24 M.R.S. § 2301 — ME Code / Title 24 / Chapter 19 / Section 2301
24 §2301. Purposes
Status: in_force

Any corporation organized under special Act of the Legislature, under Title 13, chapter 81 or as a public benefit corporation under Title 13‑B for the following purposes may be authorized by the superintendent on the terms and conditions provided for in this chapter, except that when such a corporation was previously organized by special Act of the Legislature, this chapter does not apply when inconsistent with that Act as previously amended: [PL 2003, c. 171, §9 (AMD).]

1. Nonprofit hospital service plans. To establish, maintain and operate nonprofit hospital service plans whereby hospital care may be provided by hospitals or groups of hospitals with which such a corporation has a contract for that purpose to those persons or groups of persons who become subscribers to that plan under a contract that entitles each subscriber to certain hospital care, and the hospital or hospitals contracting with such a corporation are governed by this chapter and by the provisions of Title 24‑A that are applicable as provided in this chapter; [PL 1993, c. 702, Pt. A, §1 (AMD).]

2. Nonprofit medical service plans. To establish, maintain and operate nonprofit medical service plans whereby medical or surgical service is provided to those persons or groups of persons who become subscribers to such a plan under contracts with such a corporation, either in the capacity of principal or in the capacity of agent of other nonprofit medical service corporations or insurance companies authorized to do business in this State, and the physician or physicians contracting with such a corporation are governed by this chapter and by the provisions of Title 24‑A that are applicable as provided in this chapter; [PL 1993, c. 702, Pt. A, §1 (AMD).]

3. Nonprofit health care plans. To establish, maintain and operate nonprofit health care plans whereby health care services not covered under subsections 1 and 2 may be provided, by institutions or persons licensed for that purpose by the State, when licensure is required, with which such a corporation has a contract for that purpose, to those persons or groups of persons who become subscribers to such a plan under a contract that entitles each subscriber to certain specific health care, and the institution or persons contracting with such a corporation are governed by this chapter and by the provisions of Title 24‑A that are applicable as provided in this chapter; [PL 1993, c. 702, Pt. A, §1 (AMD).]

3-A. Integrated medical service plans; indemnity health care contracts; health care plan administration. A corporation subject to this chapter that maintains a nonprofit hospital service plan, a nonprofit medical service plan or a nonprofit health care plan in accordance with subsections 1 , 2 or 3 may, in addition: A. Issue and maintain in force indemnity health care contracts whereby persons or groups of persons who are contract holders may be indemnified by that corporation for expenses for hospital care, medical or surgical services or other health care services. An indemnity contract issued pursuant to the authority established by this section is subject to all the requirements relating to content and interpretation of such policies and contracts that apply to policies of the same kind of insurance as set forth in Title 24‑A ; [PL 1993, c. 702, Pt. A, §1 (NEW).] B. Issue and maintain in force employee benefit excess insurance as defined in Title 24‑A, section 707, subsection 1, paragraph C‑1 with respect to health insurance and underlying risks that the corporation is authorized to cover under this chapter; [PL 1999, c. 256, Pt. M, §1 (AMD).] C. Issue and maintain in force hospital, medical service and health care plans and contracts that include health care benefits for workplace and nonworkplace injury and illness in accordance with Title 39‑A, section 403, subsection 2 ; [PL 1993, c. 702, Pt. A, §1 (NEW).] D. Receive or collect charges, contributions or premiums, adjust or settle claims, and perform related administrative, management, accounting, bookkeeping and advisory functions on behalf of any plan, fund or program established or maintained by a plan sponsor, health care services plan, health maintenance organization, health care provider or insurer, including plans, funds or programs established or maintained to provide through insurance or alternatives to insurance a type of life, annuity, health or workers' compensation benefit, except that nothing in this subsection may be interpreted as authorizing a nonprofit hospital, medical or health care service corporation to assume insurance risks not related to health care under contracts for life or workers' compensation insurance or annuities; [PL 1993, c. 702, Pt. A, §1 (NEW).] E. Establish, maintain, own, merge with, organize and operate a health maintenance organization directly as a division or line of business of the corporation, or indirectly as a subsidiary or affiliate of the corporation, pursuant to Title 24‑A, chapter 56 , which health maintenance organization has all of the rights and powers and is subject to all of the duties and responsibilities of a separately organized health maintenance organization under that chapter. A corporation subject to this chapter that engages in such activities may not be deemed to be practicing medicine and is exempt from provisions of law relating to the practice of medicine; and [PL 1993, c. 702, Pt. A, §1 (NEW).] F. Perform, on behalf of others, clerical, bookkeeping, accounting, statistical, management, personnel, marketing or similar services related to the provision of health care or health care financing, or establish, maintain, own and operate entities, independently or with others, to perform such services; [PL 1993, c. 702, Pt. A, §1 (NEW).] [PL 1999, c. 256, Pt. M, §1 (AMD).]

3-B. Hospital and medical service business exclusive. A hospital or medical service corporation may not engage in a business other than the business of hospital or medical service corporations as set forth in this section and in business activities reasonably and necessarily related to that business, except that: A. A hospital or medical service corporation may also engage in activities reasonably necessary to the management, supervision, servicing and protection of its lawful investments; [PL 1993, c. 702, Pt. A, §1 (NEW).] B. A hospital or medical service corporation may own subsidiaries or subsidiaries owning other subsidiaries that may engage in the activities under Title 24‑A, section 1157 ; and [PL 1993, c. 702, Pt. A, §1 (NEW).] C. A hospital or medical service corporation may utilize its facilities to perform administrative services for a governmental body, unit or agency; [PL 1993, c. 702, Pt. A, §1 (NEW).] [PL 1993, c. 702, Pt. A, §1 (NEW).]

3-C. Nonprofit purposes. A nonprofit hospital and medical service organization that is authorized to provide nonprofit hospital service plans under subsection 1 , nonprofit medical service plans pursuant to subsection 2 or nonprofit health care plans pursuant to subsection 3 is a charitable and benevolent institution, in accordance with Title 5, section 194‑A , and a public charity and its assets are held for the purpose of fulfilling the charitable purposes of the organization, which purposes may include, but are not limited to, the following: providing access to medical care through affordable health insurance and affordable managed care products for persons of all incomes; identifying and addressing the State's unmet health care needs, particularly with respect to medically uninsured and underserved populations; making services and care available through participating providers; and improving the quality of care for medically uninsured and underserved populations. [PL 2003, c. 171, §10 (AMD).]

4. Inadvertent payments. If direct payment is inadvertently made to a hospital, physician or other provider of medical services or health care by or on behalf of a subscriber or member, a corporation may reimburse the subscriber up to the amount payable under the plan to a hospital, a physician or other provider of medical services or health care; [PL 1993, c. 702, Pt. A, §1 (AMD).]

5. Principal or agent. In order to maintain and operate such plans, contracts, facilities and services, a corporation may act either in the capacity of principal or agent of other nonprofit hospital service corporations, insurers, health maintenance organizations, health care services plans, employee benefit plans, health care and employee benefit plan sponsors and health care providers authorized to do business in this State; [PL 1993, c. 702, Pt. A, §1 (AMD).]

6. Contracts and agreements. To contract with any similar corporations in other states for the joint administration of their business and to enter into reciprocal arrangements for the mutual benefit of their subscribers; [PL 1993, c. 702, Pt. A, §1 (AMD).]

7. Administrative services. A corporation has the right to utilize its organization and facilities, either directly or through another legal entity owned by it and similar corporations located in other states, to perform services for the United States or State or the units or agencies of either; or any public charity involved in health care; [PL 2003, c. 171, §11 (AMD).]

8. Right to contract. The State or any county, city, town or other quasi-municipal corporation has the same right to contract with a corporation subject to this chapter as it has under Title 24‑A, section 4501 with respect to insurers; [PL 1993, c. 702, Pt. A, §1 (AMD).]

8-A. Managed care plans. With respect to managed care plans that require subscribers to select primary care physicians, a corporation subject to this chapter must meet the following requirements: A. The corporation shall offer to groups of all sizes health benefit plans that meet the requirements for standardized health plans specified in Bureau of Insurance Rules, Chapter 750; [PL 1993, c. 702, Pt. A, §1 (NEW).] B. The managed care plan must provide a spectrum of providers and services that meets patient demand; [PL 1993, c. 702, Pt. A, §1 (NEW).] C. The managed care plan must provide to its members reasonable access to health care services. The Superintendent of Insurance shall adopt rules that consider geographical and transportation problems in rural areas; and [PL 1993, c. 702, Pt. A, §1 (NEW).] D. The managed care plan must demonstrate a plan for providing services for rural and underserved populations and for developing relationships with essential community providers. The corporation must make an annual report to the Superintendent of Insurance regarding the plan. [PL 1993, c. 702, Pt. A, §1 (NEW).] [PL 1993, c. 702, Pt. A, §1 (NEW).]

9. Indemnity health care contracts. [PL 1993, c. 702, Pt. A, §1 (RP).]

9-A. Investments. Investments by corporations subject to this chapter are governed by this paragraph. A. A corporation subject to this chapter may invest funds in the same manner and to the same extent as domestic mutual insurers under the provisions of Title 24‑A, chapter 13‑A and shall maintain reserves for possible losses or fluctuation in the value of investments as contemplated in Title 24‑A, section 901‑A, subsection 2 . Those reserves must comprehend, at a minimum, an asset valuation reserve and an income maintenance reserve calculated by methods that are consistent with standards that have been adopted by the superintendent for management of investment risk by life and health insurers. [PL 2001, c. 72, §1 (AMD).] B. Any limitation stated in Title 24‑A, chapter 13‑A on the investment powers of a mutual domestic insurer expressed in relation to the "surplus" of that insurer must be applied to a corporation subject to this chapter in relation to that corporation's subscriber reserves. [PL 1993, c. 702, Pt. A, §1 (NEW).] C. Notwithstanding the limitation stated in Title 24‑A, section 1156, subsection 2, paragraph D , a hospital or medical service corporation may invest in real property or interests in real property that is located in the United States, held directly or evidenced by partnership interests, stock of corporations, trust certificates or other instruments and acquired: (1) As an investment for the production of income or to be improved or developed for that investment purpose; or (2) For the convenient accommodation of the corporation's business. After giving effect to any of those investments, the aggregate amount of investments made under subparagraph (1) may not exceed 20% of the hospital or medical service corporation's total admitted assets; the aggregate amount of investments made under subparagraph (2) may not exceed 15% of the corporation's total admitted assets; and the aggregate amount of investments made under this paragraph may not exceed 25% of the corporation's total admitted assets. Investments under subparagraph (1) in any single property, including improvements on that property, may not in the aggregate exceed 2% of the corporation's total admitted assets. [PL 1993, c. 702, Pt. A, §1 (NEW).] D. In addition to the investments permitted under paragraph C , a hospital or medical service corporation that operates and establishes, maintains, merges with or organizes a health maintenance organization not organized as a separate legal entity may invest in real estate, including leasehold estates, for the convenient accommodation of the health maintenance organization's business, including hospitals, medical clinics, medical professional buildings and any other facility that is to be used by a provider in the provision of health care or by any other health care provider under contract with the health maintenance organization, and that facility must be used in the provision of health care services to members of the health maintenance organization by that provider. (1) A parcel of real estate acquired under this subsection may include excess space for rent to others if it is reasonably anticipated that that excess will be required for expansion or if the excess is reasonably required in order to have one or more buildings that function as an economic unit. (2) Real estate subject to this subsection may be subject to a mortgage. (3) The admitted value of the investment may not exceed the greater of the hospital or medical service corporation's subscriber reserve or 20% of the corporation's admitted assets, and the aggregate investment in real estate held under paragraph C and under this paragraph may not exceed 40% of the corporation's admitted assets, except with the approval of the superintendent if the superintendent finds that those percentages of the corporation's admitted assets are insufficient to provide for the convenient accommodation of the health maintenance organization's business. Investments in any single property, including improvements on that property, may not in the aggregate exceed 5% of the corporation's total admitted assets. [PL 1993, c. 702, Pt. A, §1 (NEW).] E. Notwithstanding any provisions of this section and Title 24‑A, chapter 13‑A allowing other investments, a corporation subject to this chapter shall maintain cash or investment grade obligations, as defined in Title 24‑A, section 1151‑A , that at all times have a fair market value of not less than 100% of the corporation's liability for claims payable, incurred, but not reported, claims payable, unpaid claims adjustment expenses, unearned premiums and, as applicable, any statutory, special or additional reserves provided by the corporation for the benefit of subscribers as of the close of the corporation's most recent calendar quarter prepared on the basis of statutory accounting principles. If the corporation's liability for these enumerated items increases more than 10% prior to the end of the calendar quarter, the corporation must, within 10 days of the determination, reallocate its investments to ensure compliance with this paragraph. [PL 1999, c. 715, §1 (AMD).] F. The superintendent may establish risk-based capital standards applicable to corporations subject to this chapter, their subsidiaries and controlled affiliates that engage in health care related business activities that the parent corporation conducts. [PL 1993, c. 702, Pt. A, §1 (NEW).] G. A director, officer or employee of a corporation subject to this chapter who receives, collects, disburses or invests funds in connection with the activities of that organization is responsible for those funds in a fiduciary relationship to the corporation. [PL 1993, c. 702, Pt. A, §1 (NEW).] H. For corporations subject to this subsection, the following terms have the following meanings. (1) "Admitted assets" means those assets owned by the corporation, recognized pursuant to Title 24‑A, section 901‑A , reduced in amount by any applicable provision of this Title or Title 24‑A . For purposes of applying the investment limitations of Title 24‑A, chapter 13‑A , the asset value must be that contained in the annual statement of the corporation as of December 31st of the year next preceding the making of the investment or contained in an audited financial report, as defined in Title 24‑A, section 221‑A , of more current origin prepared on the basis of statutory accounting principles. (2) "Subscriber reserves" means those reserves held by the corporation for the protection of subscribers that are the excess of the corporation's assets over its liabilities as set forth in the annual statement of the corporation as of December 31st of the year next preceding the making of the investment or contained in an audited financial report, as defined in Title 24‑A, section 221‑A , of more current origin prepared on the basis of statutory accounting principles; [PL 2001, c. 72, §2 (AMD).] [PL 2001, c. 72, §§1, 2 (AMD).]

9-B. Conversion to mutual insurer. [PL 2003, c. 171, §12 (RP).]

9-C. Health maintenance organizations. A corporation subject to this chapter is not required to maintain separate reserves or surplus with respect to the operations of a health maintenance organization that is not a separate legal entity. All assets of the corporation must be available to pay claims arising from corporate operations, with the exception of assets supporting reserves set aside in accordance with a plan for the continuation of benefits to health maintenance organization members under Title 24‑A, section 4204, subsection 7 and assets supporting additional reserves to the extent required by rules adopted by the superintendent pursuant to Title 24‑A, section 901‑A . A hospital or medical service corporation that establishes and maintains a health maintenance organization not organized as a separate legal entity shall maintain separate accounting for the health maintenance organization; [PL 2001, c. 72, §3 (AMD).]

9-D. Conversion to a domestic stock insurer. Conversion of a nonprofit hospital and medical service organization as defined in paragraph B , subparagraph (8) to a domestic stock insurer is governed by this subsection. A. A nonprofit hospital and medical service organization or other entity authorized by the superintendent or organized pursuant to this chapter may convert to a domestic stock insurer subject to the provisions of this subsection. [PL 2001, c. 550, Pt. B, §2 (AMD).] B. As used in this subsection, unless the context otherwise indicates, the following terms have the following meanings. (1) "Charitable trust" has the meaning set forth in Title 5, section 194‑A, subsection 1, paragraph C . (2) "Charitable trust plan" means the plan submitted to the Attorney General pursuant to Title 5, section 194‑A, subsection 5 . (3) "Conversion" means the process by which an organization, with the approval of the superintendent, converts to a domestic stock insurer pursuant to this subsection. (4) "Conversion plan" means a written plan that sets forth the provisions required by the superintendent, that is filed with the superintendent pursuant to this subsection, that sets forth a complete description of the proposed conversion and that contains sufficient detail to permit the superintendent to make the findings required under this subsection. (5) "Converted stock insurer" means the domestic stock insurer resulting from a conversion pursuant to this subsection. (6) "Fair market value" means the value of an organization or an affiliate or the value of the assets of such an entity determined as if the entity had voting stock outstanding and 100% of its stock were freely transferrable and available for purchase without restrictions. In determining fair market value, consideration must be given to value as a going concern, market value, investment or earnings value, net asset value and a control premium, if any. (7) "Member" means a member of the organization entitled to vote under the articles or bylaws of the organization. (8) "Nonprofit hospital and medical service organization" or "organization" means a corporation or other entity authorized by the superintendent or organized pursuant to this chapter for the purpose of providing nonprofit hospital service plans within the meaning of subsection 1 , nonprofit medical service plans within the meaning of subsection 2 and any organization that provides only nonprofit health care plans within the meaning of subsection 3 . (10) "Subscriber" means an individual who has subscribed to one or more of the hospital, medical or health care service plans or contracts offered or issued by the organization or health insurance affiliate as defined in section 2308‑A through an individual or family policy or group policy. [PL 2003, c. 171, §13 (AMD).] C. A nonprofit hospital and medical service organization may, without the need for reincorporation, amend its charter pursuant to this subsection to become a domestic stock insurer under and pursuant to the terms and conditions of a conversion plan that complies with this subsection and is approved by the superintendent after an adjudicatory hearing on the proposed conversion. Notice of the hearing must be given to the public and the organization's directors or trustees, officers, employees, members and subscribers, all of whom have the right to appear and be heard at the hearing. Beginning on the date on which a conversion plan is filed with the superintendent for approval, the conversion plan must be available for public inspection and copying at the office of the superintendent, at the principal executive office of the organization that filed the conversion plan and at other locations the superintendent designates. [PL 1997, c. 344, §4 (NEW).] D. Concurrent with the filing of the conversion plan with the superintendent, the organization shall file a charitable trust plan with the Attorney General pursuant to Title 5, section 194‑A and submit a copy to the superintendent. The organization shall file a copy of the conversion plan with the Attorney General at the time the organization files the conversion plan with the superintendent. The superintendent shall commence review of the conversion plan pursuant to this subsection upon receipt by the superintendent of the Superior Court's approval or approval with modifications of the charitable trust plan or at such earlier time as the superintendent determines necessary. [PL 1997, c. 344, §4 (NEW).] E. The superintendent may not issue final approval of a conversion plan unless the superintendent finds that: (1) The terms and conditions of the conversion plan are fair and equitable and, in determining what is fair and equitable, consideration may be given to, but is not limited to, the factors set forth in paragraph L ; (2) The conversion plan is subject to approval by the vote of not less than 2/3 of the organization's board of directors; (3) The conversion plan provides for the issuance of capital stock or assets of the converted stock insurer or a combination of stock and assets, without consideration, to the charitable trust equal to 100% of the fair market value of the organization; (5) Immediately after, and giving effect to the terms of, the conversion, the converted stock insurer would be in safe and sound financial condition and would have paid-in capital stock and surplus in amounts not less than the minimum paid-in capital stock and surplus set forth under Title 24‑A, section 410 required of a domestic stock insurer authorized to transact like kinds of insurance; (7) The conversion plan provides that during the first 3 years after the conversion, to avoid dilution of the value of the shares issued in the conversion, the converted stock insurer and its affiliates may not issue shares greater in seniority, including voting rights or dividends, than the shares issued under the conversion plan. The superintendent may waive the provisions contained in this subparagraph if the superintendent, in the superintendent's sole discretion, determines that the charitable trust has control, as defined in Title 24‑A, section 222 , of the converted stock insurer; (8) The conversion plan is consistent with the charitable trust plan and does not adversely affect the distribution of the organization's value to the charitable trust; and (9) The conversion plan complies with all applicable law. [PL 2003, c. 171, §14 (AMD).] F. The conversion plan must include the proposed articles of incorporation and bylaws of the converted stock insurer and all references in this subsection to the conversion plan are deemed to include such instruments. [PL 1997, c. 344, §4 (NEW).] G. [PL 2003, c. 171, §15 (RP).] H. The conversion plan sets forth a comparative premium rate analysis of all the organization's plans and product offerings, comparing actual premium rates for the 3-year period before the filing of the conversion plan and projected premium rates for the 3-year period following the proposed conversion. The rate analysis must address the projected impact, if any, of the proposed conversion upon the cost to subscribers as well as the projected impact, if any, of the proposed conversion upon the organization's underwriting profit, investment income, tax position and loss and claim reserves, including the effect, if any, of adverse market or risk selection on reserves. [PL 1997, c. 344, §4 (NEW).] I. The conversion plan must include an appraisal of the fair market value, or range of values, of the aggregate equity of the converted stock insurer to be outstanding upon completion of the conversion plan and, if a range of values, the methodology for fixing a final value coincident with the completion of the transactions provided for in the conversion plan. (1) The appraisal must enable determinations of value for purposes of the amount of cash or other assets that the charitable trust will be entitled to receive, without consideration, under the provisions of the conversion plan required by paragraph E , subparagraph (3). (2) The appraisal required by this paragraph must be prepared by persons independent of the organization, experienced and expert in the area of corporate appraisal and acceptable to the superintendent. The appraisal must be in form and content acceptable to the superintendent and contain a complete and detailed description of the elements that make up the appraisal, justification for the methodology employed and sufficient support for the conclusions reached in the appraisal. (3) To the extent that the appraisal is based on a capitalization of the pro forma income of the converted stock insurer, the appraisal must indicate the basis for determination of the income to be derived from any proceeds of the sale of stock and demonstrate the appropriateness of the earnings-multiple used, including assumptions made regarding future earnings growth. (4) To the extent that the appraisal is based on the comparison of the capital stock of the converted stock insurer with outstanding capital stock of existing stock entities offering comparable insurance products, the existing stock entities must be reasonably comparable to the converting stock insurer in terms of such factors as size, market area, competitive conditions, profit history and expected future earnings. (5) In those instances when the superintendent determines that the appraisal is materially deficient or substantially incomplete, the superintendent may deem the entire conversion plan materially deficient or substantially incomplete and decline to further process or reject the application for conversion. (6) The converting organization shall submit to the superintendent information demonstrating to the satisfaction of the superintendent the independence and expertise of any person preparing the appraisal or related materials under this paragraph. (7) An appraiser may not serve as an underwriter or selling agent under the same conversion plan and an affiliate of an appraiser may not act as an underwriter or selling agent unless procedures are followed and representations and warranties made to ensure that an appraiser is separate from the underwriter or selling agent affiliate and the underwriter or selling agent affiliate does not make recommendations or in any way have an impact on the appraisal. (8) An appraiser may not receive any other fee except the fee for services rendered in connection with the appraisal. [PL 2003, c. 171, §16 (AMD).] J. A director, officer, agent or employee of the organization or any other person may not receive any fee, commission or other valuable consideration whatsoever other than that person's usual and regular salary and compensation for in any manner aiding, promoting or assisting in a conversion under this section or any related transaction, except as set forth in the conversion plan and approved by the superintendent. For the purposes of this paragraph, "usual and regular salary and compensation" does not include any salary, compensation or other economic benefit that is in any way contingent on completion of the conversion. This paragraph does not prohibit the payment of reasonable fees and compensation to attorneys-at-law, accountants and actuaries for services performed in the independent practice of their professions, even though also directors of the organization. [PL 1997, c. 344, §4 (NEW).] K. For the purpose of determining whether a conversion plan meets the requirements of this subsection and any other relevant provisions of this Title and Title 24‑A , the superintendent may employ staff personnel and outside consultants including, without limitation, financial advisors, investment bankers, actuaries, attorneys and accountants. All costs related to the review of a conversion plan, including those costs attributable to the use of staff personnel, must be borne by the organization making the filing. [PL 1997, c. 344, §4 (NEW).] L. In making a determination under paragraph E , subparagraph (1) as to whether a conversion plan is fair and equitable, the superintendent shall consider, among other factors, the following: (1) Whether the conversion plan complies with the provisions of and purposes of this subsection and any rules of the superintendent that may be adopted under this subsection; and (2) Whether the conversion plan would adversely affect, in any manner, the services to be rendered to subscribers. [PL 1997, c. 344, §4 (NEW).] M. The superintendent may aggregate any transactions that are part of a plan or series of like transactions to determine whether those transactions constitute a conversion. [PL 1997, c. 344, §4 (NEW).] N. The superintendent, in the superintendent's sole discretion, may determine when an application for conversion under this subsection is complete and may request additional information from the organization as the superintendent determines necessary to review the application and conversion plan. The superintendent may also conduct an examination under Title 24‑A, section 221 to obtain any information the superintendent determines necessary in connection with an application for conversion or transaction or series of transactions that the superintendent determines constitute a conversion under paragraph M . The failure of the organization to provide the information or cooperate in the examination, in addition to other applicable penalties, constitutes grounds for denial of the application for conversion. [PL 1997, c. 344, §4 (NEW).] O. The Attorney General has the right to intervene as a party in a proceeding before the superintendent and, if the Attorney General intervenes, has the right to receive any documents or other information received by the superintendent in connection with the proceeding. The Attorney General is subject to all confidentiality provisions that apply to the superintendent. [PL 1997, c. 344, §4 (NEW).] P. The superintendent may adopt rules, not inconsistent with the provisions of this subsection, the superintendent determines necessary or desirable and appropriate to effect the purposes of this subsection. Rules adopted under this subsection are routine technical rules pursuant to Title 5, chapter 375, subchapter II‑A . [PL 1997, c. 344, §4 (NEW).] [PL 2003, c. 171, §§13-16 (AMD).]

10. Superintendent defined. As used in this chapter "superintendent" means the Superintendent of Insurance of this State; and [PL 1993, c. 702, Pt. A, §1 (AMD).]

11. Separate accounts. A hospital or medical services corporation that issues indemnity contracts, contracts pursuant to hospital, medical or health care service plans or integrated medical service plans shall maintain separate accounting for each of these lines of business. [PL 1993, c. 702, Pt. A, §1 (NEW).]
24-A M.R.S. § 6809 — ME Code / Title 24-A / Chapter 85 / Section 6809
24-A §6809. General provisions for settlement contracts
Status: in_force

1. Prior conditions. A settlement provider entering into a settlement contract with a viator shall first obtain: A. If the viator is the insured, a written statement from a licensed attending physician that the viator is of sound mind and under no constraint or undue influence to enter into a settlement contract; [PL 2003, c. 636, §12 (AMD).] B. Prior to or at the time of execution of the settlement contract, a witnessed document in which the viator consents to the settlement contract, represents that the viator has a full and complete understanding of the settlement contract and that the viator has a full and complete understanding of the benefits of the life insurance policy, acknowledges that the viator has entered into the settlement contract freely and voluntarily and, for persons who are terminally ill or chronically ill, acknowledges that the insured is terminally ill or chronically ill and that the terminal or chronic illness was diagnosed after the life insurance policy was issued; and [PL 2003, c. 636, §12 (AMD).] C. Notwithstanding section 2159, subsection 3 or any other provisions of state law, a document in which the insured consents to the release of the insured's medical records to a settlement provider and, if the life insurance policy was issued less than 2 years from the date of application for a settlement contract to the insurance company that issued the life insurance policy covering the life of the insured. [PL 2003, c. 636, §12 (AMD).] The insurer shall respond to a request for verification of coverage submitted by a settlement provider not later than 30 calendar days from the date the request is received. The request for verification of coverage must be made on a form approved by the superintendent. In its response, the insurer shall indicate whether, based on the medical evidence and documents provided, the insurer intends to pursue an investigation regarding the validity of the insurance contract. [PL 2003, c. 636, §12 (AMD).]

2. Confidentiality of medical information. All medical information solicited or obtained by any licensee is subject to the applicable provisions of state law relating to confidentiality of medical information. [PL 1997, c. 430, §1 (NEW); PL 1997, c. 430, §2 (AFF).]

3. Unconditional rescission. All settlement contracts must contain a provision that the viator has the right to rescind a settlement contract before the earlier of 30 calendar days after the date upon which the settlement contract is executed by all parties or 15 calendar days after the date upon which payment is received by the viator as provided in section 6808 . Rescission if exercised by the viator is effective only if both notice of the rescission is given and a full repayment of all proceeds and any premiums, loans and loan interest to the settlement provider is made within the rescission period. If the insured dies during the rescission period, the settlement contract is deemed to have been rescinded, subject to repayment of all proceeds and any premiums, loans and loan interest to the settlement provider. [PL 2003, c. 636, §12 (AMD).]

4. Transfer of insurance policy. The settlement provider shall designate an independent escrow agent and instruct the viator to send the executed documents required to effect the change in ownership or assignment or change in beneficiary directly to the independent escrow agent. Within 3 business days after the date the escrow agent receives the document, or from the date the settlement provider receives the documents, if the viator erroneously provides the documents directly to the provider, the settlement provider shall pay or transfer the proceeds of the settlement into an escrow or trust account maintained in a state or federally chartered financial institution whose deposits are insured by the Federal Deposit Insurance Corporation or its successor. Upon payment of the settlement proceeds into the escrow account, the escrow agent shall deliver the original change in ownership or assignment or change in beneficiary forms to the settlement provider or related provider trust. Upon the escrow agent's receipt of the acknowledgment of the properly completed transfer of ownership or assignment or designation of beneficiary from the insurance company, the escrow agent shall pay the settlement proceeds to the viator. [PL 2009, c. 376, §13 (AMD).]

5. Effect of failure to tender consideration. Failure to tender consideration for the settlement under the terms of the settlement contract renders the contract voidable for lack of consideration until the time consideration is tendered to and accepted by the viator. [PL 2003, c. 636, §12 (AMD).]

6. Unlicensed provider. [PL 2003, c. 636, §12 (RP).]

7. Income. [PL 2003, c. 636, §12 (RP).]

8. Advertising standards. [PL 2003, c. 636, §12 (RP).]

9. Contacts with the insured. An insured may designate one or more adult individuals in regular contact with the insured as the individual for all inquiries regarding the insured's health status and, if that designation is made, a settlement provider may not make these inquiries to the insured unless the settlement provider is unable, for more than 30 days, to contact the designee after diligent effort. The insured may change this designation at any time upon written notice to the settlement provider. Contacts with the insured for the purpose of determining the health status of the insured after the settlement has occurred are limited to once every 3 months for insureds with an estimated life expectancy of more than one year and once per month for insureds with a life expectancy of one year or less. The settlement provider shall explain to the insured the procedure for these contacts prior to the time the settlement contract is entered into. The limitation in this rule on contacts does not apply to contacts made for reasons other than determining the insured's health status or necessary to maintain the policy in force. Settlement providers are responsible for the actions of their authorized representatives. [PL 2003, c. 636, §12 (AMD).]
24 M.R.S. § 2332-J — ME Code / Title 24 / Chapter 19 / Section 2332-J
24 §2332-J. Coverage for contraceptives
Status: in_force

1. Coverage requirements. All individual and group nonprofit hospital and medical services plan policies and contracts and all nonprofit health care plan policies and contracts that provide coverage for prescription drugs or outpatient medical services must provide coverage for all prescription contraceptives, nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives approved by the federal Food and Drug Administration or for outpatient contraceptive services in accordance with the requirements of this section. For purposes of this section, "outpatient contraceptive services" means consultations, examinations, procedures and medical services provided on an outpatient basis and related to the use of contraceptive methods to prevent an unintended pregnancy. This section may not be construed to apply to prescription drugs or devices that are designed to terminate a pregnancy. [PL 2025, c. 445, §1 (AMD); PL 2025, c. 445, §14 (AFF).]

2. Exclusion for religious employer. A religious employer may request and a nonprofit hospital or medical service organization or nonprofit health care service organization shall grant an exclusion under the policy or contract for the coverage required by this section if the required coverage conflicts with the religious employer's bona fide religious beliefs and practices. A religious employer that obtains an exclusion under this subsection shall provide prospective insureds and those individuals insured under its policy written notice of the exclusion. This section may not be construed as authorizing a nonprofit hospital or medical service organization or nonprofit health care service organization to exclude coverage for prescription drugs prescribed for reasons other than contraceptive purposes or for prescription contraception that is necessary to preserve the life or health of a covered person. For the purposes of this section, "religious employer" means an employer that is a church, convention or association of churches or an elementary or secondary school that is controlled, operated or principally supported by a church or by a convention or association of churches as defined in 26 United States Code, Section 3121 (w) (3) (A) and that qualifies as a tax-exempt organization under 26 United States Code, Section 501(c) (3). [PL 1999, c. 341, §1 (NEW); PL 1999, c. 341, §5 (AFF).]

3. 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, §7 (NEW).]

4. Coverage of contraceptive supplies. Coverage required under this section must include coverage for contraceptive supplies in accordance with the following requirements. For purposes of this section, "contraceptive supplies" means all contraceptive drugs, devices and products approved by the federal Food and Drug Administration to prevent an unwanted pregnancy, including nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives. A. Coverage must be provided without any deductible, coinsurance, copayment or other cost-sharing requirement. [PL 2021, c. 609, §1 (NEW); PL 2021, c. 609, §5 (AFF).] B. If the federal Food and Drug Administration has approved one or more therapeutic equivalents of a contraceptive supply, an insurer is not required to cover all those therapeutically equivalent versions in accordance with this subsection, as long as at least one is covered without any deductible, coinsurance, copayment or other cost-sharing requirement in accordance with this subsection. [PL 2021, c. 609, §1 (NEW); PL 2021, c. 609, §5 (AFF).] C. Coverage must be provided for the furnishing or dispensing of prescribed contraceptive supplies and nonprescription oral hormonal contraceptive supplies intended to last for a 12-month period, which may be furnished or dispensed all at once or over the course of the 12 months at the discretion of the health care provider for prescribed contraceptive supplies. [PL 2025, c. 445, §2 (AMD); PL 2025, c. 445, §14 (AFF).] D. A prescription is not required to obtain a nonprescription oral hormonal contraceptive or nonprescription emergency contraceptive. [PL 2025, c. 445, §2 (NEW); PL 2025, c. 445, §14 (AFF).] E. A nonprofit hospital or medical service organization or nonprofit health care service organization shall establish mechanisms to ensure that an enrollee who seeks coverage for a nonprescription oral hormonal contraceptive or nonprescription emergency contraceptive at a pharmacy has the option to obtain the nonprescription oral hormonal contraceptive or nonprescription emergency contraceptive at the point of sale without payment of any cost-sharing amount or to make the purchase at the pharmacy counter through an out-of-pocket payment at the point of sale and submit a claim for reimbursement. [PL 2025, c. 445, §2 (NEW); PL 2025, c. 445, §14 (AFF).] F. The superintendent shall monitor compliance with the requirements for coverage of nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives and any rules adopted in accordance with subsection 5 , including any complaints or barriers to implementation. [PL 2025, c. 445, §2 (NEW); PL 2025, c. 445, §14 (AFF).] [PL 2025, c. 445, §2 (AMD); PL 2025, c. 445, §14 (AFF).]

5. Rules. The superintendent may adopt rules as necessary to implement the requirements of this section, including rules related to mechanisms to ensure coverage for nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives and rules regarding notice to enrollees about how to access coverage for nonprescription oral hormonal contraceptives and nonprescription emergency contraceptives. Rules adopted pursuant to this subsection are routine technical rules as described in Title 5, chapter 375, subchapter 2‑A . [PL 2025, c. 445, §3 (NEW); PL 2025, c. 445, §14 (AFF).]

Revisor's Note: §2332-J. Coverage for services of certified nurse practitioners; certified nurse midwives (As enacted by PL 1999, c. 396, §1 and affected by §7 is REALLOCATED TO TITLE 24, SECTION 2332-K)

Revisor's Note: §2332-J. Coverage for services provided by registered nurse first assistants (As enacted by PL 1999, c. 412, §1 is REALLOCATED TO TITLE 24, SECTION 2332-L)
24-A M.R.S. § 2850-B — ME Code / Title 24-A / Chapter 36 / Section 2850-B
24-A §2850-B. Guaranteed renewal; cessation of business
Status: in_force

1. Application. This section applies to: A. Individual health plans subject to section 2736‑C ; and [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] B. Group and blanket medical insurance contracts subject to chapter 35 except: (1) Medicare supplement policies subject to chapter 67 ; and (2) Contracts designed to cover specific diseases, hospital indemnity or accidental injury only. [PL 1999, c. 256, Pt. L, §10 (AMD).] [PL 1999, c. 256, Pt. L, §10 (AMD).]

2. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Carrier" means an insurance company, nonprofit hospital and medical service organization or health maintenance organization authorized to issue group health plans in this State. [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] B. "Individual market" means individual or group policies or contracts subject to section 2736‑C . [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] C. "Large group market" means groups not subject to section 2736‑C or 2808‑B . [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] D. "Small group market" means groups subject to section 2808‑B . [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).]

3. Cancellation of coverage; renewal. Coverage may not be rescinded for an individual, a group or eligible members and their dependents in those groups once an individual, a group or eligible members and their dependents in those groups are covered under an individual or group health plan, except that this subsection does not prohibit rescission with respect to a covered individual, a group or eligible members and their dependents in those groups who have performed an act or practice that constitutes fraud or made an intentional misrepresentation of material fact as prohibited by the terms of the individual or group health plan to the extent consistent with section 2411 . Such coverage may not be cancelled, and renewal must be guaranteed to all individuals, to all groups and to all eligible members and their dependents in those groups except: A. When the policyholder or contract holder fails to pay premiums or contributions in accordance with the terms of the contract or the carrier has not received timely premium payments; [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] B. For fraud or intentional misrepresentation of material fact by the policyholder or contract holder; [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] C. With respect to coverage of individuals under a group policy or contract, for fraud or intentional misrepresentation of material fact on the part of the individual or the individual's representative; [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] D. In the large or small group market, for noncompliance with the carrier's minimum participation requirements, which may not exceed the participation requirement when the policy was issued; [PL 2007, c. 199, Pt. C, §1 (AMD).] E. With respect to a managed care plan, as defined in section 4301‑A , if there is no longer an insured who lives, resides or works in the service area; [RR 2001, c. 1, §34 (COR).] F. When the carrier ceases offering large or small group health plans in compliance with subsection 4 and does not renew any existing policies in that market; [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).] F-1. When the carrier ceases offering individual health plans in compliance with section 2736‑C, subsection 4 and does not renew any existing policies in that market; [PL 2007, c. 199, Pt. C, §2 (NEW).] G. When the carrier ceases offering a product and meets the following requirements: (1) In the large group market: (a) The carrier provides notice to the policyholder and to the certificate holders at least 90 days before termination; (b) The carrier offers to each policyholder the option to purchase any other product currently being offered in the large group market; and (c) In exercising the option to discontinue the product and in offering the option of coverage under division (b), the carrier acts uniformly without regard to the claims experience of the policyholders or the health status of the certificate holders or their dependents or prospective certificate holders or their dependents; (2) In the small group market: (a) The carrier replaces the product with a product that complies with the requirements of this section, including renewability, and with section 2808‑B ; (b) The superintendent finds that the replacement is in the best interests of the policyholders; and (c) The carrier provides notice of the replacement to the policyholder and to the certificate holders at least 90 days before replacement, including notice of the policyholder's right to purchase any other product currently being offered by that carrier in the small group market pursuant to section 2808‑B, subsection 4 ; or (3) In the individual market: (a) The carrier replaces the product with a product that complies with the requirements of this section, including renewability, and with section 2736‑C ; (b) The superintendent finds that the replacement is in the best interests of the policyholders; and (c) The carrier provides notice of the replacement to the policyholder and, if a group policy subject to section 2736‑C , to a certificate holder at least 90 days before replacement, including notice of the policyholder's or certificate holder's right to purchase any other product currently being offered by that carrier in the individual market pursuant to section 2736‑C, subsection 3 ; [PL 2011, c. 238, Pt. F, §1 (AMD).] H. In renewing a large group policy in accordance with this section, a carrier may modify the coverage, terms and conditions of the policy consistent with other applicable provisions of state and federal laws as long as the modifications are applied uniformly to all policyholders of the same product; or [PL 2003, c. 428, Pt. A, §1 (AMD).] I. In renewing an individual or small group policy in accordance with this section, a carrier may make minor modifications to the coverage, terms and conditions of the policy consistent with other applicable provisions of state and federal laws as long as the modifications meet the conditions specified in this paragraph and are applied uniformly to all policyholders of the same product. Modifications not meeting the requirements in this paragraph are considered a discontinuance of the product pursuant to paragraph G . (1) A modification pursuant to this paragraph must be approved by the superintendent. The superintendent shall approve the modification if it meets the requirements of this section. (2) A change in a requirement for eligibility is not a minor modification pursuant to this paragraph if the change results in the exclusion of a class or category of enrollees currently covered. (3) Benefit modifications required by law are deemed minor modifications for purposes of this paragraph. (4) Benefit modifications other than modifications required by law are minor modifications only if they meet the requirements of this subparagraph. For purposes of this subparagraph, changes in administrative conditions or requirements specified in the policy, such as preauthorization requirements, are not considered benefit modifications. (a) The total of any increases in benefits may not increase the actuarial value of the total benefit package by more than 5%. (b) The total of any decreases in benefits may not decrease the actuarial value of the total benefit package by more than 5%. (c) For purposes of the calculations in divisions (a) and (b), increases and decreases must be considered separately and may not offset one another. (5) A carrier must give 60 days' notice of any modification pursuant to this paragraph to all affected policyholders and certificate holders. [PL 2011, c. 90, Pt. F, §3 (AMD).] [PL 2019, c. 5, Pt. A, §17 (AMD).]

4. Cessation of business. Carriers that provide health plans in the large group or small group markets after the effective date of this section that plan to cease offering coverage in one or both of those markets must comply with the following requirements. A. Notice of the decision to cease business in that market must be provided to the bureau 3 months before the cessation unless a shorter notice period is approved by the superintendent. If existing contracts are nonrenewed, notice must be provided to the bureau and to the policyholder or contract holder 6 months before nonrenewal. [PL 2001, c. 258, Pt. B, §3 (AMD).] B. Carriers that cease to write new small group business continue to be governed by section 2808‑B with respect to small group contracts in force and their renewal or replacement contracts. [PL 2001, c. 258, Pt. E, §11 (AMD).] C. Carriers that cease to write new business in that market are prohibited from writing new business in that market for a period of 5 years after the date of termination of the last policy unless the superintendent waives this requirement for good cause shown. [PL 2001, c. 258, Pt. B, §3 (AMD).] [PL 2001, c. 258, Pt. B, §3 (AMD); PL 2001, c. 258, Pt. E, §11 (AMD).]

5. Association plans. The requirements of this subsection apply to group contracts that are subject to this section and that are issued to association groups pursuant to section 2805‑A . Carriers shall renew coverage for association members if coverage through an association is terminated because the association ceases to exist, changes its membership eligibility criteria, fails to pay premiums, commits fraud or misrepresentation or voluntarily terminates the group policy. A. If coverage to an employer through an association is terminated, the carrier shall renew the coverage with the employer becoming the policyholder. [PL 2005, c. 121, Pt. G, §1 (NEW).] B. If coverage to an individual member of an association is terminated, the carrier shall renew the coverage with the individual becoming the policyholder. A carrier that has been granted an exemption pursuant to section 2736‑C, subsection 9 does not lose that exemption simply by virtue of renewing coverage to individuals under this paragraph. [PL 2005, c. 121, Pt. G, §1 (NEW).] The requirements of this subsection do not apply if the employer or individual fails to pay premiums, commits fraud or misrepresentation, voluntarily terminates membership in the association or ceases to qualify for membership for reasons other than a change in the association's membership eligibility criteria. [PL 2005, c. 121, Pt. G, §1 (NEW).]
24-A M.R.S. § 2426 — ME Code / Title 24-A / Chapter 27 / Section 2426
24-A §2426. Advance payments
Status: in_force

1. A payment or payments made by any person, or by the person's insurer by virtue of an insurance policy, on account of bodily injury or death or damage to or loss of property of another, does not constitute an admission of liability or waiver of defense as to such injury, death, loss or damage, or be admissible in evidence in any action brought against the insured person or the person's insurer for damages, indemnity or benefits arising out of such injury, death, loss or damage unless pleaded as a defense to the action. [RR 2021, c. 1, Pt. B, §218 (COR).]

2. All such payments must be credited upon any settlement with respect to the same damage, expense, or loss made by, or upon any judgment rendered therefor in such an action against, the payor or the payor's insurer, and in favor of any person to whom or on whose account payment was made. [RR 2021, c. 1, Pt. B, §218 (COR).]
24-A M.R.S. § 4216 — ME Code / Title 24-A / Chapter 56 / Section 4216
24-A §4216. Suspension or revocation of certificate of authority
Status: in_force

1. Notwithstanding Title 4, chapter 5 and Title 5, section 10051 , the superintendent may suspend or revoke a certificate of authority issued to a health maintenance organization under this chapter if the superintendent finds that any of the following conditions exist after a hearing held in accordance with Title 5, chapter 375, subchapter IV : A. The health maintenance organization is operating significantly in contravention of its basic organizational document or in a manner contrary to that described in and reasonably inferred from any other information submitted under section 4203 , unless amendments to such submissions have been filed with and approved by the superintendent; [PL 1975, c. 503 (NEW).] B. The health maintenance organization issues evidence of coverage or uses a schedule of charges for health care services that do not comply with the requirements of section 4207 ; [PL 1997, c. 592, §71 (AMD).] C. The health maintenance organization does not provide or arrange for basic health care services; [PL 1975, c. 503 (NEW).] D. The Commissioner of Health and Human Services certifies to the superintendent that: (1) The health maintenance organization does not meet the requirements of section 4204, subsection 2‑A, paragraph B ; or (2) The health maintenance organization is unable to fulfill its obligations to furnish health care services; [PL 1997, c. 683, Pt. B, §14 (AMD); PL 2003, c. 689, Pt. B, §7 (REV).] E. The health maintenance organization is no longer financially responsible and may reasonably be expected to be unable to meet its obligations to enrollees or prospective enrollees; [PL 1975, c. 503 (NEW).] F. The health maintenance organization has failed to implement a mechanism affording the enrollees an opportunity to participate in matters of policy and operation under section 4206 ; [PL 1975, c. 503 (NEW).] G. The health maintenance organization has failed to implement the complaint system required by section 4211 in a manner to reasonably resolve valid complaints; [PL 1975, c. 503 (NEW).] H. The health maintenance organization, or any person on its behalf, has advertised or merchandised its services in an untrue, misrepresentative, misleading, deceptive or unfair manner; [PL 1975, c. 503 (NEW).] I. The continued operation of the health maintenance organization would be hazardous to its enrollees; [PL 1975, c. 503 (NEW).] I-1. The health maintenance organization has failed to meet the surplus requirements of section 4204‑A ; or [PL 1989, c. 842, §17 (NEW).] J. The health maintenance organization has otherwise failed to substantially comply with this chapter. [PL 1975, c. 503 (NEW).] [PL 1999, c. 547, Pt. B, §46 (AMD); PL 1999, c. 547, Pt. B, §80 (AFF); PL 2003, c. 689, Pt. B, §7 (REV).]

2. A certificate of authority shall be suspended or revoked only after compliance with the requirements of section 4219 . [PL 1975, c. 503 (NEW).]

3. When the certificate of authority of a health maintenance organization is suspended, the health maintenance organization shall not, during the period of such suspension, enroll any additional enrollees except newborn children or other newly acquired dependents of existing enrollees and shall not engage in any advertising or solicitation whatsoever. [PL 1975, c. 503 (NEW).]

4. When the certificate of authority of a health maintenance organization is revoked, such organization shall proceed, immediately following the effective date of the order of revocation, to wind up its affairs, and may not conduct further business except as may be essential to the orderly conclusion of the affairs of such organization. It may not engage in further advertising or solicitation whatsoever. The superintendent may, by written order, permit such further operation of the organization as the superintendent may find to be in the best interest of enrollees, to the end that enrollees will be afforded the greatest practical opportunity to obtain continuing health care coverage. [RR 2021, c. 1, Pt. B, §347 (COR).]
24-A M.R.S. § 4302 — ME Code / Title 24-A / Chapter 56-A / Section 4302
24-A §4302. Reporting requirements
Status: in_force

To offer or renew a health plan in this State, a carrier must comply with the following requirements. [PL 2007, c. 199, Pt. B, §2 (AMD).]

1. Description of plan. A carrier shall provide to prospective enrollees and participating providers, and to members of the public and nonparticipating providers upon request, information on the terms and conditions of the plan to enable those persons to make informed decisions regarding their choice of plan. A carrier shall provide this information annually to current enrollees, participating providers and the superintendent. This information must be presented in a standardized format acceptable to the superintendent. In adopting rules or developing standardized reporting formats, the superintendent shall consider the nature of the health plan and the extent to which rules or standardized formats are appropriate to the plan. All written and oral descriptions of the health plan must be truthful and must use appropriate and objective terms that are easy to understand. These descriptions must be consistent with standards developed for supplemental insurance coverage under the United States Social Security Act, Title XVIII, 42 United States Code, Sections 301 to 1397 (1988). Descriptions of plans under this subsection must be standardized so that enrollees may compare the attributes of the plans and be in a format that is substantially similar to the format required for a carrier pursuant to the federal Affordable Care Act as of January 1, 2019. After a carrier has provided the required information, the annual information requirement under this subsection may be satisfied by the provision of any amendments to the materials on an annual basis. A carrier shall post descriptions of its plans on its publicly accessible website and, in addition to the plan description, include a link to the health plan's certificate of coverage. Specific items that must be included in a description are as follows: A. Coverage provisions, benefits and any exclusions by category of service, type of provider and, if applicable, by specific service, including but not limited to the following types of services, exclusions and limitations: (1) Health care services excluded from coverage; (2) Health care services requiring copayments or deductibles paid by enrollees; (3) Restrictions on access to a particular provider type; (4) Health care services that are or may be provided only by referral; (5) Childhood immunizations as recommended by the United States Department of Health and Human Services, Centers for Disease Control and Prevention and the American Academy of Pediatrics; and (6) Coverage requirements for contraceptive supplies, as defined in section 4247, subsection 4 , and the procedures an enrollee must follow to access coverage for over-the-counter contraceptive supplies and nonprescription contraceptives at a pharmacy without an out-of-pocket cost at the point of sale or by submitting a claim for reimbursement; [PL 2025, c. 445, §13 (AMD); PL 2025, c. 445, §14 (AFF).] B. Any prior authorization or other review requirements, including preauthorization review, concurrent review, postservice review, postpayment review and any procedures that may result in the enrollee being denied coverage or not being provided a particular service; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] C. A general description of the methods used to compensate providers, including capitation and methods in which providers receive compensation based upon referrals, utilization or cost criteria; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] D. An explanation of how health plan limitations affect enrollees, including information on enrollee financial responsibilities for payment of coinsurance or other noncovered or out-of-plan services and limits on preexisting conditions and waiting periods; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] E. The terms under which the health plan may be renewed by the plan members or enrollees, including any reservation by the health plan of any right to increase premiums; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] F. A statement as to when benefits cease in the event of nonpayment of the prepaid or periodic premium and the effect of nonpayment upon the enrollees who are hospitalized or undergoing treatment for an ongoing condition; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] G. A description of the manner in which the plan addresses the following: the provision of appropriate and accessible care in a timely fashion; an effective and timely grievance process and the circumstances in which an enrollee may obtain a 2nd opinion; timely determinations of coverage issues; confidentiality of medical records; and written copies of coverage decisions that are not explicit in the health plan agreement. The description must also include a statement explaining the circumstances under which health status may be considered in making coverage decisions in accordance with state and federal laws and that enrollees may refuse particular treatments without jeopardizing future treatment; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] H. Procedures an enrollee must follow to obtain drugs and medicines that are subject to a plan list or plan formulary, if any; a description of the formulary; and a description of the extent to which an enrollee will be reimbursed for the cost of a drug that is not on a plan list or plan formulary. Enrollees may request additional information related to specific drugs that are not on the drug formulary; [PL 1999, c. 742, §4 (AMD).] I. Information on where and in what manner health care services may be obtained; [PL 1999, c. 742, §4 (AMD).] J. A description of the independent external review procedures and the circumstances under which an enrollee is entitled to independent external review as required by this chapter; [PL 2009, c. 439, Pt. B, §2 (AMD).] K. A description of the requirements for enrollees to obtain coverage of routine costs of clinical trials and information on the manner in which enrollees not eligible to participate in clinical trials may qualify for the compassionate use program of the federal Food and Drug Administration for use of investigational drugs pursuant to 21 Code of Federal Regulations, Section 312.34, as amended; [PL 2017, c. 232, §3 (AMD).] L. A description of a provider profiling program that may be a part of the health plan, including the location of provider performance ratings in the plan materials or on a publicly accessible website, information explaining the provider rating system and the basis upon which provider performance is measured, the limitations of the data used to measure provider performance, the process for selecting providers and a conspicuous written disclaimer explaining the provider performance ratings should only be used as a guide for choosing a provider and that enrollees should consult their current provider before making a decision about their health care based on a provider rating; and [PL 2017, c. 232, §4 (AMD).] M. If the health plan is subject to the requirements of section 4318‑A , a description of the incentives available to an enrollee and how to earn such incentives if enrolled in a health plan offering a comparable health care service incentive program designed pursuant to section 4318‑A . [PL 2017, c. 232, §5 (NEW).] [PL 2025, c. 445, §13 (AMD); PL 2025, c. 445, §14 (AFF).]

2. Plan complaints and adverse decisions statistics. A carrier shall provide annually to the superintendent information for each health plan that it offers or renews on plan complaints and adverse decisions statistics. This statistical information must contain, at a minimum: A. The ratio of the number of complaints received by the plan to the total number of enrollees, reported by type of complaint and category of enrollee; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] B. The ratio of the number of adverse decisions issued by the plan to the number of complaints received, reported by category; [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] C. [PL 2023, c. 680, Pt. B, §1 (RP).] D. The ratio of the number of successful enrollee appeals overturning the original denial to the total number of appeals filed; [PL 2023, c. 680, Pt. B, §1 (AMD).] E. The number of disenrollments by enrollees and providers from the health plan within the previous 12 months and the reasons for the disenrollments. With respect to enrollees, the information provided in this paragraph must differentiate between voluntary and involuntary disenrollments; and [PL 2025, c. 348, §33 (AMD).] F. Enrollee satisfaction statistics, including provider-to-enrollee ratio by geographic region and medical specialty and a report on what actions, if any, the carrier has taken to improve complaint handling and eliminate the causes of valid complaints. [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).] [PL 2025, c. 348, §33 (AMD).]

2-A. Reporting of information related to prior authorization. In addition to the information required to be provided under subsection 2 , a carrier shall annually report to the superintendent the following information related to prior authorization determinations for the prior calendar year: A. A list of all items and services that require prior authorization; [PL 2023, c. 680, Pt. B, §2 (NEW).] B. The number and percentage of standard prior authorization requests that were approved, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] C. The number and percentage of standard prior authorization requests that were denied, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] D. The number and percentage of standard prior authorization requests that were approved after appeal, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] E. The number and percentage of prior authorization requests for which the time frame for review was extended and the request approved, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] F. The number and percentage of expedited prior authorization requests that were approved, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] G. The number and percentage of expedited prior authorization requests that were denied, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] H. The average and median time that elapsed between the submission of a request and a determination by the carrier, for standard prior authorizations, aggregated for all items and services; [PL 2023, c. 680, Pt. B, §2 (NEW).] I. The average and median time that elapsed between the submission of a request and a decision by the carrier for expedited prior authorizations, aggregated for all items and services; and [PL 2023, c. 680, Pt. B, §2 (NEW).] J. The average and median time that elapsed between the submission of a concurrent care prior authorization request to extend a course of treatment and a determination by the carrier, aggregated for all items and services. [PL 2023, c. 680, Pt. B, §2 (NEW).] [PL 2023, c. 680, Pt. B, §2 (NEW).]

2-B. Data reporting; utilization review data. Beginning April 1, 2025 and April 1st of each year thereafter, the superintendent shall collect the information required under subsections 2 and 2‑A , together with the utilization review information collected pursuant to section 2749 , and post this information on the bureau's publicly accessible website. [PL 2023, c. 680, Pt. B, §3 (NEW).]

3. Acceptable methods of providing information. A carrier may meet any of the reporting requirements set forth in this section by providing information in conformity with the requirements of the federal Health Maintenance Organization Act of 1973, 42 United States Code, Sections 280c and 300e to 300e-17 (1988), or any other applicable state or federal law or any accrediting organization recognized by the superintendent, as long as the superintendent finds that the information is substantially similar to the information required by this section and is presented in a format that provides a meaningful comparison between health plans. When the superintendent determines that it is feasible and appropriate, the information required by this section must be provided by geographic region, age, gender and type of employer or group. With respect to geographical breakdown, the information must be provided in a manner that permits comparisons between urban and rural areas. [PL 1995, c. 673, Pt. C, §1 (NEW); PL 1995, c. 673, Pt. C, §2 (AFF).]

4. Claims data. By February 1st of each year, a carrier that provides only administrative services for a plan sponsor shall annually file with the superintendent for the most recent complete calendar year for all covered individuals in the State the total number of claims paid for each plan sponsor and the total dollar amount of claims paid for each plan sponsor. [PL 2001, c. 457, §23 (NEW).]

5. Annual report; claims for diagnosis and treatment of Lyme disease and other tick-borne illnesses. By February 1st of each year, all carriers shall file with the superintendent for the most recent calendar year for all covered individuals in the State the total claims made for the diagnosis and treatment of Lyme disease and other tick-borne illnesses. The filing must include information on the number of claims made for the diagnosis and treatment of Lyme disease and other tick-borne illnesses, the total dollar amount of those claims, the number of claim denials and the reasons for those denials, the number and outcome of internal appeals and the number of external appeals related to the diagnosis and treatment of Lyme disease and other tick-borne illnesses. The superintendent shall compile from all carriers this data in an annual report and submit the report by March 15th of each year to the joint standing committee of the Legislature having jurisdiction over health insurance matters. The superintendent shall consult with the Department of Health and Human Services, Maine Center for Disease Control and Prevention to determine any additional information to be collected from carriers, beginning with data for calendar year 2011. [PL 2009, c. 494, §5 (AMD).]

6. Reporting required pursuant to the Affordable Care Act. Notwithstanding any other requirements of this Title, a carrier shall provide to the Secretary of the United States Department of Health and Human Services, and make available to the public when required by federal law, any information required by the federal Affordable Care Act. Carriers shall provide the information to the superintendent upon request. [PL 2011, c. 364, §24 (NEW).]
24-A M.R.S. § 3708 — ME Code / Title 24-A / Chapter 52 / Section 3708
24-A §3708. General powers
Status: in_force

1. Powers. For the specific purpose of exercising the responsibilities granted in this chapter and effectuating the purposes of this chapter, the company has the powers otherwise granted to a casualty insurer and may: A. Hire employees or enter into contracts relating to the administration of a workers' compensation insurer; [PL 1991, c. 885, Pt. C, §8 (NEW).] B. Declare a dividend when there is an excess of assets over liabilities and surplus requirements established in this Title; and [PL 1991, c. 885, Pt. C, §8 (NEW).] C. Enter into agreements to reinsure all or part of the company's exposure to loss and to otherwise limit the risk to the company and manage its financial condition. [PL 1991, c. 885, Pt. C, §8 (NEW).] [PL 1991, c. 885, Pt. C, §8 (NEW).]

2. Assessments; plan of operation. The board shall: A. Assess policyholders to cover its expenses, claims, obligations and other funding needs consistent with this chapter and Title; and [PL 1991, c. 885, Pt. C, §8 (NEW).] B. Develop and file with the superintendent for review and approval a plan of operation and any amendments to a plan of operation necessary or suitable to ensure the fair, reasonable and equitable administration of the company. [PL 1991, c. 885, Pt. C, §8 (NEW).] [PL 1991, c. 885, Pt. C, §8 (NEW).]
24-A M.R.S. § 3309 — ME Code / Title 24-A / Chapter 47 / Section 3309
24-A §3309. Completion of incorporation; general powers, duties
Status: in_force

The incorporation of an insurer is effective as of the date of filing of the appropriate document by the Secretary of State as provided for in section 3308‑A , and thereupon the corporation is vested with all the powers, rights and privileges and is subject to all the duties, liabilities and restrictions applicable to insurer corporations subject to qualification and application for, and issuance to the corporation of, a certificate of authority as an insurer by the superintendent under this Title. [PL 2009, c. 56, §19 (AMD).]
24-A M.R.S. § 4348 — ME Code / Title 24-A / Chapter 56-C / Section 4348
24-A §4348. Licensure of pharmacy benefits managers
Status: in_force

Beginning January 1, 2020, a person may not act as a pharmacy benefits manager in this State without first obtaining a license from the superintendent in accordance with this section and paying the licensing fee required under section 601, subsection 28‑A . [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

1. Applicant information. An applicant for licensure as a pharmacy benefits manager must file with the superintendent at least the following information: A. The name of the applicant; [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. The address and telephone number of the applicant; [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] C. The name and address of the applicant's agent for service of process in the State; [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] D. The name and address of each person beneficially interested in the applicant; and [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] E. The name and address of each person with management or control over the applicant. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

2. Qualification. The superintendent may issue a pharmacy benefits manager license to an applicant only if the superintendent is satisfied that the applicant possesses the necessary organization, expertise and financial integrity to supply the services sought to be offered. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

3. Restrictions permitted. The superintendent may issue a pharmacy benefits manager license subject to restrictions or limitations, including the type of services that may be supplied or the activities in which the pharmacy benefits manager may engage. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

4. Valid for 3 years. A license issued pursuant to this section is valid for a period of 3 years and must be renewed. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

5. Nontransferable. A license issued pursuant to this section is not transferable. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

6. Suspension, revocation or probationary license. The superintendent may suspend, revoke or place on probation a pharmacy benefits manager license under any of the following circumstances: A. The pharmacy benefits manager has engaged in fraudulent activity that constitutes a violation of state or federal law; [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] B. The superintendent has received consumer complaints that justify an action under this subsection to protect the safety and interests of consumers; [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] C. The pharmacy benefits manager fails to pay the original issuance or renewal fee for the license; or [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] D. The pharmacy benefits manager fails to comply with a requirement set forth in this chapter. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).] [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

7. Penalty for failure to obtain license. If a pharmacy benefits manager acts without obtaining a license pursuant to this section, the pharmacy benefits manager is subject to a fine of $5,000 per day for the period the pharmacy benefits manager is found to be in violation. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

8. Rules. The superintendent may adopt routine technical rules pursuant to Title 5, chapter 375, subchapter 2‑A to administer and enforce the requirements of this section. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

9. Enforcement. The superintendent may enforce this section under sections 220 and 223 and other provisions of this Title. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]

10. Registration remains effective until January 1, 2020 or registration date. The registration of a pharmacy benefits manager issued during 2019 in accordance with former section 1913 remains valid until January 1, 2020 or the next yearly anniversary of the registration date, whichever is later. Upon expiration of that registration, the pharmacy benefits manager shall obtain a license under this section in order to do business in this State. [PL 2019, c. 469, §8 (NEW); PL 2019, c. 469, §9 (AFF).]
24-A M.R.S. § 2151-B — ME Code / Title 24-A / Chapter 23 / Section 2151-B
24-A §2151-B. Rules
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 promulgate rules defining, limiting or prescribing acts and practices which are deemed to be in violation of this chapter. [PL 1985, c. 648, §5 (NEW).]
24-A M.R.S. § 2269 — ME Code / Title 24-A / Chapter 24-B / Section 2269
24-A §2269. Application; exceptions
Status: in_force

1. Small business exception. A licensee with fewer than 10 employees, including any independent contractors working for the licensee in the business of insurance, is exempt from section 2264 . [PL 2021, c. 24, §1 (NEW).]

2. Licensees subject to federal law. The following provisions apply to licensees subject to federal law. A. A licensee that is subject to and in compliance with the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191 and related privacy, security and breach notification regulations pursuant to 45 Code of Federal Regulations, Parts 160 and 164 and the federal Health Information Technology for Economic and Clinical Health Act, Public Law 111-5 is considered to meet the requirements of this chapter, other than the requirements of section 2266, subsection 1 for notification to the superintendent, if: (1) The licensee maintains a program for information security and breach notification that treats all nonpublic information relating to consumers in this State in the same manner as protected health information; (2) The licensee annually submits to the superintendent a written statement certifying that the licensee is in compliance with the requirements of this paragraph; and (3) The superintendent has not issued a determination finding that the applicable federal regulations are materially less stringent than the requirements of this chapter. [PL 2021, c. 24, §1 (NEW).] B. A licensee that is an insurance producer business entity, as licensed pursuant to section 1420‑E , owned by a depository institution and that maintains an information security program in compliance with the standards for safeguarding customer information as set forth pursuant to the federal Gramm-Leach-Bliley Act, 15 United States Code, Sections 6801 and 6805 is considered to meet the requirements of section 2264 if: (1) Upon request, the licensee produces documentation satisfactory to the superintendent that independently validates the controlling depository institution's adoption of an information security program that satisfies the standards for safeguarding customer information; (2) The licensee annually submits to the superintendent a written statement certifying that the licensee is in compliance with the requirements of this paragraph; and (3) The superintendent has not issued a determination finding that the standards for safeguarding customer information are materially less stringent than the requirements of section 2264 . [PL 2021, c. 24, §1 (NEW).] [PL 2021, c. 24, §1 (NEW).]

3. Employee, agent, representative or designee also a licensee. An employee, agent, representative or designee of a licensee that is also a licensee is exempt from section 2264 and need not develop its own information security program to the extent that the employee, agent, representative or designee is covered by the information security program of the other licensee. [PL 2021, c. 24, §1 (NEW).]

If a licensee ceases to qualify for an exception under this section, the licensee has 180 days to comply with this chapter. [PL 2021, c. 24, §1 (NEW).]
24-A M.R.S. § 4320-A — ME Code / Title 24-A / Chapter 56-A / Section 4320-A
24-A §4320-A. Coverage of preventive and primary health services
Status: in_force

Notwithstanding any other requirements of this Title, a carrier offering a health plan in this State shall, at a minimum, provide coverage for and may not impose cost-sharing requirements for preventive and primary health services as required by this section. [PL 2019, c. 653, Pt. C, §1 (AMD).]

1. Preventive services. A health plan must, at a minimum, provide coverage for: A. The evidence-based items or services that have a rating of A or B in the recommendations of the United States Preventive Services Task Force or equivalent rating from a successor organization; [PL 2017, c. 343, §1 (NEW); PL 2017, c. 343, §2 (AFF).] B. With respect to the individual insured, immunizations that have a recommendation from the federal Department of Health and Human Services, Centers for Disease Control and Prevention, Advisory Committee on Immunization Practices and that are consistent with the recommendations of the American Academy of Pediatrics, the American Academy of Family Physicians or the American College of Obstetricians and Gynecologists or a successor organization; [PL 2017, c. 343, §1 (NEW); PL 2017, c. 343, §2 (AFF).] C. With respect to infants, children and adolescents, evidence-informed preventive care and screenings provided for in the most recent version of the comprehensive guidelines supported by the federal Department of Health and Human Services, Health Resources and Services Administration that are consistent with the recommendations of the American Academy of Pediatrics or a successor organization; and [PL 2017, c. 343, §1 (NEW); PL 2017, c. 343, §2 (AFF).] D. With respect to women, such additional preventive care and screenings not described in paragraph A , provided for in the comprehensive guidelines supported by the federal Department of Health and Human Services, Health Resources and Services Administration women's preventive services guidelines that are consistent with the recommendations of the American College of Obstetricians and Gynecologists women's preventive services initiative. [PL 2017, c. 343, §1 (NEW); PL 2017, c. 343, §2 (AFF).] [PL 2017, c. 343, §1 (NEW); PL 2017, c. 343, §2 (AFF).]

2. Change in recommendations. If a recommendation described in subsection 1 is changed during a health plan year, a carrier is not required to make changes to that health plan during the plan year. [PL 2017, c. 343, §1 (NEW); PL 2017, c. 343, §2 (AFF).]

3. Primary health services. An individual or small group health plan with an effective date from January 1, 2021 to December 31, 2022 must provide coverage without cost sharing for the first primary care office visit and first behavioral health office visit in each plan year and may not apply a deductible or coinsurance to the 2nd or 3rd primary care and 2nd or 3rd behavioral health office visits in a plan year. Any copayments for the 2nd or 3rd primary care and 2nd or 3rd behavioral health office visits in a plan year count toward the deductible. This subsection does not apply to a plan offered for use with a health savings account unless the federal Internal Revenue Service determines that the benefits required by this section are permissible benefits in a high deductible health plan as defined in the federal Internal Revenue Code, Section 223(c)(2). The superintendent shall conduct a study analyzing the effects of this subsection on premiums based on experience in plan years 2020 and 2021. The superintendent may adopt rules as necessary to address the coordination of the requirements of this subsection for coverage without cost sharing for the first primary care visit and the requirements of this section with respect to coverage of an annual well visit. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2021, c. 638, §1 (AMD).]

3-A. Parity in cost sharing for primary care and behavioral health office visits; individual or small group health plan. An individual or small group health plan with an effective date on or after January 1, 2023 must provide coverage without cost sharing for the first primary care office visit and first behavioral health office visit in each plan year and may not apply a deductible or coinsurance to the 2nd or 3rd primary care and 2nd or 3rd behavioral health office visits in a plan year. Any copayments for primary care office visits and behavioral health office visits in a plan year count toward the deductible. After the first behavioral health office visit, a health plan may not apply a copayment amount to a behavioral health office visit that is greater than the copayment for a primary care office visit. For the purposes of this subsection, “behavioral health office visit” means an office visit to address mental health and substance use conditions. This subsection does not apply to a plan offered for use with a health savings account unless the federal Internal Revenue Service determines that the benefits required by this section are permissible benefits in a high deductible health plan as defined in the federal Internal Revenue Code, Section 223(c)(2). The superintendent may adopt rules as necessary to address the coordination of the requirements of this subsection for coverage without cost sharing for the first primary care visit and the requirements of this section with respect to coverage of an annual well visit. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2021, c. 638, §2 (NEW).]

3-B. Parity in cost sharing for primary care and behavioral health office visits; group health plan. A group health plan, other than a small group health plan subject to subsection 3‑A , with an effective date on or after January 1, 2023 must provide coverage without cost sharing for the first primary care office visit and first behavioral health office visit in each plan year. After the first behavioral health office visit, a health plan may not apply a copayment amount to a behavioral health office visit that is greater than the copayment for a primary care office visit. For the purposes of this subsection, "behavioral health office visit" means an office visit to address mental health and substance use conditions. This subsection does not apply to a plan offered for use with a health savings account unless the federal Internal Revenue Service determines that the benefits required by this section are permissible benefits in a high deductible health plan as defined in the federal Internal Revenue Code, Section 223(c)(2) or to a health plan that has no deductible, no coinsurance and out-of-pocket limits that meet the applicable federal requirements. The superintendent may adopt rules as necessary to address the coordination of the requirements of this subsection for coverage without cost sharing for the first primary care visit and the requirements of this section with respect to coverage of an annual well visit. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2025, c. 213, §1 (AMD).]
24-A M.R.S. § 3956 — ME Code / Title 24-A / Chapter 54-A / Section 3956
24-A §3956. Selection of administrator
Status: in_force

1. Selection of administrator. The board shall select an insurer or 3rd-party administrator through a competitive bidding process to administer the reinsurance provided by the association. [PL 2011, c. 90, Pt. B, §8 (NEW).]

2. Contract with administrator. The administrator selected pursuant to subsection 1 serves for a period of 3 years pursuant to a contract with the association. At least one year prior to the expiration of that 3-year period of service, the board shall invite all insurers, including the current administrator, to submit bids to serve as the administrator for the succeeding 3-year period. The board shall select the administrator for the succeeding period at least 6 months prior to the ending of the 3-year period. [PL 2011, c. 90, Pt. B, §8 (NEW).]

3. Duties of administrator. The administrator selected pursuant to subsection 1 shall: A. Perform all administrative functions relating to the association; [PL 2011, c. 90, Pt. B, §8 (NEW).] B. Submit regular reports to the board regarding the operation of the association. The frequency, content and form of the reports must be as determined by the board; [PL 2011, c. 90, Pt. B, §8 (NEW).] C. Following the close of each calendar year in which premiums are collected for reinsurance, determine reinsurance premiums less any administrative expense allowance, the expense of administration pertaining to the reinsurance operations of the association and the incurred losses of the year, and report this information to the superintendent; and [PL 2019, c. 653, Pt. B, §16 (AMD).] D. Pay reinsurance amounts as provided for in the plan of operation under section 3953, subsection 3 . [PL 2011, c. 90, Pt. B, §8 (NEW).] [PL 2019, c. 653, Pt. B, §16 (AMD).]

4. Payment to administrator. The administrator selected pursuant to subsection 1 must be paid, as provided in the contract of the association under subsection 2 , for its direct and indirect expenses incurred in the performance of its services. As used in this subsection, "direct and indirect expenses" includes that portion of the audited administrative costs, printing expenses, claims administration expenses, management expenses, building overhead expenses and other actual operating and administrative expenses of the administrator that are approved by the board as allocable to the administration of the association and included in the bid specifications pursuant to subsection 1 . [PL 2011, c. 90, Pt. B, §8 (NEW).]
24-A M.R.S. § 3952 — ME Code / Title 24-A / Chapter 54-A / Section 3952
24-A §3952. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 2011, c. 90, Pt. B, §8 (NEW).]

1. Association. "Association" means the Maine Guaranteed Access Reinsurance Association under section 3953 . [PL 2011, c. 90, Pt. B, §8 (NEW).]

2. Board. "Board" means the Board of Directors of the Maine Guaranteed Access Reinsurance Association under section 3953, subsection 2 . [PL 2011, c. 90, Pt. B, §8 (NEW).]

3. Covered person. "Covered person" means an individual covered as a policyholder, participant or dependent under a plan, policy or contract of medical insurance. [PL 2011, c. 90, Pt. B, §8 (NEW).]

4. Dependent. "Dependent" means a spouse, a domestic partner or a child under 26 years of age. [PL 2021, c. 567, §36 (AMD).]

4-A. Eligible claim. "Eligible claim" means either: A. For a high-priced item or service, a claim amount that is no greater than 200% of the allowed charge determined for the item or service under the original Medicare fee-for-service program under Part A and Part B of Title XVIII of the Social Security Act for the applicable year; or [PL 2019, c. 653, Pt. B, §8 (NEW).] B. For all other items or services, a claim paid by the member insurer in accordance with the terms of the policy. [PL 2019, c. 653, Pt. B, §8 (NEW).] [PL 2019, c. 653, Pt. B, §8 (NEW).]

5. Health maintenance organization. "Health maintenance organization" means an organization authorized under chapter 56 to operate a health maintenance organization in this State. [PL 2011, c. 90, Pt. B, §8 (NEW).]

5-A. High-priced item or service. "High-priced item or service" means an item or service covered under the original Medicare fee-for-service program under Part A and Part B of Title XVIII of the Social Security Act that the board, in consultation with and based on analysis by the Department of Health and Human Services and Maine Health Data Organization, has identified in advance of a plan year that contributes to association costs and offers an opportunity for savings. [PL 2019, c. 653, Pt. B, §9 (NEW).]

6. Insurer. "Insurer" means an entity that is authorized to write medical insurance or that provides medical insurance in this State. For the purposes of this chapter, "insurer" includes an insurance company, a nonprofit hospital and medical service organization, a fraternal benefit society, a health maintenance organization, a self-insured employer subject to state regulation as described in section 2848‑A , a 3rd-party administrator, a multiple-employer welfare arrangement, a reinsurer that reinsures health insurance in this State or a captive insurance company established pursuant to chapter 83 that insures the health coverage risks of its members. [PL 2019, c. 653, Pt. B, §10 (AMD).]

7. Medical insurance. "Medical insurance" means a hospital and medical expense-incurred policy, nonprofit hospital and medical service plan, health maintenance organization subscriber contract or other health care plan or arrangement that pays for or furnishes medical or health care services whether by insurance or otherwise, whether sold as an individual or group policy. "Medical insurance" does not include accidental injury, specified disease, hospital indemnity, dental, vision, disability income, Medicare supplement, long-term care or other limited benefit health insurance or credit insurance; coverage issued as a supplement to liability insurance; insurance arising out of workers' compensation or similar law; automobile medical payment insurance; or insurance under which benefits are payable with or without regard to fault and that is statutorily required to be contained in any liability insurance policy or equivalent self-insurance. [PL 2011, c. 90, Pt. B, §8 (NEW).]

8. Medicare. "Medicare" means coverage under both Parts A and B of Title XVIII of the federal Social Security Act, 42 United States Code, Section 1395 et seq., as amended. [PL 2011, c. 90, Pt. B, §8 (NEW).]

9. Member insurer. "Member insurer" means an insurer that offers individual health plans and is actively marketing individual health plans in this State. In any calendar year in which the association reinsures small group health plans, "member insurer" also includes an insurer that offers small group health plans and is actively marketing small group health plans in this State. [PL 2019, c. 653, Pt. B, §11 (AMD).]

10. Producer. "Producer" means a person who is licensed to sell health insurance in this State. [PL 2011, c. 90, Pt. B, §8 (NEW).]

11. Reinsurer. "Reinsurer" means an insurer from whom a person providing health insurance for a resident procures insurance for itself with the insurer with respect to all or part of the medical insurance risk of the person. "Reinsurer" includes an insurer that provides employee benefits excess insurance. [PL 2011, c. 90, Pt. B, §8 (NEW).]

12. Resident. "Resident" has the same meaning as in section 2736‑C, subsection 1, paragraph C‑2 . [PL 2011, c. 90, Pt. B, §8 (NEW).]

13. Third-party administrator. "Third-party administrator" means an entity that is paying or processing medical insurance claims for a resident. [PL 2011, c. 90, Pt. B, §8 (NEW).]
24-A M.R.S. § 5057 — ME Code / Title 24-A / Chapter 68 / Section 5057
24-A §5057. Applicability
Status: in_force

This chapter applies only to policies and certificates issued before January 1, 2000. [PL 1999, c. 292, §1 (NEW).]
24-A M.R.S. § 2748 — ME Code / Title 24-A / Chapter 33 / Section 2748
24-A §2748. Coverage for chiropractic services
Status: in_force

1. Therapeutic, adjustive and manipulative services. Notwithstanding any other provisions of this chapter, every insurer which issues health care contracts providing coverage for the services of a "physician" or "doctor" to residents of this State shall provide coverage to any subscriber or other person covered under those contracts for those services when performed by a chiropractor, to the extent that the services are within the lawful scope of practice of a chiropractor licensed to practice in this State. Therapeutic, adjustive and manipulative services shall be covered whether performed by an allopathic, osteopathic or chiropractic doctor. [PL 1985, c. 516, §3 (NEW).]

2. Limits; coinsurance; deductibles. Any contract which 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 or the limitations, coinsurance, deductibles or exclusions imposed on other providers. [PL 1985, c. 516, §3 (NEW).]

3. Reports to the Superintendent of Insurance. Every insurer subject to this section shall report its experience for each calendar year to the Superintendent of Insurance not later than April 30th of the following year. The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this section and the total amount of claims paid in this State for health care contracts. The report must include complaints concerning access to services under this section and the results of those complaints. The superintendent shall compile this data for all insurers in an annual report. [PL 1993, c. 669, §2 (AMD).]

4. Application; expiration. [PL 1989, c. 141, §4 (RP).]

5. Reimbursement; discrimination. An insurer subject to this section may not refuse to reimburse a chiropractic provider who participates in the insurer's provider network for providing a health care service or procedure covered by the insurer as long as the chiropractic provider is acting within the lawful scope of that provider's license in the delivery of the covered service or procedure. Consistent with reasonable medical management techniques specified under the insurer's contract with respect to the method, treatment or setting for a covered service or procedure, the insurer may not discriminate based on the chiropractic provider's license. This subsection does not require an insurer to accept all chiropractic providers into a network or govern the amount of the reimbursement paid to a chiropractic provider. [PL 2015, c. 111, §1 (NEW); PL 2015, c. 111, §4 (AFF).]
24-A M.R.S. § 1401 — ME Code / Title 24-A / Chapter 16 / Section 1401
24-A §1401. Scope of chapter
Status: in_force

1. Producers, consultants and adjusters. This chapter governs the qualifications, licensing and general requirements for producers, consultants and adjusters as to any and all kinds of insurance and types of insurers, nonprofit hospital or medical service organizations, health maintenance organizations, fraternal benefit societies, viatical settlement providers and risk retention groups, except reinsurers. [PL 2001, c. 259, §2 (AMD).]

2. Agents and brokers. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF); MRSA T. 24-A §1401, sub-§2 (RP).]
24-A M.R.S. § 3006 — ME Code / Title 24-A / Chapter 41 / Section 3006
24-A §3006. Willful violations
Status: in_force

Any insurer or agent who shall make, issue or deliver a policy of fire insurance in willful violation of sections 3002 or 3003 shall forfeit for each offense not less than $50 nor more than $200, but the policy shall nevertheless be binding upon the insurer issuing the same. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 7303 — ME Code / Title 24-A / Chapter 93 / Section 7303
24-A §7303. Financial responsibility
Status: in_force

1. Insurance coverage required. A transportation network company driver or a transportation network company on the driver's behalf shall maintain primary automobile liability insurance that recognizes that the driver is a transportation network company driver or otherwise uses a vehicle to transport riders for compensation and that covers the driver in accordance with this section. [PL 2015, c. 279, §1 (NEW).]

2. Minimum insurance requirements for driver while on digital network. While a transportation network company driver is logged into the transportation network company digital network but is not engaged in a prearranged ride, primary automobile liability insurance must be maintained in the following amounts: A. For death and bodily injury, $50,000 per person; for death and bodily injury per incident, $100,000; and for property damage, $25,000; [PL 2015, c. 279, §1 (NEW).] B. The minimum amounts of insurance coverage for medical payments under Title 29‑A, section 1605‑A ; and [PL 2015, c. 279, §1 (NEW).] C. Uninsured vehicle and underinsured motor vehicle coverage required pursuant to section 2902 . [PL 2015, c. 279, §1 (NEW).] The coverage requirements of this subsection may be satisfied by automobile insurance maintained by the transportation network company driver, automobile insurance maintained by the transportation network company or a combination of automobile insurance maintained by the transportation network company driver and the transportation network company. [PL 2015, c. 279, §1 (NEW).]

3. Minimum insurance requirements while engaged in prearranged ride. While a transportation network company driver is engaged in a prearranged ride, primary automobile liability insurance must be maintained in the following amounts: A. For death, bodily injury and property damage, $1,000,000; [PL 2015, c. 279, §1 (NEW).] B. The minimum amounts of insurance coverage for medical payments under Title 29‑A, section 1605‑A ; and [PL 2015, c. 279, §1 (NEW).] C. Uninsured vehicle and underinsured motor vehicle coverage required pursuant to section 2902 . [PL 2015, c. 279, §1 (NEW).] The coverage requirements of this subsection may be satisfied by automobile insurance maintained by the transportation network company driver, automobile insurance maintained by the transportation network company or a combination of automobile insurance maintained by the transportation network company driver and the transportation network company. [PL 2015, c. 279, §1 (NEW).]

4. Lapse of coverage; duty to defend. When automobile insurance maintained by a transportation network company driver to fulfill the insurance obligations of this section has lapsed or does not provide the coverage required by this section, the transportation network company shall provide the coverage required by this section beginning with the first dollar of a claim, and the transportation network company's insurer has a duty to defend the claim. [PL 2015, c. 279, §1 (NEW).]

5. Coverage not dependent on denial of claim. Coverage under an automobile insurance policy maintained by a transportation network company may not be dependent on the denial of the claim under a personal automobile insurance policy. [PL 2015, c. 279, §1 (NEW).]

6. Insurer. Insurance required by this section may be placed with an insurer that is licensed under the provisions of this Title or is authorized as a surplus lines insurer pursuant to chapter 19 . [PL 2015, c. 279, §1 (NEW).]

7. Satisfaction of financial responsibility requirements. Insurance satisfying the requirements of this section is deemed to satisfy the financial responsibility requirement for a motor vehicle set forth in section 2902 and Title 29‑A, section 1605 . [PL 2015, c. 279, §1 (NEW).]

8. Evidence of coverage for transportation network company insurance. A transportation network company driver shall carry at all times evidence of coverage satisfying this section during the driver's use of a vehicle in connection with a transportation network company's digital network. A transportation network company driver shall provide evidence of insurance coverage to a law enforcement officer upon request and, in the event of an accident, a transportation network company driver shall provide insurance coverage information to the directly interested parties, automobile insurers and investigating police officers, upon request pursuant to Title 29‑A, section 1601 . Upon request, a transportation network company driver shall also disclose to directly interested parties, automobile insurers and investigating police officers whether the driver was logged into the transportation network company's digital network or engaged in a prearranged ride at the time of an accident. [PL 2015, c. 279, §1 (NEW).]

9. Claims payments. If a transportation network company's insurer makes a payment for a claim covered under comprehensive coverage or collision coverage, the transportation network company shall cause its insurer to issue the payment directly to the business repairing the vehicle or jointly to the owner of the vehicle and the primary lienholder on the covered vehicle. [PL 2015, c. 279, §1 (NEW).]
24-A M.R.S. § 956 — ME Code / Title 24-A / Chapter 11 / Section 956
24-A §956. Optional reserve calculation
Status: in_force

1. Reserve calculation. Reserves for any category of policies, contracts or benefits as established by the superintendent that are subject to section 953, subsection 2 , may be calculated at the option of the insurer according to any standards that produce greater aggregate reserves for that category than those calculated according to the minimum standard provided in section 955 , but the rate or rates of interest used for policies and contracts, other than annuity and pure endowment contracts, may not be higher than the corresponding rate or rates of interest used in calculating any nonforfeiture benefits provided. [PL 1993, c. 634, Pt. B, §3 (NEW).]

2. Lower standard of valuation. Any insurer that adopts any standard of valuation producing greater aggregate reserves than those calculated according to the minimum standard provided in section 955 may adopt, with the approval of the superintendent, any lower standards of valuation, but not lower than the minimum required, except that for the purposes of this section the holding of additional reserves previously determined necessary by the appointed actuary in the opinion required by section 952‑A may not be determined to be the adoption of a higher standard of valuation. [PL 2013, c. 238, Pt. C, §8 (AMD).]
24-A M.R.S. § 3481 — ME Code / Title 24-A / Chapter 47 / Section 3481
24-A §3481. -- review by Attorney General; filing with Secretary of State
Status: in_force

1. Upon approval by the superintendent as provided in section 3480 , the plan and agreement of merger or consolidation must be submitted to the Attorney General and be examined by the Attorney General. If the Attorney General finds the plan and agreement to be properly drawn and signed and otherwise in conformity with the Constitution and laws of this State, the Attorney General shall so certify thereon in writing. [RR 2021, c. 1, Pt. B, §290 (COR).]

2. Within 60 days from date of approval by the superintendent, both an original and a copy of the plan and agreement showing thereon the certificate of the Attorney General, shall be delivered to the office of the Secretary of State. The Secretary of State shall file such copy and enter the date of filing on both the copy and the original, shall record the copy and return the original to the surviving merged or consolidated corporation. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

3. From time of filing the copy of the plan and agreement in the office of the Secretary of State, the agreement shall be deemed to be the agreement and act of merger or consolidation of the insurers, and the original of such agreement or a certified copy thereof shall be evidence of the existence of such merged or consolidated corporation and of the performance of all acts and conditions necessary for the effectuation of such merger or consolidation. [PL 1969, c. 132, §1 (NEW).]

4. If a domestic insurer is merged into or consolidated with a foreign insurer, the foreign insurer shall not transact insurance in this State until it has procured a certificate of authority from the superintendent therefor under this Title. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 7105 — ME Code / Title 24-A / Chapter 91 / Section 7105
24-A §7105. Required provisions; service contracts
Status: in_force

1. Form; language. A service contract marketed, sold, offered for sale, issued, made, proposed to be made or administered in this State must be written, printed or typed in clear and understandable language that is in a font size that is easily readable by a person with average eyesight and must conspicuously disclose the requirements set forth in this section, as applicable. A provider may comply with the font size requirement of this subsection by directing the consumer to a publicly accessible website containing a complete sample of terms and conditions of the service contract. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

2. Notice of reimbursement insurance policy. A service contract insured under a reimbursement insurance policy pursuant to section 7103 must contain a statement in substantially the following form: "Obligations of the provider under this service contract are insured under a service contract reimbursement insurance policy. If the provider fails to pay or provide service on a claim, including any claim for the return of the unearned portion of the provider fee, within 60 days after proof of loss has been filed, the contract holder is entitled to make a claim directly against the insurance company." The service contract must also state the name and address of the insurer. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

3. Notice when no reimbursement insurance policy. A service contract not insured under a reimbursement insurance policy pursuant to section 7103 must contain a statement in substantially the following form: "Obligations of the provider under this service contract are backed by the full faith and credit of the provider and are not guaranteed under a service contract reimbursement insurance policy." [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

4. Contact information. A service contract must state the name and address of the provider, the service contract seller and the administrator if different than the provider. A service contract must state the service contract holder's name and address to the extent furnished by the service contract holder. The identities of the service contract seller and service contract holder, to the extent furnished by the service contract holder, are not required to be preprinted on the service contract but may be added to the service contract at the time of sale. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

5. Purchase price and terms. A service contract must state the total purchase price of the service contract and the terms under which the service contract is sold. The purchase price is not required to be preprinted on the service contract and may be negotiated at the time of sale with the service contract holder. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

6. Prior approval. A service contract must conspicuously state the procedure for obtaining prior approval for repair work when prior approval is required and for making a claim, including a toll-free telephone number for claim service and a procedure for obtaining emergency repairs performed outside of normal business hours. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

7. Deductible amount. A service contract must conspicuously state the existence of any deductible amount, if applicable. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

8. Merchandise and services to be provided. A service contract must specify the merchandise and services to be provided and any limitations, exceptions or exclusions. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

9. Nonoriginal manufacturer's parts. A service contract covering a motor vehicle must state whether the use of nonoriginal manufacturer's parts is allowed. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

10. Transferability. A service contract must state any restrictions governing the transferability of the service contract, if applicable. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

11. Cancellation. A service contract must state the terms, restrictions or conditions governing cancellation of the service contract prior to the termination or expiration date of the service contract by either the provider or the service contract holder. The provider of the service contract shall mail a written notice to the service contract holder at the last known address of the service contract holder contained in the records of the provider at least 15 days prior to cancellation by the provider. The notice must state the effective date of the cancellation and the reason for the cancellation. If a service contract is cancelled by the provider for a reason other than nonpayment of the provider fee, 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).]

12. Obligations and duties. A service contract must set forth all of the obligations and duties of the service contract holder, such as the duty to protect against any further damage and any requirement to follow instructions in the owner's manual. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

13. Consequential damages. A service contract must state whether the service contract provides for or excludes consequential damages or preexisting conditions, if applicable. A service contract may, but is not required to, cover damage resulting from rust, corrosion or damage caused by a noncovered part or system. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]
24-A M.R.S. § 3417 — ME Code / Title 24-A / Chapter 47 / Section 3417
24-A §3417. Participating policies
Status: in_force

1. If provided for in its articles of incorporation, certificate of organization or charter, a stock insurer or mutual insurer may issue any or all of its policies or contracts with or without participation in profits, savings, unabsorbed portions of premiums or surplus; may classify policies issued and perils insured on a participating and nonparticipating basis; and may determine the right to participate and the extent of participation of any class or classes of policies. Any such classification or determination must be reasonable, and may not unfairly discriminate as between policies so classified. [PL 2013, c. 299, §12 (AMD).]

2. A life insurer may issue both participating and nonparticipating policies or contracts if the right or absence of right to participate is reasonably related to the premium charged. [PL 1969, c. 132, §1 (NEW).]

3. After the first policy year, no dividend, otherwise earned under a life or health insurance policy or annuity contract, shall be made contingent upon the payment of renewal premium on any such policy or contract; except that a participating life or health insurance policy providing for participation at the end of the first or second policy year may provide that the dividend or dividends will be paid subject to payment of premium for the next ensuing year. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2753 — ME Code / Title 24-A / Chapter 33 / Section 2753
24-A §2753. Standardized claim forms
Status: in_force

All insurers providing individual medical expense insurance on an expense-incurred basis providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a health care practitioner must accept the current standardized claim form for professional services approved by the Federal Government and submitted electronically. All insurers providing individual medical expense insurance on an expense-incurred basis 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. An insurer 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 insurer 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, §4 (AMD).]
24-A M.R.S. § 2188 — ME Code / Title 24-A / Chapter 23 / Section 2188
24-A §2188. Permitted activities of insurance producers; navigators; requirements
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Exchange" means a health benefit exchange established or operated in this State, including a health benefit exchange established or operated by the Secretary of the United States Department of Health and Human Services, pursuant to Section 1311 of the federal Affordable Care Act. [PL 2011, c. 631, §1 (NEW).] B. "Navigator" means a person selected to perform the activities and duties identified in Section 1311(i) of the federal Affordable Care Act. For the purposes of this section, if an organization or business entity serves as a navigator, an individual performing navigator duties for that organization or business entity is considered to be acting in the capacity of a navigator within the meaning of subsection 4 . [PL 2011, c. 631, §1 (NEW).] [PL 2011, c. 631, §1 (NEW).]

2. Prohibited activities. Certification as a navigator under this section does not authorize a person who is not licensed as an insurance producer or consultant in this State in accordance with chapter 16 to act as an insurance producer or consultant. Regardless of whether a navigator certified under this section is also licensed as an insurance producer or consultant in this State in accordance with chapter 16 , a navigator may not, while acting as a navigator for an individual, enrollee, potential enrollee or employer: A. Sell, solicit or negotiate insurance; [PL 2013, c. 388, Pt. A, §1 (AMD).] B. Make recommendations to purchasers, enrollees or employers or prospective purchasers or enrollees to choose or reject a particular health plan; or [PL 2013, c. 388, Pt. A, §1 (AMD).] C. Enroll an individual or employee in a qualified health plan offered through an exchange or act as an intermediary between an employer and an insurer that offers a qualified health plan offered through an exchange, except that the actions of a navigator to provide assistance to an individual or employee to facilitate that individual's or employee's enrollment in a qualified health plan is not considered enrolling an individual or employee in a qualified health plan under this paragraph. [PL 2013, c. 388, Pt. A, §1 (AMD).] [PL 2013, c. 388, Pt. A, §1 (AMD).]

3. Certification of navigators. Prior to any exchange becoming operational in this State, the superintendent shall: A. [PL 2013, c. 388, Pt. A, §1 (RP).] B. Adopt rules to establish a certification program for individual navigators who are not licensed as insurance producers and training requirements for all individual navigators and prospective individual navigators that include initial and continuing education requirements and an examination. [PL 2013, c. 388, Pt. A, §1 (AMD).] C. [PL 2013, c. 388, Pt. A, §1 (RP).] [PL 2013, c. 388, Pt. A, §1 (AMD).]

4. Navigator requirements. An individual may not act in the capacity of a navigator unless the individual is either licensed as an insurance producer under chapter 16 or certified by the superintendent as a navigator under this section. To be certified as a navigator, an individual must: A. Be at least 18 years of age; [PL 2013, c. 388, Pt. A, §1 (AMD).] B. Have completed and submitted a disclosure form, which must be developed by the superintendent and which may include such information as the superintendent determines necessary, and have declared under penalty of refusal, suspension or revocation of the navigator certification that the statements made in the form are true, correct and complete to the best of the individual’s knowledge and belief; [PL 2013, c. 388, Pt. A, §1 (AMD).] C. Have submitted to any criminal history record check or regulatory background check required by the superintendent by rule; [PL 2013, c. 388, Pt. A, §1 (AMD).] D. [PL 2013, c. 388, Pt. A, §1 (RP).] E. Have successfully completed the initial training requirements and any other certification requirements adopted by the superintendent in accordance with subsection 3 ; and [PL 2013, c. 388, Pt. A, §1 (AMD).] F. Have paid any fees required by the superintendent. [PL 2013, c. 388, Pt. A, §1 (AMD).] [PL 2013, c. 388, Pt. A, §1 (AMD).]

5. Unfair practices. The provisions of this chapter and any rules adopted pursuant to this chapter apply to navigators. This subsection may not be construed to create or imply a private cause of action for a violation of any provision of this chapter. [PL 2013, c. 388, Pt. A, §1 (AMD).]

5-A. Privacy. A navigator may not collect, use, disclose or retain personal information, as defined in section 2204, subsection 20 , except for the purposes of performing the duties of a navigator or as permitted by an exchange under privacy standards adopted in accordance with the federal Affordable Care Act. A navigator is a regulated insurance entity for purposes of chapter 24 only if the navigator collects, uses, discloses or retains personal information for purposes other than performing the duties of a navigator. [PL 2013, c. 388, Pt. A, §1 (NEW).]

6. Denial, suspension or revocation. The superintendent may deny certification and may suspend or revoke the authority of a navigator certified pursuant to this section for any ground specified in section 1420‑K, subsection 1 . The superintendent may assess civil penalties in accordance with section 12‑A for violations of laws regulating the activities of navigators. [PL 2013, c. 388, Pt. A, §1 (AMD).]

7. Rules. The superintendent may adopt rules as necessary to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2011, c. 631, §1 (NEW).]

8. Construction. This section may not be construed to prevent the application of any provisions of the federal Affordable Care Act relating to the duties of a navigator. [PL 2013, c. 388, Pt. A, §1 (NEW).]
24-A M.R.S. § 4320-U — ME Code / Title 24-A / Chapter 56-A / Section 4320-U
24-A §4320-U. Coverage for fertility services (REALLOCATED FROM TITLE 24-A, SECTION 4320-S)
Status: in_force

(REALLOCATED FROM TITLE 24-A, SECTION 4320-S)

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Experimental fertility procedure" means a procedure for which the published medical evidence is not sufficient for the American Society for Reproductive Medicine, its successor organization or a comparable organization to regard the procedure as established medical practice. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] B. "Fertility diagnostic care" means procedures, products, medications and services intended to provide information about an individual's fertility, including laboratory assessments and imaging studies. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] C. "Fertility patient" means an individual or couple with infertility, an individual or couple who is at increased risk of transmitting a serious inheritable genetic or chromosomal abnormality to a child or an individual unable to conceive as an individual or with a partner because the individual or couple does not have the necessary gametes for conception. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] D. "Fertility preservation services" means procedures, products, medications and services, intended to preserve fertility, consistent with established medical practice and professional guidelines published by the American Society for Reproductive Medicine, its successor organization or a comparable organization for an individual who has a medical or genetic condition or who is expected to undergo treatment that may directly or indirectly cause a risk of impairment of fertility. "Fertility preservation services" includes the procurement and cryopreservation of gametes, embryos and reproductive material and storage from the time of cryopreservation for a period of 5 years. Storage may be offered for a longer period of time. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] E. "Fertility treatment" means procedures, products, medications and services intended to achieve pregnancy that results in a live birth with healthy outcomes and that are provided in a manner consistent with established medical practice and professional guidelines published by the American Society for Reproductive Medicine, its successor organization or a comparable organization. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] F. "Gamete" means a cell containing a haploid complement of deoxyribonucleic acid that has the potential to form an embryo when combined with another gamete. "Gamete" includes sperm and eggs. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] G. "Infertility" means the presence of a demonstrated condition recognized by a provider as a cause of loss or impairment of fertility or a couple's inability to achieve pregnancy after 12 months of unprotected intercourse when the couple has the necessary gametes for conception, including the loss of a pregnancy occurring within that 12-month period, or after a period of less than 12 months due to a person's age or other factors. Pregnancy resulting in a loss does not cause the time period of trying to achieve a pregnancy to be restarted. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).]

2. Required coverage. A carrier offering a health plan in this State shall provide coverage as provided in this subsection and as set forth in rules adopted by the bureau to an enrollee: A. For fertility diagnostic care; [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] B. For fertility treatment if the enrollee is a fertility patient; and [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] C. For fertility preservation services. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).]

3. Limitations on coverage. A health plan that provides coverage for the services required by this section may include reasonable limitations to the extent that these limitations are not inconsistent with the following requirements and rules adopted by the bureau. A. A carrier may not impose a waiting period. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] B. A carrier may not use any prior diagnosis or prior fertility treatment as a basis for excluding, limiting or otherwise restricting the availability of coverage required by this section. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] C. A carrier may not impose any limitations on coverage for any fertility services based on an enrollee's use of donor gametes, donor embryos or surrogacy. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] D. A carrier may not impose different limitations on coverage for, provide different benefits to or impose different requirements on a class of persons protected under Title 5, chapter 337 than those of other enrollees. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] E. Any limitations imposed by a carrier must be based on an enrollee's medical history and clinical guidelines adopted by the carrier. Any clinical guidelines used by a carrier must be based on current guidelines developed by the American Society for Reproductive Medicine, its successor organization or a comparable organization, must cite with specificity any data or scientific reference relied upon, must be maintained in written form and must be made available to an enrollee in writing upon request. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).]

4. Certain services not required. This section does not require a carrier to provide coverage for: A. Any experimental fertility procedure; or [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] B. Any nonmedical costs related to donor gametes, donor embryos or surrogacy. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).] [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).]

5. Rules. The superintendent may adopt rules to implement the requirements of this section, including, without limitation, cost-sharing, benefit design and clinical guidelines. In adopting rules under this subsection, the superintendent shall consider the clinical guidelines developed by the American Society for Reproductive Medicine, its successor organization or a comparable organization. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A. [PL 2021, c. 692, §1 (NEW); PL 2021, c. 692, §3 (AFF); RR 2021, c. 2, Pt. A, §81 (RAL).]
24-A M.R.S. § 742 — ME Code / Title 24-A / Chapter 9 / Section 742
24-A §742. Reinsurance intermediaries; licensing
Status: in_force

1. Qualifications for license. For the protection of the people of this State, the superintendent may not issue, continue or permit to exist any reinsurance intermediary license except in compliance with this subchapter. [PL 1995, c. 544, §7 (AMD).]

2. License requirement. [PL 1995, c. 544, §7 (RP).]

2-A. License requirement. A person or organization may be authorized by the superintendent to act as a reinsurance intermediary under the following circumstances. A. A person or organization acting in this State as a reinsurance intermediary broker who has an office in this State must be licensed as a resident agent, broker or reinsurance intermediary broker in order to do business in this State. [PL 1995, c. 544, §7 (NEW).] B. A person or organization acting in this State as a reinsurance intermediary broker who does not maintain an office in this State must either: (1) Be licensed in this State as a nonresident agent, broker or reinsurance intermediary broker; or (2) Be licensed in another state with substantially similar laws. [PL 1995, c. 544, §7 (NEW).] C. A person or organization acting in this State as a reinsurance intermediary manager, by representing a domestic insurer or by maintaining an office in this State, must be licensed as a resident agent, broker or reinsurance intermediary broker in order to do business in this State. [PL 1995, c. 544, §7 (NEW).] D. A person or organization acting in this State as a reinsurance intermediary manager who does not maintain an office in this State and who does not represent a domestic insurer must either: (1) Be licensed as a nonresident agent, broker or reinsurance intermediary manager in this State; or (2) Be licensed as an agent, broker or reinsurance intermediary manager in another state with substantially similar laws. [PL 1995, c. 544, §7 (NEW).] [PL 1995, c. 544, §7 (NEW).]

3. License forms. The superintendent shall prescribe, consistent with the applicable requirements of this subchapter, and furnish all printed forms required under this subchapter in connection with application for and issuance of licenses. [PL 1991, c. 828, §20 (NEW).]

4. Application for licensure. Application for licensure is governed by this subsection. A. Written application for a reinsurance intermediary license must be made to the superintendent by the applicant and be accompanied by the applicable license application and issuance fee shown in section 601 . The application must be signed and duly sworn to by the applicant. [PL 1991, c. 828, §20 (NEW).] A-1. Prior to filing an application with the superintendent, the superintendent may require each applicant to take a written examination to test the applicant's competence to act as a reinsurance intermediary. [PL 1995, c. 544, §7 (NEW).] B. If the applicant is an individual, the application must include full answers to questions reasonably necessary to determine the applicant's identity, age, residence, present occupation, financial responsibility and insurance experience. The application must contain any other facts as the superintendent may require relative to the applicant's qualifications for the license as those qualifications are stated in this subchapter. [PL 1995, c. 544, §7 (AMD).] C. If the applicant is a firm, association, partnership or corporation, the application must include, in addition, the names and residence addresses of all members, officers and directors and designate the name and residence address of each individual who is to exercise the license powers. Each individual shall furnish information concerning that individual for an individual license. Every individual named in the application is authorized to act in the name of the organization licensed as a reinsurance intermediary in this State. [PL 1995, c. 544, §7 (AMD).] D. The application must indicate whether any insurance license was ever refused, suspended, revoked or continuance refused and whether any insurer, general agent, individual or organization claims that the applicant is indebted to it and, if so, the details of the indebtedness and the applicant's defense to that indebtedness. [PL 1995, c. 544, §7 (AMD).] [PL 1995, c. 544, §7 (AMD).]

5. Additional requirements. The superintendent may require a reinsurance intermediary manager to: A. File a surety bond issued by a licensed insurer, in an amount and format acceptable to the superintendent, for the protection of the reinsurer; or [PL 1991, c. 828, §20 (NEW).] B. Maintain an errors and omissions policy issued by an insurer licensed in this State in an amount acceptable to the superintendent. [PL 1991, c. 828, §20 (NEW).] [PL 1995, c. 544, §7 (AMD).]

6. Nonresident applicant. If the applicant for a reinsurance intermediary license is a nonresident, the applicant, as a condition precedent to receiving or holding a license, must designate the superintendent as agent for service of process in the manner and with the same legal effect provided for by this Title for designation of service of process upon unauthorized insurers. The applicant shall furnish the superintendent with the name and address of a resident of this State upon whom notices or orders of the superintendent or process affecting the nonresident reinsurance intermediary may be served. If a nonresident applicant becomes licensed, the licensee shall promptly notify the superintendent in writing of every change in its designated agent for service of process. Such a change is not effective until acknowledged by the superintendent. [PL 1991, c. 828, §20 (NEW).]

7. Attorneys exempted. Licensed attorneys-at-law of this State when acting in their professional capacity are exempt from this section. [PL 1991, c. 828, §20 (NEW).]
24-A M.R.S. § 14 — ME Code / Title 24-A / Chapter 1 / Section 14
24-A §14. Affordable Care Act defined
Status: in_force

As used in this Title, "federal Affordable Care Act" means the federal Patient Protection and Affordable Care Act, Public Law 111-148, as amended by the federal Health Care and Education Reconciliation Act of 2010, Public Law 111-152, and any amendments to or regulations or guidance issued under those acts. [PL 2011, c. 90, Pt. D, §1 (NEW).]
24-A M.R.S. § 4608 — ME Code / Title 24-A / Chapter 62 / Section 4608
24-A §4608. Powers and duties of the association
Status: in_force

In addition to the powers and duties enumerated in other sections of this chapter: [PL 1983, c. 846 (NEW).]

1. Impaired insurer; association action. If a member insurer is an impaired insurer, the association may, subject to any fair and equitable conditions imposed by the association that do not impair the contractual obligations of the impaired insurer and that are approved by the superintendent: A. Guarantee, assume, reissue or reinsure or cause to be guaranteed, assumed, reissued or reinsured all the covered policies of the impaired insurer; or [PL 2017, c. 382, §16 (AMD).] B. Provide such money, pledges, loans, notes, guarantees or other means as are proper to effectuate paragraph A and assure payment of the appropriate contractual obligations of the impaired insurer pending action under paragraph A . [PL 2005, c. 346, §6 (AMD); PL 2005, c. 346, §16 (AFF).] C. [PL 2005, c. 346, §6 (RP); PL 2005, c. 346, §16 (AFF).] [PL 2017, c. 382, §16 (AMD).]

2. Foreign or alien impaired insurer; association action prior to final order of liquidation, rehabilitation or conservation. [PL 2005, c. 346, §6 (RP); PL 2005, c. 346, §16 (AFF).]

3. Domestic impaired insurer under final order of liquidation or rehabilitation; association action. [PL 2005, c. 346, §6 (RP); PL 2005, c. 346, §16 (AFF).]

3-A. Impaired and insolvent insurer; association action. If a member insurer is an insolvent insurer, the association may, in its discretion, either: A. Take the following actions: (1) Guarantee, assume, reissue or reinsure or cause to be guaranteed, assumed, reissued or reinsured the policies or contracts of the insolvent insurer, or assure payment of the contractual obligations of the insolvent insurer; and (2) Provide money, pledges, loans, notes, guarantees or other means reasonably necessary to discharge the association's duties; or [PL 2017, c. 382, §17 (AMD).] B. Provide benefits and coverages in accordance with this paragraph. (1) With respect to life and health insurance policies and annuities, the association shall assure payment of benefits that would have been payable under the policies or contracts of the insolvent insurer, for claims incurred: (a) With respect to group policies and contracts, not later than the earlier of the next renewal date under those policies or contracts or 45 days, but in no event less than 30 days, after the date on which the association becomes obligated with respect to the policies and contracts; and (b) With respect to nongroup policies, contracts and annuities, not later than the earlier of the next renewal date if any under the policies or contracts and one year, but in no event less than 30 days, after the date on which the association becomes obligated with respect to the policies or contracts. (2) The association shall make diligent efforts to provide all known insureds, enrollees or annuitants for nongroup policies and contracts, or group policy or contract owners with respect to group policies and contracts, 30 days' notice of the termination of the benefits provided. (3) With respect to nongroup life and health insurance policies and annuities covered by the association, the association shall make available to each known insured, enrollee or annuitant, or owner if other than the insured, enrollee or annuitant, and, with respect to an individual formerly insured, formerly enrolled or formerly an annuitant under a group policy or contract who is not eligible for replacement group coverage, make available substitute coverage on an individual basis in accordance with the provisions of subparagraph (4), if the insureds, enrollees or annuitants had a right under law or the terminated policy or annuity to convert coverage to individual coverage or to continue an individual policy or annuity in force until a specified age or for a specified time, during which the insurer had no right unilaterally to make changes in any provision of the policy or annuity or had a right only to make changes in premium by class. (4) In providing substitute coverage, the association may offer either to reissue the terminated coverage or to issue an alternative policy in accordance with the following: (a) Alternative or reissued policies must be offered without requiring evidence of insurability and may not provide for any waiting period or exclusion that would not have applied under the terminated policy; (b) The association may reinsure any alternative or reissued policy; (c) Alternative policies adopted by the association and any amendments to reissued policies are subject to the approval of the superintendent. The association may adopt alternative policies of various types for future issuance without regard to any particular impairment or insolvency; (d) Alternative policies must contain at least the minimum statutory provisions required in this State and provide benefits that are not unreasonable in relation to the premium charged. The association shall set the premium in accordance with an actuarially justified table of rates that it adopts, subject to prior approval of the superintendent. The premium must reflect the amount of insurance to be provided and the age and class of risk of each insured, but may not reflect any changes in the health of the insured after the original policy was last underwritten; and (e) Any alternative policy issued by the association must provide coverage of a type similar to that of the policy issued by the impaired or insolvent insurer, as determined by the association. (5) If the association elects to reissue terminated coverage at a premium rate different from that charged under the terminated policy, the premium must be actuarially justified and set by the association in accordance with the amount of coverage provided and the age and class of risk, subject to approval of the superintendent. (6) The association's obligations with respect to coverage under any policy of the impaired or insolvent insurer or under any reissued or alternative policy must cease on the date the coverage or policy is replaced by another similar policy by the policy owner, the insured, the enrollee or the association. (7) When proceeding under this paragraph with respect to a policy or contract carrying guaranteed minimum interest rates, the association shall assure the payment or crediting of a rate of interest consistent with section 4603 . (8) Nonpayment of premiums within 31 days after the date required under the terms of any guaranteed, assumed, alternative or reissued policy or contract or substitute coverage terminates the association's obligations under the policy or coverage under this chapter with respect to the policy or coverage, except with respect to any claims incurred or any net cash surrender value that may be due in accordance with the provisions of this chapter. (9) Premiums due for coverage after entry of an order of liquidation of an insolvent insurer belong to and are payable at the direction of the association, and the association is liable for unearned premiums due to policy or contract owners arising after the entry of the order. (10) The protection provided by this chapter does not apply when any guaranty protection is provided to residents of this State by the laws of the domiciliary state or jurisdiction of the impaired or insolvent insurer other than this State. [PL 2017, c. 382, §17 (AMD).] [PL 2017, c. 382, §17 (AMD).]

4. Foreign or alien impaired insurer under final order of liquidation, rehabilitation or conservation; association action. [PL 2005, c. 346, §6 (RP); PL 2005, c. 346, §16 (AFF).]

5. Policy liens; contract liens; moratoriums on payments. [PL 2005, c. 346, §6 (RP); PL 2005, c. 346, §16 (AFF).]

5-A. Policy liens; contract liens; moratoriums on payments. In carrying out its duties under subsection 3‑A , the association may: A. Subject to approval by a court in this State, impose permanent policy or contract liens in connection with a guarantee, assumption or reinsurance agreement, if the association finds that the amounts that can be assessed under this chapter are less than the amounts needed to assure full and prompt performance of the association's duties under this chapter or that the economic or financial conditions as they affect member insurers are sufficiently adverse to render the imposition of such permanent policy or contract liens to be in the public interest; and [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] B. Subject to approval by a court in this State, impose temporary moratoriums or liens on payments of cash values and policy loans or on any other right to withdraw funds held in conjunction with policies or contracts, in addition to any contractual provisions for deferral of cash or policy loan value. In addition, in the event of a temporary moratorium or moratorium charge imposed by the receivership court on payment of cash values or policy loans or on any other right to withdraw funds held in conjunction with policies or contracts, out of the assets of the impaired or insolvent insurer, the association may defer the payment of cash values, policy loans or other rights by the association for the period of the moratorium or moratorium charge imposed by the receivership court, except for claims covered by the association to be paid in accordance with a hardship procedure established by the liquidator or rehabilitator and approved by the receivership court. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).]

6. Association liability. The association has no liability under this section for any covered policy of a foreign or alien insurer whose domiciliary jurisdiction or state of entry provides by statute for residents of this State protection substantially similar to that provided by this chapter for residents of other states. [PL 2005, c. 346, §6 (AMD); PL 2005, c. 346, §16 (AFF).]

6-A. Failure to act. If the association fails to act within a reasonable period of time with respect to an insolvent insurer, as provided in subsection 3‑A , the superintendent has the powers and duties of the association under this chapter with respect to the insolvent insurer. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).]

6-B. Retention of deposit; final order of liquidation or rehabilitation plan. A deposit in this State, held pursuant to law or required by the superintendent for the benefit of creditors, including policy owners, not turned over to the domiciliary liquidator upon the entry of a final order of liquidation or order approving a rehabilitation plan of a member insurer domiciled in this State or in a reciprocal state, pursuant to this Title must be promptly paid to the association. The association is entitled to retain a portion of any amount so paid to it equal to the percentage determined by dividing the aggregate amount of policy owners' claims related to that insolvency for which the association has provided statutory benefits by the aggregate amount of all policy owners' claims in this State related to that insolvency and shall remit to the domiciliary receiver the amount so paid to the association and not retained pursuant to this subsection. Any amount so paid to the association less the amount not retained by it must be treated as a distribution of estate assets pursuant to chapter 57 or similar provision of the state of domicile of the impaired or insolvent insurer. [PL 2017, c. 382, §18 (AMD).]

7. Assistance and advice to superintendent. The association may render assistance and advice to the superintendent, upon the superintendent's request, concerning rehabilitation, payment of claims, continuations of coverage or the performance of other contractual obligations of any impaired or insolvent insurer. [PL 2005, c. 346, §6 (AMD); PL 2005, c. 346, §16 (AFF).]

8. Standing to appear before court. The association has standing to appear or intervene before any court or agency in this State with jurisdiction over an impaired or insolvent insurer concerning which the association is or may become obligated under this chapter or with jurisdiction over any person or property against whom the association may have rights through subrogation or otherwise. This standing extends to all matters germane to the powers and duties of the association, including, but not limited to, proposals for reinsuring, reissuing, modifying or guaranteeing the covered policies or contracts and contractual obligations of the impaired or insolvent insurer and the determination of the covered policies or contracts and contractual obligations. The association also has the right to appear or intervene before a court or agency in another state with jurisdiction over an impaired or insolvent insurer for which the association is or may become obligated or with jurisdiction over any person or property against whom the association may have rights through subrogation or otherwise. [PL 2017, c. 382, §19 (AMD).]

9. Subrogation rights. Any person receiving benefits under this chapter is deemed to have assigned that person's rights under, and any causes of action against any person for losses arising under, resulting from or otherwise relating to, the covered policy or contract to the association to the extent of the benefits received because of this chapter whether the benefits are payments of or on account of contractual obligations, continuation of coverage or provision of substitute or alternative coverages. The association may require an assignment to it of these rights and cause of action by any payee, policy or contract owner, beneficiary, insured, enrollee or annuitant as a condition precedent to the receipt of any rights or benefits conferred by this chapter upon that person. The association is subrogated to these rights against the assets of any impaired or insolvent insurer. The subrogation rights of the association under this subsection must have the same priority against the assets of the impaired or insolvent insurer as that possessed by the person entitled to receive benefits under this chapter. In addition, the association has all common law rights of subrogation and any other equitable or legal remedy that would have been available to the impaired or insolvent insurer or owner, beneficiary, insured, enrollee or payee of a policy or contract with respect to the policy or contract, including without limitation, in the case of a structured settlement annuity, any rights of the owner, beneficiary or payee of the annuity, to the extent of benefits received pursuant to this chapter, against a person originally or by succession responsible for the losses arising from the personal injury relating to the annuity or payment therefor, excepting any such person responsible solely by reason of serving as an assignee in respect of a qualified assignment under Section 130 of the federal Internal Revenue Code. If the provisions of this subsection are invalid or ineffective with respect to any person or claim for any reason, the amount payable by the association with respect to the related covered obligations must be reduced by the amount realized by any other person with respect to the person or claim that is attributable to the policies or portion thereof covered by the association. If the association has provided benefits with respect to a covered obligation and a person recovers amounts as to which the association has rights as described in this subsection, the person shall pay to the association the portion of the recovery attributable to the policies or portion thereof covered by the association. [PL 2017, c. 382, §19 (AMD).]

10. Association's contractual obligation; impaired insurer. [PL 2005, c. 346, §6 (RP); PL 2005, c. 346, §16 (AFF).]

11. Other powers. The association may: A. Enter into such contracts as are necessary or proper to carry out the provisions and purposes of this chapter; [PL 1983, c. 846 (NEW).] B. Subject to the provisions of section 4617 , sue or be sued, including taking any legal actions necessary or proper for recovery of any unpaid assessments under section 4609 or to settle claims or potential claims against it; [PL 2005, c. 346, §6 (AMD); PL 2005, c. 346, §16 (AFF).] C. Borrow money to effect the purposes of this chapter. Any notes or other evidence of indebtedness of the association not in default are legal investments for domestic member insurers and may be carried as admitted assets; [PL 2017, c. 382, §20 (AMD).] D. Employ or retain such persons as are necessary or appropriate to handle the financial transactions of the association and to perform such other functions as become necessary or proper under this chapter; [PL 2005, c. 346, §6 (AMD); PL 2005, c. 346, §16 (AFF).] E. Negotiate and contract with any liquidator, rehabilitator, conservator or ancillary receiver to carry out the powers and duties of the association; [PL 1983, c. 846 (NEW).] F. Take such legal action as may be necessary to avoid or recover payment of improper claims; [PL 2005, c. 346, §6 (AMD); PL 2005, c. 346, §16 (AFF).] G. Exercise, for the purposes of this chapter and to the extent approved by the superintendent, the powers of a domestic life or health insurer or health maintenance organization, but in no case may the association issue policies or contracts other than those issued to perform the contractual obligations of the impaired insurer; [PL 2017, c. 382, §20 (AMD).] H. Organize itself as a corporation or in other legal form permitted by the laws of this State; [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] I. Request information from a person seeking coverage from the association in order to aid the association in determining its obligations under this chapter with respect to the person, and the person shall promptly comply with the request; [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] J. Join an organization of one or more other state associations of similar purposes, to further the purposes and administer the powers and duties of the association; [PL 2017, c. 382, §21 (AMD).] J-1. In accordance with the terms and conditions of the policy or contract, if not otherwise prohibited by applicable law, file for actuarially justified rate or premium increases for any policy or contract for which it provides coverage under this chapter; and [PL 2017, c. 382, §22 (NEW).] K. Take necessary or appropriate action to discharge its duties and obligations under this chapter or to exercise its powers under this chapter. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] [PL 2017, c. 382, §§20-22 (AMD).]

12. Reinsurance of obligations; election by association. At any time within one year after the date on which the association becomes responsible for the obligations of a member insurer, the association may elect to succeed to the rights and obligations of the member insurer that accrue on or after the coverage date and that relate to contracts covered in whole or in part by the association under any one or more indemnity reinsurance agreements entered into by the member insurer as a ceding insurer and selected by the association. However, the association may not exercise an election with respect to a reinsurance agreement if the receiver, rehabilitator or liquidator of the member insurer has previously and expressly disaffirmed the reinsurance agreement. The election is effected by a notice to the receiver, rehabilitator or liquidator and to the affected reinsurers. If the association makes an election, the following requirements apply with respect to the agreements selected by the association. A. For contracts covered in whole or in part by the association, the association is responsible for all unpaid premiums due under the agreements for periods both before and after the coverage date and for the performance of all other obligations to be performed after the coverage date. The association may charge contracts covered in part by the association, through reasonable allocation methods, the costs for reinsurance in excess of the obligations of the association. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] B. The association is entitled to any amounts payable by the reinsurer under the agreements with respect to losses or events that occur in periods after the coverage date and that relate to contracts covered by the association in whole or in part, except that, upon receipt of any such amounts, the association is obliged to pay to the beneficiary under the policy or contract on account of which the amounts were paid a portion of the amount equal to the excess of the amount received by the association over the benefits paid by the association on account of the policy or contract less the retention of the impaired or insolvent insurer applicable to the loss or event. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] C. Within 30 days following the association's election, the association and each indemnity reinsurer shall calculate the net balance due to or from the association under each reinsurance agreement as of the date of the association's election, giving full credit to all items paid by either the member insurer or its receiver, rehabilitator or liquidator or the indemnity reinsurer during the period between the coverage date and the date of the association's election. Either the association or indemnity reinsurer shall pay the net balance due the other within 5 days of the completion of the calculation. If the receiver, rehabilitator or liquidator has received any amounts due the association pursuant to paragraph B , the receiver, rehabilitator or liquidator shall remit them to the association as promptly as practicable. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] D. If the association, within 60 days of the election, pays the premiums due for periods both before and after the coverage date that relate to contracts covered by the association in whole or in part, the reinsurer is not entitled to terminate the reinsurance agreements insofar as the agreements relate to contracts covered by the association in whole or in part and is not entitled to set off any unpaid premium due for periods prior to the coverage date against amounts due the association. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] E. In the event the association transfers its obligations to another insurer and if the association and the other insurer agree, the other insurer must succeed to the rights and obligations of the association under this chapter effective as of the date agreed upon by the association and the other insurer and regardless of whether the association has made the election referred to in this subsection, except that: (1) The indemnity reinsurance agreements automatically terminate for new reinsurance unless the indemnity reinsurer and the other insurer agree to the contrary; and (2) The obligations described in this chapter no longer apply on and after the date the indemnity reinsurance agreement is transferred to the 3rd-party insurer. This paragraph does not apply if the association has previously expressly determined in writing that it will not exercise the election. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] F. This subsection supersedes the provisions of any law of this State or of any affected reinsurance agreement that provides for or requires any payment of reinsurance proceeds, on account of losses or events that occur in periods after the coverage date, to the receiver, liquidator or rehabilitator of an insolvent insurer. The receiver, rehabilitator or liquidator is entitled to any amounts payable by the reinsurer under the reinsurance agreement with respect to losses or events that occur in periods prior to the coverage date subject to applicable set-off provisions. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] G. Except as otherwise expressly provided, this subsection does not alter or modify the terms and conditions of the indemnity reinsurance agreements of an insolvent insurer. This subsection may not be construed to abrogate or limit any rights of any reinsurer to claim that it is entitled to rescind a reinsurance agreement. This subsection may not be construed to give a policy owner, contract owner, enrollee, certificate holder or beneficiary an independent cause of action against an indemnity reinsurer that is not otherwise set forth in the indemnity reinsurance agreement. [PL 2017, c. 382, §23 (AMD).] [PL 2017, c. 382, §23 (AMD).]

13. Discretion. The board of directors of the association has discretion and may exercise reasonable business judgment to determine the means by which the association is to provide the benefits of this chapter in an economical and efficient manner. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).]

14. No additional benefits. When the association has arranged or offered to provide the benefits of this chapter to a covered person under a plan or arrangement that fulfills the association's obligations under this chapter, the person is not entitled to benefits from the association in addition to or other than those provided under the plan or arrangement. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).]

15. Venue. Venue in a suit against the association arising under this chapter is Kennebec County. The association may not be required to give an appeal bond in an appeal that relates to a cause of action arising under this chapter. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).]

16. Issuance of substitute coverage. In carrying out its duties in connection with guaranteeing, assuming, reissuing or reinsuring policies or contracts under this section, the association may issue substitute coverage for a policy or contract that provides an interest rate, crediting rate or similar factor determined by use of an index or other external reference stated in the policy or contract employed in calculating returns or changes in value by issuing an alternative policy or contract in accordance with this subsection. A. In lieu of the index or other external reference provided for in the original policy or contract, the alternative policy or contract must provide for: (1) A fixed interest rate; (2) Payment or dividends with minimum guarantees; or (3) A different method for calculating interest or changes in value. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] B. There may not be a requirement for evidence of insurability, waiting period or other exclusion that would not have applied under the replaced policy or contract. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] C. The alternative policy or contract must be substantially similar to the replaced policy or contract in all other material terms. [PL 2005, c. 346, §6 (NEW); PL 2005, c. 346, §16 (AFF).] [PL 2017, c. 382, §24 (AMD).]
24-A M.R.S. § 731-E — ME Code / Title 24-A / Chapter 9 / Section 731-E
24-A §731-E. Reinsurance concentration risk
Status: in_force

1. Reinsurance claim exposure. An insurer shall manage its reinsurance recoverables proportionate to its own book of business. A domestic insurer shall notify the superintendent within 30 days after reinsurance recoverables from any single assuming insurer, or group of affiliated assuming insurers, exceed 50% of the insurer's last reported surplus to policyholders or after it is determined that reinsurance recoverables from any single assuming insurer, or group of affiliated assuming insurers, are likely to exceed this limit. [PL 2013, c. 238, Pt. B, §10 (NEW).]

2. Diversification. An insurer shall diversify its reinsurance program to the extent reasonably necessary to avoid imprudent concentrations of risk. A domestic insurer shall notify the superintendent within 30 days after ceding to any single assuming insurer, or group of affiliated assuming insurers, more than 20% of the insurer's gross written premium in the prior calendar year or after the insurer has determined that the reinsurance ceded to any single assuming insurer, or group of affiliated assuming insurers, is likely to exceed this limit. [PL 2013, c. 238, Pt. B, §10 (NEW).]

3. Risk management. A notice provided by an insurer under subsection 1 or 2 must include a demonstration that the insurer is safely managing the exposure. [PL 2013, c. 238, Pt. B, §10 (NEW).]
24 M.R.S. § 2320-F — ME Code / Title 24 / Chapter 19 / Section 2320-F
24 §2320-F. Off-label use of prescription drugs for cancer
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Medically accepted indication" includes any use of a drug that has been approved by the federal Food and Drug Administration and includes another use of the drug if that use is supported by one or more citations in the standard reference compendia or if the nonprofit hospital and medical service organization involved, based upon guidance provided by the federal Department of Health and Human Services Medicare program pursuant to 42 United States Code, Section 1395x(t), determines that that use is medically accepted based on supportive clinical evidence in peer-reviewed medical literature. [PL 1997, c. 701, §1 (NEW).] B. "Off-label use" means the prescription and use of drugs for medically accepted indications other than those stated in the labeling approved by the federal Food and Drug Administration. [PL 1997, c. 701, §1 (NEW).] C. "Peer-reviewed medical literature" means scientific studies published in at least 2 articles from major peer-reviewed medical journals that present data that supports the proposed off-label use as generally safe and effective. [PL 1997, c. 701, §1 (NEW).] D. "Standard reference compendia" means: (1) The United States Pharmacopeia Drug Information or information published by its successor organization; or (2) The American Hospital Formulary Service Drug Information or information published by its successor organization. [PL 1997, c. 701, §1 (NEW).] [PL 1997, c. 701, §1 (NEW).]

2. Required coverage for off-label use. All individual and group nonprofit hospital and medical services plan contracts and nonprofit health care plan contracts that provide coverage for prescription drugs must provide coverage for off-label use in accordance with the following. A. Individual and group nonprofit hospital and medical services plan contracts and nonprofit health care plan contracts that provide coverage for prescription drugs may not exclude coverage for any such drug used for the treatment of cancer for a medically accepted indication on the grounds that the drug has not been approved by the federal Food and Drug Administration for that indication, as long as that use of that drug is a medically accepted indication for the treatment of cancer. [PL 1997, c. 701, §1 (NEW).] B. Coverage of a drug required by this subsection also includes medically necessary services associated with the administration of the drug. [PL 1997, c. 701, §1 (NEW).] C. This subsection may not be construed to require coverage for a drug when the federal Food and Drug Administration has determined its use to be contraindicated for treatment of the current indication. [PL 1997, c. 701, §1 (NEW).] D. A drug use that is covered pursuant to paragraph A may not be denied coverage based on a "medical necessity" requirement except for a reason that is unrelated to the legal status of the drug use. [PL 1997, c. 701, §1 (NEW).] E. A contract that provides coverage of a drug as required by this subsection may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the same extent that these provisions are applicable to coverage of all prescription drugs and are not inconsistent with the requirements of this subsection. [PL 1997, c. 701, §1 (NEW).] [PL 1997, c. 701, §1 (NEW).]

3. Application. The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1999. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 1997, c. 701, §1 (NEW).]
24-A M.R.S. § 418 — ME Code / Title 24-A / Chapter 5 / Section 418
24-A §418. Power to amend, modify or refuse to renew certificates of authority
Status: in_force

Notwithstanding the authority of the District Court, the superintendent may amend, modify or refuse to renew any insurer's certificate of authority for cause pursuant to procedures in conformity with the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV . [PL 1983, c. 419, §3 (AMD); PL 1999, c. 547, Pt. B, §78 (AMD); PL 1999, c. 547, Pt. B, §80 (AFF).]
24-A M.R.S. § 3954 — ME Code / Title 24-A / Chapter 54-A / Section 3954
24-A §3954. Liability and indemnification
Status: in_force

1. Liability. The board and its employees may not be held liable for any obligations of the association. A cause of action may not arise against the association; the board, its agents or its employees; a member insurer or its agents, employees or producers; or the superintendent for any action or omission in the performance of powers and duties pursuant to this chapter. [PL 2011, c. 90, Pt. B, §8 (NEW).]

2. Indemnification. The board may provide in its bylaws or rules for indemnification of, and legal representation for, its members and employees. [PL 2011, c. 90, Pt. B, §8 (NEW).]
24-A M.R.S. § 4303-F — ME Code / Title 24-A / Chapter 56-A / Section 4303-F
24-A §4303-F. Reimbursement for ambulance services and participation of ambulance service providers in carrier networks
Status: in_force

1. Reimbursement for ambulance services. With respect to a bill for covered services rendered by an ambulance service provider, a carrier shall reimburse the ambulance service provider or enrollee, as applicable, as follows. A. If the ambulance service provider participates in the carrier's network, the carrier shall reimburse at the ambulance service provider's rate or 200% of the Medicare rate for that service, whichever is less, plus any adjustment required by paragraph C . [PL 2021, c. 241, §3 (NEW).] B. If the ambulance service provider is an out-of-network provider, the carrier shall reimburse at the ambulance service provider's rate or 180% of the Medicare rate for that service, whichever is less, plus any adjustment required by paragraph C . [PL 2021, c. 241, §3 (NEW).] C. If the ambulance service provider is located in a rural or super rural area as designated by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services and eligible for additional Medicare reimbursement for services that were provided to a Medicare enrollee, the carrier shall increase the reimbursement to that ambulance service provider in the same amount as the additional Medicare reimbursement. [PL 2021, c. 241, §3 (NEW).] D. If, on the effective date of this subsection, an ambulance service provider's charge for ambulance services is below 200% of the Medicare rate for that service, the ambulance service provider may not increase the charge for that service by more than 5% annually. [PL 2021, c. 241, §3 (NEW).] E. A carrier may not require a ground ambulance service provider to obtain prior authorization before transporting an enrollee to a hospital, between hospitals or from a hospital to a nursing home, hospice care facility or other health care facility, as defined in Title 22, section 328, subsection 8. A carrier may not require an air ambulance service provider that is a nonprofit organization to obtain prior authorization before transporting an enrollee to a hospital or between hospitals for urgent care. [PL 2025, c. 34, §1 (AMD); PL 2025, c. 34, §2 (AFF).] Notwithstanding this subsection, a carrier is not required to reimburse an ambulance service provider at the reimbursement rates required in this subsection for covered services delivered through community paramedicine in accordance with Title 32, section 84, subsection 4 and a carrier may require an ambulance service provider to obtain prior authorization before providing services through community paramedicine. [PL 2025, c. 34, §1 (AMD); PL 2025, c. 34, §2 (AFF).]

1-A. Reimbursement for nontransport services. With respect to a health plan with an effective date on or after January 1, 2024, when an ambulance service provider responds to a call for emergency services and an enrollee refuses transport to a hospital, a carrier shall reimburse that ambulance service provider for any services other than transport provided to the enrollee as follows. A. If the ambulance service provider participates in the carrier's network, the carrier shall reimburse the ambulance service provider at the ambulance service provider's rate or 200% of the average of the Medicare rate for basic life support services and the Medicare rate for advanced life support services, whichever is less, plus any adjustment required by paragraph C . [PL 2023, c. 468, §2 (NEW).] B. If the ambulance service provider is an out-of-network provider, the carrier shall reimburse the ambulance service provider at the ambulance service provider's rate or 180% of the average of the Medicare rate for basic life support services and the Medicare rate for advanced life support services, whichever is less, plus any adjustment required by paragraph C . [PL 2023, c. 468, §2 (NEW).] C. If the ambulance service provider is located in a rural or super rural area as designated by the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services and eligible for additional Medicare reimbursement for services that were provided to a Medicare enrollee, the carrier shall increase the reimbursement to that ambulance service provider in the same amount as the additional Medicare reimbursement. [PL 2023, c. 468, §2 (NEW).] D. If, on the effective date of this subsection, an ambulance service provider's rate for ambulance services is below 200% of the average of the Medicare rate for basic life support and advanced life support services, the ambulance service provider may not increase the rate for that service by more than 5% annually. [PL 2023, c. 468, §2 (NEW).] [PL 2023, c. 468, §2 (NEW).]

2. Network participation; standard contract. A carrier shall offer a standard contract to all ambulance service providers willing to participate in the carrier's provider network with the following provisions: A. The reimbursement rate paid for ambulance services conforms to the requirements of subsection 1 ; [PL 2023, c. 468, §2 (AMD).] B. The contract term is for a minimum of 24 months; [PL 2021, c. 241, §3 (NEW).] C. The contract may be terminated as long as the party seeking to terminate the contract provides at least 180 days' prior notice; and [PL 2021, c. 241, §3 (NEW).] D. The contract provides that an ambulance service provider has a minimum of 120 days to submit a claim. [PL 2021, c. 241, §3 (NEW).] [PL 2023, c. 468, §2 (AMD).]

3. Exemption. Except as provided in subsection 1, paragraph E , this section does not apply to air ambulance services. [PL 2023, c. 591, §4 (AMD).]

4. Medical necessity. A carrier shall consider the requirements of the federal Department of Health and Human Services, Centers for Medicare and Medicaid Services related to medical necessity of ambulance services when establishing the carrier's own policies and guidelines related to the medical necessity and reasonableness of covered services provided by ambulance service providers. [PL 2023, c. 468, §2 (NEW).]
24-A M.R.S. § 994 — ME Code / Title 24-A / Chapter 11 / Section 994
24-A §994. Confidentiality
Status: in_force

1. Statement of actuarial opinion. The statement of actuarial opinion under section 993, subsection 1 must be provided with the annual statement under section 423 in accordance with the appropriate NAIC property and casualty annual statement instructions and is a public record subject to disclosure pursuant to Title 1, chapter 13 . [PL 2009, c. 511, Pt. B, §2 (AMD).]

2. Documents in possession of bureau. The confidentiality of documents in the possession of the bureau is governed by this subsection. A. Documents, materials or other information in the possession or control of the bureau that are considered an actuarial report, work papers or actuarial opinion summary provided in support of the opinion, as described in section 993 , and any other material provided by the property and casualty insurance company to the superintendent in connection with the actuarial report, work papers or actuarial opinion summary are confidential and not subject to disclosure pursuant to Title 1, chapter 13 . [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).] B. This subsection may not be construed to limit the superintendent’s authority to release documents to the Actuarial Board for Counseling and Discipline or successor organization as long as the material is required for the purpose of professional disciplinary proceedings and the Actuarial Board for Counseling and Discipline establishes procedures satisfactory to the superintendent for preserving the confidentiality of the documents. This section may not be construed to limit the superintendent’s authority to use the documents, materials or other information in furtherance of any regulatory or legal action brought as part of the superintendent’s official duties. [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).] [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).]

3. Testimony. Neither the superintendent nor any person who received documents, materials or other information while acting under the authority of the superintendent is permitted or required to testify in any private civil action concerning any confidential documents, materials or information subject to subsection 2 . [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).]

4. Sharing of documents. In order to assist in the performance of the superintendent’s duties, the superintendent may: A. Share documents, materials or other information, including confidential and privileged documents, materials or information subject to subsection 2 , with other state, federal and international regulatory agencies, with the NAIC and its affiliates and subsidiaries and with state, federal and international law enforcement authorities, as long as the recipient agrees to maintain the confidentiality of the document, material or other information and has the legal authority to maintain confidentiality; [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).] B. Receive documents, materials or information, including otherwise confidential and privileged documents, materials or information, from the NAIC and its affiliates and subsidiaries and from regulatory and law enforcement officials of other foreign or domestic jurisdictions. The superintendent shall maintain as confidential any document, material or information received with notice or the understanding that it is confidential under the laws of the jurisdiction that is the source of the document, material or information; and [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).] C. Enter into agreements governing sharing and use of information consistent with this subsection and subsections 2 and 3 . [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).] [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).]

5. Waiver. No waiver of a claim of confidentiality in the documents, materials or information may occur as a result of disclosure to the superintendent under this section or as a result of sharing as authorized in subsection 4 . [PL 2007, c. 281, §2 (NEW); PL 2007, c. 281, §3 (AFF).]
24-A M.R.S. § 2851-A — ME Code / Title 24-A / Chapter 37 / Section 2851-A
24-A §2851-A. Short title
Status: in_force

This chapter may be known and cited as the "Consumer Credit Insurance Act." [PL 2001, c. 138, §5 (NEW).]
24-A M.R.S. § 2847-H — ME Code / Title 24-A / Chapter 35 / Section 2847-H
24-A §2847-H. Coverage for services of certified nurse practitioners; certified midwives; certified nurse midwives (REALLOCATED FROM TITLE 24-A, SECTION 2847-G)
Status: in_force

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

1. Required coverage for services upon referral of primary care provider. An insurer that issues group health insurance policies and contracts shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife to a patient who is referred to the certified nurse practitioner, certified midwife or certified nurse midwife by a primary care provider when those services are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife. [PL 2021, c. 79, §3 (AMD); PL 2021, c. 79, §6 (AFF).]

2. Required coverage for self-referred services. With respect to group health insurance policies and contracts that do not require the selection of a primary care provider, an insurer shall provide coverage under those contracts for services performed by a certified nurse practitioner, certified midwife or certified nurse midwife when those services are covered services and when they are within the lawful scope of practice of the certified nurse practitioner, certified midwife or certified nurse midwife. [PL 2021, c. 79, §3 (AMD); PL 2021, c. 79, §6 (AFF).]

3. Limits; coinsurance; deductibles. Any contract that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section. [RR 1999, c. 1, §34 (RAL).]

4. Application. The requirements of this section apply to all 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, §19 (NEW).]
24-A M.R.S. § 2215 — ME Code / Title 24-A / Chapter 24 / Section 2215
24-A §2215. Disclosure limitations and conditions
Status: in_force

1. Disclosure of personal information. A regulated insurance entity or insurance support organization may not disclose any personal information about a consumer collected or received in connection with an insurance transaction unless the disclosure is made with due consideration for the safety and reputation of all persons who may be affected by the disclosure, is limited to the minimum amount of personal information necessary to accomplish a lawful purpose and is disclosed: A. With the written authorization of the individual, only: (1) If that authorization is submitted directly by the consumer, a person purporting to represent the consumer, another regulated insurance entity or insurance support organization and the authorization meets the requirements of section 2208 ; or (2) If the authorization is submitted by a person other than a regulated insurance entity or insurance support organization and the authorization describes with reasonable particularity the nature of the information to be disclosed and the purpose of the disclosure and is: (a) Dated; (b) Signed by the consumer, except that another authorized individual may provide authorization or the consumer may authorize disclosure in electronic or telephonic form in accordance with section 2208, subsection 1 ; and (c) Obtained one year or less before the date a disclosure is sought pursuant to this subsection; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. To a person other than a regulated insurance entity or insurance support organization, only if that disclosure is reasonably necessary: (1) To enable that person to perform a business, professional or insurance function for the disclosing regulated insurance entity or insurance support organization and that person agrees not to disclose the information further without the consumer's written authorization unless the further disclosure: (a) Would otherwise be permitted by this section if made by a regulated insurance entity or insurance support organization; or (b) Is reasonably necessary for that person to perform its function for the disclosing regulated insurance entity or insurance support organization; or (2) To enable that person to provide information to the disclosing regulated insurance entity or insurance support organization for the purpose of: (a) Determining a consumer's eligibility for an insurance benefit or payment; or (b) Detecting or preventing criminal activity, fraud, material misrepresentation or material nondisclosure in connection with an insurance transaction; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. To a regulated insurance entity, insurance support organization or self-insurer, only if the information disclosed is limited to that which is reasonably necessary: (1) To detect or prevent criminal activity, fraud, material misrepresentation or material nondisclosure in connection with insurance transactions; or (2) For either the disclosing or the receiving regulated insurance entity or insurance support organization to perform its function in connection with an insurance transaction involving the consumer; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] D. To a health care provider for the purpose of: (1) Verifying insurance coverage or benefits; (2) Informing a consumer of a medical problem of which the consumer may not be aware; or (3) Conducting an operations or services audit to verify the consumers of the regulated insurance entity or insurance support organization treated by the health care provider; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] E. To an insurance regulatory authority; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] F. To a law enforcement or other governmental authority to protect the interests of the regulated insurance entity or insurance support organization in preventing or prosecuting the perpetration of fraud upon that entity or organization; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] G. In response to a facially valid administrative or judicial order, including a search warrant or subpoena, or otherwise required by law; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] H. For the purpose of conducting actuarial or research studies, except that: (1) No insurance consumer may be identified in any actuarial or research report; (2) Materials allowing the consumer to be identified must be returned or destroyed as soon as they are no longer needed; and (3) The actuarial or research organization agrees not to disclose the information unless the disclosure would otherwise be permitted by this section if made by a regulated insurance entity or insurance support organization; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] I. To a party or representative of a party to a proposed or consummated sale, transfer, merger or consolidation of all or part of the business of the regulated insurance entity or insurance support organization, only if: (1) Before the consummation of the sale, transfer, merger or consolidation only such information is disclosed as is reasonably necessary to enable the recipient to make business decisions about the purchase, transfer, merger or consolidation; and (2) The recipient agrees not to disclose the information unless the disclosure would otherwise be permitted by this section if made by a regulated insurance entity or insurance support organization; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] J. To a person whose only use of the information will be in connection with the marketing of a product or service, only if: (1) No health care information, confidential investigative information or information relating to a consumer's character, personal habits, mode of living or general reputation is disclosed and no classification derived from any such information is disclosed; (2) The consumer has been given an opportunity to indicate that the consumer does not want personal information disclosed for marketing purposes and has given no indication that the consumer does not want the information disclosed; and (3) The person receiving the information agrees not to use it except in connection with the marketing of a product or service; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] K. By a consumer reporting agency to a person other than a regulated insurance entity; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] L. To a group policyholder for the purpose of reporting claims experience or conducting an audit of the regulated insurance entity's operations or services, only if the information disclosed is aggregate information and reasonably necessary for the group policyholder to conduct the review or audit; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] M. To a professional peer review organization for the purpose of reviewing the service or conduct of a health care provider; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] N. To a certificate holder or policyholder for the purpose of providing information regarding the status of an insurance transaction; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] O. To a lienholder, mortgagee, assignee, lessor or other person shown on the records of a carrier or producer as having a legal or beneficial interest in a policy of insurance, only if: (1) No health care information is disclosed unless the disclosure would otherwise be permitted by this section; and (2) The information disclosed is limited to that which is reasonably necessary to permit that person to protect its interests in the policy; [PL 2001, c. 457, §21 (AMD).] P. To an affiliate whose only use of the information will be in connection with an audit of the regulated insurance entity or the marketing of a product or service of the affiliate, if the information disclosed for marketing purposes does not include health care information and if the affiliate agrees not to disclose the information for any other purpose or to unaffiliated persons; [PL 2005, c. 127, §1 (AMD).] Q. In order to protect the public health and welfare, to state governmental entities only insofar as necessary to enable those entities to perform their duties when reporting is required or authorized by law; or [PL 2005, c. 127, §2 (AMD).] R. By a regulated insurance entity that is also a covered entity or is a business associate of a covered entity under the standards for privacy of individually identifiable health information, 45 Code of Federal Regulations, Parts 160 and 164 (2004), if the disclosure is made for purposes of treatment, payment or health care operations of the disclosing or receiving entity and is made in full compliance with the requirements of the standards for privacy of individually identifiable health information and any applicable business associate agreement. [PL 2005, c. 127, §3 (NEW).] [PL 2005, c. 127, §§1-3 (AMD).]