group health plans must meet the following requirements on issuance and renewal. A. Any small group health plan offered to any eligible group or subgroup must be offered to all eligible groups that meet the carrier's minimum participation requirements, which may not exceed 75%, to all eligible employees and their dependents in those groups. In determining compliance with minimum participation requirements, eligible employees and their dependents who have existing health care coverage may not be considered in the calculation. If an employee declines coverage because the employee has other coverage, any dependents of that employee who are not eligible under the employee's other coverage are eligible for coverage under the small group health plan. A carrier may deny coverage under a managed care plan, as defined by section 4301‑A : (1) To employers who have no employees who live, reside or work within the approved service area of the plan; and (2) To employers if the carrier has demonstrated to the superintendent's satisfaction that: (a) The carrier does not have the capacity to deliver services adequately to additional enrollees within all or a designated part of its service area because of its obligations to existing enrollees; and (b) The carrier is applying this provision uniformly to individuals and groups without regard to any health-related factor. A carrier that denies coverage in accordance with this subparagraph may not enroll individuals residing within the area subject to denial of coverage, or groups or subgroups within that area for a period of 180 days after the date of the first denial of coverage. [RR 2001, c. 1, §32 (COR).] B. Renewal is guaranteed under section 2850‑B . [PL 1997, c. 445, §17 (RPR); PL 1997, c. 445, §32 (AFF).] [RR 2001, c. 1, §32 (COR).]

5. Cessation of business. [PL 1997, c. 445, §18 (RP); PL 1997, c. 445, §32 (AFF).]

6. Fair marketing standards. Carriers providing small group health plans must meet the following standards of fair marketing. A. Each carrier must actively market small group health plan coverage, including any standardized plans required to be offered pursuant to subsection 8‑A , to eligible groups in this State. [PL 2009, c. 439, Pt. D, §2 (AMD).] B. A carrier or representative of the carrier may not directly or indirectly engage in the following activities: (1) Encouraging or directing eligible groups to refrain from filing an application for coverage with the carrier because of any of the rating factors listed in subsection 2 ; and (2) Encouraging or directing eligible groups to seek coverage from another carrier because of any of the rating factors listed in subsection 2 . [PL 1991, c. 861, §2 (NEW).] C. A carrier may not directly or indirectly enter into any contract, agreement or arrangement with a representative of the carrier that provides for or results in the compensation paid to the representative for the sale of a small group health plan to be varied because of the rating factors listed in subsection 2 . A carrier may enter into a compensation arrangement that provides compensation to a representative of the carrier on the basis of percentage of premium, provided that the percentage does not vary because of the rating factors listed in subsection 2. [PL 1991, c. 861, §2 (NEW).] D. A carrier may not terminate, fail to renew or limit its contract or agreement of representation with a representative for any reason related to the rating factors listed in subsection 2 . [PL 1991, c. 861, §2 (NEW).] E. A carrier or representative of the carrier may not induce or otherwise encourage an eligible group to separate or otherwise exclude an employee from small group health plan coverage or benefits. [PL 1991, c. 861, §2 (NEW).] F. Denial by a carrier of an application for coverage from an eligible group must be in writing and must state the reason or reasons for the denial. [PL 1991, c. 861, §2 (NEW).] G. The superintendent may establish rules setting forth additional standards to provide for the fair marketing and broad availability of small group health plans in this State. [PL 1991, c. 861, §2 (NEW).] H. A violation of this section by a carrier or a representative of the carrier is an unfair trade practice under chapter 23 . If a carrier enters into a contract, agreement or other arrangement with a 3rd-party administrator to provide administrative, marketing or other services related to the offering of small group health plans in this State, the 3rd-party administrator is subject to this section as if it were a carrier. [PL 1991, c. 861, §2 (NEW).] I. Notwithstanding any other provision of this section, prior to January 1, 2014, a carrier may choose whether it will offer to groups having only one member coverage under the carrier's individual health policies offered to other individuals in this State in accordance with section 2736‑C or coverage under a small group health plan in accordance with this section, or both, but the carrier need not offer to groups of one both small group and individual health coverage. [PL 2011, c. 364, §17 (AMD).] [PL 2011, c. 364, §17 (AMD).]

7. Applicability. This section applies to all policies, plans, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after July 15, 1993. For purposes of this section, all contracts are deemed renewed no later than the next yearly anniversary date of the policy, plan, contract or certificate. [PL 1995, c. 332, Pt. D, §4 (AMD).]

8. Standardized plans. [PL 2001, c. 410, Pt. A, §7 (RP).]

8-A. Authority of the superintendent. The superintendent may by rule define one or more standardized small group health plans that must be offered by all carriers offering small group health plans in the State. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2009, c. 439, Pt. D, §3 (NEW).]

9. Reinsurance mechanism. Small group carriers, except nonprofit hospital and medical service organizations, may form a reinsurance pool for the purpose of reinsuring small group risks. This pool may not become operative until the superintendent has approved a plan of operation. The superintendent may approve a plan only after the superintendent determines that the plan is in the public interest and is consistent with this section. The participants in the plan of operation of the pool shall guarantee, without limitation, the solvency of the pool. That guarantee constitutes a permanent financial obligation of each participant on a pro rata basis. [PL 1993, c. 325, §1 (NEW).]