24 M.R.S. § 2332-L — ME Code / Title 24 / Chapter 19 / Section 2332-L
24 §2332-L. Coverage for services provided by registered nurse first assistants (REALLOCATED FROM TITLE 24, SECTION 2332-J)
Status: in_force

(REALLOCATED FROM TITLE 24, SECTION 2332-J)

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Perioperative nursing" means a practice of nursing in which the nurse provides preoperative, intraoperative and postoperative nursing care to surgical patients. [RR 1999, c. 1, §31 (RAL).] B. "Recognized program" means a program that addresses all content of the core curriculum for registered nurse first assistants as established by the Association of Operating Room Nurses or its successor organization. [RR 1999, c. 1, §31 (RAL).] C. "Registered nurse first assistant," or "RNFA," means a person who: (1) Is licensed as a registered nurse under Title 32, chapter 31 ; (2) Is experienced in perioperative nursing; and (3) Has successfully completed a recognized program. [RR 1999, c. 1, §31 (RAL).] [RR 1999, c. 1, §31 (RAL).]

2. Institutional powers. Each health care institution, as defined in Title 22, chapter 405 , may establish specific procedures for the appointment and reappointment of registered nurse first assistants and for granting, renewing and revising their clinical privileges. [RR 1999, c. 1, §31 (RAL).]

3. Required coverage for services. Notwithstanding any other provisions of this chapter, a nonprofit hospital and medical service organization that issues individual and group health care contracts that provide coverage for surgical first assisting benefits or services shall provide coverage and payment under those contracts to a registered nurse first assistant who performs services that are within the scope of a registered nurse first assistant's qualifications. The provisions of this subsection apply only if reimbursement for an assisting physician would be covered and a registered nurse first assistant who performed those services is used as a substitute. [RR 1999, c. 1, §31 (RAL).]

4. Limits; coinsurance; deductibles. Any contract that provides coverage for the services required by 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, §31 (RAL).]

5. Application. The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. B, §9 (NEW).]
24-A M.R.S. § 6819 — ME Code / Title 24-A / Chapter 85 / Section 6819
24-A §6819. Civil remedies; individual remedy
Status: in_force

1. Civil remedies and enforcement. In addition to the penalties available pursuant to section 6814 , the superintendent may assess fines or take any other enforcement action permitted under section 12‑A against any person who violates any provision of this chapter. [PL 2003, c. 636, §18 (NEW).]

2. Superior Court action. Any person who is injured by any action of a person in violation of this chapter may bring an action in Superior Court. The requirements for notice and filing of a cause of action under this subsection are governed by the Maine Rules of Civil Procedure. The person may recover damages, together with costs and disbursements. [PL 2003, c. 636, §18 (NEW).]

3. No private right of action. Except as specifically provided in subsection 2 , this chapter provides no express or implied private right of action. [PL 2003, c. 636, §18 (NEW).]
24-A M.R.S. § 5002-A — ME Code / Title 24-A / Chapter 67 / Section 5002-A
24-A §5002-A. Standards for policy provisions and authority to adopt rules
Status: in_force

1. Duplicate benefits. A Medicare supplement policy or certificate in force in the State may not contain benefits that duplicate benefits provided by Medicare. [PL 1991, c. 740, §4 (NEW).]

2. Standardization. The superintendent may adopt rules specifying the minimum Medicare supplement contract benefits required in the State and the new and innovative benefits available for sale in the State. All other benefits or options are prohibited in a Medicare supplement contract subject to this chapter. [PL 1993, c. 154, §2 (AMD).]

3. Preexisting conditions. Notwithstanding any other provision of law of this State, a Medicare supplement policy or certificate may not exclude or limit benefits for losses incurred more than 6 months from the effective date of coverage because the medical condition involved a preexisting condition. The policy or certificate may not define a preexisting condition more restrictively than as a condition for which medical advice was given or treatment was recommended by or received from a physician within 6 months before the effective date of coverage. [PL 1991, c. 740, §4 (NEW).]

4. Specific standards. The superintendent shall adopt rules to establish specific standards for policy provisions of Medicare supplement policies and certificates. These standards must be in addition to and in accordance with applicable laws of this State. No requirement of the insurance laws relating to minimum required policy benefits, other than the minimum standards contained in this chapter, applies to Medicare supplement policies and certificates. The standards may cover, but are not limited to: A. Terms of renewability; [PL 1991, c. 740, §4 (NEW).] B. Initial and subsequent conditions of eligibility; [PL 1991, c. 740, §4 (NEW).] C. Nonduplication of coverage; [PL 1991, c. 740, §4 (NEW).] D. Probationary periods; [PL 1991, c. 740, §4 (NEW).] E. Benefit limitations, exceptions and reductions, which may not be more restrictive than those of Medicare for any type of care covered under the policy; [PL 1991, c. 740, §4 (NEW).] F. Elimination periods; [PL 1991, c. 740, §4 (NEW).] G. Requirements for replacement; [PL 1991, c. 740, §4 (NEW).] H. Recurrent conditions; and [PL 1991, c. 740, §4 (NEW).] I. Definitions of terms. [PL 1991, c. 740, §4 (NEW).] [PL 1991, c. 740, §4 (NEW).]

5. Minimum standards for benefits, claims, marketing, compensation and reporting. The superintendent shall adopt reasonable rules to establish minimum standards for benefits, claims payment, marketing practices and compensation arrangements and reporting practices for Medicare supplement policies and certificates. [PL 1991, c. 740, §4 (NEW).]

6. Other policies not prohibited. Nothing in this section may be construed to prohibit the sale of insurance policies or contracts to persons eligible for Medicare by reason of age because those policies or contracts fail to meet the requirements of this chapter. Such policies may not be advertised, marketed or designed as Medicare supplement policies. [PL 1991, c. 740, §4 (NEW).]

7. Method of identification. The superintendent shall prescribe the method of identification of Medicare supplement policies. The superintendent shall prescribe a method of identification of health insurance policies other than Medicare supplement policies or contracts that are advertised, marketed or designed for persons eligible for Medicare by reason of age. That method may include, but is not limited to, a requirement that such policies clearly indicate they are limited benefit health coverage policies and clearly specify that they do not meet the minimum standards for Medicare supplement policies. [PL 1991, c. 740, §4 (NEW).]

8. Conformance of policies to federal law. The superintendent may adopt from time to time such reasonable rules as are necessary to conform Medicare supplement policies and certificates to the requirements of federal law and rules adopted pursuant to federal law, including but not limited to: A. Requiring refunds or credits if the policies or certificates do not meet loss ratio requirements; [PL 1991, c. 740, §4 (NEW).] B. Establishing a uniform methodology for calculating and reporting loss ratios; [PL 1991, c. 740, §4 (NEW).] C. Assuring public access to policies, premiums and loss ratio information of issuers of Medicare supplement insurance; [PL 1991, c. 740, §4 (NEW).] D. Establishing a process for approving or disapproving policy forms and certificate forms and proposed premium increases; [PL 1991, c. 740, §4 (NEW).] E. Establishing a policy for holding public hearings prior to approval of premium increases; and [PL 1991, c. 740, §4 (NEW).] F. Establishing standards for Medicare select policies and certificates. [PL 1991, c. 740, §4 (NEW).] [PL 1991, c. 740, §4 (NEW).]

9. Prohibited policy provisions. The superintendent may adopt reasonable rules that prohibit policy provisions not specifically authorized by statute that in the opinion of the superintendent are unjust, unfair or unfairly discriminatory to any person insured or proposed to be insured under a Medicare supplement policy or certificate. [PL 1991, c. 740, §4 (NEW).]
24-A M.R.S. § 5010 — ME Code / Title 24-A / Chapter 67 / Section 5010
24-A §5010. Replacement of policies issued prior to January 1, 1992
Status: in_force

1. Applicability. This section applies to individual policies and group certificates and policies issued in Maine or covering Maine residents. [PL 1991, c. 740, §13 (NEW).]

2. Insured's right to replace coverage. Insureds under Medicare supplement policies issued prior to January 1, 1992 shall be permitted at any time to replace their coverage with any of the standardized plans offered by the same insurer, subject to the following conditions. A. The issuer may decline to issue a particular standardized plan to an existing insured if: (1) The standardized plan includes coverage of prescription drugs greater than that in the plan being replaced; and (2) The insured does not otherwise qualify for the standardized plan. [PL 1991, c. 740, §13 (NEW).] B. If the standardized plan is rated on the basis of age at issue, the issuer shall use the insured's age at the time of issue of the prior policy. [PL 1991, c. 740, §13 (NEW).] C. The issuer shall provide at each policy anniversary, and at the time of any rate increase, a notice describing the standardized plans which are available and the rates for those plans. [PL 1991, c. 740, §13 (NEW).] [PL 1993, c. 154, §3 (AMD).]

3. Mandatory replacement. Prior to October 1, 1992, all issuers shall submit to the superintendent a copy of each Medicare supplement policy form for which policies issued prior to January 1, 1992 are in force in Maine and a list of standardized plans offered on the effective date of this section. The issuer shall designate the standardized plan, if any, that has substantially similar benefits to the policy issued prior to January 1, 1992. For any of the policies that the superintendent determines are substantially similar to one of the offered standardized plans, the issuer shall replace the policy with the similar standardized plan or, at the option of the insured, one of the other standardized plans selected by the insured pursuant to subsection 2 , on or before the first policy anniversary after June 30, 1993. [PL 1993, c. 154, §3 (AMD).]
24-A M.R.S. § 6810 — ME Code / Title 24-A / Chapter 85 / Section 6810
24-A §6810. Rules
Status: in_force

The superintendent may adopt rules implementing this chapter. These rules are routine technical rules under Title 5, chapter 375, subchapter 2‑A . Rules may be adopted to: [PL 2003, c. 636, §13 (AMD).]

1. Standards for evaluating reasonableness of payments. Establish standards for evaluating the reasonableness of payments to viators under a settlement contract only when the insured in the policy that is the subject of a settlement contract is terminally ill or chronically ill. This authority includes, but is not limited to, regulation of discount rates used to determine the amount paid in exchange for assignment, transfer, sale, devise or bequest of a benefit under a life insurance policy; [PL 2003, c. 636, §13 (NEW).]

2. Licensing requirements and standards. Establish appropriate licensing requirements and standards for continued licensure for settlement providers; [PL 2003, c. 636, §13 (NEW).]

3. Mechanism for financial accountability. Require a bond or other mechanism for financial accountability for settlement providers; [PL 2003, c. 636, §13 (NEW).]

4. Govern relationship and responsibilities. Govern the relationship and responsibilities of both insurers and settlement providers and settlement producers and others in the business of settlement during the period of consideration or effectuation of a settlement contract; and [PL 2003, c. 636, §13 (NEW).]

5. Implement other requirements. Implement any other requirements of this chapter. [PL 2003, c. 636, §13 (NEW).]
24-A M.R.S. § 3001 — ME Code / Title 24-A / Chapter 41 / Section 3001
24-A §3001. Contracts subject to general provisions
Status: in_force

All contracts of property insurance covering subjects located in this State are subject to this chapter, to the applicable provisions of chapter 27 (the insurance contract) and to other applicable provisions of this Title. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 7757 — ME Code / Title 24-A / Chapter 103 / Section 7757
24-A §7757. Enforcement
Status: in_force

1. Enforcement; violation. Notwithstanding section 12‑A , a violation of this chapter is subject to enforcement under the Maine Unfair Trade Practices Act, including any of the remedies provided for in that Act. A violation is committed each time a prohibited act under this chapter occurs. An investigation of a violation by a manufacturer may include a wholesaler or 3rd party that may possess evidence supporting that investigation. [PL 2025, c. 388, Pt. P, §5 (NEW).]

2. Exemption from enforcement. The limited distribution of a drug required under 21 United States Code, Section 355-1 is not a violation of this chapter. [PL 2025, c. 388, Pt. P, §5 (NEW).]
24-A M.R.S. § 7110 — ME Code / Title 24-A / Chapter 91 / Section 7110
24-A §7110. Unfair methods of competition; unfair and deceptive acts and practices
Status: in_force

1. Prohibited acts and practices. A person may not engage in this State in any act or practice determined by the superintendent to be unfair or deceptive or in any of the following acts or practices in connection with the marketing, sale, offering for sale, issuance, making, proposing to make or administration or solicitation of a service contract. A. A person may not make, issue, circulate, or cause to be made, issued or circulated, any estimate, illustration, circular or statement misrepresenting the terms of any service contract issued or to be issued or the benefits or advantages promised thereby or make any misleading representation or any misrepresentation as to the financial condition of any provider. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] B. A person may not make, publish, disseminate, circulate or place before the public, or cause, directly or indirectly, to be made, published, disseminated, circulated or placed before the public, in a newspaper, magazine or other publication or on a business card, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, an advertisement, announcement or statement containing any assertion, representation or statement with respect to the business of service contracts or with respect to any person in the conduct of that person's service contract business in a manner that is untrue, deceptive or misleading. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] C. A person may not file with any supervisory or other public official, or make, publish, disseminate, circulate or deliver to any person, or place before the public, or cause directly or indirectly to be made, published, disseminated, circulated, delivered to any person or placed before the public, any false statement of financial condition of a provider with intent to deceive. A person may not make any false entry in any book, report or statement of any provider with intent to deceive any agent or examiner lawfully appointed to examine into its condition or into any of its affairs, or any public official to whom such person is required by law to report, or who has authority by law to examine into its condition or into any of its affairs, or, with like intent, willfully omit to make a true entry of any material fact pertaining to the business of such person in any book, report or statement of such provider. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] D. A person may not engage in any of the following service contract claims practices in conscious disregard of this section and any rules adopted under this section or with such frequency as to indicate a general business practice of the person to engage in such conduct: (1) Knowingly misrepresenting to service contract holders relevant facts or service contract provisions related to coverages at issue; (2) Failing to acknowledge with reasonable promptness pertinent written communications with respect to claims arising under its service contracts; (3) Failing to develop and maintain documented claim files supporting decisions made regarding liability; (4) Refusing to pay claims without conducting a reasonable investigation; (5) Failing, in the case of claims denials, to provide an accurate explanation of the basis for those actions; or (6) Failing to adopt and implement reasonable standards to ensure that the repairs of a repairer owned by or required to be used by the provider are performed in a competent and professional manner. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] E. A provider may not use in its name the words "insurance," "casualty," "surety," "mutual" or any other words descriptive of the insurance, casualty or surety business or use a name deceptively similar to the name or description of any insurance or surety corporation or to the name of any other provider. The word "guaranty" or a similar word may be used by a provider. This section does not apply to a provider that was using any of the prohibited language in its name prior to January 1, 2012; however, such provider must include in its service contracts a statement in substantially the following form: "This agreement is not subject to regulation as an insurance contract." [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] F. A person, including but not limited to a bank, savings and loan association, lending institution, manufacturer or seller of any product may not require the purchase of a service contract as a condition of a loan or a condition for the sale of any property. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] G. A provider of a service contract on a motor vehicle or its representative may not, directly or indirectly, represent in any manner, whether by written solicitation or telemarketing, a false, deceptive or misleading statement with respect to: (1) The provider's affiliation with a motor vehicle manufacturer; (2) The provider's possession of information regarding a motor vehicle owner's current motor vehicle manufacturer's original equipment warranty; (3) The expiration of a motor vehicle owner's current motor vehicle manufacturer's original equipment warranty; or (4) A requirement that a motor vehicle owner register for a new motor vehicle service contract with the provider in order to maintain coverage under the motor vehicle owner's current motor vehicle service contract or manufacturer's original equipment warranty. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

2. Cease and desist order. The superintendent may issue a cease and desist order pursuant to section 12‑A, subsection 2 if, after a hearing, the superintendent finds that any person in the State has engaged or is engaging, or that a resident of the State has engaged or is engaging in another state, in an unfair or deceptive practice not described in this chapter or in rules adopted pursuant to this chapter. For any practice not described in this chapter or in rules adopted pursuant to this chapter, the civil penalties set forth in section 12‑A, subsection 1 may not be imposed for practice engaged in prior to the issuance and service of a valid cease and desist order. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]
24-A M.R.S. § 3613 — ME Code / Title 24-A / Chapter 51 / Section 3613
24-A §3613. Guaranty capital shares; retirement
Status: in_force

Guaranty capital shares may be retired by vote of the policyholders of the insurer when the insurer's surplus, over and above all liabilities including guaranty capital, equals or exceeds the amount of the guaranty capital shares. The guaranty capital shares may be retired in part when the insurer's remaining net surplus and guaranty fund will not thereby be reduced below the amount of original guaranty capital. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 1450 — ME Code / Title 24-A / Chapter 16 / Section 1450
24-A §1450. Commissions; payment; acceptance
Status: in_force

1. Commissions. Except as provided in section 1420‑L , an insurer, health maintenance organization, fraternal benefit society or nonprofit hospital or medical service organization may not pay to any unlicensed person, either directly or indirectly, any commission on a sale of a contract of insurance issued on a risk located or to be performed within this State unless at the time of the taking of the application for the insurance the person was duly licensed by this State as an insurance producer as to the kind or kinds of insurance involved. An unlicensed person or business entity may not receive or accept any commission or compensation for insurance unless licensed pursuant to this chapter. [PL 2001, c. 259, §43 (AMD).]

2. Shared commissions. If an insurance producer does not have an appointment with an insurer, the insurance producer may place with that insurer, through a duly licensed and appointed producer of such insurer, an insurance coverage necessary for the adequate protection of a subject of insurance and share in the commission on that insurance, if each producer is licensed as to the kinds of insurance involved. A. [PL 2011, c. 238, Pt. H, §5 (RP).] B. [PL 2011, c. 238, Pt. H, §5 (RP).] C. [PL 2011, c. 238, Pt. H, §5 (RP).] D. [PL 2011, c. 238, Pt. H, §5 (RP).] E. [PL 2011, c. 238, Pt. H, §5 (RP).] [PL 2011, c. 238, Pt. H, §5 (AMD).]

3. Rules. With respect to the sale of property and casualty insurance sold to large commercial insurance risks, producers may be compensated by fees paid by or on behalf of the insured, by commissions paid by an insurer or by a combination of both. The superintendent may adopt rules to establish standards for determining large commercial insurance risks. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]
24-A M.R.S. § 2396 — ME Code / Title 24-A / Chapter 26 / Section 2396
24-A §2396. Coordination of law
Status: repealed

1. Causes of action extinguished; exception. Notwithstanding Title 1, section 302 , a cause of action or administrative proceeding that could have been asserted or instituted, whether or not pending, prior to or on the effective date of this Act arising out of or relating to sections 2386 and 2386-A and their predecessor statutes, sections 2366 and 2367 or due to an insurer's performance as a servicing carrier or other participation in the residual market mechanism may not exist or be brought against the pool, the board or an insurer that has timely paid to the pool in full at least the allocated share pursuant to section 2393, subsection 1 . This subsection does not apply to: claims by servicing carriers for quarterly reimbursement from the pool; claims arising from a written agreement among any of the major insurers and the pool relating to payment of the allocated share of a delinquent insurer pursuant to section 2393, subsection 1 ; claims by an individual policyholder against its insurer; or claims by employees for benefits under residual market policies. [PL 1995, c. 289, §11 (NEW).]

2. Repeal of chapter 720. The Bureau of Insurance Rules, chapter 720, is repealed effective July 1, 1995. The collection procedures set forth in section 2393, subsection 2, paragraph D , subparagraph (2) apply to surcharges assessed under chapter 720 prior to the effective date of this chapter. [PL 1995, c. 289, §11 (NEW).]

3. Vacation of orders. All orders of the superintendent relating to surcharges and assessments arising out of section 2386‑A are vacated except to the extent that they establish the amount and method of calculation of surcharges paid or to be paid by employers on policies issued or renewed with effective dates on or before June 30, 1995, and self-insurance plan years beginning on or before June 30, 1995. All other decisions, orders and rules issued and adopted by the superintendent relating to workers' compensation insurance are invalid to the extent that they are inconsistent with this chapter. [PL 1995, c. 289, §11 (NEW).]
24-A M.R.S. § 6909 — ME Code / Title 24-A / Chapter 87 / Section 6909
24-A §6909. Executive director
Status: in_force

1. Appointed position. The executive director is appointed by the board and serves at the pleasure of the board. The position of executive director is a major policy-influencing position as designated in Title 5, section 934‑B . [PL 2003, c. 469, Pt. A, §8 (NEW).]

2. Duties of executive director. The executive director shall: A. Serve as the liaison between the board and Dirigo Health and serve as secretary and treasurer to the board; [PL 2007, c. 447, §8 (AMD).] B. Manage Dirigo Health's programs and services, including the Maine Quality Forum established under section 6951 ; [PL 2003, c. 469, Pt. A, §8 (NEW).] C. Employ or contract on behalf of Dirigo Health for professional and nonprofessional personnel or service. Employees of Dirigo Health are subject to the Civil Service Law, except that the position of Director of the Maine Quality Forum is not subject to the Civil Service Law; [PL 2003, c. 469, Pt. A, §8 (NEW).] D. Approve all accounts for salaries, per diems, allowable expenses of Dirigo Health or of any employee or consultant and expenses incidental to the operation of Dirigo Health; and [PL 2003, c. 469, Pt. A, §8 (NEW).] E. Perform other duties prescribed by the board to carry out the functions of this chapter. [PL 2003, c. 469, Pt. A, §8 (NEW).] [PL 2007, c. 447, §8 (AMD).]
24-A M.R.S. § 3419 — ME Code / Title 24-A / Chapter 47 / Section 3419
24-A §3419. Pension and other plans for employees and others
Status: in_force

1. Pursuant to the terms of a pension plan or plans or any modification thereof, heretofore or hereafter adopted by the insurer's board of directors and approved by the superintendent, any domestic stock or mutual insurer may pay the whole or any part of the cost of retirement or disability pensions for such of its officers, employees or full-time insurance agents as are specified in such plan or plans or modifications thereof. If so specified in the plan or plans, in lieu of such pensions actuarially equivalent benefits may be paid to such officers, employees or full-time agents or to their designated beneficiaries. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. The superintendent shall approve any such plan unless the superintendent finds the same not to be within the reasonable financial resources of the insurer or not fair and equitable as between the respective classifications of participants therein. [RR 2021, c. 1, Pt. B, §279 (COR).]

3. Nothing contained in this section or in section 3420 shall be deemed to prohibit profit-sharing, stock option or similar plans for an insurer's officers, employees or agents. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2515 — ME Code / Title 24-A / Chapter 29 / Section 2515
24-A §2515. Title
Status: in_force

There shall be a title on the policy, briefly describing the same. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 207 — ME Code / Title 24-A / Chapter 3 / Section 207
24-A §207. Staff
Status: in_force

The superintendent may employ personnel as the business of the bureau may require, subject to the Commissioner of Professional and Financial Regulation's approval and in accordance with the Civil Service Law. The qualifications of those personnel must reflect the needs and responsibilities relating to the bureau's regulatory functions pursuant to this Title. The superintendent may authorize senior personnel of the bureau to carry out the superintendent's duties and authority. [PL 1995, c. 502, Pt. H, §17 (RPR).]
24-A M.R.S. § 3305 — ME Code / Title 24-A / Chapter 47 / Section 3305
24-A §3305. "Stock," "mutual" insurers defined
Status: in_force

1. A "stock" insurer is as defined in section 400 . [PL 1969, c. 132, §1 (NEW).]

2. A "mutual" insurer is as defined in section 401 . [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3607 — ME Code / Title 24-A / Chapter 51 / Section 3607
24-A §3607. Capital funds required; existing insurers
Status: in_force

1. A mutual assessment insurer heretofore organized to transact and transacting only fire, marine and glass insurance shall not have a net retention of liability on any one risk in excess of $200 until its gross assets exceed $2,000, after which its net retention of liability shall be as provided in section 3623 . [PL 1969, c. 132, §1 (NEW).]

2. Mutual insurers organized prior to January 1968 to transact and transacting kinds of insurance other than fire, marine and glass shall have a guaranty capital fund in amount not less than as required under laws in force immediately prior to January 1, 1970, and if organized on or after January 1, 1968, shall have guaranty capital funds of not less than $500,000. Such an insurer shall not be authorized to transact insurance until at least 1/4 of its guaranty capital funds have been paid in, in cash, and invested in such manner as is provided in chapter 13 . [PL 1973, c. 625, §150 (AMD).]

3. If an insurer operating under this section fails to comply with the superintendent's request to increase its paid-in guaranty capital funds within the amount otherwise required by law, it shall cease to write any class or kind of insurance other than fire, marine or glass until such time as the superintendent's request has been complied with. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

4. Except as hereinabove provided, all such insurers holding subsisting certificates of authority immediately prior to January 1, 1970 may continue to be so authorized as long as qualified for such authority as under laws in force immediately prior to such effective date. [PL 1973, c. 625, §150 (AMD).]
24-A M.R.S. § 3411 — ME Code / Title 24-A / Chapter 47 / Section 3411
24-A §3411. Directors
Status: in_force

1. The affairs of every domestic insurer must be managed by a board of directors consisting of not less than 7 directors or more than 21 directors, except that a domestic insurer may be managed by an initial board of not less than 3 directors during its first year of existence if so provided for by its articles of incorporation. [PL 2013, c. 299, §11 (AMD).]

2. Directors, other than initial directors named in the insurer's articles of incorporation, must be elected by the members or stockholders of a domestic insurer at the annual meeting of stockholders or members. Directors may be elected for terms of not more than 3 years each and until their successors are elected and have qualified; and, if the directors are to be elected for terms of more than one year, the insurer's bylaws may provide for a staggered term system under which the terms of a proportionate part of the members of the board of directors expire on the date of each annual meeting of stockholders or members. A directorship becoming vacant before expiration of the term may be filled by the board of directors for the remainder of the term. [RR 2023, c. 2, Pt. A, §35 (COR).]
24-A M.R.S. § 2527 — ME Code / Title 24-A / Chapter 29 / Section 2527
24-A §2527. Provisions required by law of other jurisdiction
Status: in_force

The policies of a foreign life insurer may contain any provision which the law of the state, territory, district, or country under which the insurer is organized prescribes shall be in such policies when issued in this State, and the policies of a domestic life insurer may, when issued or delivered in any other state, territory, district, or country, contain any provisions required by the laws thereof, anything in this chapter to the contrary notwithstanding. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2806 — ME Code / Title 24-A / Chapter 35 / Section 2806
24-A §2806. Trustee groups
Status: in_force

A group of individuals may be insured under a policy issued to a trust or to the trustee or trustees of a fund established by 2 or more employers, or by one or more labor unions or similar employee organizations, or by one or more employers and one or more labor unions or similar employee organizations, which trust or trustee or trustees shall be deemed the policyholder, to insure employees of the employers or members of the unions or organizations for the benefit of persons other than the employers or the unions or organizations, subject to the following requirements. [PL 1981, c. 147, §5 (RPR).]

1. The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions or organizations, or all of any class or classes thereof. The policy may provide that the term "employees" includes retired employees, the individual proprietor or partners if an employer is an individual proprietorship or a partnership and directors of a corporate employer. The policy may provide that the term "employees" includes the trustees or their employees, or both, if their duties are principally connected with that trusteeship. [PL 1981, c. 147, §5 (RPR).]

2. The premium for the policy shall be paid from funds contributed by the employer or employers of the insured persons or by the union or unions or similar employee organizations, or by both, or from funds contributed by the insured persons or from both the insured persons and the employer or union or similar employee organization. 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 persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing. [PL 1981, c. 147, §5 (RPR).]

3. Except as provided in section 2736‑C , section 2808‑B and chapter 36 , 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 1999, c. 256, Pt. G, §4 (AMD).]

4. [PL 1981, c. 147, §5 (RP).]
24-A M.R.S. § 4368 — ME Code / Title 24-A / Chapter 57 / Section 4368
24-A §4368. Form of claim; notice; hearing
Status: in_force

1. All claims against an insurer against which delinquency proceedings have been begun must set forth in reasonable detail the amount of the claim, or the basis upon which such amount can be ascertained, the facts upon which the claim is based, and the priorities asserted, if any. All such claims must be verified by the affidavit of the claimant or someone authorized to act on the claimant's behalf and having knowledge of the facts, and must be supported by such documents as may be material thereto. [RR 2021, c. 1, Pt. B, §365 (COR).]

2. All claims filed in this State shall be filed with the receiver, whether domiciliary or ancillary, in this State, on or before the last date for filing as specified in this chapter. [PL 1969, c. 132, §1 (NEW).]

3. Within 10 days of the receipt of any claim, or within such further period as the court may fix for good cause shown, the receiver shall report the claim to the court, specifying in such report the receiver's recommendation with respect to the action to be taken thereon. Upon receipt of such report, the court shall fix a time for hearing the claim and shall direct that the claimant or the receiver, as the court specifies, must give such notice as the court determines to such persons as appear to the court to be interested therein. All such notices must specify the time and place of the hearing and must concisely state the amount and nature of the claim, the priorities asserted, if any, and the recommendation of the receiver with reference thereto. [RR 2021, c. 1, Pt. B, §366 (COR).]

4. At the hearing, all persons interested shall be entitled to appear and the court shall enter an order allowing, allowing in part, or disallowing the claim. Any such order shall be deemed to be an appealable order. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4349-A — ME Code / Title 24-A / Chapter 56-C / Section 4349-A
24-A §4349-A. Discriminatory reimbursement of pharmacy providers prohibited
Status: in_force

A carrier, or a pharmacy benefits manager under contract with a carrier, may not reimburse a pharmacy provider for a prescription drug or pharmacy service in an amount that is less than the reimbursement amount paid to a pharmacy provider affiliated with the carrier or pharmacy benefits manager for the same prescription drug or pharmacy service. [PL 2025, c. 335, §1 (NEW).]

Revisor's Note: §4349-A. Plan sponsor access to claims data; right to audit (As enacted by PL 2025, c. 487, §3 is REALLOCATED TO TITLE 24-A, SECTION 4349-B)
24-A M.R.S. § 959 — ME Code / Title 24-A / Chapter 11 / Section 959
24-A §959. Reserves subject to valuation manual
Status: in_force

1. General requirement. On and after the operative date of the valuation manual, reserves on policies and contracts of subject lines of insurance must be valued as follows, except as otherwise specifically provided in this section or in rules adopted by the superintendent: A. For policies and contracts issued on and after the operative date of the valuation manual, in accordance with the valuation manual; [PL 2013, c. 238, Pt. C, §9 (NEW).] B. For policies and contracts described in sections 953 to 958‑A and issued before the operative date of the valuation manual, in accordance with those sections; and [PL 2013, c. 238, Pt. C, §9 (NEW).] C. For health insurance policies and contracts issued before the operative date of the valuation manual, and any other policies and contracts outside the scope of paragraphs A and B , in accordance with rules adopted by the superintendent. [PL 2013, c. 238, Pt. C, §9 (NEW).] [PL 2013, c. 238, Pt. C, §9 (NEW).]

2. Necessary provisions. The valuation manual must specify all of the following: A. Definitions of the policies and contracts subject to this section; [PL 2013, c. 238, Pt. C, §9 (NEW).] B. The following minimum valuation standards for all policies and contracts subject to this section: (1) The commissioners reserve valuation method for life insurance contracts, other than annuity contracts; (2) The commissioners annuity reserve valuation method for annuity contracts; and (3) Minimum reserves for all other policies or contracts; [PL 2013, c. 238, Pt. C, §9 (NEW).] C. Provisions specifying which policies and contracts or types of policies and contracts are subject to section 960 and specifying the minimum valuation standards consistent with those provisions; [PL 2013, c. 238, Pt. C, §9 (NEW).] D. For policies and contracts subject to section 960 : (1) Requirements for the format of reports to the superintendent under section 960, subsection 3, paragraph C , which must include information necessary to determine whether the valuation is appropriate and in compliance with this subchapter; (2) Assumptions to be prescribed for risks over which the insurer does not have significant control or influence; and (3) Procedures for corporate governance and oversight of the actuarial function and a process for appropriate waiver or modification of such procedures; [PL 2013, c. 238, Pt. C, §9 (NEW).] E. For policies and contracts not subject to section 960 , a minimum valuation standard that either: (1) Is consistent with the minimum standard of valuation for policies and contracts issued before the operative date of the valuation manual; or (2) Develops reserves that quantify the benefits and guarantees, and the funding, associated with the policies and contracts and their risks at a level of conservatism that reflects conditions that include unfavorable events that have a reasonable probability of occurring; [PL 2013, c. 238, Pt. C, §9 (NEW).] F. Other requirements, including, but not limited to, those relating to reserve methods, models for measuring risk, generation of economic scenarios, assumptions, margins, use of insurer experience, risk measurement, disclosure, certifications, reports, actuarial opinions and memoranda, transition rules and internal controls; and [PL 2013, c. 238, Pt. C, §9 (NEW).] G. The data and form of the data required under section 961 . The requirements must specify to whom the data must be submitted and may specify other requirements, including requirements with respect to data analyses and reporting of analyses. [PL 2013, c. 238, Pt. C, §9 (NEW).] [PL 2013, c. 238, Pt. C, §9 (NEW).]

3. Supplementation and resolution of conflicts. In the absence of a specific valuation requirement or if the superintendent determines that a specific valuation requirement in the valuation manual is not consistent with the requirements or purposes of this subchapter, an insurer shall comply with minimum valuation standards prescribed by the superintendent by rule or order. [PL 2013, c. 238, Pt. C, §9 (NEW).]

4. Examination. For an insurer subject to this section, the superintendent may hire, contract with or otherwise engage a qualified actuary, at the insurer's expense, to perform an actuarial examination of the insurer and provide an opinion on the appropriateness of any reserve assumption or method used by the insurer or to review and provide an opinion on the insurer's compliance with any requirement of this subchapter. The superintendent may rely on any actuarial opinion issued on behalf of another insurance regulator in the United States that is relevant to an insurer's compliance with this subchapter. [PL 2013, c. 238, Pt. C, §9 (NEW).]

5. Corrections. The superintendent may require an insurer to change any assumption or method as determined necessary by the superintendent to comply with the requirements of the valuation manual or this subchapter, and the insurer shall adjust the reserves as required by the superintendent. [PL 2013, c. 238, Pt. C, §9 (NEW).]

6. Violations. Violations of this subchapter are subject to all remedies specified in section 12‑A or otherwise available by law. [PL 2013, c. 238, Pt. C, §9 (NEW).]

7. Changes to valuation manual. Unless a later effective date is specified or the superintendent has disapproved the change by rule, a change to the valuation manual is effective on January 1st following the adoption of the change by an affirmative vote of the NAIC representing: A. At least 3/4 of the NAIC members voting; [PL 2013, c. 238, Pt. C, §9 (NEW).] B. At least a majority of the total NAIC membership; and [PL 2013, c. 238, Pt. C, §9 (NEW).] C. Jurisdictions totaling greater than 75% of the aggregate written direct premiums reported in the most recently available life, accident and health annual statements; health annual statements; and fraternal annual statements. [PL 2013, c. 238, Pt. C, §9 (NEW).] [PL 2013, c. 238, Pt. C, §9 (NEW).]
24-A M.R.S. § 2939 — ME Code / Title 24-A / Chapter 40 / Section 2939
24-A §2939. Cancellation and nonrenewal
Status: in_force

1. Cancellation and nonrenewal shall be subject to the applicable provisions set forth elsewhere in this Title. [PL 1973, c. 625, §146 (NEW).]

2. The failure of an employer, association, organization or other group to remit premiums when due for any reason, including, but not limited to, interruption or termination of employment or membership, may not be regarded as nonpayment of premium by any insured under any such plan providing for remittance of premium by such employer, association, organization or other group, unless such insured has been given written notice of such failure to remit and has not paid such premium by the later of 20 days after such notice, or the due date of such premium remittance under the mass marketing plan or pursuant to regulations set forth by the superintendent. [RR 2021, c. 1, Pt. B, §259 (COR).]

3. Upon the termination of employment or membership or upon the discontinuance of the mass marketing plan, such insured member or employee may maintain the insured member's or employee's policy in force, in the same amount, upon payment of the premium applicable to the class of risk to which the insured member or employee belongs, on an individual basis. [RR 2021, c. 1, Pt. B, §260 (COR).]

4. Any notice of cancellation or nonrenewal of any policy of any employee or member insured under a mass marketing plan must be accompanied by a notice to the employee or member that, at the employee's or member's request, the insurer will afford the employer, association, organization or other group a reasonable opportunity to consult with the insured and to present facts in opposition to cancellation or nonrenewal. [RR 2021, c. 1, Pt. B, §261 (COR).]
24-A M.R.S. § 479 — ME Code / Title 24-A / Chapter 5 / Section 479
24-A §479. Penalties
Status: in_force

Any violation of any order issued by virtue of this subchapter or any rule or regulatory provision made by the superintendent pursuant thereto shall be punishable by a fine of not more than $1,000 or by imprisonment for less than one year, or by both. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 3625 — ME Code / Title 24-A / Chapter 51 / Section 3625
24-A §3625. Directors' residence, compensation
Status: in_force

1. A majority of the board of directors of the insurer shall be residents of, and actually reside in, this State. [PL 1969, c. 132, §1 (NEW).]

2. The salary or compensation for services of the directors of the insurer shall be fixed by the policyholders at their annual meeting. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4141 — ME Code / Title 24-A / Chapter 55 / Section 4141
24-A §4141. Exemptions
Status: in_force

Except as herein provided, societies shall be governed by this chapter and shall be exempt from all other provisions of the insurance laws of this State, not only in governmental relations with the state, but for every other purpose. No law hereafter enacted shall apply to them, unless they be expressly designated therein. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 5014 — ME Code / Title 24-A / Chapter 67 / Section 5014
24-A §5014. Additional penalties
Status: in_force

1. Penalties. In addition to any other applicable penalties for violations of this Title or Title 24 , the superintendent may order issuers violating any provision of this chapter or any rule adopted pursuant to this chapter to: A. Comply with the provisions of this chapter; or [PL 1995, c. 570, §9 (NEW).] B. Cease marketing any Medicare supplement policy or certificate in this State that is directly or indirectly related to a violation. [PL 1995, c. 570, §9 (NEW).] [PL 1995, c. 570, §9 (NEW).]

2. Election of penalty options. The superintendent may exercise any of the penalty options provided by this section, in combination or in sequence, as the superintendent considers appropriate. [PL 1995, c. 570, §9 (NEW).]
24-A M.R.S. § 236 — ME Code / Title 24-A / Chapter 3 / Section 236
24-A §236. Appeal from the superintendent
Status: in_force

1. In general, judicial review of actions taken by the superintendent or the superintendent's representatives must occur in conformity with the provisions set forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter 7 . [RR 2009, c. 2, §65 (COR).]

2. An appeal from the superintendent shall be taken only from an order on hearing, or as to a matter on which the superintendent has failed to hold a hearing after application thereof under section 229 , or regarding a matter as to which the superintendent has failed to issue an order after hearing as required by section 235 . [PL 1977, c. 694, §397 (RPR).]

3. Any person who was a party to the hearing may appeal from an order of the superintendent within 30 days after receipt of notice. Any person not a party to the hearing whose interests are substantially and directly affected and who is aggrieved by an order of the superintendent may appeal within 40 days from the date the decision was rendered. If the appeal is taken from the superintendent's failure or refusal to act, the petition for review shall be filed within 6 months of the expiration of the time within which the action should reasonably have occurred. [PL 1977, c. 694, §397 (RPR).]

4. [PL 1989, c. 269, §9 (RP).]

5. [PL 1989, c. 269, §9 (RP).]

6. [PL 1989, c. 269, §9 (RP).]

7. [PL 1989, c. 269, §9 (RP).]

8. [PL 1989, c. 269, §9 (RP).]

9. [PL 1989, c. 269, §9 (RP).]

10. [PL 1989, c. 269, §9 (RP).]
24-A M.R.S. § 2381 — ME Code / Title 24-A / Chapter 25 / Section 2381
24-A §2381. Title
Status: in_force

This subchapter may be known and cited as the "Workers' Compensation Rating Act." [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]
24-A M.R.S. § 3618 — ME Code / Title 24-A / Chapter 51 / Section 3618
24-A §3618. -- order of notice to parties interested, and proceedings
Status: in_force

The court before which the complaint described in section 3617 is filed shall order notice to all parties interested, by publication or otherwise. Upon the return thereof, the court shall proceed to examine the assessment or call, the necessity therefor and all matters connected therewith. Any parties interested may appear and be heard thereon, and all questions that may arise shall be heard and determined as in other civil actions in which equitable relief is sought. The court may refer the apportionment or calculation to any competent person, and upon the examination may ratify, amend or annul the assessment or call, or order one to be made. In case the assessment or call is altered or amended, or one is ordered, the directors shall forthwith proceed to vote the same in legal form and the record of such vote shall be set forth in a supplemental answer. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2533 — ME Code / Title 24-A / Chapter 29 / Section 2533
24-A §2533. Calculation of cash surrender value of certain policies on default
Status: in_force

Any cash surrender value and any paid-up nonforfeiture benefit, available under the policy in the event of default in a premium payment due at any time other than on the policy anniversary, shall be calculated with allowance for the lapse of time and the payment of fractional premiums beyond the last preceding policy anniversary. All values referred to in sections 2530 to 2532‑A may be calculated upon the assumption that any death benefit is payable at the end of the policy year of death. The net value of any paid-up additions, other than paid-up term additions, shall be not less than the amounts used to provide those additions. Notwithstanding section 2530 , additional benefits payable: [PL 1983, c. 346, §15 (AMD).]

1. Death or accident. In the event of death or dismemberment by accident or accidental means; [PL 1969, c. 132, §1 (NEW).]

2. Total disability. In the event of total and permanent disability; [PL 1969, c. 132, §1 (NEW).]

3. Reversionary annuity. As reversionary annuity or deferred reversionary annuity benefits; [PL 1969, c. 132, §1 (NEW).]

4. Term insurance benefits. As term insurance benefits provided by a rider or supplemental policy provisions to which, if issued as a separate policy, section 2529 to 2534 would not apply; [PL 1969, c. 132, §1 (NEW).]

5. Child term insurance benefits. As term insurance on the life of a child or on the lives of children provided in a policy on the life of a parent of the child, if such term insurance expires before the child's age is 26, is uniform in amount after the child's age is one, and has not become paid up by reason of the death of a parent of the child; and [PL 1969, c. 132, §1 (NEW).]

6. Other policy benefits. As other policy benefits additional to life insurance and endowment benefits; and premiums for all such additional benefits, shall be disregarded in ascertaining cash surrender values and nonforfeiture benefits required by sections 2529 to 2534 , and no such additional benefits shall be required to be included in any paid-up nonforfeiture benefits. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4336 — ME Code / Title 24-A / Chapter 56-A / Section 4336
24-A §4336. Disclosure requirements for organizations with downstream risk arrangements
Status: in_force

1. Disclosure to superintendent. Each carrier shall provide information concerning the carrier's downstream risk arrangements as required or requested by the superintendent. The disclosure must contain the following information in sufficient detail to enable the superintendent to determine whether the risk arrangement complies with the following requirements: A. Whether services not furnished by the downstream entity are covered by the risk arrangement. If the services furnished by the downstream entity are covered by the risk arrangement, disclosure of other aspects of the plan need not be made; [PL 1999, c. 609, §20 (NEW).] B. The type of risk arrangement; for example, withhold, bonus, capitation; [PL 1999, c. 609, §20 (NEW).] C. If the risk arrangement involves a withhold or bonus, the percent of the withhold or bonus; [PL 1999, c. 609, §20 (NEW).] D. The panel size, the number of enrollees covered by the downstream entity and the total number of enrollees covered by the carrier in the State; and [PL 1999, c. 609, §20 (NEW).] E. In the case of capitated downstream entities, capitation payments paid to primary care providers for the most recent year broken down by percent for primary care services, referral services to specialists, hospital services and other types of provider services, including, but not limited to, nursing home and home health agency services. [PL 1999, c. 609, §20 (NEW).] [PL 1999, c. 609, §20 (NEW).]

2. Annual disclosure. A carrier shall provide this information to the superintendent at least annually. A carrier shall provide the capitation data required under subsection 1 for the previous calendar year to the superintendent by April 1st of each year. [PL 1999, c. 609, §20 (NEW).]

3. Disclosure to enrollees. A carrier shall provide the following information to any enrollee upon request: A. Whether the prepaid plan uses a downstream risk arrangement that affects the use of referral services; and [PL 1999, c. 609, §20 (NEW).] B. The type of risk arrangement. [PL 1999, c. 609, §20 (NEW).] [PL 1999, c. 609, §20 (NEW).]
24-A M.R.S. § 1424-A — ME Code / Title 24-A / Chapter 16 / Section 1424-A
24-A §1424-A. Application for license
Status: in_force

1. Application. An individual applying for an insurance adjuster or consultant license shall apply to the superintendent on a form as determined by the superintendent and declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individual's knowledge and belief. Before approving the application, the superintendent must find that the individual: A. Has complied with the requirements of subchapter V in the case of consultants and subchapter VI in the case of adjusters; [PL 2001, c. 259, §29 (NEW).] B. Has not committed any act that is a ground for denial, suspension or revocation set forth in sections 1417 and 1420‑K ; [PL 2001, c. 259, §29 (NEW).] C. Has completed any prelicensing requirements for the license for which the person has applied, as specified in subchapter II ; [PL 2001, c. 259, §29 (NEW).] D. Has paid any required fees set forth in section 601 ; and [PL 2001, c. 259, §29 (NEW).] E. Has successfully passed the examinations for the license for which the person, if a resident, has applied. [PL 2001, c. 259, §29 (NEW).] [PL 2001, c. 259, §29 (NEW).]

2. Business entity. A business entity acting as an insurance adjuster or consultant is required to obtain an adjuster or consultant license. Application must be made using the uniform business entity application. Before approving the application, the superintendent must find that: A. The business entity has paid any required fees set forth in section 601 ; and [PL 2001, c. 259, §29 (NEW).] B. The business entity has designated a licensed person responsible for the business entity's compliance with the insurance laws, rules and regulations of this State. [PL 2001, c. 259, §29 (NEW).] [PL 2001, c. 259, §29 (NEW).]

3. Verification. The superintendent may require any documents reasonably necessary to verify the information contained in an application. [PL 2001, c. 259, §29 (NEW).]
24-A M.R.S. § 1484 — ME Code / Title 24-A / Chapter 16 / Section 1484
24-A §1484. Failure to comply
Status: in_force

The license of any insurance producer or consultant who is out of compliance with this subchapter for at least 60 days, is subject to suspension or revocation pursuant to section 1420‑K, subsection 1, paragraph B . [PL 2001, c. 259, §45 (AMD).]
24-A M.R.S. § 2861 — ME Code / Title 24-A / Chapter 37 / Section 2861
24-A §2861. Premium not deemed interest; amount, collection
Status: in_force

1. Except as provided in Title 9‑A, section 4‑104 , the premium of cost of such insurance when issued through any creditor shall not be deemed interest, or charges, or consideration, or an amount in excess of permitted charges in connection with the loan or other credit transaction, and any benefit or return or other gain or advantage to the creditor arising out of the sale or provision of such insurance shall not be deemed a violation of any other law, general or special, of the State of Maine. [PL 1973, c. 762, §11 (AMD).]

2. The amount charged to a debtor for any consumer credit insurance may not exceed the premiums charged by the insurer, as computed at the time the charge to the debtor is determined. [PL 2001, c. 138, §14 (AMD).]

3. The insurance premium or other identifiable charge for such insurance may be collected from the insured or included in the finance charge or principal of any loan or other credit transaction at the time such transaction is completed. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 425 — ME Code / Title 24-A / Chapter 5 / Section 425
24-A §425. Transactions with parent corporation, subsidiaries, and affiliates
Status: in_force

1. No insurer shall engage directly or indirectly in any transaction or agreement with its parent corporation, or with any subsidiary or affiliated person which shall result or tend to result in: A. Substitution through any method of any asset of the insurer with an asset or assets of inferior quality or lower fair market value; or [PL 1969, c. 132, §1 (NEW).] B. Deception as to the true operating results of the insurer; or [PL 1969, c. 132, §1 (NEW).] C. Deception as to the true financial condition of the insurer; or [PL 1969, c. 132, §1 (NEW).] D. Allocation to the insurer of a proportion of the expense of combined facilities or operations which is unfair and unfavorable to the insurer; or [PL 1969, c. 132, §1 (NEW).] E. Unfair, unnecessary or excessive charges against the insurer for services, or facilities, or supplies or reinsurance; or [PL 1969, c. 132, §1 (NEW).] F. Unfair and inadequate charges by the insurer for reinsurance, services, facilities or supplies furnished by the insurer to others; or [PL 1969, c. 132, §1 (NEW).] G. Payment by the insurer for services, facilities, supplies or reinsurance not reasonably needed by the insurer. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]

2. In all transactions between the insurer and its parent corporation, or involving the insurer and any subsidiary or affiliated person, full recognition shall be given to the paramount duty and obligation of the insurer to protect the interests of policyholders, both existing and future. [PL 1969, c. 132, §1 (NEW).]

3. For the purposes of this section a "subsidiary" is a person of which either the insurer or the parent corporation, or both, holds practical control, and an "affiliated person" is a person controlled by any combination of the insurer, the parent corporation, a subsidiary, or the principal stockholders or officers or directors of any of the foregoing. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2549 — ME Code / Title 24-A / Chapter 29 / Section 2549
24-A §2549. Disclosure of limited death benefits
Status: in_force

Any contract which does not provide cash surrender benefits or does not provide death benefits at least equal to the minimum nonforfeiture amount prior to the commencement of any annuity payments shall include a statement in a prominent place in the contract that those benefits are not provided. [PL 1979, c. 442, §4 (NEW).]
24-A M.R.S. § 1416 — ME Code / Title 24-A / Chapter 16 / Section 1416
24-A §1416. Limited insurance licenses
Status: in_force

1. Limited license. The superintendent may issue to an applicant qualified under this chapter a limited insurance producer license, in the areas of authority listed as such in section 1420‑F . [PL 2001, c. 259, §17 (AMD).]

2. Fee. The fee for a limited insurance producer license is specified in section 601 . [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]
24-A M.R.S. § 218 — ME Code / Title 24-A / Chapter 3 / Section 218
24-A §218. Publications; price
Status: in_force

The superintendent may have the directory of authorized insurers, of licensed insurance representatives, license examination material, insurance laws and related laws and regulations under the superintendent's administration published in pamphlet form from time to time, and may fix a price for each copy to cover cost of printing and mailing. [RR 2021, c. 1, Pt. B, §163 (COR).]
24-A M.R.S. § 1476 — ME Code / Title 24-A / Chapter 16 / Section 1476
24-A §1476. Activities of insurance adjusters
Status: in_force

The following requirements govern the activities of insurance adjusters. [PL 1997, c. 592, §43 (NEW).]

1. Solicitation. An adjuster seeking to provide adjusting services to an insured for a fee to be paid by the insured may not offer an adjustment services contract to any person for at least 36 hours after an accident or occurrence as a result of which the person might have a potential claim. [PL 2019, c. 382, §3 (AMD).]

2. Contract provision. Any such adjustment services contract must contain a provision, prominently printed on the first page of the contract, stating that the person contracting with the adjuster has the option to rescind the contract within 2 business days after the contract is signed. [PL 1997, c. 592, §43 (NEW).]
24-A M.R.S. § 2860 — ME Code / Title 24-A / Chapter 37 / Section 2860
24-A §2860. Authorized insurer, agent required
Status: in_force

All policies of consumer credit insurance may be delivered or issued for delivery in this State only by an insurer authorized to transact such insurance therein, and may be issued only through holders of licenses or authorizations issued by the superintendent. [PL 2001, c. 138, §13 (AMD).]
24-A M.R.S. § 2693 — ME Code / Title 24-A / Chapter 32-A / Section 2693
24-A §2693. Standards for policy provisions
Status: in_force

1. Rules regarding manner, content and required disclosure. The superintendent may adopt rules to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content and required disclosure for the sale of individual and group health insurance. The superintendent may adopt additional rules to establish specific standards for the sale of dental plans and vision care plans. [PL 2001, c. 410, Pt. C, §1 (NEW).]

2. Rules regarding prohibited policies or provisions. The superintendent may adopt rules that specify prohibited policies or policy provisions not otherwise specifically authorized by statute that, in the opinion of the superintendent, are unjust, unfair or unfairly discriminatory to the policyholder or a person insured under the policy or to a beneficiary of the policy. [PL 2001, c. 410, Pt. C, §1 (NEW).]
24-A M.R.S. § 2883 — ME Code / Title 24-A / Chapter 38 / Section 2883
24-A §2883. Legal services insurance defined
Status: in_force

"Legal services insurance" is insurance which involves the assumption of a contractual obligation to reimburse the beneficiary against or pay on behalf of the beneficiary all or a portion of the beneficiary's fees, costs or expenses related to or arising out of services performed by or under the supervision of an attorney who is not an employee of or under the control of the insurer directly or indirectly and who is licensed to practice in the jurisdiction in which the services are performed. Legal services insurance may also include provisions for basic legal advice only rendered to the beneficiary, by telephone or mail, by one or more attorneys licensed to practice in the jurisdiction in which the advice is given; none of whom are employees of or under the control of the insurer, directly or indirectly. Legal services insurance does not include the provision of or reimbursement for legal services incidental to other insurance coverages. [RR 2009, c. 2, §68 (COR).]
24-A M.R.S. § 212 — ME Code / Title 24-A / Chapter 3 / Section 212
24-A §212. Rules and regulations
Status: in_force

Subject to the applicable requirements and procedures of the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II , the superintendent may adopt, amend and rescind reasonable rules to aid the administration or effectuation of any provisions of this Title or of any other state or federal statutes to the extent administered or enforced by the superintendent. [PL 2001, c. 262, Pt. C, §1 (AMD).]
24-A M.R.S. § 3156 — ME Code / Title 24-A / Chapter 44 / Section 3156
24-A §3156. Policy conditions
Status: in_force

1. Exclusion. An insurer may issue a pet insurance policy that excludes coverage on the basis of one or more preexisting conditions with appropriate disclosure to the consumer. The insurer has the burden of proving that the preexisting condition exclusion applies to the condition for which a claim is being made. [PL 2021, c. 562, §1 (NEW).]

2. Waiting periods. An insurer may issue a pet insurance policy that imposes a waiting period upon effectuation of the policy as long as that waiting period does not exceed 30 days for illnesses or orthopedic conditions not resulting from an accident. A waiting period for illnesses or orthopedic conditions resulting from an accident is prohibited. An insurer may not impose a waiting period on the renewal of existing coverage. An insurer imposing a waiting period as permitted by this subsection shall include a provision in the pet insurance policy contract that allows the waiting period to be waived upon completion of a medical examination. An insurer may require the examination to be conducted by a licensed veterinarian after the purchase of the policy. A medical examination conducted pursuant to this subsection must be paid for by the policyholder, unless the policy specifies that the insurer will pay for the examination. An insurer may specify elements to be included as part of the examination and require documentation of the elements, as long as the specifications do not unreasonably restrict a consumer's ability to waive the waiting period. [PL 2021, c. 562, §1 (NEW).]

3. Renewal. An insurer may not require a veterinary examination of the covered pet for the insured to have the pet insurance policy renewed. A condition for which coverage is afforded on a policy may not be considered a preexisting condition on any renewal of the policy. [PL 2021, c. 562, §1 (NEW).]

4. Other benefits. If an insurer includes any prescription, wellness or noninsurance benefits in the pet insurance policy form, those benefits become part of the pet insurance policy contract and the provision of those benefits must follow all applicable laws in this Title and any rules adopted pursuant to those laws. [PL 2021, c. 562, §1 (NEW).]

5. Participation in wellness program. An insurer may not condition a person's eligibility to purchase a pet insurance policy on participation, or lack of participation, in a separate wellness program. [PL 2021, c. 562, §1 (NEW).]
24 M.R.S. § 2302-C — ME Code / Title 24 / Chapter 19 / Section 2302-C
24 §2302-C. Penalty for noncompliance with utilization review programs
Status: in_force

A contract issued or renewed by a nonprofit service organization after April 8, 1994 may not contain a provision that permits, upon retroactive review and confirmation of medical necessity, the imposition of a penalty of more than $500 for failure to provide notification under a utilization review program. This section does not limit the right of nonprofit service organizations 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, §2 (NEW).]
24-A M.R.S. § 2827 — ME Code / Title 24-A / Chapter 35 / Section 2827
24-A §2827. Time for payment of benefits
Status: in_force

There shall be a provision that all benefits payable under the policy, other than benefits for loss of time, will be payable not more than 60 days after receipt of proof, and that, subject to due proof of loss, all accrued benefits payable under the policy for loss of time will be paid not later than at the expiration of each period of 30 days during the continuance of the period for which the insurer is liable, and that any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of such proof. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 6452 — ME Code / Title 24-A / Chapter 79 / Section 6452
24-A §6452. Risk-based capital reports
Status: in_force

1. Duty to file. A domestic insurer shall, on or before March 1st, submit to the superintendent a report of its risk-based capital levels as of the end of the previous calendar year, in a form and containing such information as is required by the risk-based capital instructions. In addition, a domestic insurer shall file its risk-based capital report: A. With the NAIC in accordance with the risk-based capital instructions; and [PL 1993, c. 634, Pt. A, §1 (NEW).] B. With the insurance regulator in any state in which the insurer is authorized to do business, if that regulator has notified the insurer of its request for the filing in writing, in which case the insurer shall file its risk-based capital report not later than the later of: (1) Fifteen days after the receipt of notice to file its risk-based capital report with that state; or (2) The filing date. [PL 1999, c. 113, §25 (AMD).] [PL 1999, c. 113, §25 (AMD).]

2. Determination of a life or health insurer's risk-based capital. A life or health insurer's risk-based capital must be determined in accordance with the formula set forth in the risk-based capital instructions. The formula must take into account, and may adjust for the covariance between, the following: A. The risk with respect to the insurer's assets; [PL 1993, c. 634, Pt. A, §1 (NEW).] B. The risk of adverse insurance experience with respect to the insurer's liabilities and obligations; [PL 1993, c. 634, Pt. A, §1 (NEW).] C. The interest rate risk with respect to the insurer's business; and [PL 1993, c. 634, Pt. A, §1 (NEW).] D. All other business risks and such other relevant risks as are set forth in the risk-based capital instructions, determined in each case by applying the factors in the manner set forth in the risk-based capital instructions. [PL 1993, c. 634, Pt. A, §1 (NEW).] [PL 1997, c. 81, §5 (AMD).]

3. Filing of inaccurate report. If a domestic insurer files a risk-based capital report that in the judgment of the superintendent is inaccurate, then the superintendent shall adjust the risk-based capital report to correct the inaccuracy and notify the insurer of the adjustment. The notice must contain a statement of the reason for the adjustment. A risk-based capital report so adjusted is referred to as an adjusted risk-based capital report. [PL 1993, c. 634, Pt. A, §1 (NEW).]

4. Determination of a property and casualty insurer's risk-based capital. A property and casualty insurer's risk-based capital is determined in accordance with the formula set forth in the risk-based capital instructions. The formula must take into account and may adjust for the covariance between the following: A. Asset risk; [PL 1997, c. 81, §6 (NEW).] B. Credit risk; [PL 1997, c. 81, §6 (NEW).] C. Underwriting risk; and [PL 1997, c. 81, §6 (NEW).] D. All other business risks and such other relevant risks as are set forth in the risk-based capital instructions, determined in each case by applying the factors set forth in the risk-based capital instructions. [PL 1997, c. 81, §6 (NEW).] [PL 1997, c. 81, §6 (NEW).]
24-A M.R.S. § 220 — ME Code / Title 24-A / Chapter 3 / Section 220
24-A §220. Investigation of violations
Status: in_force

1. Discretionary investigations. In addition to examinations and investigations expressly authorized, the superintendent may conduct investigations of insurance matters as the superintendent considers proper upon reasonable cause to determine whether any person has violated any provision of this Title or to secure information useful in the lawful administration of any such provision. The cost of these investigations must be borne by the State. [PL 1991, c. 26 (NEW).]

2. Response to inquiries. All insurers and other persons required to be licensed pursuant to this Title and Title 24 shall respond to all lawful inquiries of the superintendent within 10 business days of receipt of the inquiry and to all follow-up inquiries of the superintendent within 5 business days of receipt. If a substantive response cannot in good faith be provided within the required time, the person required to respond shall so advise the superintendent and provide the reason for the inability to respond. The superintendent may adopt routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A to implement the requirements of this subsection. [PL 2023, c. 59, §1 (AMD).]
24-A M.R.S. § 605 — ME Code / Title 24-A / Chapter 7 / Section 605
24-A §605. In lieu, pre-emption provision
Status: repealed

1. Payment by the insurer of the taxes as required by Title 25, section 2399 and Title 36, chapter 357 is in lieu of all taxes imposed by the State upon the insurer, or any subsidiary referred to in section 1157, subsection 5, paragraph B , subparagraph (1), upon premiums or upon income, and of any franchise, privilege or other taxes measured by income of the insurer or the subsidiary. [PL 1993, c. 502, §1 (AMD); PL 1993, c. 502, §5 (AFF).]

2. The State preempts the field of regulating, or of imposing excise, privilege, franchise, income, license, permit, registration and similar taxes, licenses and fees upon, insurers, any subsidiary referred to in section 1157, subsection 5, paragraph B, subparagraph (1), their general agents, agents and other representatives as such; and on the intangible property of insurers, any subsidiary referred to in section 1157, subsection 5, paragraph B, subparagraph (1) or such representatives; and all political subdivisions or agencies in this State are prohibited from regulating insurers, any subsidiary referred to in section 1157, subsection 5, paragraph B , subparagraph (1) or their general agents, agents and other representatives as such, and from imposing upon them any such tax, license or fee. This provision does not prohibit the imposition by political subdivisions of taxes upon real and tangible personal property. [PL 1993, c. 502, §2 (AMD); PL 1993, c. 502, §5 (AFF).]

3. This section shall not be modified or repealed by any law of general application hereafter enacted, unless expressly referred to or expressly repealed therein. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2436 — ME Code / Title 24-A / Chapter 27 / Section 2436
24-A §2436. Interest on overdue payments
Status: in_force

1. A claim for payment of benefits under a policy or certificate of insurance delivered or issued for delivery in this State is payable within 30 days after proof of loss is received by the insurer and ascertainment of the loss is made either by written agreement between the insurer and the insured or beneficiary or by filing with the insured or beneficiary of an award by arbitrators as provided for in the policy. For purposes of this section, "insured or beneficiary" includes a person to whom benefits have been assigned. A claim that is neither disputed nor paid within 30 days is overdue. If, during the 30 days, the insurer, in writing, notifies the insured or beneficiary that reasonable additional information is required, the undisputed claim is not overdue until 30 days following receipt by the insurer of the additional required information; except that: A. The time period applicable to a standard fire policy and to that portion of a policy providing a combination of coverages, as described in section 3003 , insuring against the peril of fire must be 60 days, as provided in section 3002 ; and [PL 2009, c. 244, Pt. H, §1 (NEW).] B. The time period applicable to individual life insurance must be 2 months as provided in section 2513 . [PL 2009, c. 244, Pt. H, §1 (NEW).] [PL 2009, c. 244, Pt. H, §1 (AMD).]

1-A. A claimant, including a health care provider, may submit simultaneously a claim for payment with all carriers potentially liable for payment of the claim whether primary or secondary. Payment or denial of a claim by each carrier must be made within 30 calendar days after the carrier has received all information needed to pay or deny the claim whether or not another carrier with which it is attempting to coordinate has acted on the claim. Upon request by a health care provider, a carrier shall provide the health care provider a method for making a claims payment using an electronic funds transfer through the automated clearinghouse network. Any payment made must be in accordance with rules adopted by the superintendent relative to coordination of benefits. For the purposes of this subsection, "health care provider" includes a person licensed to provide dental care services under Title 32, chapter 143, subchapter 3 and "carrier" includes an insurer that provides dental insurance. [PL 2025, c. 300, §1 (AMD).]

2. An insurer may dispute a claim by furnishing to the insured or beneficiary, or a representative of the insured or beneficiary, a written statement that the claim is disputed with a statement of the grounds upon which it is disputed. The statement must be based upon a reasonable investigation of the claim and must include sufficient detail to permit the insured or beneficiary to understand and respond to the insurer's position. For purposes of this subsection, a claim for payments under a policy or certificate providing health care coverage is disputed if the insurer has denied the claim or has requested further information that is consistent with Bureau of Insurance Rule Chapter 850. [PL 1999, c. 256, Pt. I, §1 (AMD).]

2-A. For a claim submitted by a health care provider or health care facility with respect to a carrier as defined in section 4301‑A, subsection 3 , for purposes of this section, a timely claim for payment of covered health care expenses must be submitted to a carrier in conformity with the requirements for standardized claim forms set forth in section 2753 . A. [PL 2023, c. 332, §1 (RP).] [PL 2023, c. 332, §1 (AMD).]

2-B. If a claim does not conform to the requirements specified in subsections 2‑A and 2‑C and payment is denied to a health care provider or health care facility by a carrier, the health care provider or health care facility may not request payment from the insured or beneficiary and shall attempt to rectify the deficiencies with the claim and resubmit the claim to the carrier. [PL 2023, c. 332, §2 (AMD).]

2-C. For a claim submitted by a health care provider or health care facility with respect to a carrier as defined in section 4301‑A, subsection 3 , for purposes of this section, "undisputed claim" means a manually or electronically submitted claim from a health care provider or health care facility that: A. Contains all the required data elements necessary for accurate adjudication without the need for additional information; [PL 2023, c. 332, §3 (NEW).] B. Is not materially deficient or improper, including lacking substantiating documentation required by the carrier; and [PL 2023, c. 332, §3 (NEW).] C. Has no particular or unusual circumstances requiring special treatment that prevent payment from being made by the carrier. [PL 2023, c. 332, §3 (NEW).] [PL 2023, c. 332, §3 (NEW).]

3. If an insurer fails to pay an undisputed claim or any undisputed part of the claim when due, the amount of the overdue claim or part of the claim bears interest at the rate of 1 1/2% per month after the due date. Notwithstanding this subsection, the superintendent shall adopt rules that establish a minimum amount of interest payable on an overdue undisputed claim to a health care provider before a payment must be issued. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2005, c. 50, §1 (AMD).]

4. A reasonable attorney's fee for advising and representing a claimant on an overdue claim or action for an overdue claim must be paid by the insurer if overdue benefits are recovered in an action against the insurer or if overdue benefits are paid after receipt of notice of the attorney's representation. [PL 1999, c. 256, Pt. I, §1 (AMD).]

5. Nothing in this section prohibits or limits any claim or action for a claim that the claimant has against the insurer. [PL 1999, c. 256, Pt. I, §1 (AMD).]

6. This section does not apply to a claim for payment of benefits under a policy or certificate of long-term care insurance delivered or issued for delivery in this State. [PL 2013, c. 278, §1 (NEW).]
24-A M.R.S. § 2887 — ME Code / Title 24-A / Chapter 38 / Section 2887
24-A §2887. Legal services insurance policy reserves
Status: in_force

For all legal services insurance policies, the insurer shall establish and maintain thereon a reserve which shall place a sound value on its liabilities under those policies and be not less than the reserve according to appropriate standards set forth in rules issued by the superintendent and, in no event, less in the aggregate than the pro rata gross unearned premiums for those policies. [PL 1983, c. 801, §11 (NEW).]
24-A M.R.S. § 2759 — ME Code / Title 24-A / Chapter 33 / Section 2759
24-A §2759. Coverage for hospice care services
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Hospice care services" means services provided on a 24-hours-a-day, 7-days-a-week basis to a person who is terminally ill and that person's family. "Hospice care services" includes, but is not limited to, physician services; nursing care; respite care; medical and social work services; counseling services; nutritional counseling; pain and symptom management; medical supplies and durable medical equipment; occupational, physical or speech therapies; volunteer services; home health care services; and bereavement services. [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] B. "Person who is terminally ill" means a person that has a medical prognosis that the person's life expectancy is 12 months or less if the illness runs its normal course. [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).]

2. Coverage for hospice care services. All individual health policies must provide coverage for hospice care services to a person who is terminally ill. Hospice care services must be provided according to a written care delivery plan developed by a hospice care provider and the recipient of hospice care services. Coverage for hospice care services must be provided whether the services are provided in a home setting or an inpatient setting. [PL 2001, c. 358, Pt. LL, §2 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).] Revisor's Note: §2759. Coverage for general anesthesia for dentistry (As enacted by PL 2001, c. 423, §2 and affected by § 5 is REALLOCATED TO TITLE 24-A, SECTION 2760)
24-A M.R.S. § 4353 — ME Code / Title 24-A / Chapter 57 / Section 4353
24-A §4353. Definitions
Status: in_force

For the purposes of this chapter: [PL 1969, c. 132, §1 (NEW).]

1. "Insurer," in addition to persons so defined under section 4 , includes also persons purporting to be insurers, or organizing or holding themselves out as organizing in this State for the purpose of becoming an insurer. [PL 1969, c. 132, §1 (NEW).]

2. "Delinquency proceeding" means any proceeding commenced against an insurer pursuant to sections 4351 to 4385 for the purpose of conserving, rehabilitating, reorganizing or liquidating the insurer, or the proceedings authorized by sections 4401 to 4407 . [PL 1969, c. 132, §1 (NEW).]

3. "State" has the meaning ascribed in section 7 . [PL 1969, c. 132, §1 (NEW).]

4. "Domiciliary state" means the state in which an insurer is incorporated or organized, or as to an alien insurer, the state in which, at the commencement of delinquency proceedings the larger amount of the insurer's assets are held in trust or on deposit for the benefit of policyholders and creditors in the United States of America. [PL 1969, c. 132, §1 (NEW).]

5. "Ancillary state" means any state other than a domiciliary state. [PL 1969, c. 132, §1 (NEW).]

6. "Reciprocal state" means any state other than this State in which there is in force, in substance and effect, a law substantially similar to the Uniform Insurers Liquidation Act or another law determined by the superintendent to establish adequate procedures for the conduct and interstate coordination of the rehabilitation and liquidation of delinquent insurers, including provisions requiring that the insurance superintendent or equivalent insurance supervisory official be the receiver of a delinquent insurer, and in which effective provisions exist for avoidance of fraudulent conveyances and unlawful preferential transfers. [PL 2021, c. 16, §14 (AMD).]

7. "Foreign country" means territory not in any state. [PL 1969, c. 132, §1 (NEW).]

8. "Impairment" exists as to a stock insurer when the insurer's assets do not at least equal the sum of its liabilities and its paid-in capital stock; and as to a mutual insurer when the insurer's assets do not at least equal the sum of the insurer's liabilities and the minimum basic surplus required under this Title to be maintained for authority to transact the kinds of insurance transacted. [PL 1969, c. 132, §1 (NEW).]

9. "Insolvency" exists when the insurer fails to meet its obligations as they mature or when a stock insurer's assets are less than the sum of its liabilities and the minimum paid-in capital stock required for its authority to transact insurance in this State; or when a mutual insurer's assets are less than the sum of its liabilities and the minimum basic surplus required to be maintained by the insurer under this Title for authority to transact the kinds of insurance transacted; or as otherwise expressly provided in this Title. [PL 1969, c. 132, §1 (NEW).]

10. "General assets" means all property, real, personal or otherwise, not specifically mortgaged, pledged, deposited or otherwise encumbered for the security or benefit of specified persons or a limited class or classes of persons; and as to such specifically encumbered property, the term includes all such property or its proceeds in excess of the amount necessary to discharge the sums secured thereby. Assets held in trust or on deposit for the security or benefit of all policyholders or all policyholders and creditors in the United States of America are deemed general assets. [PL 1969, c. 132, §1 (NEW).]

11. "Preferred claim" means any claim accorded priority of payment from the insurer's general assets under applicable law. [PL 1969, c. 132, §1 (NEW).]

12. "Special deposit claim" means any claim secured by deposit made under statute for the security or benefit of a limited class or classes of persons, but not including any general assets. [PL 1969, c. 132, §1 (NEW).]

13. "Secured claim" means any claim secured by mortgage, trust deed, pledge, deposit as security, escrow or otherwise, but not including special deposit claims or claims against general assets. The term also includes claims which have become liens upon specific assets through judicial process and not invalidated. [PL 1969, c. 132, §1 (NEW).]

14. "Receiver" means receiver, liquidator, rehabilitator or conservator, as context requires. [PL 1969, c. 132, §1 (NEW).]

15. "Creditor" means a person having a claim, whether matured or unmatured, liquidated or unliquidated, secured or unsecured, or absolute, fixed or contingent. [PL 1969, c. 132, §1 (NEW).]

16. Fair consideration. "Fair consideration" is given for property or an obligation: A. When in exchange for that property or obligation, as a fair equivalent for the property or obligation and in good faith, property is conveyed, services are rendered, an obligation is incurred or an antecedent debt is satisfied; or [PL 1991, c. 828, §25 (NEW).] B. When that property or obligation is received in good faith to secure a present advance or antecedent debt in an amount not disproportionately small as compared to the value of the property or obligation obtained. [PL 1991, c. 828, §25 (NEW).] [PL 1991, c. 828, §25 (NEW).]

17. Guaranty association. "Guaranty association" means the Maine Insurance Guaranty Association established by chapter 57, subchapter III , the Life and Health Insurance Guaranty Association established by chapter 62 and any other similar entity created by the laws of this State for the payment of claims of insolvent insurers. [PL 1991, c. 828, §25 (NEW).]

18. Foreign guaranty association. "Foreign guaranty association" means a guaranty association created by the legislature of any other state. [PL 1991, c. 828, §25 (NEW).]

19. Transfer. "Transfer" includes the sale and every other direct or indirect method of disposing of or of parting with property or an interest in property or with the possession of property or of fixing a lien upon property or upon an interest in property, absolutely or conditionally, voluntarily or by or without judicial proceedings. The retention of a security interest in property delivered to a debtor is a transfer suffered by the debtor. [PL 1991, c. 828, §25 (NEW).]

20. Netting agreement. "Netting agreement" means: A. A contract or agreement, including terms and conditions incorporated by reference into a contract or agreement, including a master agreement, that documents one or more transactions between the parties to the agreement for or involving one or more qualified financial contracts and that provides for the netting, liquidation, setoff, termination, acceleration or closeout under or in connection with one or more qualified financial contracts or present or future payment or delivery obligations or payment or delivery entitlements under one or more qualified financial contracts, including liquidation or close-out values relating to such obligations or entitlements among the parties to the netting agreement; [PL 2011, c. 107, §1 (NEW).] B. Any master agreement or bridge agreement for one or more master agreements described in paragraph A ; or [PL 2011, c. 107, §1 (NEW).] C. Any security agreement or arrangement or other credit enhancement or guarantee or reimbursement obligation related to any contract or agreement described in paragraph A or B . [PL 2011, c. 107, §1 (NEW).] A contract or agreement described in paragraph A or B relating to agreements or transactions that are not qualified financial contracts is considered to be a netting agreement only with respect to those agreements or transactions that are qualified financial contracts. For the purposes of this subsection, a master agreement together with all schedules, confirmations, definitions and addenda to the master agreement and transactions under any master agreement, is treated as one netting agreement. [PL 2011, c. 107, §1 (NEW).]

21. Qualified financial contract. "Qualified financial contract" means a commodity contract, forward contract, repurchase agreement, securities contract, swap agreement and any similar agreement that the superintendent determines to be a qualified financial contract. A. "Commodity contract" means: (1) A contract for the purchase or sale of a commodity for future delivery on, or subject to the rules of, a board of trade or contract market under the federal Commodity Exchange Act or a board of trade outside the United States; (2) An agreement that is subject to regulation under Section 23 of the federal Commodity Exchange Act and that is commonly known to the commodities trade as a margin account, margin contract, leverage account or leverage contract; (3) An agreement or transaction that is subject to regulation under Section 4c(b) of the federal Commodity Exchange Act and that is commonly known to the commodities trade as a commodity option; (4) Any combination of the agreements or transactions referred to in this paragraph; or (5) Any option to enter into an agreement or transaction referred to in this paragraph. [PL 2011, c. 107, §2 (NEW).] B. "Forward contract," "repurchase agreement," "securities contract" and "swap agreement" have the meanings set forth in the Federal Deposit Insurance Act, 12 United States Code, Section 1821(e)(8)(D), as amended from time to time. [PL 2011, c. 107, §2 (NEW).] [PL 2011, c. 107, §2 (NEW).]

22. Federal home loan bank. "Federal home loan bank" means an institution established under the Federal Home Loan Bank Act, 12 United States Code, Sections 1421 to 1449. [PL 2025, c. 17, §1 (NEW).]

23. Insurer member. "Insurer member" means an insurer that is a member of a federal home loan bank. [PL 2025, c. 17, §2 (NEW).]
24-A M.R.S. § 795 — ME Code / Title 24-A / Chapter 9 / Section 795
24-A §795. Asset and investment limitations
Status: in_force

1. Assets. Assets of the special purpose reinsurance vehicle held in trust to secure obligations under the special purpose reinsurance vehicle contract must at all times be held in: A. Cash and cash equivalents; [PL 2003, c. 249, §2 (NEW).] B. Securities listed by the Securities Valuation Office of the National Association of Commissioners or its successor organization and qualifying as admitted assets under statutory accounting principles pursuant to section 901‑A ; or [PL 2003, c. 249, §2 (NEW).] C. Any other form of security acceptable to the superintendent. [PL 2003, c. 249, §2 (NEW).] [PL 2003, c. 249, §2 (NEW).]

2. Investment practices. In addition, the special purpose reinsurance vehicle may enter into swap agreements or other transactions that have the objective of leveling timing differences in funding of upfront or ongoing transaction expenses or managing credit or interest rate risk of the investments in the trust to ensure that the investments are sufficient to ensure payment or repayment of the securities and related interest or principal payments issued pursuant to a special purpose reinsurance vehicle insurance securitization transaction or the reinsurance vehicle's obligations under the special purpose reinsurance vehicle contract. [PL 2003, c. 249, §2 (NEW).]
24-A M.R.S. § 212-A — ME Code / Title 24-A / Chapter 3 / Section 212-A
24-A §212-A. Parity for insurance agents and brokers
Status: in_force

Notwithstanding any other provision of law, to the extent authorized by the superintendent by rule, a licensed agent or broker has the power to engage in any insurance activity that financial institutions chartered by or otherwise subject to the jurisdiction of the Federal Government are authorized to engage in pursuant to federal law or regulation or by a court of competent jurisdiction. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 1997, c. 207, §3 (NEW).]
24-A M.R.S. § 7108 — ME Code / Title 24-A / Chapter 91 / Section 7108
24-A §7108. Obligation of reimbursement insurance policy insurers
Status: in_force

1. Receipt of premium; agency. A provider is the agent of the insurer that issued the reimbursement insurance policy for purposes of obligating the insurer to service contract holders in accordance with the service contract and this chapter. When a provider is acting as an administrator and enlists other providers, the provider acting as the administrator shall notify the insurer of the existence and identities of the other providers. An insurer issuing a reimbursement insurance policy to a provider is deemed to have received the premiums for such insurance upon the payment of provider fees by consumers for service contracts issued by the insured provider. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

2. Indemnification or subrogation. This chapter does not prevent or limit the right of an insurer that issued a reimbursement insurance policy to seek indemnification or subrogation against a provider if the insurer pays or is obligated to pay the service contract holder sums that the provider was obligated to pay pursuant to the provisions of the service contract. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]
24 M.R.S. § 2320-A — ME Code / Title 24 / Chapter 19 / Section 2320-A
24 §2320-A. Screening mammograms
Status: in_force

1. Definition. For purposes of this section, "screening mammogram" means a radiologic procedure that is provided to an asymptomatic woman for the purpose of early detection of breast cancer and that consists of 2 radiographic views per breast. [PL 1989, c. 875, Pt. I, §2 (NEW).]

2. Required coverage. All individual and group nonprofit hospital and medical services plan contracts must provide coverage for screening mammograms performed by providers that meet the standards established by the Department of Health and Human Services rules relating to radiation protection. The policies must reimburse for screening mammograms performed at least once a year for women 40 years of age and over. A. [PL 1997, c. 408, §1 (RP); PL 1997, c. 408, §8 (AFF).] B. [PL 1997, c. 408, §1 (RP); PL 1997, c. 408, §8 (AFF).] [PL 1997, c. 408, §1 (RPR); PL 1997, c. 408, §8 (AFF); PL 2003, c. 689, Pt. B, §6 (REV).]

3. Application. This section applies to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. B, §3 (AMD).]

4. Reports. Each nonprofit hospital and medical care service organization subject to this section shall report to the superintendent its experience for each calendar year beginning with 1991 not later than April 30th of the following calendar year. The report must include the information required and be presented in the form prescribed by the superintendent. The report must include the amount of claims paid in this State for services required by this section. The superintendent shall compile this data in an annual report and submit the report to the joint standing committee of the Legislature having jurisdiction over banking and insurance matters. [PL 1991, c. 701, §2 (AMD).]

5. No cost-sharing requirements. A nonprofit hospital and medical care service organization may not impose any cost-sharing requirements on a screening mammogram performed by a provider in accordance with this section. This subsection does not apply to an individual policy offered for use with a health savings account unless the United States Internal Revenue Service determines that the requirements in this subsection are permissible in a high deductible health plan as defined in the United States Internal Revenue Code of 1986, Section 223(c)(2). [PL 2025, c. 348, §1 (NEW).]
24 M.R.S. § 2349-A — ME Code / Title 24 / Chapter 19 / Section 2349-A
24 §2349-A. Medical child support
Status: in_force

A corporation organized pursuant to this chapter must comply with 42 United States Code, Section 1396g-1. [PL 1995, c. 418, Pt. C, §1 (NEW).]
24-A M.R.S. § 1911 — ME Code / Title 24-A / Chapter 18 / Section 1911
24-A §1911. Audits and examinations
Status: in_force

The superintendent may designate examiners or consultants, as appropriate, to perform an audit of an administrator when the superintendent considers an audit necessary. Administrators shall make all records and books of account available to the examiners or consultants, and shall otherwise facilitate the performance of the audit. All claims information respecting individual claimants must be kept confidential. [PL 1989, c. 846, Pt. D, §2 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).]
24-A M.R.S. § 2020 — ME Code / Title 24-A / Chapter 19 / Section 2020
24-A §2020. Producer's surety bond
Status: in_force

1. Every applicant for a surplus lines producer's authority shall file with the superintendent evidence of a bond in favor of the State executed by an authorized surety insurer. The bond is conditioned upon full accounting and due payment to the person entitled to the bond of funds coming into the surplus lines producer's possession through insurance transactions under the license. The bond may be continuous in force and aggregate liability on the bond is limited to payment of not less than $20,000. [PL 1997, c. 592, §65 (AMD).]

2. The bond must remain in force until released by the superintendent or until canceled by the surety. Without prejudice to liability previously incurred, the surety may cancel the bond upon 30 days' advance written notice to both the producer and the superintendent. Upon notice to the superintendent of cancellation by the surety and failure of the surplus lines producer to procure a satisfactory replacement bond prior to cancellation, the surplus lines producer's authority terminates. [PL 1997, c. 592, §65 (AMD).]
24-A M.R.S. § 6228 — ME Code / Title 24-A / Chapter 73 / Section 6228
24-A §6228. Transfer of residents
Status: in_force

A resident of a continuing care retirement community may be transferred to a residential care unit or a bed within the skilled nursing facility under the following conditions: [PL 1995, c. 452, §34 (NEW).]

1. Written consent. With the written consent of the resident or the resident's authorized representative; or [PL 1995, c. 452, §34 (NEW).]

2. Health or safety danger. Upon a finding that the resident poses a health or safety danger to other residents or a change in a resident's health status or abilities necessitates a move to a higher level of care. A decision to transfer or change a resident's accommodations may be made only after extended consultation between the provider's interdisciplinary team, including, but not limited to, medical personnel, social workers and therapists of the community, and the resident, the resident's treating physician and the resident's family or other representative. The decision may also consider all reasonable care alternatives. A written decision to transfer or change a resident's accommodations must describe why the resident's health care needs can not be met at the resident's present location. The resident may appeal this determination to the department pursuant to rules prescribed by the department. [PL 1995, c. 452, §34 (NEW).]
24-A M.R.S. § 404 — ME Code / Title 24-A / Chapter 5 / Section 404
24-A §404. Certificate of authority required; enforcement; penalty
Status: in_force

1. No person shall act as an insurer and no insurer shall transact insurance in this State by mail or otherwise, unless as authorized by a certificate of authority issued by the superintendent pursuant to this Title and then in full force and effect, except as to such transactions as are expressly otherwise provided in this Title. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. No insurer formed under the laws of this State, and no foreign insurer from offices or by personnel or facilities located in this State, shall solicit insurance applications or otherwise transact insurance in another state or country unless it holds a subsisting certificate of authority granted to it by the superintendent authorizing it to transact the same kind or kinds of insurance in this State. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

3. The superintendent shall enforce this section through any and all available and lawful means, including, but not limited to, the enjoining of any violation or threatened violation. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

4. Any insurer and any officer, director, agent, representative or employee of any insurer, who willfully authorizes, negotiates, makes or issues any insurance contract in violation of this section, is upon conviction thereof subject to a fine not to exceed $5,000 or imprisonment for not over 2 years, or to both. [RR 2013, c. 2, §36 (COR).]
24-A M.R.S. § 4218-A — ME Code / Title 24-A / Chapter 56 / Section 4218-A
24-A §4218-A. Compliance with the Affordable Care Act
Status: in_force

The superintendent may adopt and amend rules, establish standards and enforce federal statutes and regulations in order to carry out the purposes of the federal Affordable Care Act. Rules or amendments to rules adopted pursuant to this section, including amendments to major substantive rules, are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2011, c. 364, §19 (NEW).]
24-A M.R.S. § 3603 — ME Code / Title 24-A / Chapter 51 / Section 3603
24-A §3603. Mutual assessment plans; definitions
Status: in_force

1. For the purposes of this Title a mutual assessment insurer is a mutual insurer which is doing business on: A. A post-loss assessment plan; or [PL 1969, c. 132, §1 (NEW).] B. On an advance assessment or contingent liability plan. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]

2. A post-loss assessment plan insurer is one which depends in whole or substantial part on regular or special assessments levied upon its members after a loss or series of losses for payment of losses and expenses. A post-loss assessment plan insurer may collect from each member such initial amount as it may deem proper prior to or at the time of the effectuation of the member's insurance. Future regular or special assessments may be secured by use of a premium note signed by the policyholder. [PL 1969, c. 132, §1 (NEW).]

3. An advance assessment plan insurer shall by its bylaws and policies fix the contingent mutual liability of its members for the payment of losses and expenses not provided for by its cash funds; but such contingent liability of a member shall not be less than one or more than 6 times the advance assessment for the member's policy at the annual advance assessment rate for a term of one year. Such an advance assessment plan insurer may issue both assessable and nonassessable advance cash premium policies. Any assessment, special or regular, levied under the contingent liability provisions of this chapter shall be for the exclusive benefit of the holders of policies subject to assessment, and such policyholders shall not be liable to an assessment in an amount greater in proportion to the total deficiency than the ratio that the deficiency attributable to the assessable business bears to the total deficiency. [PL 1969, c. 132, §1 (NEW).]

4. Nothing in this chapter shall be deemed to prohibit the acquisition, accumulation and maintenance of surplus and unallocated funds. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2711 — ME Code / Title 24-A / Chapter 33 / Section 2711
24-A §2711. Proofs of loss
Status: in_force

There shall be a provision as follows: Proofs of loss: Written proof of loss must be furnished to the insurer at its said office in case of claim for loss for which this policy provides any periodic payment contingent upon continuing loss within 90 days after the termination of the period for which the insurer is liable and in case of claim for any other loss within 90 days after the date of such loss. Failure to furnish such proof within the time required shall not invalidate nor reduce any claim if it was not reasonably possible to give proof within such time, provided such proof is furnished as soon as reasonably possible and in no event, except in the absence of legal capacity, later than one year from the time proof is otherwise required. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4340 — ME Code / Title 24-A / Chapter 56-A / Section 4340
24-A §4340. Financial viability
Status: in_force

Each carrier and downstream entity requesting a waiver shall file with the superintendent a plan for managing financial exposure under those downstream risk arrangement contracts and thereafter operate in substantial conformance with the terms of that plan and of the corresponding waiver. At least 60 days before any material change in a filed and approved exposure management plan, the carrier and downstream entity shall file for the superintendent's review and approval a modified plan, along with any changes in related contracts. [PL 1999, c. 609, §20 (NEW).]
24-A M.R.S. § 1126 — ME Code / Title 24-A / Chapter 13 / Section 1126
24-A §1126. Housing developments
Status: in_force

To the extent and upon such conditions as may be authorized by the superintendent, an insurer may invest in stock and evidences of indebtedness of any housing company or redevelopment company organized under the private housing finance law of this or any other state, or of any corporation organized for the purpose of owning and operating any housing project under laws expressly designed to promote the provision of housing for persons of low and moderate income, or in the securities of any corporation organized under the laws of this or any other state for the purpose of owning, acquiring or holding real property or any interest therein as an investment for the production of income or to be developed or improved for such investment purpose, if all of the stock other than directors' qualifying shares of such housing company, redevelopment company or corporation has been or is to be originally issued to one or more insurers, whether domestic or foreign. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 4351 — ME Code / Title 24-A / Chapter 57 / Section 4351
24-A §4351. Scope of provisions
Status: in_force

The applicable provisions of this chapter shall apply as to: [PL 1969, c. 132, §1 (NEW).]

1. All insurers authorized to transact insurance in this State; [PL 1969, c. 132, §1 (NEW).]

2. All insurers having policyholders resident in this State; [PL 1969, c. 132, §1 (NEW).]

3. All insurers against whom a claim under an insurance contract may arise in this State; [PL 1969, c. 132, §1 (NEW).]

4. All persons in process of organization, or holding themselves out as organizing, or proposing to organize in this State for the purpose of becoming an insurer; [PL 2001, c. 88, §10 (AMD).]

5. All other persons as to whom such provisions are otherwise expressly made applicable by law; and [PL 2001, c. 88, §10 (AMD).]

6. Health maintenance organizations, which are considered insurers for the purposes of this subchapter and subchapter II . [PL 2001, c. 88, §11 (NEW).]
24-A M.R.S. § 2329 — ME Code / Title 24-A / Chapter 25 / Section 2329
24-A §2329. Penalties
Status: in_force

1. [PL 1989, c. 797, §32 (RP); PL 1989, c. 797, §§37, 38 (AFF).]

2. The superintendent may, after notice and opportunity for hearing, deny, revoke, suspend or limit the permissible activities of any rating or advisory organization or insurer which fails to comply with an order of the superintendent within the time period provided by the order. [PL 1989, c. 797, §33 (AMD); PL 1989, c. 797, §§37, 38 (AFF).]

3. [PL 1977, c. 694, §421 (RP).]
24-A M.R.S. § 2793 — ME Code / Title 24-A / Chapter 34-B / Section 2793
24-A §2793. Clear choice designs
Status: in_force

The superintendent shall develop clear choice designs for health plans in order to reduce consumer confusion and provide meaningful choices for consumers by promoting a level playing field on which carriers compete on the basis of price and quality. [PL 2021, c. 361, §3 (AMD).]

1. Clear choice design. For the purposes of this section, "clear choice design" means a set of annual copayments, coinsurance and deductibles for all or a designated subset of the essential health benefits. An individual health plan subject to section 2736‑C or a pooled market health plan subject to section 2792 must conform to one of the clear choice designs developed pursuant to this section unless it is approved as an alternative plan under subsection 4 . [PL 2021, c. 361, §3 (AMD).]

2. Development of clear choice designs. The superintendent shall develop clear choice designs in consultation with working groups consisting of consumers, carriers, health policy experts and other interested persons. The superintendent shall adopt rules for clear choice designs, taking into consideration the ability of plans to conform to actuarial value ranges, consumer needs and promotion of benefits with high value and return on investment. The superintendent shall develop at least one clear choice design for each tier of health insurance plan designated as bronze, silver, gold and platinum in accordance with the federal Affordable Care Act. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . Clear choice designs apply to all individual health plans offered in this State with effective dates of coverage on or after January 1, 2022 and to all small group health plans offered through the pooled market under section 2792 . [PL 2021, c. 361, §3 (AMD).]

3. Annual review. The superintendent shall consider annually whether to revise, discontinue or add any clear choice designs for use by carriers in the following calendar year, including but not limited to considering whether deductible and copayment levels should be changed to reflect medical inflation and conform with actuarial value and annual maximum out-of-pocket limits. [PL 2019, c. 653, Pt. B, §2 (NEW).]

4. Alternative plan designs. In addition to one or more health plans that include cost-sharing parameters consistent with a clear choice design developed pursuant to this section, a carrier may offer up to 3 health plan designs that modify one or more specific cost-sharing parameters in a clear choice design if the carrier submits an actuarial certification to the satisfaction of the superintendent that the alternative plan design offers significant consumer benefits and does not result in adverse selection. An alternative plan design may be offered only in a service area where the carrier offers at least one clear choice design plan at the same tier. [PL 2021, c. 361, §3 (AMD).]
24-A M.R.S. § 3865 — ME Code / Title 24-A / Chapter 53 / Section 3865
24-A §3865. Financial conditions; method of determining
Status: in_force

In determining the financial condition of a reciprocal insurer the superintendent shall apply the following rules: [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

1. The superintendent shall charge as liabilities the same reserves as are required of incorporated insurers issuing nonassessable policies on a reserve basis. [RR 2021, c. 1, Pt. B, §314 (COR).]

2. The surplus deposits of subscribers shall be allowed as assets, except that any premium deposits delinquent for 90 days shall first be charged against such surplus deposit. [PL 1969, c. 132, §1 (NEW).]

3. The surplus deposits of subscribers shall not be charged as a liability. [PL 1969, c. 132, §1 (NEW).]

4. All premium deposits delinquent less than 90 days shall be allowed as assets. [PL 1969, c. 132, §1 (NEW).]

5. An assessment levied upon subscribers, and not collected, shall not be allowed as an asset. [PL 1969, c. 132, §1 (NEW).]

6. The contingent liability of subscribers shall not be allowed as an asset. [PL 1969, c. 132, §1 (NEW).]

7. The computation of reserves shall be based upon premium deposits other than membership fees and without any deduction for expenses and the compensation of the attorney. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4224 — ME Code / Title 24-A / Chapter 56 / Section 4224
24-A §4224. Confidentiality; liability; access to records
Status: in_force

1. Confidentiality. Any data or information pertaining to the diagnosis, treatment or health of an enrollee or applicant obtained from that enrollee or applicant or a provider by a health maintenance organization must be held in confidence and may not be disclosed to any person except: to the extent that it may be necessary to carry out the purposes of this chapter; upon the express consent of the enrollee or applicant; pursuant to statute or court order for the production of evidence or the discovery of evidence; or in the event of claim or litigation between that enrollee or applicant and the health maintenance organization when such data or information is pertinent. A health maintenance organization is entitled to claim any statutory privileges against such disclosure that the provider who furnished such information to the health maintenance organization is entitled to claim. [PL 1991, c. 709, §7 (NEW).]

2. Liability. A person who, in good faith and without malice, as a member, agent or employee of a quality assurance committee, assists in the origination, investigation or preparation of a report or information related to treatment previously rendered, submits that report or information to a health maintenance organization or appropriate state licensing board, or assists the committee in carrying out any of its duties under this chapter is not subject to civil liability for damages as a consequence of those actions, nor is the health maintenance organization that established that committee or the officers, directors, employees or agents of that health maintenance organization liable for the activities of that person. This section may not be construed to relieve any person of liability arising from treatment of a patient. A. The information considered by a quality assurance committee and the records of its actions and proceedings are confidential and not subject to subpoena or order to produce except in proceedings before the appropriate state licensing or certifying agency or in an appeal, if permitted, from the findings or recommendations of the committee. A member of a quality assurance committee or an officer, director, staff person or other member of a health maintenance organization engaged in assisting the committee or any person assisting or furnishing information to the committee may not be subpoenaed to testify in any judicial or quasi-judicial proceeding if the subpoena is based solely on these activities. [PL 1991, c. 709, §7 (NEW).] B. Information considered by a quality assurance committee and the records and proceedings of that committee used pursuant to paragraph A by a state licensing or certifying agency or in an appeal must be kept confidential and are subject to the same provisions concerning discovery and use in legal actions as are the original information and records in the possession and control of the health care review committee. [PL 1991, c. 709, §7 (NEW).] [PL 1991, c. 709, §7 (NEW).]

3. Access to records. To fulfill the obligations of a health maintenance organization under section 4204, subsection 2‑A, paragraph B , a health maintenance organization must have access to treatment records and other information pertaining to the diagnosis, treatment and health status of any enrollee. [PL 1991, c. 709, §7 (NEW).]
24-A M.R.S. § 4342 — ME Code / Title 24-A / Chapter 56-A / Section 4342
24-A §4342. Related provisions
Status: in_force

The superintendent may deny a request for waiver based on any of the following characteristics: [PL 1999, c. 609, §20 (NEW).]

1. Carrier controlled. An arrangement with a downstream entity that has control of the carrier. "Control" has the same meaning as defined in section 222, subsection 2, paragraph B ; [PL 1999, c. 609, §20 (NEW).]

2. Transfer of claims processing, payment or adjudication. An arrangement by which the claims processing, claims payment or claims adjudication functions are transferred to the downstream entity from the carrier. This section may not be construed to authorize the superintendent to deny a request based on the transfer of utilization review functions from the carrier to the downstream entity; [PL 1999, c. 609, §20 (NEW).]

3. Transfer of managerial control. An arrangement by which managerial control of the carrier's information system is transferred to the downstream entity; [PL 1999, c. 609, §20 (NEW).]

4. Overlap between officers or directors. An arrangement in which there is overlap between the officers or directors of the downstream entity and the carrier; or [PL 1999, c. 609, §20 (NEW).]

5. Transfer of more than 1/12 of annual capitated payments. An arrangement that transfers more than 1/12 of the annual capitated payments at one time to the downstream entity. [PL 1999, c. 609, §20 (NEW).]
24-A M.R.S. § 423 — ME Code / Title 24-A / Chapter 5 / Section 423
24-A §423. Annual statement
Status: in_force

1. Each authorized insurer shall annually on or before March 1st, or within any reasonable extension of time that the superintendent for good cause may have granted on or before such March 1st, file with the superintendent a full and true statement of its financial condition, transactions and affairs as of December 31st preceding. The statement must be on an annual statement blank of the National Association of Insurance Commissioners, be prepared in accordance with the association's annual statement instructions, and follow practices and procedures prescribed by the association's accounting practices and procedures manual, with any useful or necessary modification or adaptation thereof and as supplemented by additional information required by the superintendent. The statement must be verified by the oath of the insurer's president or vice-president, and secretary or actuary as applicable, or in the absence of the foregoing, by 2 other principal officers; or if a reciprocal insurer, by the oath of the attorney-in-fact or its like officers if a corporation. [PL 1993, c. 313, §16 (AMD).]

2. The statement of an alien insurer shall be verified by its United States manager or other officer duly authorized, and shall relate only to the insurer's transactions and affairs in the United States unless the superintendent requires otherwise. If the superintendent requires a statement as to such an insurer's affairs throughout the world, the insurer shall file such statement with the superintendent as soon as reasonably possible. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

3. The superintendent may refuse to continue, or may suspend or revoke, the certificate of authority of any insurer failing to file its annual statement when due. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

4. Before August 10th, and at the same time the insurer makes payment for its annual assessment, the insurer shall pay the fee for filing its annual statement as prescribed by section 601 (fee schedule). [PL 1995, c. 544, §5 (AMD).]

5. The superintendent may adopt rules that prescribe accounting standards applicable to statements filed pursuant to this section. These rules may permit or require any class or classes of insurers domiciled or authorized to do business in this State to conform its financial presentations to the standards of preparation prescribed in the accounting practices and procedures manual of the National Association of Insurance Commissioners. [PL 1991, c. 828, §14 (NEW).]
24-A M.R.S. § 7603 — ME Code / Title 24-A / Chapter 99 / Section 7603
24-A §7603. Requirements for the sale of self-storage insurance
Status: in_force

1. Brochures. At each location where a self-storage provider sells or offers self-storage insurance to customers, the self-storage provider shall make available to a prospective customer brochures or other written materials that: A. Disclose that self-storage insurance may provide a duplication of coverage already provided by a customer's homeowner's insurance policy, renter's insurance policy or other source of coverage; [PL 2021, c. 676, Pt. A, §42 (NEW).] B. State that the enrollment by the customer in a self-storage insurance policy is not required in order to rent or lease storage space within a self-storage facility; [PL 2021, c. 676, Pt. A, §42 (NEW).] C. Summarize the material terms of the insurance coverage, including: (1) The identity of the insurer; (2) The identity of the supervising entity; (3) The amount of any applicable deductible and how it is to be paid; and (4) Benefits of the coverage; [PL 2021, c. 676, Pt. A, §42 (NEW).] D. Summarize the process for filing a claim; and [PL 2021, c. 676, Pt. A, §42 (NEW).] E. State that the customer may cancel enrollment for coverage under a self-storage insurance policy at any time and the person paying the premium must receive a refund of any applicable unearned premium. [PL 2021, c. 676, Pt. A, §42 (NEW).] [PL 2021, c. 676, Pt. A, §42 (NEW).]

2. Periodic basis of coverage. Self-storage insurance may be offered on a month-to-month or other periodic basis as a group or master commercial inland marine policy issued to a self-storage provider under which individual customers may elect to enroll for coverage. [PL 2021, c. 676, Pt. A, §42 (NEW).]

3. Eligibility and underwriting standards. Eligibility and underwriting standards for customers that elect to enroll in self-storage insurance must be established by an insurer for each self-storage insurance program. [PL 2021, c. 676, Pt. A, §42 (NEW).]
24-A M.R.S. § 7103 — ME Code / Title 24-A / Chapter 91 / Section 7103
24-A §7103. Requirements for doing business
Status: in_force

1. Administrator. A provider may, but is not required to, appoint an administrator or other designee to be responsible for any or all of the administration of the provider's service contracts and compliance with this chapter. All administrators of service contracts sold in this State shall register with the superintendent as provided in this section. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

2. Provision of receipt and copy of contract. A service contract may not be issued, sold or offered for sale in this State unless the provider has: A. Registered with the superintendent pursuant to this section; [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] B. Provided a receipt for, or other written evidence of, the purchase of the service contract to the service contract holder; [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] C. Provided a copy of the service contract to the service contract holder within a reasonable period of time from the date of purchase; and [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] D. Complied with the provisions of this chapter. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

3. Sample copy before sale. A provider shall make a complete sample copy of the service contract terms and conditions available for inspection by a consumer prior to the time of sale. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

4. Registration. A provider or administrator of service contracts issued, sold or offered for sale in this State shall apply for registration with the superintendent on a form prescribed by the superintendent, providing the registrant's name, full business address, telephone number and contact person and designating an agent in this State for service of process. The registration must be updated by written notification to the superintendent if changes occur in the registration on file. A. The registrant shall pay to the superintendent a fee as set forth in section 601, subsection 30 upon initial registration and every year thereafter. [RR 2011, c. 1, §44 (COR).] B. A registrant whose registration has terminated shall send notice within 15 days as follows: (1) To all in-force service contract holders, if the registrant is a provider. Such registrant shall also cease issuing new service contracts in this State and may not renew existing service contracts unless authorized by the terms of a run-off plan approved by the superintendent; and (2) To all providers for which it acts as an administrator, and to all in-force service contract holders of those providers, if the registrant is an administrator. Such registrant shall also cease acting as an administrator as to all service contract programs that it has contracted for in this State. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] This section may not be construed to require a provider or administrator to apply for and obtain a license under chapter 16, subchapter 2‑A . [RR 2011, c. 1, §44 (COR).]

5. Provider's obligations. To ensure the performance of the provider's obligations to its service contract holders, the provider shall either: A. Insure all service contracts under a reimbursement insurance policy filed with the superintendent and issued by an insurer authorized to transact casualty insurance in this State, purchased through a risk retention group registered with the superintendent, or issued pursuant to chapter 19 by an eligible surplus lines insurer that agrees in writing to comply with the terms of this chapter and to submit to the jurisdiction of the superintendent for purposes of enforcing this chapter, as long as such insurer or risk retention group either: (1) At the time the policy is filed with the superintendent and continuously thereafter: (a) Maintains surplus as to policyholders and paid-in capital of at least $15,000,000; and (b) Files annually copies of the insurer's or risk retention group's as audited financial statements, its annual statement under section 423 and the actuarial certification required by and filed in the insurer's state of domicile; or (2) At the time the policy is filed with the superintendent and continuously thereafter: (a) Maintains surplus as to policyholders and paid-in capital of at least $10,000,000; (b) Demonstrates to the satisfaction of the superintendent that the insurer maintains a ratio of net written premiums, wherever written, to surplus as to policyholders and paid-in capital of not greater than 3 to 1; and (c) Files annually copies of the insurer's audited financial statements, its annual statement under section 423 and the actuarial certification required by and filed in the insurer's state of domicile; or [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] B. Maintains, or together with its parent company maintains, a tangible net worth of at least $100,000,000 and upon request provides the superintendent with a copy of the provider's or, if the provider's financial statements are consolidated with those of its parent company, the provider's parent company's most recent Form 10-K or Form 20-F annual report filed with the United States Securities and Exchange Commission within the last calendar year or, if the company does not file with the United States Securities and Exchange Commission, a copy of the company's audited financial statements that shows a tangible net worth of the provider or its parent company of at least $100,000,000. If the provider's parent company's Form 10-K or Form 20-F annual report or financial statements are filed to meet the provider's financial stability requirement, the parent company shall agree, on a form approved by the superintendent, to guarantee the obligations of the provider relating to service contracts sold by the provider in this State. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

6. Other financial security requirements. Except for the requirements specified in subsections 4 and 5 , other financial security requirements may not be required by the superintendent for providers. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

7. Return of service contract. A service contract must require the provider to permit the service contract holder to return the service contract subject to the following conditions. A. A service contract holder may return a service contract within 20 days of the date the service contract was mailed to the service contract holder or within 10 days of delivery if the service contract is delivered to the service contract holder at the time of sale or within a longer time period permitted under the service contract. Upon return of the service contract to the provider within the applicable time period, if no claim has been made under the service contract prior to its return to the provider, the service contract is void and the provider shall refund to the service contract holder or lienholder if the service contract holder has financed the purchase of the service contract the full provider fee and any sales tax refund required pursuant to state law. The right to void the service contract provided in this subsection is not transferable and applies only to the original service contract purchaser and only if no claim has been made prior to its return to the provider. A monthly penalty equal to 10% of the provider fee outstanding must be added to a refund that is not paid or credited within 45 days after return of the service contract to the provider. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] B. After the time period specified in paragraph A for returning a service contract or if a claim has been made under the service contract within that time period, a service contract holder may cancel the service contract and the provider shall refund to the service contract holder 100% of the unearned pro rata provider fee, less any claims paid. An administrative fee not to exceed 10% of the provider fee paid by the service contract holder may be charged by the provider. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

8. Premium taxes. Insurance premium taxes under Title 36, chapter 357 apply as follows. A. Provider fees collected on service contracts are not subject to premium taxes. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] B. Premiums for reimbursement insurance policies are subject to premium taxes. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

9. Licensing exemption. Except for the registration requirements in subsection 4 , a license or registration is not required under this Title to provide, administer, market, sell or offer to sell service contracts in this State. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

10. Insurance laws exemption. The marketing, sale, offering for sale, issuance, making, proposing to make and administration of service contracts by providers and related service contract sellers, administrators and other persons are exempt from all provisions of the State's insurance laws, except as specified in this chapter, as long as a service contract provider or administrator has registered with the superintendent as required by subsection 4 . Reimbursement insurance policies are subject to all relevant provisions of this Title to the full extent consistent with this chapter. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]
24-A M.R.S. § 2833-A — ME Code / Title 24-A / Chapter 35 / Section 2833-A
24-A §2833-A. Extension of coverage for dependent children
Status: in_force

Notwithstanding section 2822 , a group health insurance policy that provides coverage for a dependent child at certain ages only if the child is a student must continue that coverage if the child is unable to remain enrolled in school on a full-time basis due to a mental or physical illness or an accidental injury. This coverage may be terminated at the age at which coverage for students terminates under the terms of the policy. An insurer may require, as a condition of eligibility for continued coverage in accordance with this section, that the student provide written documentation from a health care provider and the student's school that the student is no longer enrolled in school on a full-time basis due to a mental or physical illness or accidental injury. [PL 2005, c. 532, §2 (NEW).]
24-A M.R.S. § 2734 — ME Code / Title 24-A / Chapter 33 / Section 2734
24-A §2734. Conforming to statute
Status: in_force

1. No policy provision which is not subject to this chapter shall make a policy, or any portion thereof, less favorable in any respect to the insured or the beneficiary than the provisions thereof which are subject to this chapter. [PL 1969, c. 132, §1 (NEW).]

2. A policy delivered or issued for delivery to any person in this State in violation of this chapter shall be held valid but shall be construed as provided in this chapter. When any provision in a policy subject to this chapter is in conflict with any provision of this chapter, the rights, duties, and obligations of the insurer, the insured and the beneficiary shall be governed by the provisions of this chapter. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3034 — ME Code / Title 24-A / Chapter 41 / Section 3034
24-A §3034. Mortgagee's policy void, unless consented to
Status: in_force

When any mortgagee claims the benefit of sections 3030 to 3033 , any policy of insurance that the mortgagee had procured or subsequently procures on the mortgagee's interest in the same property by virtue of the mortgage is void, unless consented to by the insurer insuring the mortgagor's interest. [RR 2021, c. 1, Pt. B, §265 (COR).]
24-A M.R.S. § 2822 — ME Code / Title 24-A / Chapter 35 / Section 2822
24-A §2822. Age limits
Status: in_force

There shall be a provision specifying the ages, if any there be, to which the insurance provided therein shall be limited; and the ages, if any there be, for which additional restrictions are placed on benefits and the additional restrictions placed on the benefits at such ages. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 798 — ME Code / Title 24-A / Chapter 9 / Section 798
24-A §798. Exemption from insurance laws within limitations
Status: in_force

1. Titles consistent. A special purpose reinsurance vehicle is subject to chapters 1 , 3 and 5 to the extent consistent with this subchapter. [PL 2003, c. 249, §2 (NEW).]

2. Provisions not applicable. No other provisions of this Title are applicable to a special purpose reinsurance vehicle organized under this subchapter, except as expressly provided in this subchapter or in rules adopted by the superintendent pursuant to section 797 . [PL 2003, c. 249, §2 (NEW).]

3. Variance. The superintendent may issue an order exempting a special purpose reinsurance vehicle or a protected cell from provisions of this subchapter upon a finding that the variance is necessary for conformance to the laws or regulatory requirements of a ceding insurer's state of domicile and that the variance is consistent with the purposes of this subchapter given the nature of the risks to be insured. [PL 2007, c. 386, §22 (NEW).]
24-A M.R.S. § 6458 — ME Code / Title 24-A / Chapter 79 / Section 6458
24-A §6458. Confidentiality and prohibition on announcements
Status: in_force

1. Confidentiality. The following constitute information that might be damaging to the insurer if made available to its competitors and must be kept confidential by the superintendent: A. Risk-based capital reports, with respect to any domestic insurer or foreign insurer, that are filed with the superintendent, to the extent that the information in the reports is not required to be set forth in a publicly available annual statement schedule; and [PL 1993, c. 634, Pt. A, §1 (NEW).] B. Risk-based capital plans, with respect to any domestic insurer or foreign insurer, that are filed with the superintendent, including the results or report of any examination or analysis of an insurer performed pursuant to this chapter and any corrective order issued by the superintendent pursuant to the examination or analysis. [PL 1993, c. 634, Pt. A, §1 (NEW).] The information listed in paragraph A or B may be shared on a confidential basis in accordance with section 216, subsection 5 but may not be made public or be subject to subpoena, other than by the superintendent and then only for the purpose of enforcement actions taken by the superintendent pursuant to this chapter or any other provision of the insurance laws of this State. [PL 2017, c. 169, Pt. F, §2 (AMD).]

2. Prohibition on dissemination of information regarding risk-based capital levels. Except as otherwise required under this chapter, making, publishing, disseminating, circulating or placing before the public, or causing, directly or indirectly, to be made, published, disseminated, circulated or placed before the public, in a newspaper, magazine or other publication, or in the form of a notice, circular, pamphlet, letter or poster, or over any radio or television station, or in any other way, an advertisement, announcement or statement containing an assertion or representation with regard to the risk-based capital levels of any insurer, or of any component derived in the calculation of risk-based capital levels, by any insurer, agent, broker or other person engaged in any manner in the insurance business would be misleading and is prohibited; provided, however, that if any materially false statement with respect to the comparison between an insurer's total adjusted capital to its risk-based capital levels or an inappropriate comparison of any other amount to the insurer's risk-based capital levels is published in any written publication and the insurer is able to demonstrate to the superintendent with substantial proof the falsity of that statement, or the inappropriateness, as the case may be, then the insurer may publish an announcement in a written publication if the sole purpose of the announcement is to rebut the materially false statement. [PL 1993, c. 634, Pt. A, §1 (NEW).]

3. Prohibition on use in ratemaking. Risk-based capital instructions, risk-based capital reports, adjusted risk-based capital reports, risk-based capital plans and revised risk-based capital plans may not be used by the superintendent for purposes of rate review, considered or used as evidence in any rate proceeding or used by the superintendent to calculate or derive any elements of an appropriate premium level or appropriate rate of return. This subsection does not prohibit the consideration of premium rates and projected or realized rates of return for purposes of company action or regulatory action taken under this chapter. [PL 2017, c. 169, Pt. F, §3 (NEW).]
24-A M.R.S. § 2736 — ME Code / Title 24-A / Chapter 33 / Section 2736
24-A §2736. Rate filings on individual health insurance policies
Status: in_force

1. Filing of rate information. Every insurer shall file for approval by the superintendent every rate, rating formula, classification of risks and every modification of any formula or classification that it proposes to use in connection with individual health insurance policies and certain group policies specified in section 2701 . If the filing applies to individual health plans as defined in section 2736‑C , the insurer shall simultaneously file a copy with the Attorney General. Every such filing must state the effective date of the filing. Every such filing must be made not less than 60 days in advance of the stated effective date, unless the 60-day requirement is waived by the superintendent, and the effective date may be suspended by the superintendent for a period of time not to exceed 30 days. A filing required under this section must be made electronically in a format required by the superintendent unless exempted by rule adopted by the superintendent. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2009, c. 439, Pt. C, §1 (RPR).]

2. Filing; information. When a filing is not accompanied by the information upon which the insurer supports such filing, or the superintendent does not have sufficient information to determine whether such filing meets the requirements that rates not be excessive, inadequate or unfairly discriminatory, the superintendent shall require the insurer to furnish the information upon which it supports the filing. A filing and all supporting information, except for protected health information required to be kept confidential by state or federal statute and descriptions of the amount and terms or conditions or reimbursement in a contract between an insurer and a 3rd party, are public records notwithstanding Title 1, section 402, subsection 3, paragraph B and become part of the official record of any hearing held pursuant to section 2736‑A . [PL 2009, c. 439, Pt. C, §2 (AMD).]

3. Criteria for special rate hearings. [PL 2009, c. 244, Pt. C, §5 (RP).]

4. Special rate hearing. [PL 2009, c. 244, Pt. C, §6 (RP).]
24-A M.R.S. § 405-C — ME Code / Title 24-A / Chapter 5 / Section 405-C
24-A §405-C. Domestic insurers or licensed health maintenance organizations; parity with regional insurers
Status: in_force

Notwithstanding any other provision of this Title, a domestic insurer or licensed health maintenance organization authorized to transact individual health insurance in this State may offer for sale in this State an individual health plan equivalent to any plan offered for sale in this State by a regional insurer or health maintenance organization pursuant to section 405‑A . An individual health plan may not be offered for sale pursuant to this section before January 1, 2014. [PL 2011, c. 90, Pt. C, §5 (NEW).]
24-A M.R.S. § 5052-A — ME Code / Title 24-A / Chapter 68 / Section 5052-A
24-A §5052-A. Trial examination period
Status: in_force

Nursing home care, home health care and long-term care policies must have a notice prominently printed on the first page of the policy or certificate or attached to the first page stating in substance that the applicant has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if for any reason, after examination of the policy or certificate, the applicant is not satisfied. [PL 1997, c. 604, Pt. D, §4 (AMD).]
24-A M.R.S. § 2803-A — ME Code / Title 24-A / Chapter 35 / Section 2803-A
24-A §2803-A. Loss information
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Insurance policy" means the insurance policy relating to the loss information requested pursuant to this section. [PL 1995, c. 71, §2 (NEW).] A-1. "High-cost claimant" means an individual insured whose aggregate claims exceed $50,000 during the 12-month period preceding the request for loss information. [PL 2023, c. 297, §1 (NEW).] B. "Loss information" means the aggregate claims experience of the group insurance policy or contract. "Loss information" includes the amount of premium received, the amount of claims paid and the loss ratio. "Loss information" does not include any information or data pertaining to the medical diagnosis, treatment or health status that identifies an individual covered under the group contract or policy. [PL 1995, c. 71, §2 (NEW).] C. "Loss ratio" means the ratio between the amount of premium received and the amount of claims paid by the insurer under the group insurance contract or policy. [PL 1995, c. 71, §2 (NEW).] [PL 2023, c. 297, §1 (AMD).]

2. Disclosure of basic loss information. Upon written request, every insurer shall provide loss information, in accordance with the minimum requirements of paragraph A , concerning a group policy or contract to its policyholder, to a former policyholder or to a school administrative unit pursuant to Title 20‑A, section 1001, subsection 14, paragraph E within 21 business days of the date of the request. This subsection does not apply to a former policyholder whose coverage terminated more than 18 months prior to the date of a request. For the purposes of this subsection, "school administrative unit" has the same meaning as in Title 20‑A, section 1, subsection 26 . The loss information provided by an insurer must include: A. A minimum of 24 months of claims data or, if that period is less than 24 months, claims data for the period the policyholder, former policyholder or school administrative unit has been insured by the insurer; [PL 2023, c. 297, §1 (NEW).] B. The aggregate claims and loss ratio by month with the total medical and pharmacy claims provided separately for each month; and [PL 2023, c. 297, §1 (NEW).] C. High-cost claimant reports when there are more than 25 enrollees covered under the group policy. High-cost claimant reports must coincide with the time frames of any loss ratio reports and must include, at a minimum, enrollment status of active or terminated insureds and primary diagnosis. [PL 2023, c. 297, §1 (NEW).] [PL 2023, c. 297, §1 (AMD).]

3. Transmittal of request. An insurance contractor or producer who receives a request for loss information in accordance with this section shall transmit the request for loss information to the insurer within 4 business days. An insurer receiving a disclosure request under subsection 2 may transmit high-cost claimant data directly to another insurer or underwriter, or to a contractor or producer that has signed with that insurer a business associate agreement that is in accordance with 45 Code of Federal Regulations, Sections 164.502(e) and 164.504(e), for the purpose of securing quotes, developing actuarial reports, facilitating claim management or other activities related to quoting or managing the group health plan sponsored by the requesting group policyholder. [PL 2023, c. 297, §1 (AMD).]

4. Exception. An insurer is not required to provide the loss information described in this section for a group that is eligible for small group coverage pursuant to section 2808‑B . [PL 2001, c. 410, Pt. B, §2 (AMD).]
24-A M.R.S. § 7305 — ME Code / Title 24-A / Chapter 93 / Section 7305
24-A §7305. Automobile insurance provisions
Status: in_force

1. Exclude coverage. Notwithstanding section 2902 or Title 29‑A, section 1605 , an insurer that writes automobile insurance in this State may exclude coverage afforded under the policy issued to an owner or operator of a personal vehicle for any loss or injury that occurs while a transportation network company driver is logged into a transportation network company's digital network or while a driver is engaged in a prearranged ride. The authority to exclude coverage applies to any coverage included in an automobile insurance policy, including, but not limited to: A. Liability coverage for bodily injury and property damage; [PL 2015, c. 279, §1 (NEW).] B. Uninsured vehicle and underinsured motor vehicle coverage; [PL 2015, c. 279, §1 (NEW).] C. Medical payments coverage; [PL 2015, c. 279, §1 (NEW).] D. Comprehensive physical damage coverage; and [PL 2015, c. 279, §1 (NEW).] E. Collision physical damage coverage. [PL 2015, c. 279, §1 (NEW).] Nothing in this section requires that a personal automobile insurance policy provide coverage while the driver is logged into the transportation network company's digital network, the driver is engaged in a prearranged ride or the driver otherwise uses a vehicle to transport riders for compensation. Nothing in this section may be construed to preclude an insurer from entering into a contract to provide coverage for a transportation network company driver's personal vehicle. [PL 2015, c. 279, §1 (NEW).]

2. No duty to indemnify. If an insurer has excluded coverage described in section 7303 , the insurer has no duty to defend or indemnify any claim expressly excluded. Nothing in this chapter may be construed to invalidate or limit an exclusion contained in a policy, including any policy in use or approved for use in this State prior to the effective date of this chapter, that excludes coverage for vehicles used to carry persons or property for a charge or available for hire by the public. [PL 2015, c. 279, §1 (NEW).]

3. Right of contribution. An automobile insurer that defends or indemnifies a claim against a driver that is excluded under the terms of its policy has a right of contribution against other insurers that provide automobile insurance to the same driver in satisfaction of the coverage requirements of section 7303 at the time of loss. [PL 2015, c. 279, §1 (NEW).]

4. Cooperation. In a claims coverage investigation, a transportation network company and any insurer potentially providing coverage under section 7303 shall cooperate to facilitate the exchange of relevant information with directly involved parties and any insurer of the transportation network company driver if applicable, including but not limited to: A. The precise times that a transportation network company driver logged into and off of the transportation network company's digital network in the 12-hour period immediately preceding and in the 12-hour period immediately following the accident; and [PL 2015, c. 279, §1 (NEW).] B. A clear description of the coverage, exclusions and limits provided under any automobile insurance maintained under this chapter. [PL 2015, c. 279, §1 (NEW).] [PL 2015, c. 279, §1 (NEW).]
24-A M.R.S. § 2901 — ME Code / Title 24-A / Chapter 39 / Section 2901
24-A §2901. Contracts subject to general provisions
Status: in_force

All contracts of casualty insurance delivered or issued for delivery in this State and covering subjects resident, located, or to be performed in this State are also subject to the applicable provisions of chapter 27 (the insurance contract) and to other applicable provisions of this Title. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2951 — ME Code / Title 24-A / Chapter 40-A / Section 2951
24-A §2951. Group property and casualty insurance
Status: in_force

1. Group coverage permitted. The following lines of property and casualty insurance may be written on a group basis, subject to the requirements of this section and other applicable law: A. Liability insurance issued to a risk purchasing group in compliance with chapter 72‑A ; [PL 2001, c. 138, §16 (NEW).] B. Credit involuntary unemployment insurance issued to a debtor group in compliance with chapter 37 ; and [PL 2001, c. 138, §16 (NEW).] C. Other lines of insurance designated by the superintendent in compliance with rules adopted pursuant to section 2953 . [PL 2001, c. 138, §16 (NEW).] [PL 2001, c. 138, §16 (NEW).]

2. Terms of coverage. A policy must provide insured group members with terms of coverage that are no less favorable to the insured than would be required for comparable nongroup policies, at rates consistent with the requirements of this Title. [PL 2001, c. 138, §16 (NEW).]

3. Certificate of coverage. An insured group member must be issued a certificate of coverage adequately describing that insured's rights and responsibilities under the group policy in a manner satisfactory to the superintendent, delivered in the same time and manner as is required for the delivery of comparable nongroup policies. [PL 2001, c. 138, §16 (NEW).]
24-A M.R.S. § 4211 — ME Code / Title 24-A / Chapter 56 / Section 4211
24-A §4211. Complaint system
Status: in_force

1. Every health maintenance organization shall establish and maintain a complaint system which has been approved by the superintendent, after consultation with the Commissioner of Health and Human Services, to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services and general operating procedures. [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]

2. Each health maintenance organization shall submit to the superintendent and the Commissioner of Health and Human Services an annual report in a form prescribed by the superintendent after consultation with the Commissioner of Health and Human Services that includes: A. A description of the procedures of such complaint system; [PL 1975, c. 503 (NEW).] B. The total number and disposition of complaints handled through the complaint system and a compilation of causes underlying the complaints filed. Complaints concerning access to chiropractic providers and the results of those complaints must be separately identified; and [PL 1993, c. 669, §4 (AMD).] C. The number, amount and disposition of malpractice claims settled during the year by the health maintenance organization. [PL 1975, c. 503 (NEW).] [RR 2003, c. 2, §87 (COR).]

3. The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the superintendent a summary report at such times and in such format as the superintendent may require. Such complaints involving other persons shall be referred to such persons with a copy to the superintendent. [PL 1975, c. 503 (NEW).]

4. The superintendent and the Commissioner of Health and Human Services may examine such complaint system. [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
24-A M.R.S. § 3060 — ME Code / Title 24-A / Chapter 41 / Section 3060
24-A §3060. Insurance coverage for family child care providers
Status: in_force

1. Evidence of business liability insurance. An insurer may not refuse to issue or renew a policy covering the primary residence of a family child care provider licensed under Title 22, section 8301‑A, subsection 3 or cancel such policy within the first 90 days of coverage unless the denial of coverage or cancellation is based solely on underwriting factors other than the presence of a family child care business on the premises if the family child care provider has demonstrated satisfactory evidence that the child care business is covered by separate insurance coverage for business liability, including medical payments coverage equivalent to coverage in the policy. For purposes of cancellation or nonrenewal under section 3049 or 3051 , an insurer may not treat the presence of the family child care business activity as a factor related to the insurability of the primary residence of a family child care provider licensed under Title 22, section 8301‑A, subsection 3 if the family child care provider has demonstrated satisfactory evidence that the child care business is covered by separate insurance coverage for business liability in accordance with this subsection. [PL 2021, c. 35, §31 (AMD).]

2. No liability under property insurance policy. An insurer has no duty to defend or indemnify a family child care provider licensed under Title 22, section 8301‑A, subsection 3 under a policy covering the primary residence of a family child care provider issued by the insurer if: A. The loss or damage for which the family child care provider is liable or alleged to be liable arises in whole or in part from the family child care business activity; [PL 2009, c. 185, §1 (NEW).] B. The policy issued by the insurer expressly excludes that loss or damage arising from the family child care business activity; [PL 2009, c. 185, §1 (NEW).] C. The family child care provider has demonstrated satisfactory evidence of separate insurance coverage for child care business liability in accordance with subsection 1 ; and [PL 2009, c. 185, §1 (NEW).] D. The insurer issuing the policy covering the primary residence has disclosed to the family child care provider that failure to maintain separate insurance coverage for child care business liability might result in cancellation or nonrenewal of the policy covering the primary residence and that the child care business activity is excluded under the policy. [PL 2009, c. 185, §1 (NEW).] [PL 2021, c. 35, §32 (AMD).]

3. Effect of cancellation or nonrenewal of business liability policy. If a family child care provider has demonstrated satisfactory evidence of separate insurance coverage for child care business liability to the insurer as provided in subsection 2, paragraph C , the insurer issuing the policy covering the primary residence continues to have no duty to defend if the insurance policy for child care business liability is cancelled or nonrenewed during the term of the policy covering the primary residence. [PL 2009, c. 185, §1 (NEW).]
24-A M.R.S. § 4228 — ME Code / Title 24-A / Chapter 56 / Section 4228
24-A §4228. Utilization review data
Status: in_force

1. Report required. On or before April 1st of each year, each health maintenance organization which issues a program of contract in this State 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 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. (1) 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. (2) The report must separately identify the number of evaluations performed in which the health care services requested or provided include chiropractic services and the results of those evaluations; [PL 1993, c. 669, §5 (AMD).] 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 health maintenance organization; [PL 1987, c. 168, §5 (NEW).] C. The number and result of any appeals by patients or their physicians as a result of initial review decisions to reduce benefits for services as determined through prospective evaluations; and [PL 1987, c. 168, §5 (NEW).] D. Any complaints filed in a court of competent jurisdiction and served upon a health maintenance organization filing under this section stating a cause of action against that organization on the basis of damages to patients alleged to have been proximately caused by a delay, reduction or denial of medical benefits by the organization, as determined through prospective evaluations, and the determination of liability or other disposition of the complaint. [PL 1987, c. 168, §5 (NEW).] [PL 1993, c. 669, §5 (AMD).]

2. Maine residents. This section is applicable to evaluations, appeals and complaints relating to Maine residents only. [PL 1987, c. 168, §5 (NEW).]

3. Confidentiality. Any information provided pursuant to this section shall not identify the names of patients. [PL 1987, c. 168, §5 (NEW).]
24-A M.R.S. § 4245 — ME Code / Title 24-A / Chapter 56 / Section 4245
24-A §4245. NCQA accreditation survey report
Status: in_force

1. Access and confidentiality. The superintendent or the Commissioner of Health and Human Services may require a health maintenance organization to submit its NCQA accreditation survey report. An NCQA accreditation survey report obtained by or submitted to the superintendent or the Commissioner of Health and Human Services is confidential, is not subject to subpoena and may not be made public by the superintendent or the Commissioner of Health and Human Services except as otherwise provided in this section. [PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]

2. Use in examination. In conducting an examination of a health maintenance organization pursuant to section 4215 , the superintendent or the Commissioner of Health and Human Services has the discretion to adopt relevant findings in the NCQA accreditation survey report in whole or in part as the examiner's conclusions, if the examiner determines that the NCQA survey, by itself or in combination with the examiner's own findings, sufficiently demonstrates that the health maintenance organization has satisfied the pertinent requirements of this chapter. If the NCQA accreditation survey report indicates that the health maintenance organization may not be in compliance with one or more requirements of this chapter, the examiner may investigate and make independent findings. [PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]

3. Examination report. The information from the NCQA accreditation survey report that sufficiently demonstrates that the health maintenance organization has satisfied the pertinent requirements of this section as adopted by the superintendent or the Commissioner of Health and Human Services pursuant to subsection 2 may be incorporated into an examination report, which is a public record except for any information relating to an individual applicant or enrollee. [PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]

4. Use of information for regulatory purposes. The confidentiality of the NCQA accreditation survey report does not prohibit its use by the superintendent or the Commissioner of Health and Human Services for regulatory or law enforcement purposes subject to the restrictions of section 216, subsection 5 and section 226, subsection 7 . [PL 1999, c. 256, Pt. Q, §2 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).] Revisor's Note: §4245. Coverage for contraceptives (As enacted by PL 1999, c. 341, §4 and affected by §5 is REALLOCATED TO TITLE 24-A, SECTION 4247) Revisor's Note: §4245. Coverage for services of certified nurse practitioners; certified nurse midwives (As enacted by PL 1999, c. 396, §4 and affected by §7 is REALLOCATED TO TITLE 24-A, SECTION 4248)
24-A M.R.S. § 233 — ME Code / Title 24-A / Chapter 3 / Section 233
24-A §233. Witnesses; disciplinary proceedings
Status: in_force

1. If any individual without reasonable cause fails to appear when summoned as a witness, or refuses to answer a lawful and pertinent question, or refuses to produce documentary evidence when directed to do so by the superintendent, or behaves in a disrespectful or disorderly manner at the inquiry, or obstructs the proceedings by any means, whether or not in the presence of the superintendent or the superintendent's designee, the individual is guilty of contempt and may be dealt with as provided in subsection 2 . [RR 2021, c. 1, Pt. B, §174 (COR).]

2. The superintendent or the superintendent's designee, as the case may be, may file a complaint in the Superior Court, setting forth under oath the facts constituting the contempt and requesting an order returnable in not less than 2 nor more than 5 days, directing the alleged contemner to show cause before the court why the alleged contemner should not be punished for contempt. Upon the return of such order, the court shall examine the alleged contemner under oath and the alleged contemner has an opportunity to be heard. If the court determines that the respondent has committed any alleged contempt, the court shall punish the offender as if the contempt had occurred in an action arising in or pending in such court. [RR 2021, c. 1, Pt. B, §174 (COR).]
24-A M.R.S. § 6210 — ME Code / Title 24-A / Chapter 73 / Section 6210
24-A §6210. Termination of continuing care agreement
Status: in_force

1. Right to terminate. A subscriber shall have the right to terminate a continuing care agreement for any reason prior to the date of occupancy by the subscriber or up to one year after the date of occupancy. The provider may reserve the right to terminate the agreement as specified in subsection 3 . [PL 1987, c. 482, §1 (NEW).]

2. Termination by the subscriber. If, prior to the subscriber occupying a unit or within one year after that date, the subscriber dies and does not have a surviving spouse who is also a subscriber and who still wishes to occupy the unit, or the subscriber elects to terminate the continuing care agreement for any reason, the subscriber or the subscriber's legal representative shall receive within 30 days a refund of all money paid to the provider without interest, except: A. Those special additional costs incurred by the provider due to modifications in the structure or furnishings of the unit specifically requested by the subscriber and set forth in writing in a separate addendum to the agreement and signed by the subscriber; [PL 1987, c. 482, §1 (NEW).] B. In the case of the death of the subscriber, interest earned upon funds in escrow; [PL 1987, c. 563, §5 (AMD).] C. The application fee; [PL 1987, c. 482, §1 (NEW).] D. A maximum of 2% of the entrance fee for each month of occupancy, if any, which refund, in the case of a subscriber who terminates the continuing care agreement for any reason other than death, will be paid on the receipt by the provider of the same percentage deposit of the entrance fee from another subscriber for a residential unit that is the same as or similar to the residential unit to which the cancelled continuing care agreement applied; and [PL 1995, c. 452, §29 (AMD).] E. Costs to the provider of repairing damage caused by the subscriber to the subscriber's unit, other than reasonable wear and tear to the unit. [PL 1987, c. 482, §1 (NEW).] This subsection shall not be construed in a manner inconsistent with the real estate interest acquired by the purchaser of a condominium. [PL 1995, c. 452, §29 (AMD).]

3. Termination by the provider. If, prior to occupancy by the subscriber, the provider determines that the subscriber is ineligible for entrance into the facility because of a substantial change in the subscriber's physical, mental or financial condition or because of materially false statements made by the subscriber or for other just cause, the provider may terminate the agreement, provided that: A. The continuing care agreement contains a provision allowing the termination; and [PL 1987, c. 482, §1 (NEW).] B. A refund of all money paid by the subscriber, plus interest earned on escrowed funds shall be refunded, less an application fee not to exceed $500, is made at the time the agreement is terminated. [PL 1987, c. 563, §6 (AMD).] [PL 1987, c. 563, §6 (AMD).]

4. Rescission damages. A subscriber may rescind a continuing care agreement at any time if the terms of the agreement are in violation of the terms of this chapter and the subscriber is injured by the violation. In those instances when a violation of this chapter results from the fraudulent actions of the provider, the subscriber shall be entitled to treble damages for injuries arising from the violation. [PL 1987, c. 482, §1 (NEW).]
24-A M.R.S. § 2741 — ME Code / Title 24-A / Chapter 33 / Section 2741
24-A §2741. Maternity benefits for unmarried women policyholders and the minor dependents of  policyholders with dependent or family coverage required
Status: in_force

All health insurance policies and plans shall provide, at appropriate rates, the same maternity benefits for unmarried women policyholders and the minor dependents of policyholders with dependent or family coverage under the same terms and conditions as such maternity coverage is provided to married policyholders or the wives of policyholders with maternity coverage. This requirement shall apply to all insurance policies and plans issued or renewed after the effective date of this Act. [PL 1975, c. 276, §2 (NEW).]
24-A M.R.S. § 4332 — ME Code / Title 24-A / Chapter 56-A / Section 4332
24-A §4332. Safe harbor and waiver
Status: in_force

1. Authority for safe harbor. Notwithstanding any other provisions of this Title or Title 24 , including, without limitation, sections 4341 and 4342 , an arrangement between a carrier and a downstream entity with which the carrier has contracted to provide or arrange for the provision of services that allows the downstream entity to accept a limited degree of insurance risk is permitted and such a risk arrangement is deemed not to be engaging in the business of insurance by the downstream entity if: A. The arrangement does not involve substantial insurance risk or substantial enrollment risk as described in section 4334 ; and [PL 1999, c. 609, §20 (NEW).] B. The arrangement meets the requirements of sections 4335 and 4336 . [PL 1999, c. 609, §20 (NEW).] [PL 1999, c. 609, §20 (NEW).]

2. Waiver for downstream risk arrangements that exceed risk threshold described in section 4334. Carriers and downstream entities that wish to develop downstream risk arrangements that exceed the risk threshold described in section 4334 may jointly request that the superintendent grant a waiver that allows the downstream entity to accept a limited degree of insurance risk without being licensed as an insurer, a health maintenance organization or an insurance administrator. The joint request for a waiver must include a plan for managing financial exposure, based upon reasonable enrollment and utilization projections and upon the contracts, parties and features proposed, sufficient to quantify in dollars per quarter and per annum all elements of downstream risk to be assumed by the downstream entity. All other risk arrangements are prohibited unless the arrangements meet the appropriate licensing standards or are expressly permitted by the superintendent. [PL 1999, c. 609, §20 (NEW).]

3. Continuing obligation to subscribers. A carrier contracting with a downstream entity remains obligated to its subscribers for the delivery of health care benefits consistent with existing state law. The carrier remains responsible for compliance with all applicable laws. [PL 1999, c. 609, §20 (NEW).]

4. Certain incentives prohibited. A downstream risk arrangement may not contain incentives for the downstream entity or participating provider to limit or deny medically necessary care to enrollees. [PL 1999, c. 609, §20 (NEW).]

5. Requirements still applicable. The application of the safe harbor provisions in subsection 1 or a waiver of licensing requirements granted pursuant to this section does not exempt the downstream entity from any other licensure or prior approval requirements applicable to activities conducted by the downstream entity, including, but not limited to, utilization review licensure, insurance administrator licensure or preferred provider arrangement registration. [PL 1999, c. 609, §20 (NEW).]
24-A M.R.S. § 405-A — ME Code / Title 24-A / Chapter 5 / Section 405-A
24-A §405-A. Certification of regional insurers or health maintenance organizations to transact individual health insurance
Status: in_force

1. Regional insurer or health maintenance organization defined. As used in this section, "regional insurer or health maintenance organization" means an insurer or health maintenance organization that holds a valid certificate of authority to transact individual health insurance in Connecticut, Massachusetts, New Hampshire, Rhode Island or Vermont. [PL 2013, c. 388, Pt. B, §1 (AMD).]

2. Certification of regional insurers or health maintenance organizations. A regional insurer or health maintenance organization may not transact individual health insurance in this State by mail, the Internet or otherwise unless the superintendent has issued a certification that the regional insurer or health maintenance organization has met the requirements of this subsection. The superintendent shall issue a certification or deny certification within 30 days of a request. A. A policy, contract or certificate of individual health insurance offered for sale in this State by a regional insurer or health maintenance organization must comply with the applicable individual health insurance laws in the state of domicile of that regional insurer and must be actively marketed in that state. [PL 2011, c. 90, Pt. C, §3 (NEW).] B. A regional insurer or health maintenance organization shall meet the requirements of section 4302 for reporting plan information with respect to individual health plans offered for sale in this State and disclose to prospective enrollees how the health plans differ from individual health plans offered by domestic insurers in a format approved by the superintendent. Health plan policies and applications for coverage must contain the following disclosure statement or a substantially similar statement on the face page of the policy or application in a type size of at least 14 points and font that is easily readable by a person with average eyesight: "This policy is issued by a regional insurer or health maintenance organization and is governed by the laws and rules of (regional insurer's or health maintenance organization's state of domicile). This policy may not be subject to all the insurance laws and rules of the State of Maine, including coverage of certain health care services or benefits mandated by Maine law. Before purchasing this policy, you should carefully review the terms and conditions of coverage under this policy, including any exclusions or limitations of coverage." [PL 2013, c. 388, Pt. B, §2 (AMD).] C. A regional insurer or health maintenance organization shall meet the requirements of section 4303, subsection 4 for grievance procedures with respect to health plans offered for sale in this State. [PL 2011, c. 90, Pt. C, §3 (NEW).] D. A regional insurer or health maintenance organization shall meet the requirements of chapter 56‑A for provider network adequacy with respect to health plans offered for sale in this State. [PL 2011, c. 90, Pt. C, §3 (NEW).] E. A regional insurer or health maintenance organization shall meet the requirements of chapter 33 with respect to rates for individual health plans offered for sale in this State. [PL 2011, c. 90, Pt. C, §3 (NEW).] F. A regional insurer or health maintenance organization shall designate an agent for receiving service of legal documents or process in the manner provided in this Title. [PL 2011, c. 90, Pt. C, §3 (NEW).] G. A regional insurer or health maintenance organization shall meet the requirements of this Title with respect to allowing the superintendent access to records of the regional insurer or health maintenance organization. [PL 2011, c. 90, Pt. C, §3 (NEW).] [PL 2013, c. 388, Pt. B, §2 (AMD).]

3. Unfair trade practices. The provisions of chapter 23 apply to a regional insurer or health maintenance organization permitted to transact individual health insurance under this section or section 405 . [PL 2011, c. 90, Pt. C, §3 (NEW).]

4. Taxes; assessments. A regional insurer or health maintenance organization transacting individual health insurance in this State under this section is subject to applicable taxes or assessments imposed on insurers transacting individual health insurance in this State pursuant to this Title and Title 36 . [PL 2011, c. 90, Pt. C, §3 (NEW).]

5. Compliance with court orders. A regional insurer or health maintenance organization transacting individual health insurance in this State under this section shall comply with lawful orders from courts of competent jurisdiction issued in a voluntary dissolution proceeding or in response to a petition for an injunction by the superintendent asserting that the regional insurer or health maintenance organization is in a hazardous financial condition. [PL 2011, c. 90, Pt. C, §3 (NEW).]

6. Exemption from other requirements. Except as expressly provided in this section, the requirements of this Title do not apply to a regional insurer or health maintenance organization permitted to transact individual health insurance under this section. [PL 2011, c. 90, Pt. C, §3 (NEW).]

7. Agreement with insurance regulators in other state. The superintendent shall enter into a memorandum of understanding or other agreement with the insurance department of the state of domicile of a regional insurer or health maintenance organization permitted to transact individual health insurance in this State under this section with respect to enforcement of the provisions of this section. [PL 2011, c. 90, Pt. C, §3 (NEW).]

8. Sale of policies. An individual health insurance policy, contract or certificate may not be offered for sale in this State pursuant to this section before January 1, 2014. [PL 2011, c. 90, Pt. C, §3 (NEW).]
24-A M.R.S. § 3055-A — ME Code / Title 24-A / Chapter 41 / Section 3055-A
24-A §3055-A. Discontinuance of a line of business
Status: in_force

If an insurer files a plan with the superintendent to discontinue business in a line of insurance subject to this subchapter, the superintendent may authorize the nonrenewal of policies in that line of business if the plan filed by the insurer demonstrates the availability of substantially similar coverage in the admitted market. The nonrenewal of a policyholder pursuant to this section may not be considered by an insurer in future coverage determinations. An insurer may resume transacting business in a line of insurance discontinued pursuant to this section upon written notification to the superintendent. [PL 2005, c. 49, §2 (AMD).]
24-A M.R.S. § 4237 — ME Code / Title 24-A / Chapter 56 / Section 4237
24-A §4237. Coverage for breast cancer treatment
Status: in_force

1. Inpatient care. All individual and group coverage subject to this chapter that provides coverage for medical and surgical benefits must ensure that inpatient coverage with respect to the treatment of breast cancer is provided for a period of time determined by the attending physician, after providing notice to the patient regarding the coverage required by this subsection and in consultation with the patient, to be medically appropriate following a mastectomy, a lumpectomy or a lymph node dissection for the treatment of breast cancer. Nothing in this subsection may be construed to require the provision of inpatient coverage if the attending physician and patient determine that a shorter period of hospital stay is appropriate. In implementing the requirements of this subsection, an individual or group coverage contract may not modify the terms and conditions of coverage based on the determination by any enrollee to request less than the minimum coverage required under this subsection. All individual and group coverage subject to this subsection must provide written notice to each enrollee under the contract regarding the coverage required by this subsection. The notice must be prominently positioned in any literature or correspondence made available or distributed by the plan and must be transmitted in the next mailing made by the plan to the enrollee or as part of any yearly information packet sent to the enrollee, whichever is earlier. The notice must also be made available to any physician participating in the insurer's provider network. [PL 2015, c. 227, §4 (AMD); PL 2015, c. 227, §5 (AFF).]

2. Reconstruction. All individual and group coverage subject to this chapter that provides coverage for mastectomy surgery must provide coverage for reconstruction of the breast on which surgery has been performed and surgery and reconstruction of the other breast to produce a symmetrical appearance if the patient elects reconstruction and in the manner chosen by the patient and the physician. [PL 1997, c. 408, §7 (NEW); PL 1997, c. 408, §8 (AFF).]

3. Application. The requirements of this section apply to all individual and group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. B, §24 (NEW).]
24-A M.R.S. § 2553 — ME Code / Title 24-A / Chapter 29 / Section 2553
24-A §2553. Maximum rate of interest on policy loans
Status: in_force

1. Policies issued on or after the effective date of this Act shall provide for policy loan interest rates as follows: A. A provision permitting a maximum interest rate of not more than 8% each year; or [PL 1981, c. 188, §4 (NEW).] B. A provision permitting an adjustable maximum interest rate established from time to time by the life insurer as permitted by law. [PL 1981, c. 188, §4 (NEW).] [PL 1981, c. 188, §4 (NEW).]

2. The rate of interest charged on a policy loan made under subsection 1, paragraph B , shall not exceed the higher of the following: A. The published monthly average for the calendar month ending 2 months before the date on which the rate is determined; or [PL 1981, c. 188, §4 (NEW).] B. The rate used to compute the cash surrender values under the policy during the applicable period plus 1% each year. [PL 1981, c. 188, §4 (NEW).] [PL 1981, c. 188, §4 (NEW).]

3. If the maximum rate of interest is determined pursuant to subsection 1, paragraph B , the policy shall contain a provision setting forth the frequency at which the rate is to be determined for that policy. [PL 1981, c. 188, §4 (NEW).]

4. The maximum rate for each policy shall be determined at regular intervals at least once every 12 months, but not more frequently than once in any 3-month period. At the intervals specified in the policy: A. The rate being charged may be increased whenever such increase, as determined under subsection 2 , would increase that rate by 1/2% or more each year; and [PL 1981, c. 188, §4 (NEW).] B. The rate being charged shall be reduced whenever such reduction, as determined under subsection 2 , would decrease that rate by 1/2% or more each year. [PL 1981, c. 188, §4 (NEW).] [PL 1981, c. 188, §4 (NEW).]

5. The life insurer shall: A. Notify the policyholder at the time a cash loan is made of the initial rate of interest on the loan; [PL 1981, c. 188, §4 (NEW).] B. Notify the policyholder, with respect to premium loans, of the initial rate of interest on the loan as soon as it is reasonably practical to do so after making the initial loan. Notice need not be given to the policyholder when a further premium loan is added, except as provided in paragraph C ; [PL 1981, c. 188, §4 (NEW).] C. Send to policyholders with loans, reasonable advance notice of any increase in the rate; and [PL 1981, c. 188, §4 (NEW).] D. Include in the notices required under this subsection the substance of the pertinent provisions of subsections 1 and 3 . [PL 1981, c. 188, §4 (NEW).] [PL 1981, c. 188, §4 (NEW).]

6. The loan value of the policy shall be determined in accordance with section 2510 , but no policy may terminate in a policy year as the sole result of a change in the interest rate during that policy year, and the life insurer shall maintain coverage during that policy year until the time at which it would otherwise have terminated and if there had been no change during that policy year. [PL 1981, c. 188, §4 (NEW).]

7. The substance of the pertinent provisions of subsections 1 and 3 shall be set forth in the policies to which they apply. [PL 1981, c. 188, §4 (NEW).]

8. For purposes of this section: A. The rate of interest on policy loans permitted under this section includes the interest rate charged on reinstatement of policy loans for the period during and after any lapse of a policy; [PL 1981, c. 188, §4 (NEW).] B. The term "policy loan" includes any premium loan made under a policy to pay one or more premiums that were not paid to the life insurer as they fell due; [PL 1981, c. 188, §4 (NEW).] C. The term "policyholder" includes the owner of the policy or the person designated to pay premiums as shown on the records of the life insurer; and [PL 1981, c. 188, §4 (NEW).] D. The term "policy" includes certificates issued by a fraternal benefit society and annuity contracts which provide for policy loans. [PL 1981, c. 188, §4 (NEW).] [PL 1981, c. 188, §4 (NEW).]

9. No other provision of law may apply to policy loan interest rates unless made specifically applicable to such rates. [PL 1981, c. 188, §4 (NEW).]
24-A M.R.S. § 961 — ME Code / Title 24-A / Chapter 11 / Section 961
24-A §961. Experience reporting
Status: in_force

For all policies and contracts in force on or after the operative date of the valuation manual, an insurer shall submit mortality, morbidity, policyholder behavior and expense experience data, as applicable, and other data as prescribed in the valuation manual. [PL 2013, c. 238, Pt. C, §9 (NEW).]
24-A M.R.S. § 208-A — ME Code / Title 24-A / Chapter 3 / Section 208-A
24-A §208-A. Cooperative agreements
Status: in_force

The superintendent, in the superintendent's discretion, may enter into cooperative agreements with other state, federal or foreign law enforcement or regulatory agencies to facilitate the regulatory functions of the superintendent, including, but not limited to, information sharing, coordination of examinations and investigations and joint examinations and investigations. [PL 1999, c. 184, §18 (NEW).]
24-A M.R.S. § 4235 — ME Code / Title 24-A / Chapter 56 / Section 4235
24-A §4235. Standardized claim forms
Status: in_force

All health maintenance organizations providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed health care practitioner must accept the current standardized claim form for professional services approved by the Federal Government and submitted electronically. All health maintenance organizations providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed hospital must 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. A health maintenance organization 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 . All services provided by a health care practitioner in an office setting must be submitted on the standardized federal form used by noninstitutional providers and suppliers. Services in a nonoffice setting may be billed as negotiated between the health maintenance organization and health care practitioner. For purposes of this section, "office setting" means a location where the health care practitioner routinely provides health examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether or not the office is physically located within a facility. [PL 2023, c. 521, §6 (AMD).]
24-A M.R.S. § 1255 — ME Code / Title 24-A / Chapter 15 / Section 1255
24-A §1255. Responsibility for safekeeping
Status: in_force

The State shall be responsible for the safekeeping of all securities and receipts delivered to the superintendent under authority of this chapter. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 1258 — ME Code / Title 24-A / Chapter 15 / Section 1258
24-A §1258. Appraisal
Status: in_force

The superintendent may, in the superintendent's discretion, prior to acceptance for deposit of any particular security, or at any time thereafter while so deposited, have the same appraised or valued by competent appraisers. The reasonable cost of any such appraisal or valuation must be borne by the insurer. [RR 2021, c. 1, Pt. B, §197 (COR).]
24-A M.R.S. § 3709 — ME Code / Title 24-A / Chapter 52 / Section 3709
24-A §3709. President and chief executive officer
Status: in_force

1. Appointment. The board shall appoint a president who shall serve as chief executive officer and who is responsible for the operation of the company. The president must be qualified by education and experience to manage an organization with financial and operational obligations to its policyholders and claimants. [PL 1991, c. 885, Pt. C, §8 (NEW).]

2. Term. The president serves at the will of the board. [PL 1991, c. 885, Pt. C, §8 (NEW).]

3. Compensation. The president is entitled to compensation as established by the board and is subject to any reasonable requirements, including bonding, established by the board. [PL 1991, c. 885, Pt. C, §8 (NEW).]

4. Board member. The president is a member of the board, but may not be the chair of the board. [PL 1991, c. 885, Pt. C, §8 (NEW).]

5. Duties. The board, as part of its plan of operation, shall designate the powers and duties of the president. The president may, with direction from the board, assist in the development of the plan of operation and other start-up functions. [PL 1991, c. 885, Pt. C, §8 (NEW).]