24-A M.R.S. § 2680 — ME Code / Title 24-A / Chapter 32 / Section 2680
24-A §2680. Standardized claim form
Status: in_force

Administrators providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed health care practitioner or licensed hospital shall accept the current standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted electronically, and any claims for facility services must identify the physical location, including hospital off-campus locations, where services are provided. An administrator may not be required to accept a claim submitted on a form other than the applicable form specified in this section and may not be required to accept a claim that is not submitted electronically, except from a health care practitioner who is exempt pursuant to Title 24, section 2985 . [PL 2023, c. 521, §3 (AMD).]
24-A M.R.S. § 2301 — ME Code / Title 24-A / Chapter 25 / Section 2301
24-A §2301. Purpose of chapter; interpretation
Status: in_force

The purpose of this chapter is to promote the public welfare by regulating insurance rates, in accordance with the intent of Congress as expressed in Public Law 15 -- 79th Congress, to the end that they shall not be excessive, inadequate or unfairly discriminatory, and to authorize and regulate limited cooperative action among insurers in rate-making related activities and in other matters within the scope of this chapter. Nothing in this chapter is intended to prohibit or discourage reasonable competition, or to prohibit, or encourage except to the extent necessary to accomplish the aforementioned purpose, uniformity in rating systems, rating plans or practices. This chapter shall be liberally interpreted to carry into effect this section. Unless otherwise specified, all hearings held under this chapter shall be in accordance with the procedures set forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV . [PL 1989, c. 797, §1 (AMD); PL 1989, c. 797, §§37, 38 (AFF).]
24-A M.R.S. § 2321-E — ME Code / Title 24-A / Chapter 25 / Section 2321-E
24-A §2321-E. Filing of prospective loss costs and supplemental information
Status: in_force

Advisory organizations may develop and file with the superintendent for approval prospective loss costs and supplementary rating information. Such filings shall contain the statistical data and supporting information for calculations or assumptions underlying the prospective loss costs. Advisory organization filings are subject to the provisions of sections 2303 , 2304‑A and 2304‑B . [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).]
24-A M.R.S. § 4121-A — ME Code / Title 24-A / Chapter 55 / Section 4121-A
24-A §4121-A. Acquired Immune Deficiency Syndrome
Status: in_force

No certificate providing health insurance benefits delivered or issued for delivery in this State, other than a certificate providing benefits for specific diseases or accidental injuries only, may provide more restrictive coverage for Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex or HIV related diseases than for any other disease or sickness or exclude coverage for Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or HIV related diseases except through an exclusion under which all sicknesses and diseases are treated the same. [PL 1989, c. 176, §8 (NEW).]
24-A M.R.S. § 2702 — ME Code / Title 24-A / Chapter 33 / Section 2702
24-A §2702. Short title
Status: in_force

This chapter may be cited as the "Uniform Health Policy Provision Law". [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 230 — ME Code / Title 24-A / Chapter 3 / Section 230
24-A §230. Notice of hearing
Status: in_force

1. Notice of hearing shall be given in conformity with the Maine Administrative Procedure Act, Title 5, chapter 375 . [PL 1981, c. 501, §38 (RPR).]

2. Except when a different period is expressly provided by the Maine Administrative Procedure Act, Title 5, chapter 375 , or by this Title, the superintendent shall give written notice of hearing not less than 14 days in advance. Notice of hearing may be waived and the hearing held at a time mutually fixed by the superintendent and the parties. [PL 1981, c. 501, §38 (RPR).]

3. [PL 1981, c. 501, §38 (RP).]

4. [PL 1981, c. 501, §38 (RP).]
24-A M.R.S. § 400 — ME Code / Title 24-A / Chapter 5 / Section 400
24-A §400. "Stock" insurer defined
Status: in_force

A "stock" insurer is an incorporated insurer with its capital divided into shares and owned by its stockholders. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4201 — ME Code / Title 24-A / Chapter 56 / Section 4201
24-A §4201. Short title
Status: in_force

This chapter may be cited as the Health Maintenance Organization Act of 1975. [PL 1975, c. 503 (NEW).]
24-A M.R.S. § 4205-A — ME Code / Title 24-A / Chapter 56 / Section 4205-A
24-A §4205-A. Continuity of licensure; business combinations
Status: in_force

When a health maintenance organization authorized pursuant to this chapter merges or consolidates with an insurer or a nonprofit hospital, medical or health care service organization and operations of the surviving entity include those of a health maintenance organization, the surviving entity succeeds on a continuing basis to the authority possessed by the merging entities if: [PL 1993, c. 702, Pt. A, §13 (NEW).]

1. Plan approved. The superintendent has approved the plan of merger or consolidation, pursuant to section 4203, subsection 1 ; [PL 1993, c. 702, Pt. A, §13 (NEW).]

2. Entity financially qualified. The entity is financially qualified pursuant to the provisions of sections 410 and 4204‑A ; and [PL 1993, c. 702, Pt. A, §13 (NEW).]

3. Entity otherwise qualified. The entity is otherwise qualified pursuant to this chapter. [PL 1993, c. 702, Pt. A, §13 (NEW).]
24-A M.R.S. § 4405 — ME Code / Title 24-A / Chapter 57 / Section 4405
24-A §4405. -- seizure under the superintendent's order
Status: in_force

1. If it appears to the superintendent that the interests of policyholders, creditors or the public will be jeopardized by delay incident to requesting a court seizure order, then on any ground that would justify a court seizure order under section 4404 , and without notice and without applying to the court, the superintendent may issue a seizure order that must contain a statement verified by the superintendent of the grounds of the superintendent's action. As directed by the seizure order, the superintendent's representatives shall forthwith take possession and control of all or part of the property, books, accounts and records of the insurer, and of the premises occupied by the insurer for transaction of its business. The superintendent shall retain possession and control until the order is vacated or is replaced by an order of court pursuant to subsection 2 or pursuant to a formal proceeding under this chapter. [RR 2021, c. 1, Pt. B, §384 (COR).]

2. At any time after seizure under subsection 1 the insurer may apply to the Superior Court for Kennebec County or for the county in this State in which the insurer's principal office is located. The court shall thereupon order the superintendent to appear forthwith and shall thereafter proceed as if the order were a court seizure order issued under section 4404 . [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

3. Every law enforcement officer of this State shall assist the superintendent in making and enforcing any such seizure, and every sheriff's and police department shall furnish the superintendent with such deputies or other law enforcement officers as are necessary for the purpose. [PL 2021, c. 676, Pt. A, §40 (AMD).]

4. Entry of a seizure order under this section does not constitute an anticipatory breach of any contract of the insurer. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 6606 — ME Code / Title 24-A / Chapter 81 / Section 6606
24-A §6606. Deficiency in reserves, assets or reinsurance
Status: in_force

1. Examination of finances. The superintendent may conduct, upon reasonable notice, an examination to determine the financial condition of an arrangement. For arrangements subject to the requirements of section 6603‑A , the examination must be limited to the work of the certified public accountant conducting the annual audit or submitting the quarterly filings required by that section. For all other arrangements, examiners duly qualified by the superintendent may examine the loss reserves, assets, liabilities, excess insurance and working capital of a multiple-employer welfare arrangement. If the superintendent finds that the reserves, excess insurance or assets may be inadequate, or that the arrangement does not have working capital in an amount establishing the financial strength and liquidity of the arrangement to pay claims promptly and showing evidence of the financial ability of the arrangement to meet its obligations to covered employees, the superintendent shall notify the arrangement of the inadequacy. Upon notification, the arrangement shall file within 30 days with the superintendent its written plan specifying remedial action to be taken and the time for implementation of that plan. [PL 1995, c. 618, §10 (AMD).]

2. Correction of deficiency. If the superintendent determines, after reviewing the information filed, that a hazardous financial condition exists, the arrangement shall implement within 30 days its plan to correct any deficiencies and shall file with the superintendent proof of remedial action taken within 60 days. If the superintendent is satisfied that the plan submitted to improve the inadequate condition of the arrangement is sufficient, the superintendent shall notify the arrangement. The arrangement shall report monthly to the superintendent until any deficiencies and their causes have been corrected. [PL 1993, c. 688, §1 (NEW).]
24-A M.R.S. § 6451 — ME Code / Title 24-A / Chapter 79 / Section 6451
24-A §6451. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 1993, c. 634, Pt. A, §1 (NEW).]

1. Adjusted risk-based capital report. "Adjusted risk-based capital report" means a risk-based capital report that has been adjusted by the superintendent in accordance with section 6452, subsection 3 . [PL 1993, c. 634, Pt. A, §1 (NEW).]

2. Corrective order. "Corrective order" means an order issued by the superintendent specifying corrective actions that the superintendent has determined are required. [PL 1993, c. 634, Pt. A, §1 (NEW).]

3. Domestic insurer. "Domestic insurer" means any insurance company domiciled in this State. [PL 1997, c. 81, §1 (AMD).]

4. Foreign insurer. "Foreign insurer" means any insurance company that is authorized to do business in this State under section 404 but is not domiciled in this State. [PL 1997, c. 81, §1 (AMD).]

4-A. Life or health insurer. "Life or health insurer" means any insurance company described in section 409, subsection 3 and authorized to do business in this State under section 410 , or a licensed property and casualty insurer writing only accident and health insurance. [PL 1997, c. 81, §2 (NEW).]

5. NAIC. [PL 2021, c. 521, §28 (RP).]

6. Negative trend. "Negative trend" means: A. With respect to a life or health insurer, a negative trend over a period of time, as determined in accordance with the trend test calculation included in the risk-based capital instructions; and [PL 2013, c. 238, Pt. D, §1 (NEW).] B. With respect to a property and casualty insurer, a trend that meets the triggering criteria, as determined in accordance with the trend test calculation included in the risk-based capital instructions. [PL 2013, c. 238, Pt. D, §1 (NEW).] [PL 2013, c. 238, Pt. D, §1 (RPR).]

6-A. Property and casualty insurer. "Property and casualty insurer" means any insurance company authorized to do business in this State under section 410 except a life or health insurer or single line mortgage guaranty insurer, financial guaranty insurer or title insurer. [PL 1997, c. 81, §4 (NEW).]

7. Risk-based capital instructions. "Risk-based capital instructions" means the risk-based capital instructions adopted by the NAIC, as such risk-based capital instructions may be amended by the NAIC from time to time in accordance with the procedures adopted by the NAIC. [PL 1993, c. 634, Pt. A, §1 (NEW).]

8. Risk-based capital level. "Risk-based capital level" means an insurer's company action level risk-based capital, regulatory action level risk-based capital, authorized control level risk-based capital or mandatory control level risk-based capital where: A. "Company action level risk-based capital" means, with respect to any insurer, the product of 2.0 and its authorized control level risk-based capital; [PL 1993, c. 634, Pt. A, §1 (NEW).] B. "Regulatory action level risk-based capital" means the product of 1.5 and its authorized control level risk-based capital; [PL 1993, c. 634, Pt. A, §1 (NEW).] C. "Authorized control level risk-based capital" means the number determined under the risk-based capital formula in accordance with the risk-based capital instructions; and [PL 1993, c. 634, Pt. A, §1 (NEW).] D. "Mandatory control level risk-based capital" means the product of .70 and the authorized control level risk-based capital. [PL 1993, c. 634, Pt. A, §1 (NEW).] [PL 1993, c. 634, Pt. A, §1 (NEW).]

9. Risk-based capital plan. "Risk-based capital plan" means a comprehensive financial plan containing the elements specified in section 6453, subsection 2 . If the superintendent rejects the risk-based capital plan and it is revised by the insurer, with or without the superintendent's recommendation, the plan is called the revised risk-based capital plan. [PL 1993, c. 634, Pt. A, §1 (NEW).]

10. Risk-based capital report. "Risk-based capital report" means the report required in section 6452 . [PL 1993, c. 634, Pt. A, §1 (NEW).]

11. Total adjusted capital. "Total adjusted capital" means the sum of: A. An insurer's statutory capital and surplus; and [PL 1993, c. 634, Pt. A, §1 (NEW).] B. Such other items, if any, as the risk-based capital instructions provide. [PL 1993, c. 634, Pt. A, §1 (NEW).] [PL 1993, c. 634, Pt. A, §1 (NEW).]
24-A M.R.S. § 4350 — ME Code / Title 24-A / Chapter 56-C / Section 4350
24-A §4350. Prescription drug pricing; maximum allowable cost
Status: in_force

1. Single maximum allowable cost list. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use a single maximum allowable cost list to establish the maximum amount to be paid by a health plan to a pharmacy provider for a generic drug or a brand‑name drug that has at least one generic alternative available. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use the same maximum allowable cost list for each pharmacy provider. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

2. Listing of prescription drug. A maximum allowable cost may be set for a prescription drug, or a prescription drug may be allowed to continue on a maximum allowable cost list, only if that prescription drug: A. Is rated as "A" or "B" in the most recent version of the United States Food and Drug Administration's "Approved Drug Products with Therapeutic Equivalence Evaluations," also known as "the Orange Book," or an equivalent rating from a successor publication, or is rated as "NR" or "NA" or a similar rating by a nationally recognized pricing reference; and [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. Is not obsolete and is generally available for purchase in this State from a national or regional wholesale distributor by pharmacies having a contract with the pharmacy benefits manager. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

3. Changes to maximum allowable cost list. A carrier, or a pharmacy benefits manager under contract with a carrier, shall establish a process for removing a prescription drug from a maximum allowable cost list or modifying a maximum allowable cost for a prescription drug in a timely manner to remain consistent with changes to such costs and the availability of the drug in the national marketplace. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

4. Disclosure. With regard to a pharmacy with which the carrier, or the pharmacy benefits manager under contract with a carrier, has entered into a contract, a carrier, or a pharmacy benefits manager under contract with a carrier, shall: A. Upon request, disclose the sources used to establish the maximum allowable costs; [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. Provide a process for a pharmacy to readily obtain the maximum allowable payment available to that pharmacy under a maximum allowable cost list; and [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] C. At least once every 7 business days, review and update maximum allowable cost list information to reflect any modification of the maximum allowable payment available to a pharmacy under a maximum allowable cost list used by the carrier or the pharmacy benefits manager under contract with a carrier. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

5. Appeal procedure. A carrier, or a pharmacy benefits manager under contract with a carrier, shall provide a reasonable administrative appeal procedure, including a right to appeal that is limited to 14 days following the initial claim, to allow pharmacies with which the carrier or pharmacy benefits manager has a contract to challenge maximum allowable costs for a specified drug. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

6. Resolution of appeals. A carrier, or a pharmacy benefits manager under contract with a carrier, shall respond to, investigate and resolve an appeal under subsection 5 within 14 days after the receipt of the appeal. The carrier or pharmacy benefits manager shall respond to an appeal as follows: A. If the appeal is upheld, the carrier or pharmacy benefits manager shall make the appropriate adjustment in the maximum allowable cost and permit the challenging pharmacy or pharmacist to reverse and rebill the claim in question; or [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. If the appeal is denied, the carrier or pharmacy benefits manager shall provide the challenging pharmacy or pharmacist the national drug code from national or regional wholesalers of a comparable prescription drug that may be purchased at or below the maximum allowable cost. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

7. Average wholesale price; use of a prescription drug not on maximum allowable cost list. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use the average wholesale price to establish the maximum payment for a brand‑name drug for which a generic equivalent is not available or a prescription drug not included on a maximum allowable cost list. In order to use the average wholesale price of a brand‑name drug or prescription drug not included on a maximum allowable cost list, a carrier, or a pharmacy benefits manager under contract with a carrier, must use only one national drug pricing source during a calendar year, except that a carrier, or a pharmacy benefits manager under contract with a carrier, may use a different national drug pricing source if the original pricing source is no longer available. A carrier, or a pharmacy benefits manager under contract with a carrier, shall use the same national drug pricing source for each pharmacy provider and identify on its publicly accessible website the name of the national drug pricing source used to determine the average wholesale price of a prescription drug not included on the maximum allowable cost list. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

8. Payment. This subsection governs payments between a carrier or a carrier's pharmacy benefits manager and a pharmacy provider. A. The amount paid by a carrier or a carrier's pharmacy benefits manager to a pharmacy provider under contract with the carrier or the carrier's pharmacy benefits manager for dispensing a prescription drug must be the ingredient cost plus the dispensing fee less any cost‑sharing amount paid by a covered person. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. The ingredient cost may not exceed the maximum allowable cost or average wholesale price, as applicable, and must be disclosed by the carrier's pharmacy benefits manager to the carrier. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] C. Only the pharmacy provider that dispensed the prescription drug may retain the payment described in this subsection. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] D. A pharmacy provider may not be denied payment or be subject to a reduced payment retroactively unless the original claim was submitted fraudulently or in error. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
24-A M.R.S. § 8 — ME Code / Title 24-A / Chapter 1 / Section 8
24-A §8. "Authorized," "unauthorized" insurer defined
Status: in_force

1. Authorized insurer. An "authorized" insurer is one duly authorized to transact insurance in this State by a subsisting certificate of authority issued by the superintendent. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. Unauthorized insurer. An "unauthorized" insurer is one not so authorized. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3963 — ME Code / Title 24-A / Chapter 54-A / Section 3963
24-A §3963. State-federal health coverage partnerships involving the association
Status: in_force

1. Consultation with board. The superintendent shall consult with the board before developing any proposal to apply for a state-federal health coverage partnership as defined in section 2781, subsection 1 or to modify the terms of an existing state-federal health coverage partnership involving federal funding for the association or otherwise significantly affecting the operations of the association. The superintendent shall give prompt notice to the board if the superintendent becomes aware of a new federal program or material changes to an existing program with the potential for a significant effect on the operations of the association. [PL 2019, c. 653, Pt. B, §23 (NEW).]
24-A M.R.S. § 7403-A — ME Code / Title 24-A / Chapter 95 / Section 7403-A
24-A §7403-A. Insurance requirements for peer-to-peer car sharing
Status: in_force

1. Insurance coverage during car sharing period; liability. The following requirements apply to insurance coverage and liability during a car sharing period. A. A peer-to-peer car sharing program shall assume the liability, except as provided in paragraph B , of a shared vehicle owner for bodily injury or property damage to 3rd parties or uninsured and underinsured motorists or personal injury protection losses during the car sharing period in an amount stated in the car sharing program agreement as long as the amount is not less than minimum requirements in Title 29‑A, section 1605 . [PL 2021, c. 352, §8 (NEW).] B. Notwithstanding the definition of "car sharing termination time" as set forth in section 7402, subsection 5 , the assumption of liability under paragraph A does not apply when: (1) A shared vehicle owner makes an intentional or fraudulent material misrepresentation or omission to the peer-to-peer car sharing program before the car sharing period in which the loss occurred; or (2) A shared vehicle owner is acting in concert with a shared vehicle driver who fails to return the shared vehicle pursuant to the terms of car sharing program agreement. [PL 2021, c. 352, §8 (NEW).] C. Notwithstanding the definition of "car sharing termination time" as set forth in section 7402, subsection 5 , the assumption of liability under paragraph A applies to bodily injury or property damage to 3rd parties or uninsured and underinsured motorist or personal injury protection losses as required by Title 29‑A, section 1605 . [PL 2021, c. 352, §8 (NEW).] D. A peer-to-peer car sharing program shall ensure that, during each car sharing period, the shared vehicle owner and the shared vehicle driver are insured under a motor vehicle liability insurance policy that provides insurance coverage in amounts not less than the minimum amounts set forth in Title 29‑A, section 1605 and: (1) Recognizes that the shared vehicle insured under the policy is made available and used through a peer-to-peer car sharing program; or (2) Does not exclude use of a shared vehicle by a shared vehicle driver. [PL 2021, c. 352, §8 (NEW).] E. The requirement for insurance coverage described under paragraph D may be satisfied by providing evidence of a motor vehicle liability insurance maintained by: (1) A shared vehicle owner; (2) A shared vehicle driver; (3) A peer-to-peer car sharing program; or (4) A shared vehicle owner, a shared vehicle driver and a peer-to-peer car sharing program collectively. [PL 2021, c. 352, §8 (NEW).] F. Insurance coverage that meets the requirements of paragraph D and obtained in accordance with paragraph E must be primary coverage during each car sharing period and, in the event that a claim occurs in another state with minimum financial responsibility limits higher than in Title 29‑A, section 1605 , during the car sharing period the coverage maintained under paragraph E must satisfy the difference in minimum coverage amounts up to the applicable policy limits. [PL 2021, c. 352, §8 (NEW).] G. The insurer, insurers or peer-to-peer car sharing program providing coverage in accordance with paragraph D or E shall assume primary liability for a claim when: (1) A dispute exists as to who was in control of the shared motor vehicle at the time of the loss and the peer-to-peer car sharing program does not have available, did not retain or fails to provide the information required by section 7404‑A, subsection 4 ; or (2) A dispute exists as to whether the shared vehicle was returned to the alternatively agreed upon location as required under section 7402, subsection 5, paragraph B . [PL 2021, c. 352, §8 (NEW).] H. If insurance maintained by a shared vehicle owner or shared vehicle driver in accordance with paragraph E has lapsed or does not provide the required coverage, insurance maintained by a peer-to-peer car sharing program must provide the coverage required by paragraph D beginning with the first dollar of a claim, and the peer-to-peer car sharing program has the duty to defend that claim except under circumstances set forth in paragraph B . [PL 2021, c. 352, §8 (NEW).] I. Coverage under a motor vehicle liability insurance policy maintained by the peer-to-peer car sharing program may not be dependent on another insurer's first denying a claim or a requirement in another insurance policy to first deny a claim. [PL 2021, c. 352, §8 (NEW).] [PL 2021, c. 352, §8 (NEW).]

2. Exclusions in motor vehicle liability insurance policies. An insurer that writes motor vehicle liability insurance in the State may exclude any and all coverage and the duty to defend or indemnify for any claim afforded under a shared vehicle owner's motor vehicle liability insurance policy, including but not limited to: A. Liability coverage for bodily injury and property damage; [PL 2021, c. 352, §8 (NEW).] B. Personal injury protection coverage; [PL 2021, c. 352, §8 (NEW).] C. Uninsured and underinsured motorist coverage; [PL 2021, c. 352, §8 (NEW).] D. Medical payments coverage; [PL 2021, c. 352, §8 (NEW).] E. Comprehensive physical damage coverage; and [PL 2021, c. 352, §8 (NEW).] F. Collision physical damage coverage. [PL 2021, c. 352, §8 (NEW).] This subsection does not invalidate or limit an exclusion contained in a motor vehicle liability insurance policy, including any insurance policy in use or approved for use that excludes coverage for motor vehicles made available for rent, sharing or hire or for any business use. This subsection does not invalidate, limit or restrict an insurer's ability under existing law to underwrite any insurance policy or to cancel or not renew any insurance policy. [PL 2021, c. 352, §8 (NEW).]

3. Exemption; vicarious liability. A peer-to-peer car sharing program and a shared vehicle owner are exempt from vicarious liability consistent with 49 United States Code, Section 30106 and under any state or local law that imposes liability solely based on vehicle ownership. [PL 2021, c. 352, §8 (NEW).]

4. Contribution against indemnification. An insurer that defends or indemnifies a claim against a shared vehicle that is excluded under the terms of its policy has the right to seek recovery against the insurer of the peer-to-peer car sharing program if the claim is: A. Made against the shared vehicle owner or the shared vehicle driver for loss or injury that occurs during the car sharing period; and [PL 2021, c. 352, §8 (NEW).] B. Excluded under the terms of its policy. [PL 2021, c. 352, §8 (NEW).] [PL 2021, c. 352, §8 (NEW).]

5. Insurable interest. Notwithstanding any other law, statute, rule or regulation to the contrary, a peer-to-peer car sharing program has an insurable interest in a shared vehicle during the car sharing period. This section does not impose liability on a peer-to-peer car sharing program to maintain the coverage mandated by subsection 1 . A peer–to–peer car sharing program may own and maintain as the named insured one or more policies of motor vehicle liability insurance that provides coverage for: A. Liabilities assumed by the peer–to–peer car sharing program under a peer–to–peer car sharing program agreement; [PL 2021, c. 352, §8 (NEW).] B. Any liability of the shared vehicle owner; [PL 2021, c. 352, §8 (NEW).] C. Damage or loss to the shared motor vehicle; or [PL 2021, c. 352, §8 (NEW).] D. Any liability of the shared vehicle driver. [PL 2021, c. 352, §8 (NEW).] [PL 2021, c. 352, §8 (NEW).]

6. Construction. This section does not limit the liability of the peer-to-peer car sharing program for any act or omission of the peer-to-peer car sharing program itself that results in injury to any person as a result of the use of a shared vehicle through a peer-to-peer car sharing program or limit the ability of a peer-to-peer car sharing program to, by contract, seek indemnification from the shared vehicle owner or the shared vehicle driver for economic loss sustained by the peer-to-peer car sharing program resulting from a breach of the terms and conditions of the car sharing program agreement. [PL 2021, c. 352, §8 (NEW).]
24-A M.R.S. § 2385-A — ME Code / Title 24-A / Chapter 25 / Section 2385-A
24-A §2385-A. Medical expense deductibles
Status: in_force

Each insurer transacting or offering to transact workers' compensation insurance in the State shall offer deductibles for medical expenses as follows. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

1. Optional deductible of $250. To employers who are not experience-rated, insurers shall offer a deductible of $250 per occurrence. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

2. Optional deductible of $250 or $500. To employers who are experience-rated, insurers shall offer a deductible of $250 or $500 per occurrence. [PL 1995, c. 551, §1 (AMD).]

3. Mandatory deductible of $500. [PL 1995, c. 551, §2 (RP).]
24-A M.R.S. § 2703 — ME Code / Title 24-A / Chapter 33 / Section 2703
24-A §2703. Scope, format of policy
Status: in_force

No policy of health insurance shall be delivered or issued for delivery to any person in this State unless it otherwise complies with this Title, and complies with the following: [PL 1969, c. 132, §1 (NEW).]

1. The entire money and other considerations therefore shall be expressed therein; [PL 1969, c. 132, §1 (NEW).]

2. The time when the insurance takes effect and terminates shall be expressed therein; [PL 1969, c. 132, §1 (NEW).]

3. It shall purport to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children or any children under a specified age which shall not exceed 23 years and any other person dependent upon the policyholder; [PL 1969, c. 132, §1 (NEW).]

4. The style, arrangement and overall appearance of the policy shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower case unspaced alphabet length not less than one hundred and twenty-point; the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions; [PL 1969, c. 132, §1 (NEW).]

5. The exceptions and reductions of indemnity shall be set forth in the policy and, other than those contained in sections 2705 to 2729 , shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions", or "Exceptions and Reductions", except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies; [PL 1969, c. 132, §1 (NEW).]

6. Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and [PL 1969, c. 132, §1 (NEW).]

7. The policy shall contain no provision purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the superintendent. [PL 1969, c. 132, §1 (AMD); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 4369 — ME Code / Title 24-A / Chapter 57 / Section 4369
24-A §4369. Attachment and garnishment of assets
Status: in_force

During the pendency of delinquency proceedings in this or any reciprocal state, no action or proceeding in the nature of an attachment, garnishment or execution shall be commenced or maintained in the courts of this State against the delinquent insurer or its assets. Any lien obtained by any such action or proceeding within four months prior to the commencement of any such delinquency proceeding or at any time thereafter shall be void as against any rights arising in such delinquency proceeding. [PL 1969, c. 132, §1 (NEW).]
24 M.R.S. § 2344 — ME Code / Title 24 / Chapter 19 / Section 2344
24 §2344. Utilization review services
Status: in_force

As used in this subchapter, unless the context indicates otherwise, "utilization review services" or "medical utilization review services" means a program or process by which a person, partnership or corporation, on behalf of an insurer, nonprofit service organization, 3rd-party administrator, or health maintenance organization, preferred provider organization or employer that is a payor for or that arranges for payment of medical services, seeks to review the utilization, appropriateness or quality of medical services provided to a person whose medical services are paid for, partially or entirely, by that insurer, nonprofit service organization, 3rd-party administrator, health maintenance organization, preferred provider organization or employer. The terms include these programs or processes whether they apply prospectively or retrospectively to medical services. Utilization review services include, but are not limited to, the following: [PL 1993, c. 602, §3 (AMD).]

1. Second opinion programs. Second opinion programs; [PL 1989, c. 556, Pt. C, §1 (NEW).]

2. Prehospital admission certification. Prehospital admission certification; [PL 1989, c. 556, Pt. C, §1 (NEW).]

3. Preinpatient service eligibility certification. Preinpatient service eligibility certification; and [PL 1989, c. 556, Pt. C, §1 (NEW).]

4. Concurrent hospital review. Concurrent hospital review to determine appropriate length of stay. [PL 1989, c. 556, Pt. C, §1 (NEW).]
24-A M.R.S. § 3354 — ME Code / Title 24-A / Chapter 47 / Section 3354
24-A §3354. Qualifying applications for insurance; solicitation
Status: in_force

1. Upon receipt of the superintendent's approval of the bond or deposit as provided in section 3353 , the directors and officers of the proposed domestic mutual insurer may commence solicitation of such requisite applications for insurance policies as they may accept, and may receive deposits of premiums thereon. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. All such applications shall be in writing signed by the applicant, covering subjects of insurance resident, located or to be performed in this State. [PL 1969, c. 132, §1 (NEW).]

3. All applications must provide that: A. Issuance of the policy is contingent upon the insurer qualifying for and receiving a certificate of authority; [PL 1969, c. 132, §1 (NEW).] B. Insurance is not in effect until the certificate of authority has been issued; and [PL 2013, c. 299, §7 (AMD).] C. The prepaid premium or deposit, and membership or policy fee, if any, must be refunded in full to the applicant if organization is not completed and the certificate of authority is not issued and received by the insurer before a specified reasonable date, which date may not be later than one year after the date of the articles of incorporation. [PL 2013, c. 299, §7 (AMD).] [PL 2013, c. 299, §7 (AMD).]

4. All qualifying premiums collected shall be in cash. [PL 1969, c. 132, §1 (NEW).]

5. Solicitation for such qualifying applications for insurance must be by licensed producers of the corporation, and the superintendent shall, upon the corporation's application therefor, issue temporary producer's licenses expiring on the date specified pursuant to subsection 3, paragraph C to individuals qualified as for a resident producer's license except as to the taking or passing of an examination. The superintendent may suspend or revoke any such license for any of the causes and pursuant to the same procedures as are applicable to suspension or revocation of licenses of producers in general under chapter 16 . [PL 1997, c. 457, §44 (AMD); PL 1997, c. 457, §55 (AFF).]
24-A M.R.S. § 2848 — ME Code / Title 24-A / Chapter 36 / Section 2848
24-A §2848. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 1993, c. 349, §52 (RPR).]

1. Evidence of individual insurability. "Evidence of individual insurability" means medical information or other information that indicates health status, such as whether the individual is actively at work, used to determine whether coverage of an individual within the group is to be limited or excluded. [PL 1993, c. 349, §52 (RPR).]

1-A. COBRA continuation provision. "COBRA continuation provision" means any of the following: A. Section 4980B of the Internal Revenue Code of 1986, other than Subsection (f)(1) as it relates to pediatric vaccines; [PL 1997, c. 445, §20 (NEW); PL 1997, c. 445, §32 (AFF).] B. Part 6 of Subtitle B of Title I of the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Section 1161, other than Section 609; or [PL 1997, c. 445, §20 (NEW); PL 1997, c. 445, §32 (AFF).] C. Title XXII of the federal Public Health Service Act, 42 United States Code, Section 201. [PL 1997, c. 445, §20 (NEW); PL 1997, c. 445, §32 (AFF).] [PL 1997, c. 445, §20 (NEW); PL 1997, c. 445, §32 (AFF).]

1-B. Federally creditable coverage. "Federally creditable coverage" is defined as follows. A. "Federally creditable coverage" means health benefits or coverage provided under any of the following: (1) An employee welfare benefit plan as defined in Section 3(1) of the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Section 1001, or a plan that would be an employee welfare benefit plan but for the "governmental plan" or "nonelecting church plan" exceptions, if the plan provides medical care as defined in subsection 2‑A , and includes items and services paid for as medical care directly or through insurance, reimbursement or otherwise; (2) Benefits consisting of medical care provided directly, through insurance or reimbursement and including items and services paid for as medical care under a policy, contract or certificate offered by a carrier; (3) Part A or Part B of Title XVIII of the Social Security Act, Medicare; (4) Title XIX of the Social Security Act, Medicaid, other than coverage consisting solely of benefits under Section 1928 of the Social Security Act; (4-A) A state children's health insurance program under Title XXI of the Social Security Act; (5) The Civilian Health and Medical Program for the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55; (6) A medical care program of the federal Indian Health Care Improvement Act, 25 United States Code, Section 1601 et seq. or of a tribal organization; (7) A state health benefits risk pool; (8) A health plan offered under the federal Employees Health Benefits Amendments Act, 5 United States Code, Chapter 89; (9) A public health plan as defined in federal regulations authorized by the federal Public Health Service Act, Section 2701(c)(1)(I), as amended by Public Law 104-191; or (10) A health benefit plan under Section 5(e) of the Peace Corps Act, 22 United States Code, Section 2504(e). [PL 2013, c. 588, Pt. A, §27 (AMD).] B. "Federally creditable coverage" does not include coverage consisting solely of one or more of the following: (1) Coverage for accident or disability income insurance or any combination of those coverages; (2) Liability insurance, including general liability insurance and automobile liability insurance; (3) Coverage issued as a supplement to liability insurance; (4) Workers' compensation or similar insurance; (5) Automobile medical payment insurance; (6) Credit insurance; (7) Coverage for on-site medical clinics; or (8) Other similar insurance coverage, specified in federal regulations issued pursuant to Public Law 104-191, under which benefits for medical care are secondary or incidental to other insurance benefits. [PL 1999, c. 256, Pt. L, §2 (AMD).] C. "Federally creditable coverage" does not include the following benefits if those benefits are provided under a separate policy, certificate or contract of insurance or are otherwise not an integral part of the plan: (1) Limited scope dental or vision benefits; (2) Benefits for long-term care, nursing home care, home health care, community-based care or any combination of those benefits; and (3) Other similar, limited benefits as specified in federal regulations issued pursuant to Public Law 104-191. [PL 1999, c. 256, Pt. L, §2 (AMD).] D. "Federally creditable coverage" does not include the following benefits if the benefits are provided under a separate policy, certificate or contract of insurance, and if no coordination exists between the provision of the benefits and any exclusion of benefits under a group health plan maintained by the same plan sponsor and those benefits are paid for an event without regard to whether benefits are provided for that event under a group health plan maintained by the same plan sponsor: (1) Coverage only for a specified disease or illness; and (2) Hospital indemnity or other fixed indemnity insurance. [PL 1999, c. 256, Pt. L, §2 (AMD).] E. "Federally creditable coverage" does not include the following if it is offered as a separate policy, certificate or contract of insurance: (1) Medicare supplemental health insurance under the Social Security Act, Section 1882(g)(1); (2) Coverage supplemental to the coverage provided under the Civilian Health and Medical Program of the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55; and (3) Similar supplemental coverage under a group health plan. [PL 1999, c. 256, Pt. L, §2 (AMD).] For purposes of this subsection, a "period of continuing federally creditable coverage" means a period in which an individual has maintained federally creditable coverage through one or more plans or programs, with no break in coverage exceeding 63 days. In calculating the aggregate length of a period of continuing federally creditable coverage that includes one or more breaks in coverage, only the time actually covered is counted. A waiting period is not counted as a break in coverage, but is not counted as a period of actual coverage unless the individual has other federally creditable coverage during this period. For purposes of this subsection and subsection 1‑C , "group health plan" has the same meaning as specified in the federal Public Health Service Act, Title XXVII, Section 2791(a). [PL 2013, c. 588, Pt. A, §27 (AMD).]

1-C. Federally eligible individual. "Federally eligible individual" means an individual: A. Who has had a period of continuing federally creditable coverage, as defined in subsection 1‑B , ending not more than 63 days before applying for an individual health plan, with an aggregate length of federally creditable coverage, as defined in subsection 1‑B , of at least 18 months; [PL 1999, c. 256, Pt. L, §3 (AMD).] B. Whose most recent prior federally creditable coverage was under a group health plan, governmental plan, church plan or health insurance coverage offered in connection with any such plan; [PL 1999, c. 256, Pt. L, §3 (AMD).] C. Who is not eligible for coverage under a group health plan, Part A or Part B of Title XVIII of the Social Security Act, Medicare, or a state plan under Title XIX, Medicaid or any successor program and who does not have other health insurance coverage; [PL 1997, c. 445, §20 (NEW); PL 1997, c. 445, §32 (AFF).] D. Whose most recent federally creditable coverage was not terminated based on nonpayment of premiums, fraud or intentional misrepresentation of material fact; and [PL 1999, c. 256, Pt. L, §3 (AMD).] E. Who, if offered the option of continuation of coverage under a COBRA continuation provision, as defined by subsection 1‑A , or under a similar state program, elected continuation of coverage and has exhausted that coverage. For purposes of this paragraph, an individual is considered to have exhausted COBRA continuation coverage when the individual no longer resides, lives or works in a service area of a managed care plan and there is no other COBRA continuation coverage available to the individual. [PL 2001, c. 258, Pt. D, §2 (AMD).] [PL 2001, c. 258, Pt. D, §2 (AMD).]

1-D. Governmental plan. "Governmental plan" has the meaning given under Section 3(32) of the federal Employee Retirement Income Security Act of 1974 or any federal governmental employee plan. [PL 1997, c. 445, §20 (NEW); PL 1997, c. 445, §32 (AFF).]

2. Group. "Group" means any of the types of groups under sections 2804 to 2808 . [PL 1993, c. 349, §52 (RPR).]

2-A. Medical care. Medical care includes the amounts paid for: A. The diagnosis, care, mitigation, treatment or prevention of disease, or the amounts paid for the purpose of affecting a structure or function of the body; [PL 1997, c. 445, §21 (NEW); PL 1997, c. 445, §32 (AFF).] B. Transportation primarily for, and essential to, medical care under paragraph A ; and [PL 1997, c. 445, §21 (NEW); PL 1997, c. 445, §32 (AFF).] C. Insurance coverage for medical care under paragraphs A and B . [PL 1997, c. 445, §21 (NEW); PL 1997, c. 445, §32 (AFF).] [PL 1997, c. 445, §21 (NEW); PL 1997, c. 445, §32 (AFF).]

3. Preexisting condition exclusion. [PL 1997, c. 445, §22 (RP); PL 1997, c. 445, §32 (AFF).]

4. Subgroup. "Subgroup" means an employer covered under a contract issued to a multiple employer trust or to an association. [PL 1993, c. 349, §52 (RPR).]

5. Waiting period. "Waiting period" means a period of time after the date of enrollment during which a health insurance plan excludes coverage for the diagnosis or treatment of any or all medical conditions. [PL 1999, c. 256, Pt. L, §4 (AMD).]
24-A M.R.S. § 750 — ME Code / Title 24-A / Chapter 9 / Section 750
24-A §750. Duties of reinsurers utilizing the services of a reinsurance intermediary-manager
Status: in_force

1. License required. A reinsurer may not engage the services of any person to act as a reinsurance intermediary-manager on its behalf unless that person is licensed as required by this subchapter. [PL 1991, c. 828, §20 (NEW).]

2. Financial statements. The reinsurer shall annually obtain a copy of statements of the financial condition of each reinsurance intermediary-manager that the reinsurer has engaged prepared by an independent certified public accountant in a form acceptable to the superintendent. [PL 1991, c. 828, §20 (NEW).]

3. Actuarial review. If a reinsurance intermediary-manager establishes loss reserves, the reinsurer shall annually obtain the opinion of an actuary who specializes in the type of insurance under consideration attesting to the adequacy of loss reserves including losses incurred and outstanding on business produced by the reinsurance intermediary-manager. This opinion is in addition to any other required loss reserve certification. [PL 1991, c. 828, §20 (NEW).]

4. Binding authority. Binding authority for all retrocessional contracts or participation in reinsurance syndicates rests with an officer of the reinsurer who may not be affiliated with the reinsurance intermediary-manager. [PL 1991, c. 828, §20 (NEW).]

5. Notice of termination. Within 30 days of termination of a contract with a reinsurance intermediary-manager, the reinsurer shall provide written notification of termination to the superintendent. [PL 1991, c. 828, §20 (NEW).]

6. Board member qualifications. A reinsurer may not appoint to its board of directors, any officer, director, employee, controlling shareholder or subproducer of its reinsurance intermediary-manager. This subsection does not apply to relationships governed by section 222 or chapter 77 . [PL 1991, c. 828, §20 (NEW).]
24-A M.R.S. § 2934 — ME Code / Title 24-A / Chapter 40 / Section 2934
24-A §2934. Statistics
Status: in_force

An insurer selling insurance pursuant to mass marketing plans shall maintain separate statistics as to loss and expense experience pertinent thereto. [PL 1973, c. 625, §146 (NEW).]
24-A M.R.S. § 2554 — ME Code / Title 24-A / Chapter 29 / Section 2554
24-A §2554. Applicability to existing policies
Status: in_force

The provisions of sections 2552 and 2553 shall not impair any insurance contract issued before the effective date of this Act. [PL 1981, c. 188, §4 (NEW).]
24-A M.R.S. § 7054 — ME Code / Title 24-A / Chapter 90 / Section 7054
24-A §7054. Requirements
Status: in_force

A travel retailer is authorized to offer and disseminate travel insurance on behalf of and under the authority of a supervising travel insurance producer if the following requirements are met. [PL 2015, c. 133, §4 (NEW).]

1. Disclosure. The supervising travel insurance producer or travel retailer shall provide to purchasers of travel insurance brochures or other written materials that have been approved by the issuing insurer and include: A. A description of the material terms of the insurance coverage including: (1) The identity and contact information of the insurer, supervising travel insurance producer and designated responsible producer; (2) The amount of any applicable deductible and how it is to be paid; (3) The benefits of the coverage; and (4) Key terms and conditions of coverage; [PL 2015, c. 133, §4 (NEW).] B. An explanation that the purchase of travel insurance is not required in order to purchase any other product or service from the travel retailer; [PL 2015, c. 133, §4 (NEW).] C. An explanation that a travel retailer that is not licensed as an insurance producer is only permitted to provide general information about the insurance offered by the supervising travel insurance producer or insurer, including a description of the coverage and price, but is not qualified or authorized to answer technical questions about the terms and conditions of the insurance offered by the travel retailer or to evaluate the adequacy of the customer's existing insurance coverage; [PL 2015, c. 133, §4 (NEW).] D. A description of the process for filing a claim; and [PL 2015, c. 133, §4 (NEW).] E. A description of the review or cancellation process for the travel insurance policy. [PL 2015, c. 133, §4 (NEW).] [PL 2021, c. 354, §9 (AMD).]

2. Registry of travel retailers; grounds for suspension and revocation; penalties. The supervising travel insurance producer shall establish and update a register on a form prescribed by the superintendent of each travel retailer that offers travel insurance on the supervising travel insurance producer's behalf. The register must include the name, address and contact information of the travel retailer and an officer or person who directs or controls the travel retailer's operations and the travel retailer's federal employer identification number. The supervising travel insurance producer shall submit the register to the superintendent upon request. The supervising travel insurance producer shall certify that the registered travel retailer complies with 18 United States Code, Section 1033. The grounds for suspension and revocation and the penalties applicable to insurance producers under section 1420‑K are applicable to supervising travel insurance producers and travel retailers. [PL 2021, c. 354, §10 (AMD).]

3. Designated responsible producer. The supervising travel insurance producer shall designate one of its employees who is a licensed insurance producer under chapter 16, subchapter 2‑A as the designated responsible producer. [PL 2015, c. 133, §4 (NEW).]

4. License continuation or termination. Each supervising travel insurance producer license issued under this chapter is subject to section 1416‑A . [PL 2015, c. 133, §4 (NEW).]

5. Fees. The supervising travel insurance producer shall pay all applicable insurance producer licensing fees as set forth in section 601, subsection 31 . [PL 2015, c. 133, §4 (NEW).]

6. Training. The supervising travel insurance producer shall require each employee of the travel retailer whose duties include offering and disseminating travel insurance to receive a program of instruction or training, which may be subject to review and approval by the superintendent. The training material must, at a minimum, contain instructions on the types of insurance offered, ethical sales practices and required brochures or other written materials provided to prospective customers. [PL 2021, c. 354, §11 (AMD).]

7. Notice to the superintendent. Any business entity acting as a supervising travel insurance producer without being specifically licensed as such in accordance with section 7053, subsection 1 shall provide notice to the superintendent of the following: A. The fact that the business entity is acting as a supervising travel insurance producer; [PL 2021, c. 354, §12 (NEW).] B. The identity of any travel retailers that offer travel insurance on the business entity's behalf in accordance with subsection 2 ; and [PL 2021, c. 354, §12 (NEW).] C. The name and license number of the business entity's designated responsible producer. [PL 2021, c. 354, §12 (NEW).] The notice required by this subsection must be provided within 30 days of the commencement of the business entity's supervising travel insurance producer activities in the State on a form required by the superintendent. [PL 2021, c. 354, §12 (NEW).]
24-A M.R.S. § 2431 — ME Code / Title 24-A / Chapter 27 / Section 2431
24-A §2431. Exemption of proceeds, individual annuity contracts; assignability of rights
Status: in_force

1. The benefits, rights, privileges and options which under any individual annuity contract heretofore or hereafter issued are due or prospectively due the annuitant, shall not be subject to execution nor shall the annuitant be compelled to exercise any such rights, powers, or options, nor shall creditors be allowed to interfere with or terminate the contract, except: A. As to amounts paid for or as premium on any such annuity with intent to defraud creditors, with interest thereon, and of which the creditor has given the insurer written notice received at its home office prior to the making of the payment to the annuitant out of which the creditor seeks to recover. Any such notice shall specify the amount claimed or such facts as will enable the insurer to ascertain such amount, and shall set forth such facts as will enable the insurer to ascertain the annuity contract, the annuitant and the payment sought to be avoided on the ground of fraud. [PL 1969, c. 132, §1 (NEW).] B. The total exemption of benefits presently due and payable to any annuitant periodically or at stated times under all annuity contracts under which the annuitant is an annuitant, may not at any time exceed $450 per month for the length of time represented by such installments, and that such periodic payments in excess of $450 per month are subject to garnishee execution to the same extent as are wages and salaries. [RR 2021, c. 1, Pt. B, §221 (COR).] C. If the total benefits presently due and payable to any annuitant under all annuity contracts under which the annuitant is an annuitant, at any time exceed payment at the rate of $450 per month, then the court may order such annuitant to pay to a judgment creditor or apply on the judgment, in installments, such portion of such excess benefits as to the court may appear just and proper, after due regard for the reasonable requirements of the judgment debtor and the judgment debtor's family, if dependent upon the judgment debtor, as well as any payments required to be made by the annuitant to other creditors under prior court orders. [RR 2021, c. 1, Pt. B, §222 (COR).] [RR 2021, c. 1, Pt. B, §§221, 222 (COR).]

2. If the contract so provides, the benefits, rights, privileges or options accruing under such contract to a beneficiary or assignee shall not be transferable nor subject to commutation, and if the benefits are payable periodically or at stated times, the same exemptions and exceptions contained herein for the annuitant, shall apply with respect to such beneficiary or assignee. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 211 — ME Code / Title 24-A / Chapter 3 / Section 211
24-A §211. General powers, duties
Status: in_force

1. The superintendent shall enforce the provisions of, and execute the duties imposed upon the superintendent by, this Title. [RR 2021, c. 1, Pt. B, §155 (COR).]

2. The superintendent has the powers and authority expressly vested in the superintendent by or reasonably implied from this Title. [RR 2021, c. 1, Pt. B, §156 (COR).]

3. The superintendent shall have such additional rights, powers and duties as may be provided by other laws. [PL 1696, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 4143 — ME Code / Title 24-A / Chapter 55 / Section 4143
24-A §4143. Penalties
Status: in_force

1. False or fraudulent statement in application. A person who intentionally or knowingly makes a false or fraudulent statement in or relating to an application for membership or for the purpose of obtaining money from or a benefit in any society commits a Class E crime. [PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]

2. Perjury. A person who intentionally or knowingly makes a false or fraudulent statement in any verified report or declaration under oath required or authorized by this chapter or of any material fact contained in a sworn statement concerning the death or disability of a member for the purpose of procuring payment of a benefit named in the certificate commits the crime of perjury and is subject to the penalties prescribed by law. [PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]

3. Soliciting membership in society not licensed to do business. A person who solicits membership for or in any manner assists in procuring membership in a society not licensed to do business in this State commits a civil violation for which a fine of not less than $50 and not more than $200 may be adjudged. [PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]

4. General penalty. A person who intentionally or knowingly violates or neglects or refuses to comply with the provisions of this chapter for which a penalty is not otherwise prescribed is subject to the penalties under section 12‑A . [PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]
24-A M.R.S. § 7060 — ME Code / Title 24-A / Chapter 90 / Section 7060
24-A §7060. Rulemaking
Status: in_force

The superintendent may adopt rules to implement the provisions of this chapter. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2021, c. 354, §17 (NEW).]
24-A M.R.S. § 2847-O — ME Code / Title 24-A / Chapter 35 / Section 2847-O
24-A §2847-O. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 2847-M)
Status: in_force

(REALLOCATED FROM TITLE 24-A, SECTION 2847-M)

1. Hearing aid; definition. For purposes of this section, "hearing aid" means a nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, excluding batteries and cords and other assistive listening devices, including, but not limited to, frequency modulation systems. [PL 2007, c. 695, Pt. A, §29 (RAL).]

2. Required coverage. All group health insurance policies, contracts and certificates must provide coverage for the purchase of a hearing aid for each hearing-impaired ear for an individual covered under the policy, contract or certificate in accordance with the following requirements. A. The hearing loss must be documented by a physician or audiologist licensed pursuant to Title 32, chapter 137 . [PL 2015, c. 494, Pt. A, §29 (AMD).] B. The hearing aid must be purchased in accordance with federal and state laws, regulations and rules for the sale and dispensing of hearing aids. [PL 2019, c. 418, §3 (AMD); PL 2019, c. 418, §7 (AFF).] C. The policy, contract or certificate may limit coverage to $3,000 per hearing aid for each hearing-impaired ear every 36 months. [PL 2019, c. 418, §3 (AMD); PL 2019, c. 418, §7 (AFF).] [PL 2019, c. 418, §3 (AMD); PL 2019, c. 418, §7 (AFF).]

3. Application of coverage. [PL 2019, c. 418, §4 (RP); PL 2019, c. 418, §7 (AFF).]

4. Limits; coinsurance; deductibles. Except as otherwise provided in this section, any policy, contract or certificate that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section. [PL 2007, c. 695, Pt. A, §29 (RAL).]
24-A M.R.S. § 202 — ME Code / Title 24-A / Chapter 3 / Section 202
24-A §202. Seal
Status: in_force

The superintendent must have a seal of office of a suitable design, bearing the words "Insurance Superintendent of the State of Maine." The superintendent shall file an impression of the seal, duly certified by the superintendent under oath, with the Secretary of State. [RR 2021, c. 1, Pt. B, §149 (COR).]
24-A M.R.S. § 4350-C — ME Code / Title 24-A / Chapter 56-C / Section 4350-C
24-A §4350-C. Access to records; audits
Status: in_force

1. Requirements; record keeping. A carrier shall maintain and have the ability to access all data related to the administration and provision of prescription drug benefits under a health plan of a carrier, including, but not limited to: A. The names, addresses, member identification numbers, protected health information and other personal information of covered persons; and [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. All contracts, documentation and records, including transaction and pricing data, related to the dispensing of prescription drugs to covered persons under the health plan. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

2. Compliance with federal law. A sale or transaction involving the transfer of any records, information or data described in subsection 1 must comply with the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104‑191 and the federal Health Information Technology for Economic and Clinical Health Act, Public Law 111‑5 and any regulations adopted pursuant to those laws. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

3. Audit records. A carrier may audit all transaction records related to the dispensing of prescription drugs to covered persons under a health plan of the carrier. A carrier may conduct audits at a location of its choosing and with an auditor of its choosing. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

4. Maintenance of records. A carrier shall maintain all records, information and data described in subsection 1 and all audit records described in subsection 3 for a period of no less than 5 years. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

5. Authority of superintendent. Upon request, a carrier shall provide to the superintendent any records, contracts, documents or data held by the carrier or the carrier's pharmacy benefits manager for inspection, examination or audit purposes. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
24-A M.R.S. § 2902-B — ME Code / Title 24-A / Chapter 39 / Section 2902-B
24-A §2902-B. Motorcycle passenger exclusion
Status: in_force

No insurer may sell or renew, on or after January 1, 1986, a liability insurance policy covering a motorcycle, as defined in Title 29‑A, section 101, subsection 38 , that excludes coverage for injuries sustained by passengers on the insured's motorcycle unless the insurer notifies the bureau in writing of its utilization of the exclusion, the insurer notifies each of its licensed agents within the State of its utilization of the exclusion and the exclusion is provided by a separate endorsement to the insured's policy. An exclusion that does not meet the requirements of this section is invalid and of no effect. [PL 1995, c. 65, Pt. A, §69 (AMD); PL 1995, c. 65, Pt. A, §153 (AFF); PL 1995, c. 65, Pt. C, §15 (AFF).]
24-A M.R.S. § 2392 — ME Code / Title 24-A / Chapter 26 / Section 2392
24-A §2392. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 1995, c. 289, §11 (NEW).]

1. Association. "Association" means the Maine Insurance Guaranty Association. [PL 1995, c. 289, §11 (NEW).]

2. Board. "Board" means the governing board of the Maine Workers' Compensation Residual Market Pool. [PL 1995, c. 289, §11 (NEW).]

3. Chapter 250. "Chapter 250" means Bureau of Insurance Rules, Chapter 250, "Requirements for Eligibility to Self-Insurer Workers' Compensation Benefits," as amended and as in existence prior to the effective date of this chapter. [PL 1995, c. 289, §11 (NEW).]

4. Chapter 440. "Chapter 440" means Bureau of Insurance Rules, Chapter 440, "Plan of Operation for the Workers' Compensation Residual Market Mechanism," as amended, as in existence prior to the effective date of this chapter and as modified in this chapter. [PL 1995, c. 289, §11 (NEW).]

5. Delinquent insurer. "Delinquent insurer" means an insurer that has not timely paid in full that insurer's allocated share pursuant to section 2393, subsection 1, paragraph A, subparagraphs (1) or (2) or section 2393, subsection 1, paragraph B , subparagraphs (1) to (5), except as provided in section 2393, subsection 1, paragraph A , subparagraph (3), division (d) and section 2393, subsection 1, paragraph B, subparagraph (6), division (d). [PL 1995, c. 289, §11 (NEW).]

6. Employer. "Employer" means any employer in the State that, at any time relevant under this chapter, is required under the Workers' Compensation Act to secure workers' compensation benefits for its employees. [PL 1995, c. 289, §11 (NEW).]

7. Expense constant. "Expense constant" means a premium charge approved by the superintendent that applies to every policy, in addition to other premium charges, covering expenses such as those for issuing, recording and auditing that are common to all workers' compensation policies regardless of premium size. [PL 1995, c. 289, §11 (NEW).]

8. Fresh start period. "Fresh start period" means the period from January 1, 1988 to December 31, 1992. [PL 1995, c. 289, §11 (NEW).]

9. Initial surcharge period. "Initial surcharge period" means the period from July 1, 1995 to June 30, 2003. [PL 1995, c. 289, §11 (NEW).]

10. Insured employer. "Insured employer" means an employer in the State that, on or after July 1, 1995, secures or continues to secure workers' compensation benefits under the Workers' Compensation Act for its employees through the purchase of an insurance policy. [PL 1995, c. 289, §11 (NEW).]

11. Insurer. "Insurer" means every insurer or group of affiliated insurers authorized to provide workers' compensation insurance in the State at any time during the fresh start period. For purposes of this chapter, a group of affiliated companies under common ownership, management or control is treated as one entity. [PL 1995, c. 289, §11 (NEW).]

12. Large deductible policy. "Large deductible policy" means a workers' compensation policy written with a per occurrence deductible in excess of $5,000 or a medical deductible in excess of $500. [PL 1995, c. 289, §11 (NEW).]

13. Major insurer. "Major insurer" means any insurer that was designated by the superintendent as a servicing carrier in the workers' compensation residual market in the State as of October 1, 1986. [PL 1995, c. 289, §11 (NEW).]

14. Minor insurer. "Minor insurer" means any insurer other than a major insurer. [PL 1995, c. 289, §11 (NEW).]

15. Net direct written premium. "Net direct written premium" means the Maine direct gross premiums charged less all return premiums, except dividends and savings refunded under participating policies, returned to policyholders for all Workers' Compensation and Occupational Disease Insurance written in this State. Excess workers' compensation insurance is not considered "net direct written premium." [PL 1995, c. 289, §11 (NEW).]

16. Net present value. "Net present value" is the sum of future payments, discounted to a specified valuation date at the discount rate provided. [PL 1995, c. 289, §11 (NEW).]

17. Plan year. "Plan year" means, for an employer, the period beginning on the self-insured employer's plan approval or renewal date and ending the day before the next plan renewal or anniversary date. The plan renewal date for a member of a group self-insurer is the group's plan renewal date; the plan approval date for a new member joining an established group is the effective date of group membership. The plan year may be less than 12 months as a result of changes in plan accounting periods, midyear entry into a group self-insurance plan or termination of self-insurance authorization. [PL 1995, c. 289, §11 (NEW).]

18. Policy year. "Policy year" means the following: A. With respect to a particular calendar year, all policies issued or renewed in that calendar year and all subsequent events occurring in later years relating to those policies, including premium adjustments, audit results and claims experience under those policies; and [PL 1995, c. 289, §11 (NEW).] B. With respect to a particular employer, the 12-month period beginning upon the date of issuance or renewal of a policy and ending the day before the next renewal date and all subsequent events occurring in later years relating to those policies, including premium adjustments, audit results and claims experience under that policy. [PL 1995, c. 289, §11 (NEW).] [PL 1995, c. 289, §11 (NEW).]

19. Pool. "Pool" means the Maine Workers' Compensation Residual Market Pool described in and governed by chapter 440. [PL 1995, c. 289, §11 (NEW).]

20. Residual market. "Residual market" means the instrument to provide coverage to employers not able to obtain coverage in the voluntary market. [PL 1995, c. 289, §11 (NEW).]

21. Self-insured employer. "Self-insured employer" means an employer that, on or after July 1, 1995, secures or continues to secure workers' compensation through a self-insured program under the Workers' Compensation Act as approved by the superintendent pursuant to the provisions of Title 39‑A, section 403, subsection 3 . [PL 1995, c. 289, §11 (NEW).]

22. Self-insured group or groups. "Self-insured group or groups" means a self-insured group approved by the superintendent pursuant to chapter 250, section 3. [PL 1995, c. 289, §11 (NEW).]

22-A. Succession transaction. "Succession transaction" means an asset sale, merger, consolidation, reorganization or restructuring that creates a successor self-insured employer. [PL 1995, c. 619, §1 (NEW); PL 1995, c. 619, §8 (AFF).]

22-B. Successor self-insured employer. "Successor self-insured employer" means any self-insured employer that is a successor entity to another employer or employers doing business in this State. A successor self-insured employer includes any entity that purchases all or a portion of the assets of an employer or the surviving entity in any other merger, consolidation, reorganization or restructuring. [PL 1995, c. 619, §1 (NEW); PL 1995, c. 619, §8 (AFF).]

23. Superintendent. "Superintendent" means the Superintendent of Insurance. [PL 1995, c. 289, §11 (NEW).]

24. Surchargeable premium. "Surchargeable premium" means: A. For insured employers, the manual workers' compensation premium applicable to the insured employer, as adjusted by any applicable experience modification factor, premium discount, expense constant and any other debits or credits to a lawfully received premium. In calculating the surchargeable premium for retrospectively rated policies and large deductible policies, "surchargeable premium" means the discounted workers' compensation standard premium, which is the manual premium that would apply to the insured employer absent the retrospectively rated or large deductible nature of the policy, as adjusted by any applicable experience modification factor, premium discount and expense constant. For retrospectively rated and large deductible policies, the insurer shall calculate a discounted standard premium amount utilizing estimated payrolls at policy inception, subject to the final determination upon audit, applying the insurer's manual rates, the insured's experience modification factor, any premium discount, expense constant and other debits or credits to a lawfully received premium. When calculating the discounted standard premium for policies with large deductibles, the maximum credit for the deductible option may not be greater than the amount approved by the superintendent in the most recent advisory loss cost filing for a $5,000 indemnity deductible. [PL 1995, c. 289, §11 (NEW).] B. For self-insured employers, the manual workers' compensation premium adjusted by the experience modification factor applicable to the self-insured employer, and any applicable premium discount and expense constant. For purposes of this definition, "manual premium" means the workers' compensation premium that would have been applicable to the individual self-insured employer if calculated using the advisory loss costs in effect at the time the surcharge is due multiplied by 1.2, applying the rating rules, excluding any premium discount, and experience rating procedure approved by the superintendent for the designated workers' compensation advisory organization pursuant to section 2382‑B , to the exposure and experience of the individual self-insured employer. For a self-insured employer who is a member of a self-insurance group, "surchargeable premium" means the actual amount of workers' compensation premium that is paid to the self-insurance group including experience modification, premium discount and expense constant in accordance with the requirements of chapter 250, but excluding any surplus distributions credited against or applied to reduce premiums. [PL 1995, c. 289, §11 (NEW).] [PL 1995, c. 289, §11 (NEW).]

25. Timely pay; timely paid; timely payment. "Timely pay," "timely paid" or "timely payment" means payment by the party responsible for the payments on or before the due date specified in this chapter. [PL 1995, c. 289, §11 (NEW).]

26. Voluntary market. "Voluntary market" means the workers' compensation insurance market in which insurance companies voluntarily offer coverage to applicants who meet the insurers' underwriting standards or guidelines. [PL 1995, c. 289, §11 (NEW).]

27. Workers' Compensation Act. "Workers' Compensation Act" means and refers to the Maine Workers' Compensation Act of 1992, as amended. [PL 1995, c. 289, §11 (NEW).]

28. Worker's compensation residual market mechanism. "Worker's compensation residual market mechanism" or "residual market mechanism" means the workers' compensation residual market mechanism described in and governed by Chapter 440. [PL 1995, c. 289, §11 (NEW).]
24 M.R.S. § 2332-N — ME Code / Title 24 / Chapter 19 / Section 2332-N
24 §2332-N. Offer of coverage for breast reduction surgery and symptomatic varicose vein surgery
Status: in_force

All individual and group nonprofit hospital and medical services plan policies, contracts and certificates and all nonprofit health care plan 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 Title 24-A, section 4301-A, subsection 10-A . [PL 2005, c. 128, §1 (NEW); PL 2005, c. 128, §5 (AFF).]
24-A M.R.S. § 2605-A — ME Code / Title 24-A / Chapter 31 / Section 2605-A
24-A §2605-A. Labor union groups
Status: in_force

The lives of a group of individuals may be insured under a policy issued to a labor union, or similar employee organization, which is considered to be the policyholder, to insure members of that union or organization for the benefit of persons other than the union or organization or any of its officials, representatives or agents, subject to the following requirements. [PL 1981, c. 150, §7 (NEW).]

1. The members eligible for insurance under the policy are all of the members of the union or organization, or all of any class or classes thereof. [PL 1981, c. 150, §7 (NEW).]

2. The premium for the policy shall be paid either from funds of the union or organization, or from funds contributed by the insured members specifically for their insurance, or from both. Except as provided in subsection 3 , a policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance must insure all eligible members, except those who reject that coverage in writing. [PL 1981, c. 150, §7 (NEW).]

3. An insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer. [PL 1981, c. 150, §7 (NEW).]
24-A M.R.S. § 2844 — ME Code / Title 24-A / Chapter 35 / Section 2844
24-A §2844. Coordination of benefits
Status: in_force

1. Authorization. Provisions contained in group and blanket health insurance contracts relating to coordination of benefits payable under the contract and under other plans of insurance or of health care coverage under which a certificate holder or the certificate holder's dependents may be covered must conform to rules adopted by the superintendent. These rules may establish uniformity in the permissive use of coordination of benefits provisions in order to avoid claim delays and misunderstandings that otherwise result from the use of inconsistent or incompatible provisions among the several insurers and nonprofit hospital, medical service and health care plans. [PL 1995, c. 332, Pt. H, §1 (AMD).]

1-A. Coordination with Medicare. Coordination of benefits is governed by the following provisions. A. The contract may not coordinate benefits with Medicare Part A unless: (1) The insured is enrolled in Medicare Part A; (2) The insured was previously enrolled in Medicare Part A and voluntarily disenrolled; (3) The insured stated on an application or other document that the insured was enrolled in Medicare Part A; or (4) The insured is eligible for Medicare Part A without paying a premium and the certificate states that it will not pay benefits that would be payable under Medicare even if the insured fails to exercise the insured's right to premium-free Medicare Part A coverage. [PL 1997, c. 604, Pt. G, §2 (NEW).] B. The contract may not coordinate benefits with Medicare Part B unless: (1) The insured is enrolled in Medicare Part B; (2) The insured was previously enrolled in Medicare Part B and voluntarily disenrolled; (3) The insured stated on an application or other document that the insured was enrolled in Medicare Part B; or (4) The insured is eligible for Medicare Part A without paying a premium and the insurer provided prominent notification to the insured both when the certificate was issued and, if applicable, when the insured becomes eligible for Medicare due to age. The content of the notification must be approved by the bureau. The notification must state that the contract will not pay benefits that would be payable under Medicare even if the insured fails to enroll in Medicare Part B and state that the insured may contact the bureau, the Health Insurance Consumer Assistance Program established in section 4326 or another relevant organization or agency for assistance in understanding coordination of benefits with Medicare Part B under the insured's contract. [PL 2023, c. 104, §3 (AMD).] C. Coordination is not permitted with Medicare coverage for which the insured is eligible but not enrolled except as provided in paragraphs A and B . [PL 1997, c. 604, Pt. G, §2 (NEW).] [PL 2023, c. 104, §3 (AMD).]

2. Medicaid and Children's Health Insurance Program. Insurers may not consider the availability or eligibility for medical assistance under 42 United States Code, Section 13969, referred to as "Medicaid," or Title 22, section 3174‑T , referred to as the "Children's Health Insurance Program," when considering coverage eligibility or benefit calculations for insureds and covered family members. A. To the extent that payment for coverage expenses has been made under the Medicaid program or the Children's Health Insurance Program for health care items or services furnished to an individual, the State is considered to have acquired the rights of the insured or family member to payment by the insurer for those health care items or services. Upon presentation of proof that the Medicaid program or the Children's Health Insurance Program has paid for covered items or services, the insurer shall make payment to the Medicaid program or the Children's Health Insurance Program according to the coverage provided in the contract or certificate. [PL 2023, c. 597, §17 (AMD).] B. An insurer may not impose requirements on a state agency that has been assigned the rights of an individual eligible for Medicaid or Children's Health Insurance Program coverage and covered by a subscriber contract that are different from requirements applicable to an agent or assignee of any other covered individual. [PL 2023, c. 597, §17 (AMD).] [PL 2023, c. 597, §17 (AMD).]

3. Credit toward deductible. When an insured is covered under more than one expense-incurred health plan, payments made by the primary plan, payments made by the insured and payments made from a health savings account or similar fund for benefits covered under the secondary plan must be credited toward the deductible of the secondary plan. This subsection does not apply if the secondary plan is designed to supplement the primary plan. [PL 2005, c. 121, Pt. D, §3 (NEW).]
24-A M.R.S. § 2847 — ME Code / Title 24-A / Chapter 35 / Section 2847
24-A §2847. Utilization review data
Status: in_force

1. Report required. On or before April 1st of each year, any insurer or 3rd-party administrator which issues or administers a program or contract in this State providing coverage for hospital care that contains a provision whereby in nonemergency cases the insured is required to be prospectively evaluated through a prehospital admission certification, preinpatient service eligibility program or any similar preutilization review or screening eligibility program or any similar preutilization review or screening procedure prior to the delivery of contemplated hospitalization, inpatient or outpatient health care or medical services which are prescribed or ordered by a duly licensed physician shall file a report on the results of that evaluation for the preceding year with the superintendent which shall contain the following: A. The number and type of evaluations performed. For the purposes of this section, the term "type of evaluations" means the following preutilization review categories: presurgical inpatient days; setting of medical service, such as inpatient or outpatient services; and the number of days of service; [PL 1989, c. 556, Pt. C, §3 (NEW).] B. The result of the evaluation, such as whether the medical necessity of the level of service contemplated by the patient's physician was agreed to or whether benefits paid for the service were reduced by the insurer; [PL 1989, c. 556, Pt. C, §3 (NEW).] C. The number and result of any appeals by the patients or their physicians as a result of initial review decisions to reduce benefits for services as determined through prospective evaluations; and [PL 1989, c. 556, Pt. C, §3 (NEW).] D. Any complaints filed in a court of competent jurisdiction and served upon an insurer filing under this section stating a cause of action against that insurer on the basis of damages to patients alleged to have been approximately caused by a delay, reduction or denial of medical benefits by the insurer, as determined through prospective evaluations, and the determination of liability or other disposition of the complaint. [PL 1989, c. 556, Pt. C, §3 (NEW).] [PL 1989, c. 556, Pt. C, §3 (NEW).]

2. Residents. This section is applicable to evaluations, appeals and complaints relating to residents of this State only. [PL 1989, c. 556, Pt. C, §3 (NEW).]

3. Confidentiality. Any information provided pursuant to this section shall not identify the patients. [PL 1989, c. 556, Pt. C, §3 (NEW).]
24-A M.R.S. § 3713 — ME Code / Title 24-A / Chapter 52 / Section 3713
24-A §3713. Authority to contract with licensed producers
Status: in_force

The company may contract with licensed producers to submit applications and otherwise assist applicants and insureds. [PL 1997, c. 661, §12 (AMD).]
24-A M.R.S. § 2834-A — ME Code / Title 24-A / Chapter 35 / Section 2834-A
24-A §2834-A. Maternity and routine newborn care
Status: in_force

An insurer that issues group contracts and certificates providing maternity benefits, including benefits for childbirth, shall provide coverage for services related to maternity and routine newborn care, including coverage for hospital stay, in accordance with the attending physician's or attending certified nurse midwife's determination in conjunction with the mother that the mother and newborn meet the criteria outlined in the "Guidelines for Perinatal Care," published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. For the purposes of this section, "routine newborn care" does not include any services provided after the mother has been discharged from the hospital. For the purposes of this section, "attending physician" includes the obstetrician, pediatrician or other physician attending the mother and newborn. Benefits for routine newborn care required by this section are part of the mother's benefit. The mother and the newborn are treated as one person in calculating the deductible, coinsurance and copayments for coverage required by this section. [PL 2003, c. 517, Pt. B, §12 (AMD).]
24-A M.R.S. § 4355 — ME Code / Title 24-A / Chapter 57 / Section 4355
24-A §4355. Jurisdiction over related persons and transactions
Status: in_force

1. A court of this State, in which an order of rehabilitation or liquidation has been entered in delinquency proceedings against a domestic insurer or alien insurer domiciled in this State, has jurisdiction also over persons, served as provided in subsection 2 , in an action brought by the insurer's receiver on or arising out of such obligation or relationship, as follows: A. Persons obligated to the insurer as a result of agency or brokerage or transactions between such persons and the insurer; [PL 1969, c. 132, §1 (NEW).] B. Reinsurers of the insurer, and their representatives; [PL 1991, c. 828, §27 (AMD).] C. Past or present officers, managers, trustees, directors, organizers and promoters of the insurer, and other persons in positions of similar responsibility with the insurer; [PL 1991, c. 828, §27 (AMD).] D. Persons served who are or were at the time of the institution of the delinquency proceeding against the insurer holding assets in which the receiver claims an interest on behalf of the insurer, in any action concerning the assets; and [PL 1991, c. 828, §28 (NEW).] E. Persons served who are obligated to the insurer in any way whatsoever, in any action on or incident to the obligation. [PL 1991, c. 828, §28 (NEW).] [PL 1991, c. 828, §§27, 28 (AMD).]

2. As to those of such persons who are in this State, personal service of process shall be made as in other civil actions. As to those of such persons who cannot be found in this State at the time process is to be served, personal service of process shall be made thereon by a public officer of the jurisdiction in which such person may be found, in the same manner as personal service of process is required to be made within this State under the laws of this State; and the affidavit or certificate under oath setting forth the facts of such service shall be filed in the court in this State in which the action is pending. [PL 1969, c. 132, §1 (NEW).]
24 M.R.S. § 2324 — ME Code / Title 24 / Chapter 19 / Section 2324
24 §2324. Certified ambulatory health care center outpatient coverage
Status: in_force

1. Contract coverage. Every nonprofit hospital and medical service organization which issues group and individual health care contracts providing coverage for inpatients and outpatient hospital care to residents of the State shall make available coverage for outpatient health care to subscribers with health care facilities certified by the Department of Health and Human Services for purposes of reimbursement under the United States Rural Health Clinic Services Act, Public Law 95-210, or its successor, and with incorporated nonprofit health centers engaged in the delivery of comprehensive primary care provided the health care facility or nonprofit health center providing the care has contracted with the organization on terms and conditions which the organization deems satisfactory to its membership. [PL 1979, c. 376 (NEW); PL 2003, c. 689, Pt. B, §6 (REV).]

2. Services required. Services provided under such contract to certified rural health clinics shall include, but need not be limited to, services presently provided for under group and individual health care contracts to hospitals or groups of hospitals presently licensed under Title 22, chapter 405 , or its successor. In no way shall services provided under such contracts to these health clinics be construed to require a nonprofit hospital or medical services organization to provide contract coverage for a service in a particular rural health clinic which does not meet state qualifications or criteria. [PL 1979, c. 376 (NEW).]
24-A M.R.S. § 2856 — ME Code / Title 24-A / Chapter 37 / Section 2856
24-A §2856. Term of insurance
Status: in_force

1. The term of credit life insurance or credit health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor; except that where a group policy provides coverage with respect to existing obligations, the insurance on a debtor with respect to such indebtedness shall commence on the effective date of the policy. [PL 1969, c. 132, §1 (NEW).]

2. Where evidence of insurability is required and such evidence is furnished more than 30 days after the date when the debtor becomes obligated to the creditor, the term of the insurance may commence on the date on which the insurer determines the evidence to be satisfactory, and in such event there shall be an appropriate refund or adjustment of any charge to the debtor for insurance. [PL 1969, c. 132, §1 (NEW).]

3. The term of such insurance shall not extend more than 15 days beyond the original or revised scheduled maturity date of the indebtedness, except when extended without additional cost to the debtor. [PL 1969, c. 132, §1 (NEW).]

4. If the indebtedness is discharged due to renewal or refinancing prior to the scheduled maturity date, the insurance in force shall be terminated before any new insurance may be issued in connection with the renewed or refinanced indebtedness. In all cases of termination prior to scheduled maturity, a refund shall be paid or credited as provided in section 2859 . [PL 1969, c. 132, §1 (NEW).]

5. For credit involuntary unemployment insurance, benefits must start after a waiting period of not longer than 30 days but need not be retroactive to the first day of unemployment and must have a maximum benefit period of at least 6 months. [PL 2001, c. 138, §9 (NEW).]
24-A M.R.S. § 2757 — ME Code / Title 24-A / Chapter 33 / Section 2757
24-A §2757. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2756)
Status: in_force

(REALLOCATED FROM TITLE 24-A, SECTION 2756)

1. Required coverage for services upon referral of primary care provider. An insurer that issues individual health insurance policies and contracts shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife to a patient who is referred to the certified nurse practitioner, certified midwife or certified nurse midwife by a primary care provider when those services are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife. [PL 2021, c. 79, §2 (AMD); PL 2021, c. 79, §6 (AFF).]

2. Required coverage for self-referred services. With respect to individual health insurance policies and contracts that do not require the selection of a primary care provider, an insurer shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife when those services are covered services and when they are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife. [PL 2021, c. 79, §2 (AMD); PL 2021, c. 79, §6 (AFF).]

3. Limits; coinsurance; deductibles. Any contract that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section. [RR 1999, c. 1, §32 (RAL).]
24-A M.R.S. § 709-A — ME Code / Title 24-A / Chapter 9 / Section 709-A
24-A §709-A. Financial guaranty insurance defined
Status: in_force

The term "financial guaranty insurance" includes any insurance under which loss is payable upon proof of occurrence of any of the following events to the damage of an insured claimant or obligee: [PL 1987, c. 707, §2 (NEW).]

1. Failure of any obligor or obligors on any debt instrument or other monetary obligation, including common or preferred stock, to pay when due the principal, interest, dividend or purchase price of the instrument or obligation, whether the failure is the result of a financial default or insolvency and whether or not the obligation is incurred directly or as guarantor by, or on behalf of, another obligor which has also defaulted; [PL 1987, c. 707, §2 (NEW).]

2. Changes in the level of interest rates,whether short term or long term, or in the difference between interest rates existing in various markets; [PL 1987, c. 707, §2 (NEW).]

3. Changes in the rate of exchange of currency, or from the inconvertibility of one currency into another for any reason; or [PL 1987, c. 707, §2 (NEW).]

4. Changes in the value of specific assets, including the residual value of property at the termination of a lease. [PL 1987, c. 707, §2 (NEW).]
24-A M.R.S. § 7001 — ME Code / Title 24-A / Chapter 89 / Section 7001
24-A §7001. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 2011, c. 297, §5 (NEW).]

1. Customer. "Customer" means a person who purchases a portable electronic device or service. [PL 2011, c. 297, §5 (NEW).]

2. Enrolled customer. "Enrolled customer" means a customer who elects coverage under a portable electronic device insurance policy issued to a vendor. [PL 2011, c. 297, §5 (NEW).]

3. Limited lines license. "Limited lines license" means a license to sell or offer a policy for portable electronic device insurance. [PL 2011, c. 297, §5 (NEW).]

4. Location. "Location" means any physical location in the State or any publicly accessible website, call center or similar operation directed to residents of the State. [PL 2011, c. 297, §5 (NEW).]

5. Portable electronic device. "Portable electronic device" means an electronic device that is portable in nature, its accessories and services related to the use of the device. [PL 2011, c. 297, §5 (NEW).]

6. Portable electronic device insurance. "Portable electronic device insurance" means insurance authorized under section 705 providing coverage for the repair or replacement of a portable electronic device that may cover a portable electronic device against any one or more of the following causes of loss: loss, theft, inoperability due to mechanical failure, malfunction, damage or other similar causes of loss. "Portable electronic device insurance" does not include: A. A service contract or extended warranty providing coverage limited to the repair, replacement or maintenance of property for the operational or structural failure of property due to a defect in materials, workmanship, accidental damage from handling or normal wear and tear; [PL 2011, c. 297, §5 (NEW).] B. A policy of insurance covering a seller's or a manufacturer's obligations under a warranty; or [PL 2011, c. 297, §5 (NEW).] C. Homeowner's or renter's insurance, private passenger automobile insurance, commercial multiple peril insurance or any similar policy. [PL 2011, c. 297, §5 (NEW).] [PL 2011, c. 297, §5 (NEW).]

7. Portable electronic device transaction. "Portable electronic device transaction" means: A. The sale or lease of a portable electronic device by a vendor to a customer; or [PL 2011, c. 297, §5 (NEW).] B. The sale of a service related to the use of a portable electronic device by a vendor to a customer. [PL 2011, c. 297, §5 (NEW).] [PL 2011, c. 297, §5 (NEW).]

8. Supervising entity. "Supervising entity" means a business entity that is a licensed insurance producer or insurer. [PL 2011, c. 297, §5 (NEW).]

9. Vendor. "Vendor" means a person in the business of engaging in portable electronic device transactions directly or indirectly. [PL 2011, c. 297, §5 (NEW).]
24-A M.R.S. § 1154 — ME Code / Title 24-A / Chapter 13-A / Section 1154
24-A §1154. Authorization; record of investments
Status: in_force

1. Authorization required. An insurer shall not make any investment or loan, other than policy loans or annuity contract loans, unless it is authorized or approved by the insurer's board of directors or by a committee of the board of directors charged with supervision of investments and loans. [PL 1987, c. 399, §14 (NEW).]

2. Records. The insurer shall maintain a full record of each investment, showing, among other things, the name of any officer, director or principal stockholder of the insurer having any direct, indirect or contingent interest in the securities, loan or property constituting the investment, or in the person in whose behalf the investment is made, and the nature of that interest. [PL 1987, c. 399, §14 (NEW).]
24-A M.R.S. § 2512 — ME Code / Title 24-A / Chapter 29 / Section 2512
24-A §2512. Reinstatement
Status: in_force

There shall be a provision that unless: [PL 1969, c. 132, §1 (NEW).]

1. The policy has been surrendered for its cash surrender value; [PL 1981, c. 188, §2 (AMD).]

2. Its cash surrender value has been exhausted; or [PL 1969, c. 132, §1 (NEW).]

3. The paid-up term insurance, if any, has expired; the policy will be reinstated at any time within 3 years, or 2 years in the case of industrial life insurance policies, from the date of premium default upon written application therefor, the production of evidence of insurability satisfactory to the insurer, the payment of all premiums in arrears with interest at a rate not exceeding 6% per annum compounded annually and the payment or reinstatement of any other indebtedness to the insurer upon the policy with interest at the policy loan interest rate. [PL 1969, c. 132, §1 (NEW); PL 1981, c. 188, §2 (AMD).]
24-A M.R.S. § 6611 — ME Code / Title 24-A / Chapter 81 / Section 6611
24-A §6611. Annual report; actuarial report
Status: in_force

1. Filing required. Annually within 4 months of the end of the fiscal year or within such extension of time as the superintendent for good cause may grant, every arrangement shall file a report with the superintendent, verified by the oath of the chair of the board of trustees. The report must summarize the business activities of the trust for the immediately preceding year and must contain a financial statement of the arrangement, including its balance sheet and a statement of operations for the preceding year certified by an independent certified public accountant. The report must also include an analysis of the adequacy of reserves and contributions or premiums charged based on a review of past and projected claims and expenses. [PL 1993, c. 688, §1 (NEW).]

1-A. Accountant's letter or qualification. The annual financial statement of the arrangement must include a letter of qualification from the certifying accountant stating: A. That the accountant is independent with respect to the arrangement and conforms to the standards of the accountant's profession as contained in the code of professional ethics and pronouncements of the American Institute of Certified Public Accountants and the rules of professional conduct of the appropriate state Board of Accountancy or similar code; [PL 1995, c. 618, §13 (NEW).] B. The background and experience in general and the experience in audits or arrangements of the staff assigned to the engagement and whether each is an independent certified public accountant. This requirement may not be construed as prohibiting the accountant from utilizing staff as the accountant considers appropriate where that is consistent with the standards prescribed by generally accepted auditing standards; [PL 1995, c. 618, §13 (NEW).] C. That the accountant understands the annual audited financial report and the accountant's opinion will be filed in compliance with this requirement and that the accountant knows the superintendent will be relying on this information in the monitoring and regulation of the financial position of the arrangement; [PL 1995, c. 618, §13 (NEW).] D. That the accountant consents and agrees to make available for review by the superintendent or the superintendent's designee or appointed agent, the accountant's workpapers relating to the arrangement. For purposes of this paragraph, workpapers are the records kept by the accountant of the procedures followed, the tests performed, the information obtained and the conclusions reached pertinent to the accountant's examination of the financial statements of the arrangement. Workpapers may include audit planning documents, work programs, analyses, memoranda, letters of confirmation and representation, abstracts of arrangement documents and schedules or commentaries prepared or obtained by the accounts in the course of the accountant's examination; and [PL 1995, c. 618, §13 (NEW).] E. A representation that the accountant is properly licensed by an appropriate state licensing authority and that the accountant is a member in good standing in the American Institute of Certified Public Accountants. [PL 1995, c. 618, §13 (NEW).] [PL 1995, c. 618, §13 (NEW).]

2. Actuarial report. At least once every 2 years each arrangement must have a report prepared by an actuary who is an associate or fellow of the Society of Actuaries and the American Academy of Actuaries as to the actuarial soundness of the arrangement. After an arrangement has filed 2 actuarial reports pursuant to this subsection, an arrangement may request that the superintendent grant a waiver of the filing requirement to the arrangement. If required, the report must be filed with the superintendent. The report must consist of at least the following: A. An assessment of the adequacy of contribution rates in meeting the level of benefits provided and changes, if any, needed in the contribution rates to achieve or preserve a level of funding adequate to enable payment of the benefit amounts provided under the arrangement, which must include a valuation of present assets, valued in accordance with insurance accounting precepts, and prospective assets and liabilities of the plan and the extent of unfunded accrued liabilities; [PL 1993, c. 688, §1 (NEW).] B. A plan and schedule to amortize any unfunded liabilities and a description of actions taken to reduce unfunded liabilities; [PL 1993, c. 688, §1 (NEW).] C. A description and explanation of actuarial assumptions; [PL 1993, c. 688, §1 (NEW).] D. A comparative review illustrating the level of funds available to the arrangement from rates, investment income and other sources realized over the period covered by the report indicating the assumptions used; [PL 1993, c. 688, §1 (NEW).] E. A certification by the actuary that the report is complete and accurate and that in the actuary's opinion the techniques and assumptions used are reasonable, make good and sufficient provision to meet the obligations of the arrangement and meet the requirements and intent of this chapter; and [PL 1993, c. 688, §1 (NEW).] F. Other factors or statements as may be reasonably required by the superintendent in order to determine the actuarial soundness of the plan. [PL 1993, c. 688, §1 (NEW).] [PL 2001, c. 570, §3 (AMD).]
24-A M.R.S. § 1956 — ME Code / Title 24-A / Chapter 18-A / Section 1956
24-A §1956. Authority of superintendent
Status: in_force

1. Alliance conduct. The superintendent has the authority to regulate the establishment and conduct of alliances as set forth in this chapter. [PL 1995, c. 673, Pt. A, §3 (NEW).]

2. Representations. A person or entity not licensed by the superintendent as a private purchasing alliance and engaged in the purchase, sale, marketing or distribution of health insurance or health care benefit plans may not represent itself as an alliance, health insurance purchasing alliance, purchasing alliance, health insurance purchasing cooperative or purchasing cooperative, or otherwise use a confusingly similar name. [PL 1995, c. 673, Pt. A, §3 (NEW).]

3. Conflict. Nothing in this chapter may be considered in conflict with or limit the duties and powers granted to the superintendent under the laws of this State. [PL 1995, c. 673, Pt. A, §3 (NEW).]

4. Penalties. Violations of this chapter are subject to the penalties contained in section 12‑A . [PL 1995, c. 673, Pt. A, §3 (NEW).]
24-A M.R.S. § 2445 — ME Code / Title 24-A / Chapter 27 / Section 2445
24-A §2445. Effective dates
Status: in_force

1. Policy form delivered. No policy form shall be delivered or issued for delivery in this State on or after June 1, 1984, unless approved by the superintendent or permitted to be issued under this Act. Any policy form which has been approved or permitted to be issued prior to June 1, 1984, and which meets the standards set by this Act need not be refiled for approval, but may continue to be lawfully delivered or issued for delivery in this State upon the filing with the superintendent of a list of forms identified by form number and accompanied by a certificate as to each form in the manner provided in section 2441, subsection 4 . [PL 1979, c. 267, §2 (NEW).]

2. Dates extended. The superintendent may, in the superintendent's sole discretion, extend the dates in subsection 1 . [RR 2021, c. 1, Pt. B, §225 (COR).]
24-A M.R.S. § 4350-D — ME Code / Title 24-A / Chapter 56-C / Section 4350-D
24-A §4350-D. Treatment of pharmacy benefits manager compensation
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Anticipated loss ratio" means the ratio of the present value of the future benefits payments to the present value of the future premiums of a policy form over the entire period for which rates are computed to provide health insurance coverage. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. "Pharmacy benefits manager compensation" means the difference between: (1) The value of payments made by a carrier of a health plan to its pharmacy benefits manager; and (2) The value of payments made by the pharmacy benefits manager to dispensing pharmacists for the provision of prescription drugs or pharmacy services with regard to pharmacy benefits covered by the health plan. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

2. Pharmacy benefits manager compensation included as administrative cost. If a carrier uses a pharmacy benefits manager to administer or manage prescription drug benefits provided for the benefit of covered persons, for purposes of calculating a carrier's anticipated loss ratio, any pharmacy benefits manager compensation: A. Constitutes an administrative cost incurred by the carrier in connection with a health plan; and [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. May not constitute a benefit provided under a health plan. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] A carrier may claim only the amounts paid by the pharmacy benefits manager to a pharmacy or pharmacist as an incurred claim. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

3. Calculation of pharmacy benefits manager compensation. Each rate filing submitted by a carrier with respect to a health plan that provides coverage for prescription drugs or pharmacy services that is administered or managed by a pharmacy benefits manager must include: A. A memorandum prepared by a qualified actuary describing the calculation of the pharmacy benefits manager compensation; and [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. Such records and supporting information as the superintendent reasonably determines is necessary to confirm the calculation of the pharmacy benefits manager compensation. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

4. Records. Upon request, a carrier shall provide any records to the superintendent that relate to the calculation of the pharmacy benefits manager compensation. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

5. Documentation from pharmacy benefits manager. A pharmacy benefits manager shall provide any necessary documentation requested by a carrier that relates to pharmacy benefits manager compensation in order to comply with the requirements of this section. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
24-A M.R.S. § 2745 — ME Code / Title 24-A / Chapter 33 / Section 2745
24-A §2745. Home health care coverage
Status: in_force

Every insurer which issues or issues for delivery in this State individual health policies, which provide coverage on an expense incurred basis for inpatient hospital care, shall make available such coverage for home health care services by a home health care provider. [PL 1977, c. 470, §2 (NEW).]

The policy providing coverage for home health care services may contain reasonable limitation on the number of home care visits and other services provided, but the number of such visits shall not be less than 90 in any continuous period of 12 months for each person covered under the policy. Each visit by an individual member of a home health care provider shall be considered as one home care visit. [PL 1977, c. 470, §2 (NEW).]

1. Definition of home health care services. "Home health care services" means those health care services rendered in a covered person's place of residence on a part-time basis to a covered person only if: A. Hospitalization or confinement in a skilled nursing facility as defined in Title XVIII of the Social Security Act, 42 U.S.C. § 1395, et seq., would otherwise have been required if home health care was not provided; and [PL 1977, c. 470, §2 (NEW).] B. The plan covering the home health services is established as prescribed in writing by a physician. [PL 1977, c. 470, §2 (NEW).] There may not be a requirement that hospitalization be an antecedent to coverage under the policy. [RR 2021, c. 1, Pt. B, §242 (COR).]

2. Home health care services included. Home health care services shall include: A. Visits by a registered nurse or licensed practical nurse to carry out treatments prescribed, or supportive nursing care and observation as indicated; [PL 1977, c. 470, §2 (NEW).] B. A physician's home or office visits or both; [PL 1977, c. 470, §2 (NEW).] C. Visits by a registered physical, speech, occupational, inhalation or dietary therapist for services or for evaluation of, consultation with and instruction of nurses in carrying out such therapy prescribed by the attending physician, or both; [PL 1977, c. 470, §2 (NEW).] D. Any prescribed laboratory tests and x-ray examination using hospital or community facilities, drugs, dressings, oxygen or medical appliances and equipment as prescribed by a physician, but only to the extent that such charges would have been covered under the contract if the covered person had remained in the hospital; and [PL 1977, c. 470, §2 (NEW).] E. Visits by persons who have completed a home health aide training course under the supervision of a registered nurse for the purpose of giving personal care to the patient and performing light household tasks as required by the plan of care, but not including services. [PL 1977, c. 470, §2 (NEW).] [PL 1977, c. 470, §2 (NEW).]

3. Home health care provider. "Home health care provider" means a home health care agency which is certified under Title XVIII of the Social Security Act of 1965, as amended, which: A. Is primarily engaged in and licensed or certified to provide skilled nursing and other therapeutic services; [PL 1977, c. 470, §2 (NEW).] B. Has standards, policies and rules established by a professional group, associated with the agency or organization, which professional group must include at least one physician and one registered nurse; [PL 1977, c. 470, §2 (NEW).] C. Is available to provide the care needed in the home 7 days a week and has telephone answering service available 24 hours per day; [PL 1977, c. 470, §2 (NEW).] D. Has the ability to and does provide, either directly or through contract, the services of a coordinator responsible for case discovery and planning and assuring that the covered person receives the services ordered by the physician; [PL 1977, c. 470, §2 (NEW).] E. Has under contract the services of a physician-advisor licensed by the State or a physician; [PL 1977, c. 470, §2 (NEW).] F. Conducts periodic case conferences for the purpose of individualized patient care planning and utilization review; and [PL 1977, c. 470, §2 (NEW).] G. Maintains a complete medical record on each patient. [PL 1977, c. 470, §2 (NEW).] [PL 1977, c. 470, §2 (NEW).]

4. Exclusions. A. No policy shall require home health care coverage to persons eligible for medicare; and [PL 1977, c. 470, §2 (NEW).] B. No payment shall be made for services provided by a person who resides in the covered person's residence or who is a member of the covered person's family. [PL 1977, c. 470, §2 (NEW).] [PL 1977, c. 470, §2 (NEW).]
24-A M.R.S. § 4121 — ME Code / Title 24-A / Chapter 55 / Section 4121
24-A §4121. Accident and health insurance and total and permanent disability insurance certificates
Status: in_force

A society may not issue or deliver in this State any certificate or other evidence of any contract or accident insurance or health insurance or of any total and permanent disability insurance contract unless and until the form thereof, together with the form of application and all riders or endorsements for use in connection therewith, has been filed with the superintendent and approved by the superintendent as conforming to reasonable rules from time to time made by the superintendent and as not inconsistent with any other provisions of law applicable thereto. For each such form filing, the society shall pay the superintendent a fee that must be the same as for an insurer, as provided in section 601 . The superintendent shall, within a reasonable time after the filing of any such form, notify the society filing the form either of the superintendent's approval or of the superintendent's disapproval of that form. The superintendent may approve any such form that in the superintendent's opinion contains provisions on any one or more of the several requirements made by the superintendent that are more favorable to the members than the one or ones so required. The superintendent may make, alter and supersede reasonable regulations prescribing the required, optional and prohibited provisions in such contracts, and such regulations must conform, as far as practicable, to chapter 33 . When the superintendent considers inapplicable, either in part or in their entirety, the provisions of the foregoing sections, the superintendent may prescribe the portions or summary thereof of the contract to be printed on the certificate issued to the member. Any filing made under this section is deemed approved unless disapproved within 60 days from the date of such filing. The procedures governing all rules promulgated under authority of this section must conform to Title 5, chapter 375, subchapter 2 . [RR 2021, c. 1, Pt. B, §329 (COR).]
24-A M.R.S. § 4435 — ME Code / Title 24-A / Chapter 57 / Section 4435
24-A §4435. Definitions
Status: in_force

As used in this subchapter, unless context otherwise requires: [PL 1969, c. 561 (NEW).]

1. Account. "Account" means any one of the 3 accounts created by section 4436 . [PL 1969, c. 561 (NEW).]

1-A. Affiliate. "Affiliate" means a person who directly, or indirectly, through one or more intermediaries, controls, is controlled by or is under common control with an insolvent insurer on December 31st of the year immediately before the year in which the insurer becomes an insolvent insurer. [PL 1989, c. 751, §2 (NEW).]

2. Association. "Association" means the Maine Insurance Guaranty Association created under section 4436 . [PL 1969, c. 561 (NEW).]

3. Board of directors. "Board of directors" means the board of directors of the association. [PL 1969, c. 561 (NEW).]

4. Covered claim. "Covered claim" means an unpaid claim, including one for unearned premiums but excluding one for punitive damages, arising under and within the coverage and applicable limits of a policy of a kind of insurance referred to in section 4433 to which this subchapter applies issued by an insurer that becomes an insolvent insurer after May 9, 1970, and where: A. The claimant or insured is a resident of this State at the time of the insured event; or [PL 1969, c. 561 (NEW).] B. The property from which the claim arises is permanently located in this State. [PL 1969, c. 561 (NEW).] "Covered claim" includes claim obligations that arose through the issuance of an insurance policy by a member insurer, which are later allocated, transferred, merged into, novated, assumed by or otherwise made the sole responsibility of a member or nonmember insurer if: the original member insurer has no remaining obligations on the policy after the transfer; a final order of liquidation with a finding of insolvency has been entered against the insurer that assumed the member's coverage obligations by a court of competent jurisdiction in the insurer's state of domicile; the claim would have been a covered claim if the claim had remained the responsibility of the original member insurer and the order of liquidation had been entered against the original member insurer, with the same claim submission date and liquidation date; and, in cases for which the member's coverage obligations were assumed by a nonmember insurer, the transaction received prior regulatory or judicial approval. "Covered claim" does not include any amount due any insurer, reinsurer, affiliate, insurance pool or underwriting association, as subrogation recoveries or otherwise, except that any payment made to the workers' compensation residual market pool pursuant to section 4438, subsection 1, paragraph A‑1 must be included as a covered claim. "Covered claim" does not include any first-party claims by an insured whose net worth exceeds $25,000,000 on December 31st of the year prior to the year in which the member insurer becomes an insolvent insurer. An insured's net worth on that date is deemed to include the aggregate net worth of the insured and all its subsidiaries as calculated on a consolidated basis. [PL 2025, c. 348, §38 (AMD).]

4-A. Cybersecurity insurance. "Cybersecurity insurance" means first-party or 3rd-party coverage, in a policy or endorsement, written on a direct, admitted basis for losses and loss mitigation arising out of or relating to data privacy breaches, unauthorized information network security intrusions, computer viruses, ransomware, extortion through electronic means, identity theft and similar exposures. [PL 2025, c. 348, §39 (NEW).]

5. Insolvent insurer. "Insolvent insurer" means a member insurer: A. Authorized to transact insurance in this State either at the time the policy was issued or when the insured event occurred; and [PL 1995, c. 289, §13 (AMD).] B. Against whom a final order of liquidation has been entered with a finding of insolvency by a court of competent jurisdiction. [PL 2001, c. 478, §6 (AMD); PL 2001, c. 478, §11 (AFF).] Effective July 1, 1995, the workers' compensation residual market pool, as created by the Bureau of Insurance Rules, Chapter 440, is deemed an insolvent insurer. [PL 2001, c. 478, §6 (AMD); PL 2001, c. 478, §11 (AFF).]

6. Member insurer. "Member insurer" means any authorized insurer that writes any kind of insurance to which this subchapter applies and that is not a risk retention group as defined in section 6093, subsection 13 . If an insurer is authorized at the time of an insolvency and subsequently is approved to withdraw its license authority for the kinds of insurance covered by any account to which claims relating to the insolvency are allocated, the withdrawn insurer shall continue to be a member of each account solely for purposes of assessments relating to claims resulting from the insolvency until these claims are paid or otherwise extinguished. [PL 2013, c. 238, Pt. E, §2 (AMD).]

7. Net direct written premiums. "Net direct written premiums" means direct gross premiums written on insurance policies to which this subchapter applies, less return premiums thereon and dividends paid or credited to policyholders on such direct business. "Net direct written premiums" does not include premiums on contracts between insurers or reinsurers or premiums written through the United States Government Flood Insurance Program. [PL 1999, c. 790, Pt. A, §29 (AMD).]

8. Insurer. "Insurer" means any insurer as defined in section 4 . [PL 1981, c. 484, §1 (AMD).]

9. Line of credit. "Line of credit" means an irrevocable stand-by commitment whereby the association or member insurer and a qualified financial institution or group of qualified financial institutions enter into a formal and binding contract in which the qualified financial institution or group of qualified financial institutions agree to lend a certain amount of money within a stated period of time. The terms and conditions of any line of credit shall be established by rules adopted jointly by the Bureau of Financial Institutions and the Bureau of Insurance. [PL 1989, c. 67, §4 (NEW); PL 2001, c. 44, §11 (AMD); PL 2001, c. 44, §14 (AFF).]

9-A. Person. "Person" means an individual or legal entity, including a governmental entity. [PL 2001, c. 478, §7 (NEW); PL 2001, c. 478, §11 (AFF).]

10. Qualified financial institution. "Qualified financial institution" means one which is insured by the Federal Deposit Insurance Corporation, Federal Savings and Loan Insurance Corporation or a successor federal deposit insurance agency or agencies, and has an equity capital to assets ratio of 6.5% or greater, as determined in accordance with generally accepted accounting principles. [PL 1989, c. 67, §4 (NEW).]
24-A M.R.S. § 1464 — ME Code / Title 24-A / Chapter 16 / Section 1464
24-A §1464. Consultant's bond
Status: in_force

1. Bond. Every applicant for license as a consultant shall file with the license application and maintain in effect while licensed a bond issued by an authorized surety insurer in this State, continuous in form and providing for aggregate liability of $20,000. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]

2. Indemnification. The bond must indemnify any person damaged by any fraudulent act or conduct of the licensee in transactions under the license, and must likewise be conditioned upon faithful accounting and application of all money coming into the licensee's possession in connection with activities as such a licensee. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]

3. Release. The bond remains in force until released by the superintendent or until canceled by the surety. Without prejudice to any liability previously incurred, the surety may cancel the bond upon 30 days advance written notice to the licensee and the superintendent. Upon cancellation by the surety and failure to procure a satisfactory replacement bond prior to cancellation, the consultant's license terminates. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]
24-A M.R.S. § 3856 — ME Code / Title 24-A / Chapter 53 / Section 3856
24-A §3856. Organization of reciprocal insurer
Status: in_force

1. Twenty-five or more persons domiciled in this State may organize a domestic reciprocal insurer and make application to the superintendent for a certificate of authority to transact insurance. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. The proposed attorney shall fulfill the requirements of and shall execute and file with the superintendent when applying for a certificate of authority, a declaration setting forth: A. The name of the insurer; [PL 1969, c. 132, §1 (NEW).] B. The location of the insurer's principal office, which shall be the same as that of the attorney and shall be maintained within this State; [PL 1969, c. 132, §1 (NEW).] C. The kinds of insurance proposed to be transacted; [PL 1969, c. 132, §1 (NEW).] D. The names and addresses of the original subscribers; [PL 1969, c. 132, §1 (NEW).] E. The designation and appointment of the proposed attorney and a copy of the power of attorney; [PL 1969, c. 132, §1 (NEW).] F. The names and addresses of the officers and directors of the attorney, if a corporation, or its members if a firm; [PL 1969, c. 132, §1 (NEW).] G. The powers of the subscribers' advisory committee; and the names and terms of office of the members thereof; [PL 1969, c. 132, §1 (NEW).] H. That all moneys paid to the reciprocal shall, after deducting therefrom any sum payable to the attorney, be held in the name of the insurer and for the purposes specified in the subscribers' agreement; [PL 1969, c. 132, §1 (NEW).] I. A statement that each of the original subscribers has in good faith applied for insurance of a kind proposed to be transacted, and that the insurer has received from each such subscriber the full premium or premium deposit required for the policy applied for, for a term of not less than 6 months at an adequate rate theretofore filed with and approved by the superintendent; [PL 1973, c. 625, §12 (AMD).] J. A statement of the financial condition of the insurer, a schedule of its assets, and a statement that the surplus as required by section 410 is on hand; and [PL 1969, c. 132, §1 (NEW).] K. A copy of each policy, endorsement and application form it then proposes to issue or use. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

The declaration shall be acknowledged by the attorney in the manner required for the acknowledgment of deeds. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 1160 — ME Code / Title 24-A / Chapter 13-A / Section 1160
24-A §1160. Prohibited transactions and investment underwriting
Status: in_force

1. Purchase of own common stock. A stock insurer may not purchase its own common stock, except for the purpose of mutualization under chapter 47 ; for retirement; or pursuant to a plan for investment or loan submitted in writing by the insurer to the superintendent in advance, and which the superintendent has not disapproved within 20 days after the submission or within any additional reasonable period as the superintendent may request, as being unfair or inequitable to the insurer's policyholders or stockholders. [PL 1987, c. 769, Pt. A, §90 (AMD).]

2. Underwriting. No insurer may underwrite or participate in the underwriting of an offering of securities or property of any person. This provision may not be considered to prohibit: A. The acquisition and ownership by the insurer of its subsidiary corporation acting as an investment adviser or principal underwriter of a management company or investment company registered with the United States Securities and Exchange Commission under the Investment Company Act of 1940, United States Code, Title 11, Section 72 and 102, and Title 15, Sections 80a-1 to 80a-52, as amended; [PL 1987, c. 399, §14 (NEW).] B. The registration by the insurer, under the United States Securities Act of 1933, United States Code, Title 15, Sections 77a to 77aa or other applicable law, of restricted or other securities acquired and owned by it in the regular course of business; and [PL 1987, c. 399, §14 (NEW).] C. The underwriting by an insurer individually or on its account jointly with one or more of its subsidiaries of the securities of any company that is engaged primarily in the business of investing in or holding securities or real property and to which the insurer or any of its subsidiaries renders management, investment advisory or sales services nor from participating in sales or purchases of those securities jointly with any person in the insurer's holding company system, as defined in section 222 . [PL 1987, c. 399, §14 (NEW).] [PL 1987, c. 399, §14 (NEW).]

3. Investments in affiliates. No insurer may purchase the stock of or otherwise invest in or lend its funds upon the security of any note or other evidence of indebtedness of any affiliate in the insurer's holding company system, except as authorized by section 222 or 1157 , or lend its funds to any director or officer of the insurer or the spouse or child of any director or officer. This provision does not prohibit: A. Policy loans authorized under section 1158 . [PL 1999, c. 715, §15 (AMD).] B. [PL 1999, c. 715, §15 (RP).] C. [PL 1999, c. 715, §15 (RP).] [PL 1999, c. 715, §15 (AMD).]

4. Encumbrance of securities. [PL 1999, c. 715, §16 (RP).]

5. Disposition of property. An insurer may enter into any agreement to sell or withhold from sale any of its property, as long as the insurer is not participating in a prohibited underwriting. The disposition of an insurer's property shall be the responsibility of its board of directors, in accordance with its charter and bylaws. [PL 1987, c. 399, §14 (NEW).]

6. Encumbrance of securities. An insurer may enter into securities lending transactions that are conducted directly, through a custodian bank that is a qualified bank, or through an agent, and may enter into repurchase transactions, reverse repurchase transactions and dollar roll transactions, subject to the following requirements. A. The insurer's board of directors shall adopt a written plan regarding such transactions that specifies guidelines and objectives to be followed, such as: (1) A description of how cash received will be invested or used for general corporate purposes of the insurer; (2) Operational procedures to manage interest rate risk, counter-party default risk, the conditions under which proceeds from reverse repurchase transactions may be used in the ordinary course of business and the use of acceptable collateral in a manner that reflects the liquidity needs of the transaction; and (3) The extent to which the insurer may engage in these transactions. [PL 1999, c. 715, §17 (NEW).] B. The insurer shall enter into a written agreement for all transactions authorized in this subsection other than dollar roll transactions. The written agreement must require each transaction to terminate no more than one year from its inception. The agreement must be made with the counter-party, except that, for securities lending transactions, the agreement may be through a custodian bank that is a qualified bank or the agreement may be with an agent acting on behalf of the insurer if the agent or the guarantor of the agent's obligations under the agreement is a qualified bank or a qualified business entity and if the agreement with the agent requires the agent to enter into separate agreements with each counter-party that are consistent with the requirements of this subsection and prohibits securities lending transactions under the agreement with the agent or its affiliates. [PL 1999, c. 715, §17 (NEW).] C. Cash received in a transaction under this subsection, if not used by the insurer for its general corporate purposes in accordance with the plan adopted by the board of directors pursuant to paragraph A , must be invested in accordance with this chapter and in a manner that recognizes the liquidity needs of the transaction. For so long as any transaction under this subsection remains outstanding, the insurer, its agent or custodian shall maintain either physically or through the book entry systems of the Federal Reserve, Depository Trust Company, Participants Trust Company or other securities depositories approved by the superintendent: (1) Possession of acceptable collateral for the transaction; (2) A perfected security interest in acceptable collateral for the transaction; or (3) In the case of a foreign jurisdiction, title to, or rights of a secured creditor to, acceptable collateral for the transaction. The amount of acceptable collateral required for the purposes of subparagraphs (1), (2) and (3) is the amount required pursuant to the provisions of the purposes and procedures manual of the Securities Valuation Office of the National Association of Insurance Commissioners or its successor publication. [PL 1999, c. 715, §17 (NEW).] D. An insurer may not enter into a transaction under this subsection if, as a result of and after giving effect to the transaction: (1) The aggregate amount of securities then loaned to, sold to or purchased from any one counter-party under this subsection would exceed 5% of its admitted assets. In calculating the amount sold to or purchased from a counter-party under repurchase or reverse repurchase transactions, effect may be given to netting provisions under a written master agreement; or (2) The aggregate amount of all securities then loaned to, sold to or purchased from all counter-parties under this subsection would exceed 40% of its admitted assets. [PL 1999, c. 715, §17 (NEW).] [PL 1999, c. 715, §17 (NEW).]
24-A M.R.S. § 1420-P — ME Code / Title 24-A / Chapter 16 / Section 1420-P
24-A §1420-P. Reporting of actions
Status: in_force

1. Administrative actions. A producer shall report to the superintendent any administrative action taken against the producer in another jurisdiction or by another governmental agency in this State within 30 days of the final disposition of the matter. This report must include a copy of the order, consent to order or other relevant legal documents. [PL 2001, c. 259, §24 (NEW).]

2. Criminal actions. Within 30 days of the initial pretrial hearing date, a producer shall report to the superintendent any criminal prosecution of the producer taken in any jurisdiction. The report must include a copy of the initial complaint filed, the order resulting from the hearing and any other relevant legal documents. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 2303-B — ME Code / Title 24-A / Chapter 25 / Section 2303-B
24-A §2303-B. Clean fuel vehicle incentive
Status: in_force

An insurer may credit or refund any portion of the premium charges for an insurance policy for a clean fuel vehicle in order to encourage its policyholders to use clean fuel vehicles if insurance premiums on other vehicles are not increased to fund these credits or refunds. [PL 1997, c. 500, §7 (NEW).]

For purposes of this section, "clean fuel vehicle" means a vehicle that may be propelled by a clean fuel or a fuel-cell electric vehicle that uses any fuel. For purposes of this paragraph, "clean fuel" means all products or energy sources used to propel motor vehicles, as defined in Title 29‑A, section 101 , other than conventional gasoline, diesel or reformulated gasoline, that, when compared to conventional gasoline, diesel or reformulated gasoline, result in lower emissions of oxides of nitrogen, volatile organic compounds, carbon monoxide or particulates or any combination of these. "Clean fuel" includes, but is not limited to, compressed natural gas; liquefied natural gas; liquefied petroleum gas; hydrogen; hythane, which is a combination of compressed natural gas and hydrogen; dynamic flywheels; solar energy; alcohol fuels containing not less than 85% alcohol by volume; and electricity. [PL 2019, c. 160, §9 (AMD).]
24-A M.R.S. § 1257 — ME Code / Title 24-A / Chapter 15 / Section 1257
24-A §1257. Assignment, transfer of securities or assets
Status: in_force

All assets deposited by an insurer and not negotiable by delivery must be duly assigned or transferred to the superintendent and the superintendent's successors in office. Upon release of any such security to the insurer, the superintendent shall reassign or transfer the same to the insurer. [RR 2021, c. 1, Pt. B, §196 (COR).]
24-A M.R.S. § 4140 — ME Code / Title 24-A / Chapter 55 / Section 4140
24-A §4140. Taxation
Status: in_force

Every society organized or licensed under this chapter is hereby declared to be a charitable and benevolent institution, and all of its funds shall be exempt from all and every state, county, district, municipal and school tax other than taxes on real estate and office equipment. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2772 — ME Code / Title 24-A / Chapter 34 / Section 2772
24-A §2772. Minimum standards
Status: in_force

A utilization review program of the applicant must meet the following minimum standards. [PL 1989, c. 556, Pt. C, §2 (NEW).]

1. Notification of adverse decisions. Notification of an adverse decision by the utilization review agent must be provided to the insured or other party designated by the insured within a time period to be determined by the superintendent through rulemaking and must include the name of the utilization review agent who made the decision. [PL 1993, c. 602, §5 (AMD).]

2. Reconsideration of determinations. All licensees shall maintain a procedure by which insureds, patients or providers may seek reconsideration of determinations of the licensee. [PL 1989, c. 556, Pt. C, §2 (NEW).]

3. Accessibility of representatives. A representative of the licensee must be accessible by telephone to insureds, patients or providers and the superintendent may adopt standards of accessibility by rule. [RR 2015, c. 1, §27 (COR).]

3-A. Medical utilization review criteria. The licensee must have written medical utilization review criteria to be employed in the review process. The criteria must be available for review as a part of any review conducted pursuant to section 2774, subsection 1 and a copy of the criteria must be provided to the bureau upon request. [PL 1995, c. 332, Pt. M, §7 (NEW).]

4. Information materials; confidentiality. A copy of the materials designed to inform applicable patients of the requirements of the utilization plan and the responsibilities and rights of patients under the plan and an acknowledgment that all applicable state and federal laws to protect the confidentiality of individual medical records are followed must be filed with the bureau. [PL 1989, c. 556, Pt. C, §2 (NEW).]

5. Penalty for noncompliance with utilization review programs. A medical utilization review program may not recommend or implement a penalty of more than $500 for failure to provide notification. This subsection does not limit the right of insurers to deny a claim when appropriate prospective or retroactive review concludes that services or treatment rendered were not medically necessary. [PL 1995, c. 332, Pt. M, §8 (AMD).]

6. Prohibited activities. A medical utilization review entity shall ensure that an employee does not perform medical utilization review services involving a health care provider or facility in which that employee has a financial interest. [RR 1993, c. 2, §15 (RNU).]
24-A M.R.S. § 2817 — ME Code / Title 24-A / Chapter 35 / Section 2817
24-A §2817. Applicant's statements; waivers, amendments
Status: in_force

There shall be a provision that no statement made by the applicant for insurance shall avoid the insurance or reduce benefits thereunder unless contained in the written application signed by the applicant; and a provision that no agent has authority to change the policy or to waive any of its provisions; and that no change in the policy shall be valid unless approved by an officer of the insurer and evidenced by indorsement on the policy, or by amendment to the policy signed by the policyholder and the insurer. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 6818 — ME Code / Title 24-A / Chapter 85 / Section 6818
24-A §6818. Fraud prevention and control
Status: in_force

1. Fraudulent viatical or life settlement acts prohibited. Notwithstanding any other provision of law to the contrary: A. A person may not commit a fraudulent viatical or life settlement act; [PL 2003, c. 636, §18 (NEW).] B. A person may not knowingly or intentionally interfere with the enforcement of the provisions of this chapter or investigations of suspected or actual violations of this chapter; and [PL 2003, c. 636, §18 (NEW).] C. A person in the business of settlements may not knowingly or intentionally permit any person convicted of a crime involving dishonesty or breach of trust to participate in the business of settlements. [PL 2003, c. 636, §18 (NEW).] [PL 2003, c. 636, §18 (NEW).]

2. Fraud warning required. Settlement contracts and applications for settlements, regardless of the form of transmission, must contain the following statement or a substantially similar statement: "Any person who knowingly presents false information in an application for insurance or a settlement contract is guilty of a crime and may be subject to fines and confinement in prison." The lack of a statement as required in this subsection does not constitute a defense in any prosecution for a fraudulent viatical or life settlement act. [PL 2003, c. 636, §18 (NEW).]

3. Mandatory reporting of fraudulent viatical or life settlement acts. Any person engaged in the business of settlements having knowledge or a reasonable belief that a fraudulent viatical or life settlement act is being, will be or has been committed shall provide to the superintendent the information required by, and in a manner prescribed by, the superintendent. Any other person having knowledge or a reasonable belief that a fraudulent viatical or life settlement act is being, will be or has been committed may provide to the superintendent the information required by, and in a manner prescribed by, the superintendent. [PL 2003, c. 636, §18 (NEW).]

4. Immunity from liability. Except as provided in subsection 5 , civil liability may not be imposed on and a cause of action may not arise from a person's furnishing information concerning suspected, anticipated or completed fraudulent viatical or life settlement acts or suspected or completed fraudulent insurance acts if the information is provided to or received from: A. The superintendent or the superintendent's employees, agents or representatives; [PL 2003, c. 636, §18 (NEW).] B. Federal, state or local law enforcement or regulatory officials or their employees, agents or representatives; [PL 2003, c. 636, §18 (NEW).] C. The National Association of Insurance Commissioners or its successor organization, National Association of Securities Dealers or its successor organization, the North American Securities Administrators Association or its successor organization, or their employees, agents or representatives of these organizations, or other regulatory body overseeing life insurance, settlements securities or investment fraud; [PL 2003, c. 636, §18 (NEW).] D. A person involved in the prevention and detection of fraudulent viatical or life settlement acts or that person's agents, employees or representatives; or [PL 2003, c. 636, §18 (NEW).] E. The life insurer that issued the life insurance policy covering the life of the insured. [PL 2003, c. 636, §18 (NEW).] [PL 2003, c. 636, §18 (NEW).]

5. Exception. The following provisions apply to the imposition of civil liability arising from information provided to or received from the superintendent or the superintendent's employees, agents or representatives. A. Subsection 4 does not apply to statements made with actual malice. In an action brought against a person for filing a report or furnishing other information concerning a fraudulent viatical or life settlement act or a fraudulent insurance act, the party bringing the action shall plead specifically any allegation that Subsection 4 does not apply because the person filing the report or furnishing the information did so with actual malice. [PL 2003, c. 636, §18 (NEW).] B. Subsection 4 does not apply to a person's furnishing information concerning that person's own suspected, anticipated or completed fraudulent viatical or life settlement acts or suspected or completed fraudulent insurance acts. [PL 2003, c. 636, §18 (NEW).] C. This subsection does not abrogate or modify common law or statutory privileges or immunities enjoyed by a person described in subsection 4 . [PL 2003, c. 636, §18 (NEW).] [PL 2003, c. 636, §18 (NEW).]

6. Confidentiality. The following provisions apply. A. The documents and evidence provided pursuant to subsection 4 or obtained by the superintendent in an investigation of suspected or actual fraudulent viatical or life settlement acts is privileged and confidential and is not a public record under Title 1, chapter 13 and is not subject to discovery or subpoena in a civil or criminal action. [PL 2003, c. 636, §18 (NEW).] B. Paragraph A does not prohibit release by the superintendent of documents and evidence obtained in an investigation of suspected or actual fraudulent viatical or life settlement acts: (1) In administrative or judicial proceedings to enforce laws administered by the superintendent; (2) To federal, state or local law enforcement or regulatory agencies, to an organization established for the purpose of detecting and preventing fraudulent viatical or life settlement acts or to the National Association of Insurance Commissioners or its successor organization; or (3) At the discretion of the superintendent, to a person in the business of settlements that is aggrieved by a fraudulent viatical or life settlement act. [PL 2003, c. 636, §18 (NEW).] C. Release of documents and evidence under paragraph B does not abrogate or modify the privilege granted in paragraph A . [PL 2003, c. 636, §18 (NEW).] [PL 2003, c. 636, §18 (NEW).]

7. Other law enforcement or regulatory authority. This section does not: A. Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate, examine and prosecute suspected violations of law; [PL 2003, c. 636, §18 (NEW).] B. Prevent or prohibit a person from disclosing voluntarily information concerning viatical or life settlement fraud to a law enforcement or regulatory agency other than the bureau; or [PL 2003, c. 636, §18 (NEW).] C. Limit the powers granted elsewhere by the laws of this State to the superintendent or an insurance fraud unit to investigate and examine possible violations of law and to take appropriate action against wrongdoers. [PL 2003, c. 636, §18 (NEW).] [PL 2003, c. 636, §18 (NEW).]

8. Viatical or life settlement antifraud initiatives. In accordance with this subsection, a settlement provider licensee must have in place antifraud initiatives reasonably calculated to detect, prosecute and prevent fraudulent viatical or life settlement acts. A. At the discretion of the superintendent, the superintendent may order, or a licensee may request and the superintendent may grant, such modifications of the required initiatives under paragraph B as necessary to ensure an effective antifraud program. The modifications may be more or less restrictive than the required initiatives as long as the modifications may reasonably be expected to accomplish the purpose of this subsection. [PL 2003, c. 636, §18 (NEW).] B. Antifraud initiatives must include: (1) Fraud investigators, who may be employees of a settlement provider or independent contractors; and (2) An antifraud plan, which must be submitted to the superintendent. The antifraud plan must include, but is not limited to: (a) A description of the procedures for detecting and investigating possible fraudulent viatical or life settlement acts and procedures for resolving material inconsistencies between medical records and insurance applications; (b) A description of the procedures for reporting possible fraudulent viatical or life settlement acts to the superintendent; (c) A description of the plan for antifraud education and training of underwriters and other personnel; and (d) A description or chart outlining the organizational arrangement of the antifraud personnel who are responsible for the investigation and reporting of possible fraudulent viatical or life settlement acts and investigating unresolved material inconsistencies between medical records and insurance applications. [PL 2003, c. 636, §18 (NEW).] C. Antifraud plans submitted to the superintendent are privileged and confidential and are not a public record under Title 1, chapter 13 or subject to discovery or subpoena in a civil or criminal action. [PL 2003, c. 636, §18 (NEW).] [PL 2003, c. 636, §18 (NEW).]
24-A M.R.S. § 3953 — ME Code / Title 24-A / Chapter 54-A / Section 3953
24-A §3953. Maine Guaranteed Access Reinsurance Association
Status: in_force

1. Guaranteed access reinsurance mechanism established. The Maine Guaranteed Access Reinsurance Association is established as a nonprofit legal entity. As a condition of doing business in the State, an insurer that has issued or administered medical insurance within the previous 12 months or is actively marketing a medical insurance policy or medical insurance administrative services in this State must participate in the association. The association may operate a reinsurance program contingent on the approval of, or continued approval of, a state innovation waiver under Section 1332 of the federal Affordable Care Act submitted by the superintendent as provided for in section 2781 . A. [PL 2019, c. 653, Pt. B, §12 (RP).] B. [PL 2019, c. 653, Pt. B, §12 (RP).] C. [PL 2019, c. 653, Pt. B, §12 (RP).] [PL 2019, c. 653, Pt. B, §12 (AMD).]

2. Board of directors. The association is governed by the Board of Directors of the Maine Guaranteed Access Reinsurance Association established under Title 5, section 12004‑G, subsection 14‑H . A. The board consists of 12 members appointed as described in this paragraph: (1) Seven members appointed by the superintendent: 2 members chosen from the general public and who are not associated with the medical profession, a hospital, an insurer or a producer; 2 members who represent medical providers; one member who represents individual health insurance consumers who is not associated or formerly associated with the medical profession, a hospital, an insurer or a producer; one member who represents a statewide organization that represents small businesses; and one member who represents producers. A board member appointed by the superintendent may not be removed without cause; and (2) Five members appointed by the member insurers, at least one of whom is a domestic insurer and at least one of whom is a 3rd-party administrator. [PL 2013, c. 273, §2 (AMD).] B. Members of the board serve for 3-year terms. Members of the board may serve up to 3 consecutive terms. [PL 2011, c. 90, Pt. B, §8 (NEW).] C. The board shall elect one of its members as chair. [PL 2011, c. 90, Pt. B, §8 (NEW).] D. Board members may be reimbursed from funds of the association for actual and necessary expenses incurred by them as members but may not otherwise be compensated for their services. [PL 2011, c. 90, Pt. B, §8 (NEW).] E. The board shall establish regular places and times for meetings and may meet at other times at the call of the chair. The board shall post notice of scheduled meetings, meeting agendas and minutes of meetings on a publicly accessible website maintained by the association. [PL 2013, c. 273, §3 (NEW).] F. The board shall establish a mechanism on its publicly accessible website for the public to submit comments on matters related to the operations of the association. [PL 2013, c. 273, §3 (NEW).] G. The board shall establish a process for taking public comment at selected board meetings to be held at such time and place as the board may determine. The opportunity for public comment must be made available not less often than quarterly. Except as specified in this paragraph, meetings of the board are not open to the public. [PL 2013, c. 273, §3 (NEW).] [PL 2013, c. 273, §§2, 3 (AMD).]

3. Plan of operation; rules. The board shall adopt a plan of operation in accordance with the requirements of this chapter and submit its articles, bylaws and operating rules to the superintendent for approval. If the board fails to adopt the plan of operation and suitable articles and bylaws within 90 days after the appointment of the board, the superintendent shall adopt rules to effectuate the requirements of this chapter and those rules remain in effect until superseded by a plan of operation and articles and bylaws submitted by the board and approved by the superintendent. Rules adopted by the superintendent pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2011, c. 90, Pt. B, §8 (NEW).]

4. Immunity. A board member is not liable and is immune from suit at law or equity for any conduct performed in good faith that is within the scope of the board's jurisdiction. [PL 2011, c. 90, Pt. B, §8 (NEW).]
24-A M.R.S. § 4317-B — ME Code / Title 24-A / Chapter 56-A / Section 4317-B
24-A §4317-B. Orally administered cancer therapy
Status: in_force

1. Coverage. A carrier that provides coverage for cancer chemotherapy treatment shall provide coverage for prescribed, orally administered anticancer medications used to kill or slow the growth of cancerous cells that is equivalent to the coverage provided for intravenously administered or injected anticancer medications. An increase in patient cost sharing for anticancer medications may not be used to achieve compliance with this section. [PL 2013, c. 449, §1 (NEW); PL 2013, c. 449, §2 (AFF).]

2. Construction. This section may not be construed to prohibit or limit a carrier's ability to establish a prescription drug formulary or to require a carrier to cover an orally administered anticancer medication on the sole basis that it is an alternative to an intravenously administered or injected anticancer medication. [PL 2013, c. 449, §1 (NEW); PL 2013, c. 449, §2 (AFF).]
24-A M.R.S. § 4311-A — ME Code / Title 24-A / Chapter 56-A / Section 4311-A
24-A §4311-A. Access to pain management services
Status: in_force

1. Access to pain management services. A carrier shall develop a plan to provide adequate coverage of and access to a broad spectrum of pain management services, including, but not limited to, nonopioid, nonnarcotic medication for pain management and nonmedication pain management services that serve as alternatives to the prescribing of opioid or narcotic drugs in accordance with guidelines developed by the bureau. [PL 2023, c. 661, §1 (NEW).]

2. Approval by bureau. A carrier shall file a plan required under subsection 1 with the bureau for approval. In its review, the bureau shall consider the adequacy of access to a broad spectrum of pain management services under the plan and whether any policies adopted by the carrier may create unduly preferential coverage of and access to prescribed opioids for pain management without consideration of other pain management services. [PL 2023, c. 661, §1 (NEW).]

3. Information for enrollees. A carrier shall distribute educational materials to network providers about a pain management access plan under subsection 1 and post information about the pain management access plan on the carrier's publicly accessible website. [PL 2023, c. 661, §1 (NEW).]
24-A M.R.S. § 2432 — ME Code / Title 24-A / Chapter 27 / Section 2432
24-A §2432. Exemption of employee's interest; group annuities, pension trusts
Status: in_force

If any group annuity contract or pension trust, whether heretofore or hereafter issued, is effected by an employer for the benefit of the employer's employees, whether or not requiring any contribution toward the cost thereof by such employees, the interest of any employee, beneficiary or joint or contingent annuitant in any policy, certificate or fund in connection therewith and the interest in any payments or proceeds thereof and in any optional or death benefits is not in any way subject to execution, levy, attachment, garnishment, trustee process or any other legal or equitable process. [RR 2021, c. 1, Pt. B, §223 (COR).]
24-A M.R.S. § 2112 — ME Code / Title 24-A / Chapter 21 / Section 2112
24-A §2112. Reciprocal judgment
Status: in_force

The Attorney General upon request of the superintendent may proceed in the courts of this State or any reciprocal state or in any federal court or agency to enforce an order or decision in any court proceeding or in any administrative proceeding before the superintendent. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

1. Definitions. In this section: A. "Reciprocal state" means any state the laws of which contain procedures substantially similar to those specified in this section for the enforcement of decrees or orders in equity issued by courts located in other states, against insurers incorporated or authorized to do business in such state. [PL 1969, c. 132, §1 (NEW).] B. "Foreign decree" means any decree or order in equity of a court located in a "reciprocal state," including a court of the United States located therein, against a "domestic insurer" obtained by a "qualified party." [PL 1969, c. 132, §1 (NEW).] C. "Domestic insurer" means any insurer incorporated or authorized to do business in this State. [PL 1969, c. 132, §1 (NEW).] D. "Qualified party" means a state regulatory agency acting in its capacity to enforce the insurance laws of its state. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]

2. List of reciprocal states. The superintendent shall determine which states qualify as reciprocal states and shall maintain at all times an up-to-date list of such states. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

3. Filing and status of foreign decrees. A copy of any foreign decree authenticated in accordance with the Act of Congress or the statutes of this State may be filed in the office of the clerk of any Superior Court of this State. The clerk, upon verifying with the superintendent that the decree or order qualifies as a foreign decree shall treat the foreign decree in the same manner as a decree of a Superior Court of this State. A foreign decree so filed has the same effect and shall be deemed as a decree of a Superior Court of this State, and is subject to the same procedures, defenses and proceedings for reopening, vacating, or staying as a decree of a Superior Court of this State and may be enforced or satisfied in like manner. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

4. Notice of filing. A. At the time of the filing of the foreign decree, the Attorney General shall make and file with the clerk of the court an affidavit setting forth the name and last known post office address of the defendant. [PL 1969, c. 132, §1 (NEW).] B. Promptly upon the filing of the foreign decree and the affidavit, the clerk shall mail notice of the filing of the foreign decree to the defendant at the address given, and to the superintendent, and shall make a note of the mailing in the docket. In addition, the Attorney General may mail a notice of the filing of the foreign decree to the defendant and to the superintendent and may file proof of mailing with the clerk. Lack of mailing notice or filing by the clerk shall not affect the enforcement proceedings if proof of mailing by the Attorney General has been filed. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).] C. No execution or other process for enforcement of a foreign decree filed hereunder shall issue until 30 days after the date the decree is filed. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

5. Stay. A. If the defendant shows the Superior Court that an appeal from the foreign decree is pending or will be taken, or that a stay of execution has been granted, the court shall stay enforcement of the foreign decree until the appeal is concluded, the time for appeal expires, or the stay of execution expires or is vacated, upon proof that the defendant has furnished the security for the satisfaction of the decree rquired by the state in which it was rendered; [PL 1969, c. 132, §1 (NEW).] B. If the defendant shows the Superior Court any ground upon which enforcement of a decree of any Superior Court of this State would be stayed, the court shall stay enforcement of the foreign decree for an appropriate period, upon requiring the same security for satisfaction of the decree which is required in this State. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]

6. Fees. Any person filing a foreign decree shall pay to the clerk of court the applicable fee. Fees for docketing, transcription or other enforcement proceedings shall be as provided for decrees of the Superior Court. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2625 — ME Code / Title 24-A / Chapter 31 / Section 2625
24-A §2625. Notice as to conversion right
Status: in_force

If any individual insured under a group life insurance policy hereafter delivered in this State becomes entitled under the terms of such policy to have an individual policy of life insurance issued to the individual without evidence of insurability, subject to making of application and payment of the first premium within the period specified in such policy, and if such individual is not given notice of the existence of such right at least 15 days prior to the expiration date of such period, then, in such event the individual must have an additional period within which to exercise such right, but nothing herein contained may be construed to continue any insurance beyond the period provided in such policy. This additional period expires 15 days next after the individual is given such notice but in no event may such additional period extend beyond 60 days next after the expiration date of the period provided in such policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder constitutes notice for the purpose of this section. [RR 2021, c. 1, Pt. B, §236 (COR).]
24-A M.R.S. § 1443-A — ME Code / Title 24-A / Chapter 16 / Section 1443-A
24-A §1443-A. Licensing of financial institutions and related parties
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Affiliate" means any of the following entities: (1) A subsidiary of a financial institution or credit union authorized to do business in this State or of a financial institution holding company; (2) An employee, an officer other than a director, or licensed 3rd-party producer of a financial institution or credit union authorized to do business in this State, a financial institution holding company or any institution listed in subparagraph (1); (3) A person or entity possessing 5% or more of the ownership interests of a financial institution or credit union authorized to do business in this State, or of a financial institution holding company or of any institution listed in subparagraph (1); or (4) An insurer or insurance producer or consultant utilizing space in the retail area of a financial institution or credit union authorized to do business in this State or of a financial institution holding company or an institution listed in subparagraph (1) in order to engage in the transaction of insurance when payments for use of the space are made to the that institution pursuant to a space-sharing agreement based directly or indirectly upon a percentage of the volume of business conducted by the insurer, insurance agent, broker or consultant. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] B. "Credit union authorized to do business in this State" or "credit union" has the same meaning as defined in Title 9‑B, section 131, subsection 12‑A . [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] C. "Financial institution authorized to do business in this State" or "financial institution" has the same meaning as defined in Title 9‑B, section 131, subsection 17‑A . [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] D. "Financial institution holding company" has the same meaning as defined in Title 9‑B, section 1011 and includes a mutual holding company as defined in Title 9‑B, section 1052 . [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] E. "Licensed 3rd-party producer" means a licensed insurance producer or consultant who engages in authorized insurance activities related to insurance products directly on behalf of a specified licensed insurance entity through an independent contractor relationship. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] F. "Ownership interest" includes general partnership shares, limited partnership shares and shares of stock that possess any voting rights. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] G. "Subsidiary" means any corporation, partnership, association or other business entity in which either: (1) One or more financial institutions or credit unions authorized to do business in this State, financial institution holding companies or any officers, employees, agents or representatives of the financial institutions or credit unions authorized to do business in this State or financial institution holding companies possess directly or indirectly, singly or in the aggregate, an ownership interest of at least 25%; or (2) It is determined by the superintendent after notice and opportunity for hearing that one or more financial institutions or credit unions authorized to do business in this State, financial institution holding companies or any officers, employees, agents or representatives of financial institutions or credit unions authorized to do business in this State or financial institution holding companies, singly or in the aggregate, exercise a controlling influence over the management and policies of the entity. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).] [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]

2. Licensing. A financial institution or credit union authorized to do business in this State, financial institution holding company or the subsidiary or affiliate of any of those entities or an officer, employee, agent or representative of a financial institution, credit union, financial institution holding company or the subsidiary of any of those entities may be licensed as an insurance producer or consultant in this State or may act as an insurance producer or consultant in this State. These organizations are not required to become licensed as insurance producers or consultants with respect to: credit life and credit health insurance to the extent authorized by chapter 37 when the insured is enrolled in the policy; group health insurance to the extent authorized by chapter 35 when the insured is enrolled in the policy; and group life insurance to the extent authorized by chapter 31 when the insured is enrolled in the policy; credit property insurance; credit involuntary unemployment insurance; forced placed property insurance; a vendor's single interest policy; and any other insurance product as determined by the superintendent. In addition, a financial institution, credit union, financial institution holding company or a subsidiary or employee of any such entity may sell annuities, arrange for the sale of annuities or share commissions in connection with the sale of annuities to the extent authorized by Title 9‑B, section 443, subsection 11 , if the entity has been licensed pursuant to this chapter and if that activity includes the sale of variable annuity contracts, a national association of securities dealers registration form must be submitted to the superintendent as required by the provisions of section 1410, subsection 8 . [PL 2001, c. 259, §37 (AMD).]

3. Rulemaking. The superintendent, the Superintendent of Financial Institutions and the Superintendent of Consumer Credit Protection may, pursuant to this subsection, Title 9‑A, section 4‑407 and Title 9‑B, section 448, subsection 5 , undertake joint rulemaking to carry out the purpose of this section, including issues regarding signs, the physical location of sales of insurance and identification of producers affiliated with financial institutions, credit unions, financial institution holding companies or supervised lenders. In adopting rules pursuant to this section, the superintendent, the Superintendent of Financial Institutions and the Superintendent of Consumer Credit Protection shall consider the possibility of confusion and perception of coercion among the insurance-consuming public, the need for cost-effective delivery of insurance products to insurance consumers and the importance of parity among producers affiliated with federally chartered and state-chartered financial institutions and credit unions. Any rule adopted may not interfere significantly with the ability of a producer to solicit or negotiate the sale of an insurance product, whether or not that producer is affiliated with a financial institution, credit union, financial institution holding company or supervised lender, except when no other reasonable alternative exists to protect the insurance-consuming public. Rules adopted under this section are routine technical rules pursuant to Title 5, chapter 375, subchapter II‑A . Nothing in this section is intended to restrict or interfere with the ability of the bureau, the Bureau of Financial Institutions or the Bureau of Consumer Credit Protection to adopt rules with respect to areas in which the respective agencies have independent jurisdiction. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF); PL 2001, c. 44, §11 (AMD); PL 2001, c. 44, §14 (AFF); PL 2007, c. 273, Pt. B, §§5, 6 (REV); PL 2007, c. 695, Pt. A, §47 (AFF).]
24-A M.R.S. § 2159-B — ME Code / Title 24-A / Chapter 23 / Section 2159-B
24-A §2159-B. Discrimination against victims of domestic abuse prohibited
Status: in_force

1. Discrimination prohibited. An insurer, nonprofit hospital and medical service organization or health maintenance organization that issues life, health or disability coverage may not deny, cancel, refuse to renew or restrict coverage of any person or require the payment of additional charges based on the fact or perception that the person is, or may become, the victim of domestic abuse, under Title 19‑A, section 4102 . This subsection does not prohibit applying an underwriting or rating criterion to a victim of domestic abuse based on physical or mental history or other factors of general applicability regardless of the underlying cause and in accordance with the requirements of section 2159, subsections 1 and 2 . An insurer, nonprofit hospital and medical service organization or health maintenance organization may not be held criminally or civilly liable for any cause of action that may result from compliance with this subsection. This subsection does not prohibit an insurer, nonprofit hospital and medical service organization or health maintenance organization from declining to issue coverage to an applicant known to be, or to have been, an abuser of the proposed insured. [PL 2021, c. 647, Pt. B, §52 (AMD); PL 2021, c. 647, Pt. B, §65 (AFF).]

2. Justification of adverse insurance decisions. An insurer, nonprofit hospital and medical service organization or health maintenance organization that issues life, health or disability coverage that takes an action that adversely affects an applicant or insured on the basis of a medical condition that the insurer, nonprofit hospital and medical service organization or health maintenance organization knows or has reason to know is related to domestic abuse shall explain the reasons for its action to the applicant or insured in writing and shall demonstrate that its action, and any applicable policy provision: A. Does not have the purpose or effect of treating abuse status as a medical condition or underwriting or rating criterion; [PL 2001, c. 16, §1 (NEW).] B. Is not based upon any actual or perceived correlation between a medical condition and domestic abuse; [PL 2001, c. 16, §1 (NEW).] C. Is otherwise permissible by law and applies in the same manner and to the same extent to all applicants and insureds with a similar medical condition or disability without regard to whether the medical condition or disability is related to domestic abuse; and [PL 2001, c. 16, §1 (NEW).] D. Except for claims actions, is based on a determination made in conformance with sound actuarial principles and otherwise supported by actual or reasonably anticipated experience that there is a correlation between the medical condition or disability and a material increase in insurance risk. [PL 2001, c. 16, §1 (NEW).] [PL 2001, c. 16, §1 (NEW).]
24-A M.R.S. § 4316 — ME Code / Title 24-A / Chapter 56-A / Section 4316
24-A §4316. Coverage for telehealth services
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Mobile health device" means a wearable device used to track health and wellness, including, but not limited to, a heart rate and respiratory monitor, an electrocardiogram monitor and a glucose monitor. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] A-1. "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as amended. [PL 2019, c. 649, §3 (NEW).] B. "Store and forward transfers" means transmission of an enrollee's recorded health history through a secure electronic system to a provider. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] B-1. "Asynchronous encounters" means the interaction or consultation between an enrollee and the enrollee’s provider or between providers regarding the enrollee through a system with the ability to store digital information, including, but not limited to, still images, video, audio and text files, and other relevant data in one location and subsequently transmit such information for interpretation at a remote site by health professionals without requiring the simultaneous presence of the patient or the health professionals. [PL 2021, c. 291, Pt. A, §4 (NEW).] B-2. "Synchronous encounters" means a real-time interaction conducted with interactive audio or video connection between an enrollee and the enrollee’s provider or between providers regarding the enrollee. [PL 2021, c. 291, Pt. A, §4 (NEW).] C. "Telehealth," as it pertains to the delivery of health care services, means the use of information technology and includes synchronous encounters, asynchronous encounters, store and forward transfers and telemonitoring. [PL 2021, c. 291, Pt. A, §4 (AMD).] D. "Telemonitoring," as it pertains to the delivery of health care services, means the use of information technology to remotely monitor an enrollee's health status via electronic means, allowing the provider to track the enrollee's health data over time. Telemonitoring may be synchronous or asynchronous. [PL 2021, c. 291, Pt. A, §4 (AMD).] E. [PL 2021, c. 291, Pt. A, §4 (RP).] [PL 2021, c. 291, Pt. A, §4 (AMD).]

2. Parity for telehealth services. A carrier offering a health plan in this State may not deny coverage on the basis that the health care service is provided through telehealth if the health care service would be covered if it were provided through in-person consultation between an enrollee and a provider and as long as the provider is acting within the scope of practice of the provider’s license and in accordance with rules adopted by the board, if any, that issued the provider’s license related to standards of practice for the delivery of a health care service through telehealth. Coverage for health care services provided through telehealth must be determined in a manner consistent with coverage for health care services provided through in-person consultation. If an enrollee is eligible for coverage and the delivery of the health care service through telehealth is medically appropriate, a carrier may not deny coverage for telehealth services. A carrier may offer a health plan containing a provision for a deductible, copayment or coinsurance requirement for a health care service provided through telehealth as long as the deductible, copayment or coinsurance does not exceed the deductible, copayment or coinsurance applicable to a comparable service provided through in-person consultation. A carrier may not exclude a health care service from coverage solely because such health care service is provided only through a telehealth encounter, as long as telehealth is appropriate for the provision of such health care service. [PL 2021, c. 291, Pt. A, §5 (AMD).]

3. Coverage for telehealth services. Except as provided in this section, a carrier shall provide coverage for any medically necessary health care service delivered through telehealth as long as the following requirements are met. A. The health care service is otherwise covered under an enrollee's health plan. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] B. The health care service delivered by telehealth is of comparable quality to the health care service delivered through in-person consultation. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] C. Prior authorization is required for telehealth services only if prior authorization is required for the corresponding covered health care service. An in-person consultation prior to the delivery of services through telehealth is not required. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] D. Coverage for telehealth services is not limited in any way on the basis of geography, location or distance for travel. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] E. The carrier shall require that a clinical evaluation is conducted either in person or through telehealth before a provider may write a prescription that is covered. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] F. The carrier shall provide coverage for the treatment of 2 or more persons who are enrolled in the carrier's health plan at the same time through telehealth, including counseling for substance use disorders involving opioids. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] G. The carrier may not place any restriction on the prescribing of medication through telehealth by a provider whose scope of practice includes prescribing medication that is more restrictive than any requirement in state and federal law for prescribing medication through in-person consultation. [PL 2021, c. 291, Pt. A, §6 (NEW).] [PL 2021, c. 291, Pt. A, §6 (AMD).]

4. Telemonitoring requirements. A carrier shall provide coverage for telemonitoring if: A. The telemonitoring is intended to collect an enrollee's health-related data, including, but not limited to, pulse and blood pressure readings, that assist a provider in monitoring and assessing the enrollee's medical condition; [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] B. The telemonitoring is medically necessary for the enrollee; [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] C. The enrollee is cognitively and physically capable of operating the mobile health devices or the enrollee has a caregiver willing and able to assist with the mobile health devices; and [PL 2021, c. 293, Pt. A, §29 (AMD).] D. The enrollee's residence is suitable for telemonitoring. If the residence appears unable to support telemonitoring, the telemonitoring may not be provided unless necessary adaptations are made. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).] [PL 2021, c. 293, Pt. A, §29 (AMD).]

5. Coverage for telephonic services. [PL 2021, c. 291, Pt. A, §7 (RP).]

6. Utilization review. This section does not prohibit or limit a carrier from conducting a utilization review for telehealth services as long as the utilization review is conducted in the same manner and uses the same clinical review criteria as a utilization review for an in-person consultation for the same service. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).]

7. Provider eligibility. In order to be eligible for reimbursement under this section, a provider providing health care services through telehealth must be acting within the scope of the provider's license. A carrier may not impose additional credentialing requirements or prior approval requirements for a provider as a condition of reimbursement for health care services provided under this section unless those credentialing requirements or prior approval requirements are the same as those imposed for a provider that does not provide health care services through telehealth. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).]

8. Telehealth equipment. A carrier may not require a provider to use specific telecommunications technology and equipment as a condition of coverage under this section as long as the provider uses telecommunications technology and equipment that comply with current industry interoperability standards and that comply with standards required under the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 and regulations promulgated under that Act. [PL 2019, c. 289, §2 (NEW); PL 2019, c. 289, §3 (AFF).]

9. Medicare coverage policy. A carrier may provide coverage for health care services delivered through telehealth that is consistent with the Medicare coverage policy for interprofessional Internet consultations. If a carrier provides coverage consistent with the Medicare coverage policy for interprofessional Internet consultations, the carrier may also provide coverage for interprofessional Internet consultations that are provided by a federally qualified health center or rural health clinic as defined in 42 United States Code, Section 1395x, subsection (aa)(1993). [PL 2019, c. 649, §4 (NEW).]

10. Network adequacy. The availability of health care services through telehealth may not be considered for the purposes of demonstrating the adequacy of a carrier’s network pursuant to section 4303, subsection 1 and Bureau of Insurance Rule Chapter 850: Health Plan Accountability. [PL 2021, c. 291, Pt. A, §8 (NEW).]
24-A M.R.S. § 2834-D — ME Code / Title 24-A / Chapter 35 / Section 2834-D
24-A §2834-D. Maternity and postpartum care
Status: in_force

An insurer that issues group contracts providing maternity benefits shall provide coverage for 12 months following childbirth for postpartum care services and support necessary to transition a patient to a healthy and stable condition that meets the recommendations of the American College of Obstetricians and Gynecologists outlined in the "Optimizing Postpartum Care" opinion published May 2018. The postpartum care services and support provided in accordance with this section must include coverage for development of a postpartum care plan; contact with the patient within 3 weeks of the end of pregnancy; a comprehensive postpartum visit, including a full assessment of the patient's physical, social and psychological well-being; treatment of complications of pregnancy and childbirth, including pelvic floor disorders and postpartum depression; assessment of risk factors for cardiovascular disease; and care related to pregnancy loss. [PL 2021, c. 691, §2 (NEW); PL 2021, c. 691, §5 (AFF).]
24-A M.R.S. § 2384-A — ME Code / Title 24-A / Chapter 25 / Section 2384-A
24-A §2384-A. Advisory organization filing requirements
Status: in_force

1. Filing. Every advisory organization shall file with the superintendent every pure premium, manual of rating rules, rating schedule and change, amendment or modification of the foregoing proposed for use in the State at least 30 days prior to the proposed effective date. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

2. Effective date. The superintendent may extend the proposed effective date for an additional period not to exceed 60 days if the superintendent gives written notice to the advisory organization that made the filing that the superintendent needs additional time for consideration of the filing. The superintendent may require any additional information necessary to evaluate the filing. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

3. Disapproval. The superintendent may disapprove, without hearing, an advisory organization filing that has not become effective if the pure premiums are excessive, inadequate or unfairly discriminatory or if the rating rules or rating procedure would produce premiums that are excessive, inadequate or unfairly discriminatory. If the pure premium rates, rating rules or rating schedule has been disapproved, the advisory organization must be notified of the reason for disapproval and must be given a hearing upon a written request made within 30 days after the disapproval order. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]
24-A M.R.S. § 5052 — ME Code / Title 24-A / Chapter 68 / Section 5052
24-A §5052. Specific standards
Status: in_force

1. Standards for long-term care, home health care and nursing home care policies. The superintendent may adopt rules to establish specific standards for policy provisions of long-term care, home health care and nursing home care policies. The standards must be in addition to and in accordance with applicable laws of this State, including chapters 33 and 35 , and may include, but are not limited to: A. Terms of renewability; [PL 1985, c. 648, §12 (NEW).] B. Initial and subsequent conditions of eligibility; [PL 1985, c. 648, §12 (NEW).] C. Nonduplication of coverage; [PL 1985, c. 648, §12 (NEW).] D. Probationary periods; [PL 1985, c. 648, §12 (NEW).] E. Benefit limitations, exceptions and reductions; [PL 1985, c. 648, §12 (NEW).] F. Elimination periods; [PL 1985, c. 648, §12 (NEW).] G. Requirements for replacement; [PL 1985, c. 648, §12 (NEW).] H. Recurrent confinements; and [PL 1985, c. 648, §12 (NEW).] I. Definition of terms. [PL 1985, c. 648, §12 (NEW).] [PL 1997, c. 604, Pt. D, §3 (AMD).]

2. Prohibited policy provision. The superintendent may adopt rules that specify prohibited provisions not otherwise specifically authorized by law that, in the opinion of the superintendent, are unjust, unfair, inequitable or unfairly discriminatory to any person insured or proposed for coverage under a long-term care, home health care or nursing home care policy. [PL 1997, c. 604, Pt. D, §3 (AMD).]
24-A M.R.S. § 4359 — ME Code / Title 24-A / Chapter 57 / Section 4359
24-A §4359. Grounds for ancillary liquidation, foreign and alien insurers
Status: in_force

The superintendent may apply to the court for an order appointing the superintendent to liquidate the business of a foreign or alien insurer having assets, business or claims in this State upon the appointment in the domiciliary sovereignty of such insurer of a receiver, liquidator, conservator, rehabilitator or other officer by whatever name called for the purpose of liquidating the business of the insurer. [RR 2021, c. 1, Pt. B, §355 (COR).]