24-A M.R.S. § 4379 — ME Code / Title 24-A / Chapter 57 / Section 4379
24-A §4379. Priorities in distribution of assets
Status: in_force

The priorities in distribution of assets from the insurer's estate to pay unsecured claims, including the unsecured portion of undersecured claims, are in the order as shown in this section. The first $50 of the amount allowed on each claim in the classes under subsections 3 , 4 , 4‑B , 5 and 6 must be deducted from the claim and included in the class under subsection 8 . Claims may not be cumulated by assignment to avoid application on the $50 deductible provision. Subject to the $50 deductible provision, every claim in each class must be paid in full or adequate funds retained for the payment thereof before claims of the next succeeding class receive any payment. No subclasses may be established within any class. [PL 2017, c. 169, Pt. D, §1 (AMD).]

1. Administration costs. The costs and expenses of administration, including but not limited to the actual and necessary costs of preserving or recovering the assets of the insurer; compensation for all services rendered in the liquidation; any necessary filing fees; the fees and mileage payable to witnesses; and reasonable attorney's fees. Any provider or member claims for covered services under a health maintenance organization contract, including a point-of-service contract, incurred between the date a petition of liquidation is filed and the date coverage terminates may be treated as administration costs under this subsection. [PL 2001, c. 88, §12 (AMD).]

2. Wages. [PL 2017, c. 169, Pt. D, §2 (RP).]

3. Loss claims. All claims under policies for losses incurred, including 3rd-party claims, and all claims against the insurer for liability for bodily injury or for injury to or destruction of tangible property that are not under policies, except the first $200 of losses otherwise payable to any claimant under this subsection. All claims under life insurance policies and annuity contracts, whether for death proceeds, annuity proceeds or investment values, must be treated as loss claims. Claims may not be cumulated by assignment to avoid application of the $200 deductible provision. That portion of any loss for which indemnification is provided by other benefits or advantages recovered or recoverable by the claimant may not be included in this class, other than benefits or advantages recovered or recoverable in discharge of familial obligations of support or by way of succession at death or as proceeds of life insurance, or as gratuities. No payment made by an employer to an employee may be treated as a gratuity. Any provider or member claims for covered services under a health maintenance organization contract, including a point-of-service contract, not paid under subsection 1 are included in this class. Obligations of an insolvent insurer arising out of reinsurance contracts are excluded from this subsection. [PL 2003, c. 202, §1 (AMD).]

4. Unearned premiums and small loss claims. Claims under nonassessable policies for unearned premiums or other premium refunds and the first $200 or loss excepted by the deductible provision in subsection 3 , except that, if the receiver fails to prorate a premium due to the insurer based on a termination of coverage under this chapter, any resulting unearned premium must be paid to the insured under subsection 1 as an expense of the administration. [PL 2001, c. 88, §12 (AMD).]

4-A. Federal claims. Claims of the Federal Government not included in the classes under subsection 3 or 4 , except to the extent that a similar claim would be subordinated in a proceeding conducted under the United States Bankruptcy Code. [RR 2021, c. 2, Pt. A, §84 (COR).]

4-B. Wages. Debts due to employees of the insurer, other than officers, for services performed, not to exceed $1,000 to each employee and earned within one year immediately preceding the filing of the petition for liquidation. This priority is in lieu of any other similar priority authorized by law as to wages or compensation of such employees. [PL 2017, c. 169, Pt. D, §3 (NEW).]

5. Residual classification. All other claims, including claims of any state or local government, not falling within other classes under this section. Claims, including those of any governmental body, for a penalty or forfeiture are included in this class only to the extent of the pecuniary loss sustained from the act, transaction or proceeding out of which the penalty or forfeiture arose, with reasonable and actual costs occasioned thereby. The remainder of such claims must be postponed to the class of claims under subsection 8 . [PL 2017, c. 169, Pt. D, §4 (AMD).]

6. Judgments. Claims based solely on judgments. If a claimant files a claim and bases it both on the judgment and on the underlying facts, the claim must be considered by the liquidator who shall give the judgment such weight as the liquidator considers appropriate. The claim as allowed must receive the priority it would have received in the absence of the judgment. If the judgment is larger than the allowance on the underlying claim, the remaining portion of the judgment must be treated as if it were a claim based solely on a judgment. [RR 2021, c. 1, Pt. B, §373 (COR).]

7. Interest on claims already paid. Interest at the legal rate compounded annually on all claims in the classes under subsections 1 through 6 from the date of the petition for liquidation or the date on which the claim becomes due, whichever is later, until the date on which the dividend is declared. The liquidator, with the court's approval, may make reasonable classifications of claims for purpose of computing interest, may make approximate computations and may ignore certain classifications and time periods as de minimis. [PL 1969, c. 132, §1 (NEW).]

8. Miscellaneous subordinated claims. The remaining claims or portions of claims not already paid, with interest as in subsection 7 : A. The first $50 of each claim in the classes under subsections 3 , 4 , 4‑B , 5 and 6 subordinated under this section; [PL 2017, c. 169, Pt. D, §5 (AMD).] B. Claims subordinated by section 4380 (subordination of claims for noncooperation); [PL 1969, c. 132, §1 (NEW).] C. Claims filed late; [PL 1969, c. 132, §1 (NEW).] D. Portions of claims subordinated under subsection 5 ; and [PL 1969, c. 132, §1 (NEW).] E. Claims or portions of claims payment of which is provided by other benefits or advantages recovered or recoverable by the claimant. [PL 1969, c. 132, §1 (NEW).] [PL 2017, c. 169, Pt. D, §5 (AMD).]

9. Preferred ownership claims. Surplus or contribution notes, or similar obligations, and premium refunds on assessable policies. Interest at the legal rate shall be added to each claim, as in subsections 7 and 8 . [PL 1969, c. 132, §1 (NEW).]

10. Proprietary claims. The claims of stockholders or other owners of the insurer. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3610 — ME Code / Title 24-A / Chapter 51 / Section 3610
24-A §3610. Guaranty capital shares; dividends, investment, deposit, voting rights
Status: in_force

1. Where the insurer is permitted or required to have guaranty capital shares, such capital shall be divided into shares of $100 each and certificates shall be issued therefor. [PL 1969, c. 132, §1 (NEW).]

2. The holders of guaranty capital shares may receive dividends not exceeding 7% of the amount received by the insurer for issuance of such shares in any one calendar year from the net earnings of the insurer after providing for all expenses, losses, reserves and liabilities then incurred. [PL 1969, c. 132, §1 (NEW).]

3. Guaranty capital resulting from shares shall be invested in such manner as is provided in chapter 13 . [PL 1969, c. 132, §1 (NEW).]

4. Guaranty capital shareholders and members of the insurer shall be subject to the same provisions of law relative to their right to vote as apply respectively to stockholders in stock insurers and policyholders in purely mutual insurers. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4603 — ME Code / Title 24-A / Chapter 62 / Section 4603
24-A §4603. Scope
Status: in_force

1. Application. This chapter applies to direct nongroup life insurance policies, health insurance policies, annuity contracts and contracts supplemental to life and health insurance policies and annuity contracts and to certificates under direct group life insurance policies, health insurance policies and annuity contracts, except as limited by this chapter. For the purposes of this chapter: A. Health insurance policies include individual and group health maintenance organization enrollment contracts, and health maintenance organizations are considered to be health insurers; [PL 2017, c. 382, §2 (NEW).] B. Annuity contracts and certificates under group annuity contracts include allocated funding agreements, structured settlement annuities and any immediate or deferred annuity contracts; and [PL 2017, c. 382, §2 (NEW).] C. Benefits provided by a long-term care rider to a life insurance policy or annuity contract are considered the same type of benefits as the base life insurance policy or annuity contract to which the rider relates. [PL 2017, c. 382, §2 (NEW).] [PL 2017, c. 382, §2 (AMD).]

1-A. Persons covered. This chapter provides coverage for the policies and contracts specified in subsection 1 : A. To any person, regardless of where the person resides, except for a nonresident certificate holder under a group policy or contract, who is the beneficiary, assignee or payee, including a health care provider rendering services covered under a health insurance policy or certificate, of a person covered under paragraph B ; [PL 2017, c. 382, §3 (AMD).] B. To any person who owns, or is a certificate holder or enrollee under, a policy or contract specified in subsection 1 , other than a structured settlement annuity, who: (1) Is a resident; or (2) Is not a resident, if all the following conditions are met: (a) The insurer that issued the policy or contract is domiciled in this State; (b) The insurer never held a license or certificate of authority in the state in which the person resides; (c) The state in which the person resides has an association similar to the Maine Life and Health Insurance Guaranty Association; and (d) The person is not eligible for coverage by the association in that state; and [PL 2017, c. 382, §3 (AMD).] C. To any person who is a payee under a structured settlement annuity, or to a beneficiary or beneficiaries of a payee if the payee is deceased, if the payee: (1) Is a resident, regardless of where the contract owner resides; or (2) Is not a resident, if all of the conditions of either division (a) or (b) are met: (a) The contract owner of the structured settlement annuity is a resident; or (b) The contract owner of the structured settlement annuity is not a resident, but: (i) The insurer that issued the structured settlement annuity is domiciled in this State; (ii) The state in which the contract owner resides has an association similar to the association created by this chapter; and (iii) The payee or beneficiary and the contract owner are not eligible for coverage by the association of the state in which the payee or contract owner resides. This chapter does not provide coverage to a person who is a payee or beneficiary of a contract owner who is a resident of this State if the payee or beneficiary is afforded any coverage by a similar association of another state. [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] This chapter is intended to provide coverage to a person who is a resident, and, in special circumstances as provided by this section, to a person who is not a resident. In order to avoid duplicate coverage, if a person who would otherwise receive coverage under this chapter is provided coverage under the laws of any other state, that person may not be provided coverage under this chapter. In determining the application of the provisions of this subsection in a situation in which a person could be covered by the association of more than one state, whether as an owner, payee, beneficiary, enrollee or assignee, this chapter must be construed in conjunction with other state laws to result in coverage by only one association. [PL 2017, c. 382, §3 (AMD).]

2. Exceptions. This chapter does not apply to: A. That portion of a policy or contract not guaranteed by an insurer; [PL 2005, c. 346, §2 (AMD); PL 2005, c. 346, §16 (AFF).] B. Any policies or contracts, or any part of these policies or contracts, under which the risk is borne by the policyholder; [PL 2005, c. 346, §2 (AMD); PL 2005, c. 346, §16 (AFF).] C. Any contract of reinsurance, other than reinsurance for which assumption certificates have been issued; [PL 2005, c. 346, §2 (AMD); PL 2005, c. 346, §16 (AFF).] D. Any policy or contract issued by assessment mutuals and nonprofit hospital and medical service plans; [PL 2005, c. 346, §2 (AMD); PL 2005, c. 346, §16 (AFF).] E. With the exception of a policy or contract or portion of a policy or contract, including a rider, that provides long-term care or any other health insurance benefits, any portion of a policy or contract to the extent that the rate of interest on which it is based, 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: (1) Averaged over a period of 4 years before the date on which the member insurer becomes an impaired insurer or becomes an insolvent insurer under this chapter, whichever is earlier, exceeds a rate of interest determined by subtracting 2 percentage points from Moody's Corporate Bond Yield Average averaged over the same 4-year period or for a lesser period if the policy or contract was issued less than 4 years before the member insurer becomes an impaired insurer or becomes an insolvent insurer, whichever is earlier; and (2) On or after the date on which the member insurer becomes an impaired insurer or becomes an insolvent insurer under this chapter, whichever is earlier, exceeds the rate of interest determined by subtracting 3 percentage points from Moody's Corporate Bond Yield Average as most recently available; [PL 2017, c. 382, §4 (AMD).] F. Any portion of a policy or contract issued to a plan or program of an employer, association or other person to provide life, health or annuity benefits to its employees, members or others, to the extent that the plan or program is self-funded or uninsured, including but not limited to benefits payable by an employer, association or other person under: (1) A multiple employer welfare arrangement as defined in 29 United States Code, Section 1144; (2) A minimum premium group insurance plan; (3) A stop loss group insurance plan; or (4) An administrative-services-only contract; [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] G. Any portion of a policy or contract to the extent that it provides for: (1) Dividends or experience rating credits; (2) Voting rights; or (3) Payment of any fees or allowances to any person, including the policy or contract owner, in connection with the service to or administration of the policy or contract; [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] H. Any policy or contract issued in this State by a member insurer at a time when it was not licensed or did not have a certificate of authority to issue the policy or contract in this State; [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] I. Any portion of a policy or contract to the extent that the assessments required by section 4609 with respect to the policy or contract are preempted by federal or state law; [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] J. Any obligation that does not arise under the express written terms of the policy or contract issued by the insurer to the contract owner, policy owner, enrollee or certificate holder, including without limitation: (1) Claims based on marketing materials; (2) Claims based on side letters, riders or other documents that were issued by the insurer without meeting applicable form filing or approval requirements; (3) Misrepresentations of or regarding policy or contract benefits; (4) Extra-contractual claims; or (5) Claims for penalties or consequential or incidental damages; [PL 2017, c. 382, §5 (AMD).] K. Any contractual agreement that establishes the member insurer's obligations to provide a book value accounting guaranty for defined contribution benefit plan participants by reference to a portfolio of assets that is owned by the benefit plan or its trustee, neither of which is an affiliate of the member insurer; [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] L. Any unallocated annuity contract, except any annuity, whether allocated or unallocated, issued to a governmental retirement benefit plan established under the United States Internal Revenue Code, 26 United States Code, Section 401, 403(b) or 457; [PL 2017, c. 382, §6 (AMD).] M. Any portion of a policy or contract to the extent it provides for interest or other changes in value to be determined by the use of an index or other external reference stated in the policy or contract, but that have not been credited to the policy or contract, or as to which the policy or contract owner's rights are subject to forfeiture, as of the date the member insurer becomes an impaired insurer or becomes an insolvent insurer under this chapter, whichever is earlier. If a policy's or contract's interest or changes in value are credited less frequently than annually, then for purposes of determining the values that have been credited and are not subject to forfeiture under this paragraph, the interest or change in value determined by using the procedures defined in the policy or contract will be credited as if the contractual date of crediting interest or changing values was the date of impairment or insolvency, whichever is earlier, and will not be subject to forfeiture; and [PL 2017, c. 382, §7 (AMD).] N. Any policy or contract providing hospital, medical, prescription drug or other health care benefits pursuant to 42 United States Code, Chapter 7, Subchapter XVIII, Part C or D (2018), also known as Medicare Part C or D, or pursuant to 42 United States Code, Chapter 7, Subchapter XIX (2018), also known as Medicaid, or any regulations issued pursuant thereto. [PL 2017, c. 382, §8 (NEW).] [PL 2017, c. 382, §§4-8 (AMD).]

3. Benefits; limitations of coverage. The benefits that the association may become obligated to cover may not exceed the least of: A. The contractual obligations for which the member insurer is liable or would have been liable if it were not an impaired or insolvent insurer; [PL 2017, c. 382, §9 (AMD).] B. With respect to one life, regardless of the number of policies or contracts: (1) Three hundred thousand dollars in life insurance death benefits, but not more than $100,000 in net cash surrender and net cash withdrawal values for life insurance; (2) The following limits for health insurance benefits: (a) Three hundred thousand dollars for coverages not defined as disability income insurance, long-term care insurance or health plans as defined in section 4301‑A, subsection 7 , including any net cash surrender and net cash withdrawal values; (b) Three hundred thousand dollars for disability income and long-term care insurance; or (c) Five hundred thousand dollars for health plans as defined in section 4301‑A, subsection 7 ; or (3) Two hundred fifty thousand dollars in the present value of annuity benefits, including net cash surrender and net cash withdrawal values; [PL 2017, c. 382, §10 (AMD).] C. With respect to each payee of a structured settlement annuity, or beneficiary or beneficiaries of the payee if deceased, $250,000 in present value annuity benefits, in the aggregate, including net cash surrender and net cash withdrawal values; and [PL 2009, c. 652, Pt. A, §35 (RPR).] D. With respect to each individual participating in a governmental retirement benefit plan established under the United States Internal Revenue Code, 26 United States Code, Section 401, 403(b) or 457, or the beneficiaries of each individual if deceased, the financial interest of such participant allocated to an annuity contract by either the member insurer that issued the annuity or the plan, but not to exceed in the aggregate $250,000 in present value of annuity benefits, including net cash surrender and net cash withdrawal values under all such annuities issued by the same member insurer. [PL 2009, c. 118, §4 (NEW); PL 2009, c. 118, §5 (AFF).] [PL 2017, c. 382, §§9, 10 (AMD).]

4. Maximum obligation in benefits. Notwithstanding subsection 3 , the association is not in any event obligated to cover more than: A. An aggregate of $300,000 in benefits with respect to any one life under subsection 3, paragraph B except with respect to benefits for health plans under subsection 3, paragraph B , subparagraph (2), in which case the aggregate liability of the association may not exceed $500,000 with respect to any one individual; or [PL 2017, c. 382, §11 (AMD).] B. Five million dollars in benefits, regardless of the number of policies and contracts held by the owner, with respect to one owner of multiple nongroup policies of life insurance, whether the policy owner is an individual, firm, corporation or other person, and whether the persons insured are officers, managers, employees or other persons. [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).] [PL 2017, c. 382, §11 (AMD).]

5. Subrogation and assignment rights. The limitations set forth in subsections 3 and 4 are limitations on the benefits for which the association is obligated before taking into account either its subrogation and assignment rights or the extent to which those benefits could be provided out of the assets of the impaired or insolvent insurer attributable to covered policies. The costs of the association's obligations under this chapter may be met by the use of assets attributable to covered policies or reimbursed to the association pursuant to its subrogation and assignment rights. [PL 2005, c. 346, §2 (NEW); PL 2005, c. 346, §16 (AFF).]

6. Material economic benefits; contractual obligations. In performing its obligations to provide coverage under section 4608 , the association is not required to guarantee, assume, reinsure, reissue or perform, or cause to be guaranteed, assumed, reinsured, reissued or performed, the contractual obligations of the insolvent or impaired insurer under a covered policy or contract that do not materially affect the economic values or economic benefits of the covered policy or contract. [PL 2017, c. 382, §12 (AMD).]
24-A M.R.S. § 2809-A — ME Code / Title 24-A / Chapter 35 / Section 2809-A
24-A §2809-A. Conversion on termination of policy or eligibility
Status: in_force

1. A group policy issued prior to January 1, 1996, that provides hospital, surgical or major medical expense insurance or any combination thereof, other than a policy that provides benefits for specific diseases or accidental injuries only, must contain a provision that if the insurance on an employee or member ceases because of termination of employment or termination of the policy or any portion of a policy, and the person has been continuously insured for a period of at least 3 months under the group policy or under the group policy and any prior group policy or contract providing similar benefits that it replaces, that person is entitled to have issued to that person by the insurer, without evidence of insurability, an individual policy or, at the insurer's option, a group certificate of health insurance, provided that application is made and the first premium paid to the insurer within 90 days after that termination. At the option of the employee or member, the converted policy may cover the employee or member, the employee or member and the employee or member's dependents or the dependents of the employee or member if, in the latter 2 cases, the dependents have been covered for a period of at least 3 months under the group policy, unless the dependent persons were not eligible for coverage until after the beginning of the 3-month period. The insurer has the option to provide the required coverage upon conversion through either a group or individual policy, and may issue a separate converted policy to cover any dependent. An insurer is not required to provide a conversion privilege if termination of insurance under the group policy occurred because the employee or member failed to pay any required contribution or if any discontinued group coverage is replaced by continuous and substantially similar group coverage within 31 days. [PL 1995, c. 332, Pt. A, §8 (AMD).]

1-A. Notification of cancellation. An insurer may not cancel or refuse to renew any policy for hospital, surgical, dental or major medical expense insurance until the insurer has provided by first class mail at least 10 days' prior notification according to this section. The notice must include the date of cancellation of coverage and, if applicable, the time period for exercising policy conversion rights. The notice also must include an explanation of any applicable grace period. Notification is not required when the insurer has received written notice from the group policyholder that replacement coverage has been obtained. A. Notice must be mailed to the group policyholder or subgroup sponsor. [PL 1995, c. 625, Pt. A, §25 (RPR).] B. [PL 2003, c. 156, §2 (RP).] B-1. At the time of notification under paragraph A , notice must be mailed to the certificate holder at the last address provided to the insurer by the subgroup sponsor, the group policyholder or the certificate holder. If the insurer does not have an address on file for the certificate holder, the notice must be mailed to the office of the subgroup sponsor, if any, or the group policy holder. The notice must also include information to the certificate holder about the availability of individual coverage as described in subsection 1‑B . [PL 2003, c. 428, Pt. B, §2 (AMD).] B-2. All notices of cancellation sent to certificate holders pursuant to paragraph B‑1 must include a toll-free telephone number that certificate holders can call to determine if the policy has been cancelled for nonpayment of premium or if the policy has been reinstated because the premium has been paid. [PL 2009, c. 439, Pt. A, §1 (NEW).] C. [PL 2003, c. 428, Pt. B, §2 (RP).] [PL 2009, c. 439, Pt. A, §1 (AMD).]

1-B. Notification of availability of individual coverage. An insurer shall provide forms to group policyholders, and certificate holders when required by subsection 1‑A , for the purpose of informing terminating group members of their right to purchase any individual health plan available in this State, including their eligibility for any special enrollment period to purchase an individual health plan pursuant to the federal Affordable Care Act, and of the availability of public health coverage options available in this State, including but not limited to MaineCare coverage. An adequate supply of forms must be provided to each group policyholder when the policy is issued and at least annually after the policy is issued. The superintendent may prescribe the content of the form by routine technical rule pursuant to Title 5, chapter 375, subchapter 2‑A . The form must include at least the following: A. A statement that all state residents not eligible for Medicare have a right to purchase any individual health plan available in this State; [PL 1997, c. 604, Pt. B, §3 (NEW).] B. A statement that in order to avoid a gap in coverage, the individual should apply for individual coverage prior to termination of group coverage; [PL 1997, c. 604, Pt. B, §3 (NEW).] C. [PL 2021, c. 80, §1 (RP).] D. A statement that information concerning individual coverage is available from the Bureau of Insurance. The bureau's toll-free telephone number must also be provided; [PL 2021, c. 80, §1 (AMD).] E. A statement that termination of coverage may be a qualifying life event for a special enrollment period to purchase an individual health plan. The length of time for the relevant special enrollment period and the dates for the next annual open enrollment must also be provided; [PL 2021, c. 80, §1 (NEW).] F. A statement that financial assistance may be available to eligible individuals to purchase a qualified health plan through the Maine Health Insurance Marketplace established in Title 22, section 5403 . The marketplace's publicly accessible website and the toll-free telephone number must also be provided; [PL 2021, c. 80, §1 (NEW).] G. A statement that eligible individuals may qualify for free health coverage through MaineCare. The MaineCare program's publicly accessible website and toll-free telephone number must also be provided; and [PL 2021, c. 80, §1 (NEW).] H. A statement that the individual may contact the Health Insurance Consumer Assistance Program established in section 4326 for help obtaining health insurance coverage, including additional information and assistance enrolling in coverage. The program's publicly accessible website, toll-free telephone number and e-mail address must also be provided. [PL 2021, c. 80, §1 (NEW).] [PL 2021, c. 80, §1 (AMD).]

2. If a conversion privilege is applicable pursuant to subsection 1 , it must also be available: A. Upon the death of an employee or member, to the surviving spouse with respect to the spouse and the children whose coverage terminates by reason of that death, or if there is no surviving spouse to each surviving child whose coverage so terminates. If the group policy provides for continuation of dependents' coverage upon the death of the employee or member, the conversion privilege must be made available at the end of that continuation; [PL 1995, c. 332, Pt. A, §10 (AMD).] B. To the spouse of a member or employee upon termination of coverage by reason of ceasing to be a qualified family member under the group policy whether by divorce or otherwise, whether or not the employee or member remains insured, with respect to the spouse and the children whose coverage terminates at the same time; [PL 1981, c. 606, §2 (NEW).] C. To a child upon termination of coverage by reason of ceasing to be a qualified family member under the group policy if a conversion privilege is not otherwise provided with respect to that child in this subsection; or [PL 1995, c. 332, Pt. A, §10 (AMD).] D. To an employee or member whose coverage would otherwise continue under the group policy upon retirement prior to eligibility for coverage under Medicare,"United States Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, Public Law 89-97, as amended, at the option of that employee or member in lieu of continued coverage under the group policy. [PL 1981, c. 606, §2 (NEW).] [PL 1995, c. 332, Pt. A, §10 (AMD).]

3. The insurer shall not be required to issue a converted policy covering an otherwise eligible person: A. If: (1) That person is eligible for Medicare; or (2) That person: (a) Is covered for similar benefits by any other plan or program; (b) Is eligible for similar benefits under any group coverage arrangement whether on an insured or uninsured basis; or (c) Has similar benefits provided for or available to the person pursuant to requirements of any state or federal law; and [RR 2021, c. 1, Pt. B, §243 (COR).] B. The benefits as described in paragraph A , subparagraph 2, division (a) (b) or (c) provided for or available to the person together with the benefits provided by the converted policy would result in overinsurance according to standards which have been filed by the insurer prior to denial of coverage and approved by the superintendent. [PL 1981, c. 606, §2 (NEW).] [RR 2021, c. 1, Pt. B, §243 (COR).]

3-A. Policies issued or renewed on or after January 1, 1996. An insurer that offers individual health plans pursuant to section 2736‑C is permitted, but not required, to include a conversion privilege in group policies issued or renewed on or after January 1, 1996. If the insurer does include a conversion privilege in those policies, individuals exercising these rights must be offered a choice of any individual health plan offered by the insurer. An insurer that does not offer individual health plans pursuant to section 2736‑C may not include a conversion privilege in group policies issued or renewed on or after January 1, 1996. [PL 1995, c. 332, Pt. A, §11 (NEW).]

4. The premium on the converted policy must be determined in accordance with premium rates applicable to individually underwritten standard risks for the age and class of risk of each person to be covered and the type and amount of insurance provided. Experience under converted policies is not an acceptable basis for establishing rates for converted policies, except to the extent permitted by rules adopted by the superintendent. The superintendent may establish maximum rates by rule for standard benefit options. Maximum rates do not apply if all of the following conditions are met: A. Conversion is provided through a form that is also issued to members of the general public applying for an individual health plan pursuant to section 2736‑C ; [PL 1995, c. 332, Pt. A, §12 (AMD).] B. The rates for that form comply with section 2736‑C ; and [PL 1995, c. 332, Pt. A, §12 (AMD).] C. The rates have been filed pursuant to section 2736 . [PL 1991, c. 668, §2 (NEW).] [PL 1995, c. 332, Pt. A, §12 (AMD).]

5. The effective date of the converted policy shall be the date of termination of the individual's insurance under the group policy. [PL 1981, c. 606, §2 (NEW).]

6. A converted policy issued under this section must conform to rules adopted by the superintendent. These rules must ensure that continuity of coverage with similar benefits as determined by the superintendent is offered. The rules must also specify plans with more limited benefits that must be offered, but may not require an insurer to provide benefits in excess of those provided under the group policy from which conversion is made. [PL 1991, c. 668, §2 (AMD).]

7. Notice. Notice of the conversion privilege, if one is applicable, must be included in each certificate of coverage. [PL 1995, c. 332, Pt. A, §13 (AMD).]

8. A converted policy issued pursuant to this section which is delivered outside this State may be on such form as the insurer may then be offering for that conversion in the jurisdiction where the delivery is to be made. [PL 1981, c. 606, §2 (NEW).]

9. Refusal to renew. A policy issued pursuant to the conversion privilege provided by this section may provide that the insurer may refuse to renew the policy or coverage of any person insured only as permitted by section 2736‑C . A. [PL 1995, c. 332, Pt. A, §13 (RP).] B. [PL 1995, c. 332, Pt. A, §13 (RP).] [PL 1995, c. 332, Pt. A, §13 (AMD).]

10. Additional conversion period for injured workers. [PL 1995, c. 332, Pt. A, §14 (RP).]

11. Continued group coverage; certain circumstances. Notwithstanding this section, if the termination of an individual's group insurance coverage is for one of the reasons listed in paragraph A‑1 , the insurer shall allow the member or employee to elect, within the time period prescribed by paragraph B , to continue coverage under the group policy at no higher level than the level of benefits or coverage received by the employee immediately before termination and at the member's or employee's expense or, at the member's or employee's option, to convert to a policy of individual coverage without evidence of insurability in accordance with this section. A. For the purposes of this subsection, the term "member or employee" includes only those persons who have been a member or employee for at least 6 months. [PL 1985, c. 684, §2 (NEW).] A-1. A member or employee is eligible for continued coverage under this section only if the member or employee's group insurance coverage terminated for one of the following reasons: (1) The member or employee was temporarily laid off; (2) The member or employee was permanently laid off on or after the effective date of this paragraph and is eligible for premium assistance pursuant to federal law providing premium assistance for laid-off employees who continue coverage under their former employer's group health plan as determined by the superintendent; or (3) The member or employee lost employment because of an injury or disease that the employee claims to be compensable under former Title 39 or Title 39‑A . [PL 2009, c. 574, §1 (NEW).] B. [PL 1989, c. 447, §2 (RP).] B-1. The member or employee has 31 days from the termination of coverage in which to elect and make the initial payment under this subsection. [PL 1991, c. 885, Pt. E, §30 (AMD); PL 1991, c. 885, Pt. E, §47 (AFF).] C. An insurer is not required to continue coverage under a group policy if the member or employee meets the conditions set out in subsection 3, paragraph A . [PL 1985, c. 684, §2 (NEW).] D. The payment amount for continued group coverage under this subsection may not exceed 102% of the group rate in effect for a group member, including an employer's contribution, if any. [PL 1987, c. 25, §3 (AMD).] E. At the option of the member or employee, the continued group coverage may cover the member or employee, the member or employee and any dependents or only the dependents of the member or employee; provided that, in the latter 2 cases, the dependents have been covered for a period of at least 3 months under the group policy, unless the dependents were not eligible for coverage until after the beginning of the 3-month period. [PL 1989, c. 447, §2 (AMD).] F. Except as provided in paragraph G , coverage provided under this section continues and may not be terminated until one year from the last day of work. [PL 1991, c. 885, Pt. E, §30 (AMD); PL 1991, c. 885, Pt. E, §47 (AFF).] G. Coverage provided under this section may be terminated sooner than provided under paragraph F if: (1) The member or employee fails to make timely payment of a required premium amount; (2) The member or employee becomes eligible for coverage under another group policy; or (3) The Workers' Compensation Board determines that the injury or disease that entitles the employee to continue coverage under this section is not compensable under Title 39‑A . [PL 1991, c. 885, Pt. E, §30 (AMD); PL 1991, c. 885, Pt. E, §47 (AFF).] H. At the expiration of any continued group coverage obtained under this subsection, the member or employee has the same conversion privileges as otherwise granted under this section. [PL 1985, c. 684, §2 (NEW).] I. This subsection may not be construed to: (1) Prevent members or employees from negotiating for or receiving greater continued coverage of group insurance than is provided in this subsection; (2) Require coverage beyond the time limit set in paragraph F ; or (3) Permit an employee to increase the level of benefits or coverage that the employee received immediately before the termination of the employee's coverage. [PL 1991, c. 885, Pt. E, §30 (AMD); PL 1991, c. 885, Pt. E, §47 (AFF).] J. This subsection does not apply to any group policy subject to the United States Consolidated Omnibus Budget Reconciliation Act, Public Law 99-272, Title X, Private Health Insurance Coverage, Sections 10001 to 10003. [PL 1987, c. 25, §4 (NEW).] [PL 2009, c. 574, §1 (AMD).]

12. This section applies to all policies issued in other states to the extent they cover employees whose primary workplace is in this State. [PL 1991, c. 668, §3 (NEW).]
24-A M.R.S. § 1467 — ME Code / Title 24-A / Chapter 16 / Section 1467
24-A §1467. Obligation to serve interest of client
Status: in_force

A consultant is obligated, under the license, to serve with objectivity and complete loyalty the interests of the client and to render to the client such information, counsel and service that, within the knowledge, understanding and opinion in good faith of the consultant, best serves the client's insurance or annuity needs and interests. A consultant may not use knowledge gained as a result of the consultant's insurance relationship with the client for the consultant's own personal gain, other than the receipt of fees or commissions allowed under section 1450 , or use knowledge gained as a result of the relationship for the purpose of investing the client's money in property or assets in which the consultant, or any person in which the consultant has a pecuniary interest or a familial relationship, has or will have a personal ownership interest unless such activity is otherwise specifically authorized under insurance, banking, or securities laws. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]
24-A M.R.S. § 4319-A — ME Code / Title 24-A / Chapter 56-A / Section 4319-A
24-A §4319-A. Guaranteed issue
Status: in_force

A carrier offering a health plan in this State in the individual, small group or large group market must offer to an individual or group in the State all health plans that are approved for sale in the applicable market and must accept any individual or group that applies for any of those health plans in accordance with the requirements of section 2736‑C, subsection 3 and section 2808‑B, subsection 4 and section 2850‑B . [PL 2019, c. 5, Pt. A, §24 (NEW).]
24-A M.R.S. § 2737 — ME Code / Title 24-A / Chapter 33 / Section 2737
24-A §2737. Noncancellable disability insurance defined
Status: in_force

"Noncancellable disability insurance" means insurance against disability resulting from sickness, ailment or bodily injury, but not including insurance solely against accidental injury, under any contract which does not give the insurer the option to cancel or otherwise terminate the contract at or after one year from its effective date or renewal date. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 6808 — ME Code / Title 24-A / Chapter 85 / Section 6808
24-A §6808. Disclosure
Status: in_force

With each application for a settlement, a settlement provider shall disclose in writing at least the following disclosures to a viator. Disclosure to a viator must include distribution of a brochure, approved by the superintendent, describing the process of settlements. The disclosures must be provided to the viator no later than the time the application for the settlement contract is signed by all parties and must be signed by the viator and the settlement provider and provide the following information: [PL 2003, c. 636, §10 (AMD).]

1. Alternatives or options. Possible alternatives to or options that can be used in conjunction with settlement contracts, including, but not limited to, accelerated death benefits or policy loans offered by the issuer of the life insurance policy; [PL 2003, c. 636, §10 (AMD).]

2. Federal tax implications. The fact that some or all of the proceeds of the settlement contract may be free from federal income tax under the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191; and that restrictions, qualifications and other tax laws, particularly those of the state in which the viator resides, may apply and assistance should be sought from a professional tax advisor; [PL 2003, c. 636, §10 (AMD).]

3. State tax implications. The fact that some or all of the proceeds of the settlement may be free from state income tax under section 6809 and that restrictions, qualifications and other tax laws, including those of the state in which the viator resides, may apply and assistance should be sought from a professional tax advisor; [PL 2003, c. 636, §10 (AMD).]

4. Claims of creditors. The fact that proceeds of the settlement could be subject to the claims of creditors; [PL 2003, c. 636, §10 (AMD).]

5. Effect on government benefits. The fact that receipt of the proceeds of the settlement may adversely affect the recipient's eligibility for Medicaid or other means-based government programs, benefits or entitlements and that advice should be obtained from the appropriate agencies; [PL 2003, c. 636, §10 (AMD).]

6. Right to rescind. The fact 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 6809 . If exercised by the viator, rescission is effective only if both notice of the rescission is given and 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, §10 (AMD).]

7. Potential reduction or loss of benefits to beneficiary. The fact that entering into a settlement contract may cause other rights or benefits, including conversion rights and waiver of premium benefits that may exist under the policy or certificate, to be forfeited by the viator and that assistance should be sought from a financial adviser; [PL 2003, c. 636, §10 (AMD).]

7-A. Potential inability to purchase additional insurance. The fact that, because of limits insurers may set on the amount of insurance on a single life, a change of ownership could leave the viator without the ability to purchase insurance in the future to replace the transferred policy; [PL 2009, c. 376, §9 (NEW).]

8. Funds. The fact that funds will be sent to the viator within 3 business days after the settlement provider has received the insurer's or group administrator's acknowledgment that ownership of the policy or interest in the certificate has been transferred and the beneficiary has been designated; and [PL 2003, c. 636, §10 (NEW).]

9. Privacy disclosure. A statement containing the following language: "All medical, financial or personal information solicited or obtained by a settlement provider or settlement producer about an insured, including the insured's identity or the identity of family members, a spouse or a significant other, may be disclosed as necessary to effect the settlement contract between the viator and the settlement provider. If you are asked to provide this information, you will be asked to consent to the disclosure. The information may be provided to someone who buys the policy or provides funds for the purchase. You may be asked to renew your permission to share information every 2 years." [PL 2003, c. 636, §10 (NEW).]
24-A M.R.S. § 3489 — ME Code / Title 24-A / Chapter 47 / Section 3489
24-A §3489. Requirements applicable to a mutual holding company
Status: in_force

1. Definitions. As used in section 3488 , this section and section 3490, unless the context otherwise indicates, the following terms have the following meanings. A. "Mutual holding company" means a mutual holding company formed pursuant to section 3488 . [PL 1999, c. 656, §5 (NEW).] B. "Outside director" means a person who is not an officer, employee or consultant of the mutual holding company, a related stock holding company, the reorganized insurer or other subsidiary of the mutual holding company or a related stock holding company. [PL 1999, c. 656, §5 (NEW).] C. "Public offering" means an offer that includes an offer to individuals that is made by means of public advertising or general solicitation. "Public offering" does not include: (1) Issuance of stock to the mutual holding company or any related stock holding company; or (2) An offer or sale that is exempt from registration by virtue of Title 32, section 16202, subsections 13 , 15 , 16 , 19 or 26 . [PL 2005, c. 65, Pt. C, §11 (AMD).] D. "Reorganized insurer" means a mutual insurer reorganized as a stock insurer pursuant to section 3488 . [PL 1999, c. 656, §5 (NEW).] E. "Stock holding company" and "related stock holding company" mean an incorporated entity that holds, directly or indirectly, at least 51% of the voting stock of a reorganized insurer. [PL 1999, c. 656, §5 (NEW).] F. "Voting stock" means common stock with general voting rights in the election of directors. [PL 1999, c. 656, §5 (NEW).] [PL 2005, c. 65, Pt. C, §11 (AMD).]

2. Mutual holding company formed through reorganization. The following provisions apply to a mutual holding company. A. The provisions of Title 13‑C that are applicable to a mutual insurer apply to a mutual holding company as though it were a mutual insurer. [RR 2001, c. 2, Pt. B, §44 (COR); RR 2001, c. 2, Pt. B, §58 (AFF).] B. A mutual holding company may not dissolve, liquidate or wind up except through proceedings under this Title for the liquidation or dissolution of the reorganized insurer or as the superintendent may otherwise approve. In the event proceedings are instituted for the complete liquidation of the reorganized insurer: (1) The mutual holding company automatically becomes a party to the proceedings; (2) All of the mutual holding company's assets, including its holdings of shares in the reorganized insurer or any stock holding company, are deemed assets of the estate of the reorganized domestic stock insurer to the extent necessary to satisfy claims of persons who have class 1, class 2, class 3 or class 4 claims under section 4379 ; and (3) Members of the mutual holding company are deemed to hold class 8 claims with respect to the mutual holding company under section 4379 . [PL 1999, c. 656, §5 (NEW).] C. The name of a mutual holding company must contain the word "mutual" and may not contain the words "insurance," "assurance" or "annuity." The mutual holding company's powers may not include doing insurance business. The articles of incorporation of a mutual holding company must contain provisions stating that: (1) It is "a mutual holding company organized under the Maine Revised Statutes, Title 24‑A, section 3488 "; (2) A purpose of the mutual holding company is to hold, directly or through one or more stock holding companies, not less than 51% of the voting stock of a reorganized insurer; (3) It is not authorized to issue voting stock; (4) It is not authorized to conduct any business other than that of a holding company, except for the acquisition, ownership, management and disposition of its assets and all reasonably related actions; and (5) Its members have the rights specified in, and are subject to, sections 3360 , 3361 , 3362 , 3363 , 3488 , this section, the mutual holding company's articles of incorporation and its bylaws. [PL 1999, c. 656, §5 (NEW).] D. At least a majority of the directors of the mutual holding company and any related stock holding company and any committee of the board of directors of the mutual holding company and of any related stock holding company must be outside directors. [PL 1999, c. 656, §5 (NEW).] E. Each time voting stock of the reorganized insurer or any related stock holding company is offered in a public offering for a price payable in cash, each policyholder of the reorganized insurer must receive, without payment, nontransferable subscription rights to purchase that voting stock at the same price and in accordance with procedures approved by the superintendent as fair and equitable. [PL 1999, c. 656, §5 (NEW).] F. At least 30 days before the issuance of any voting stock or securities convertible into voting stock of the reorganized insurer or any related stock holding company, other than in an underwritten public offering or a bona fide sale to an unrelated 3rd party, the reorganized insurer or related stock holding company shall provide to the superintendent written notice of the proposed price of those securities or the procedure whereby the price will be determined and the terms and conditions of the offering. The superintendent may disapprove the issuance of the stock or securities if the superintendent finds that the price is unfair. The superintendent's failure to make a finding on a transaction subject to this paragraph within 30 days after it has been filed with the superintendent has the effect of an approval unless the superintendent has requested supplemental information or issued a notice of hearing. [PL 1999, c. 656, §5 (NEW).] G. The stock holding company or the reorganized insurer may not award any stock options or stock grants to officers or directors of the mutual holding company, the stock holding company or the reorganized insurer until 6 months after the completion of either a public offering or private placement of voting stock or securities convertible into voting stock of the reorganized insurer or a related stock holding company to any person other than the mutual holding company or the stock holding company. [PL 1999, c. 656, §5 (NEW).] H. The aggregate percentage of voting stock of the reorganized insurer or any related stock holding company directly or indirectly owned or controlled by outside directors may not exceed 18%, unless the reorganized insurer or the related stock holding company has provided at least 30 days' prior written notice to the superintendent and the superintendent has not objected to a higher percentage. [PL 1999, c. 656, §5 (NEW).] I. The aggregate percentage of voting stock of the reorganized insurer or any related stock holding company directly or indirectly owned or controlled by directors and officers of the mutual holding company, a related stock holding company or the reorganized insurer who are also employed by any of the foregoing may not exceed 18% of the voting stock of the reorganized insurer or any related stock holding company, unless the reorganized insurer or the related stock holding company has provided 30 days' prior written notice to the superintendent and the superintendent has not objected to a higher percentage. [PL 1999, c. 656, §5 (NEW).] J. A trust established in connection with an employee stock ownership plan or other employee benefit plan established for the benefit of employees of the reorganized insurer, a related stock holding company or the mutual holding company may not directly or indirectly own or control, in the aggregate, more than 10% of the voting stock of the stock holding company or the reorganized insurer, unless the reorganized insurer or the related stock holding company has provided 30 days' prior written notice to the superintendent and the superintendent has not objected to a higher percentage. The holdings of any such employee stock ownership plan or other employee benefit plan that are allocated to directors and officers who are employees must be included in determining compliance with paragraph I . [PL 1999, c. 656, §5 (NEW).] K. A person may not own or control, directly or indirectly, more than 15% of any class of voting stock of the reorganized insurer or any related stock holding company without the prior approval of the superintendent. [PL 1999, c. 656, §5 (NEW).] L. All voting stock of the reorganized insurer or any related stock holding company acquired by any person in excess of the maximum amount permitted to be acquired by that person pursuant to this subsection is deemed to be nonvoting stock for so long as it is held by any person in excess of those limitations. In addition to any other enforcement powers of the superintendent under this Title, a violation of the limitations of ownership may be enforced or enjoined, as the case may be, by appropriate proceedings commenced by the reorganized insurer or any related stock holding company, the superintendent, the attorney general, any member of the mutual holding company or any stockholder of the reorganized insurer or of any related stock holding company. The action must be commenced in the Kennebec County Superior Court or the superior court in the jurisdiction of which the reorganized insurer has its home office, and the court may issue any order, injunctive or otherwise, that it finds necessary to cure the violation or to prevent the action. [PL 1999, c. 656, §5 (NEW).] M. A mutual holding company and a related stock holding company are each deemed to be a holding company of the reorganized insurer within the meaning of section 222 , and all provisions of that section apply to transactions occurring between the mutual holding company, the stock holding company and the reorganized insurer. Approval of the plan of reorganization by the superintendent pursuant to section 3488 is considered approval of the acquisition of control by a mutual holding company and any related stock holding company under sections 222 and 3476 . [PL 1999, c. 656, §5 (NEW).] N. For purposes of the limitations on ownership or control of voting stock contained in this subsection, any issued and outstanding securities that represent the right to acquire or that are convertible into voting stock, including warrants, options and rights to purchase voting stock, are deemed to represent the number of shares of voting stock issuable upon conversion or exercise of such securities or rights for the purposes of both the number of shares owned or controlled by a person and the total number of shares of voting stock outstanding. For purposes of determining ownership or control of voting stock, the indirect ownership of stock in the reorganized insurer by virtue of having an ownership interest in the mutual holding company may not be considered. [PL 1999, c. 656, §5 (NEW).] [RR 2001, c. 2, Pt. B, §44 (COR); RR 2001, c. 2, Pt. B, §58 (AFF).]

3. Merger or consolidation by mutual holding company or stock holding company. With the written approval of the superintendent, a mutual holding company or stock holding company may: A. Merge or consolidate with or acquire the assets of a mutual holding company organized pursuant to this chapter or pursuant to the mutual holding company laws of another state; [PL 1999, c. 656, §5 (NEW).] B. Either alone or together with one or more of the reorganized insurers or stock holding companies or subsidiaries of any of them, merge or consolidate with or acquire the assets of a mutual insurer; or [PL 1999, c. 656, §5 (NEW).] C. Merge or consolidate with any other person. [PL 1999, c. 656, §5 (NEW).] [PL 1999, c. 656, §5 (NEW).]

4. Merger with another mutual holding company. If a mutual holding company merges with a mutual holding company organized under the laws of another state or acquires the membership interests in a foreign mutual insurer, that merger or acquisition must comply with the requirements of Maine law and rules and of any other state's law, rule or regulation that is applicable to the foreign mutual holding company or mutual insurer. In the event of a conflict of state laws, rules or regulations, Maine laws and rules apply. A foreign mutual insurer that is merged or acquired pursuant to this section may at the same time redomesticate to this State by complying with the applicable requirements of this State and of the foreign mutual insurer's state of domicile. [PL 1999, c. 656, §5 (NEW).]

5. Acquisition of stock or assets of other persons. A mutual holding company may acquire the capital stock or assets of other persons. [PL 1999, c. 656, §5 (NEW).]

6. Membership interest. A membership interest in a mutual holding company does not constitute a security under Title 32, section 16102, subsection 28 or any other law of this State and is not transferable. [PL 2005, c. 65, Pt. C, §12 (AMD).]

7. Election of directors. Directors of the mutual holding company must be elected by plurality vote of all members voting in that election in person or by proxy. If the mutual holding company takes any action, other than election of its directors, that would require a vote of policyholders if the mutual holding company were a mutual insurer, then that action requires a vote of members of the mutual holding company. [PL 1999, c. 656, §5 (NEW).]
24-A M.R.S. § 2616 — ME Code / Title 24-A / Chapter 31 / Section 2616
24-A §2616. Application; statements deemed representations
Status: in_force

The group life insurance policy must contain a provision that a copy of the application, if any, of the policyholder must be attached to the policy when issued, that all statements made by the policyholder or by the persons insured are deemed representations and not warranties and that no statement made by any person insured may be used in any contest, unless a copy of the instrument containing the statement is or has been furnished to such person or, in the event of death or incapacity of the insured person, to the person's beneficiary or personal representative. [RR 2021, c. 1, Pt. B, §228 (COR).]
24-A M.R.S. § 2407 — ME Code / Title 24-A / Chapter 27 / Section 2407
24-A §2407. Power to contract -- purchase of insurance and annuities by minors
Status: in_force

1. Any person of competent legal capacity may contract for insurance. [PL 1969, c. 132, §1 (NEW).]

2. Any minor not less than 15 years of age, nearest birthday, may, notwithstanding the minor's minority, contract for or own annuities, or insurance, or affirm by novation or otherwise preexisting contracts for annuities or insurance upon the minor's own life, body, health, property, liabilities or other interests, or on the persons of another in whom the minor has an insurable interest. Such a minor must, notwithstanding such minority, be deemed competent to exercise all rights and powers with respect to or under any contract for annuity or for insurance upon the minor's own life, body or health, or any contract such minor effected upon the minor's own property, liabilities or other interests, or any contract effected or owned by the minor on the person of another, as might be exercised by a person of full legal age, and may at any time surrender the minor's interest in any such contracts and give valid discharge for any benefit accruing or money payable thereunder. Such a minor may not, by reason of the minor's minority, be entitled to rescind, avoid or repudiate the contract, nor to rescind, avoid or repudiate any exercise of a right or privilege thereunder, except that such a minor not otherwise emancipated may not be bound by any unperformed agreement to pay by promissory note or otherwise, any premium on any such annuity or insurance contract. [RR 2021, c. 1, Pt. B, §209 (COR).]

3. Any annuity contract or policy of life or health insurance procured by or for a minor under subsection 2 must be made payable either to the minor or the minor's estate or to a person having an insurable interest in the life of the minor. [RR 2021, c. 1, Pt. B, §210 (COR).]
24-A M.R.S. § 2268 — ME Code / Title 24-A / Chapter 24-B / Section 2268
24-A §2268. Confidentiality
Status: in_force

1. Materials held confidential. Documents, materials and other information in the control or possession of the bureau that are furnished by a licensee or an employee or agent acting on behalf of the licensee pursuant to section 2264, subsection 9 or section 2266, subsection 2, paragraph B , C , D , E , H , J or K or that are obtained by the superintendent in an investigation or examination pursuant to section 2267 are confidential by law and privileged, are not subject to Title 1, chapter 13, subchapter 1 , are not subject to subpoena and are not subject to discovery or admissible in evidence in any private civil action; however, the superintendent is authorized to use the documents, materials and other information in the furtherance of any regulatory or legal action brought as a part of the superintendent's duties and to share them on a confidential basis in accordance with section 216, subsection 5 . [PL 2021, c. 24, §1 (NEW).]

2. Private civil action. Neither the superintendent nor any person who received documents, materials or other information while acting under the authority of the superintendent may be permitted or required to testify in any private civil action concerning any confidential documents, materials or other information subject to subsection 1 . [PL 2021, c. 24, §1 (NEW).]

3. Disclosure not waiver. Disclosure of information to the superintendent under this section or as a result of sharing as authorized in section 216, subsection 5 does not constitute a waiver of any applicable privilege or claim of confidentiality regarding the documents, materials or other information. [PL 2021, c. 24, §1 (NEW).]

4. Final actions. This chapter may not be construed to prohibit the superintendent from releasing final, adjudicated actions that are open to public inspection pursuant to Title 1, chapter 13, subchapter 1 to a database or other clearinghouse service maintained by the National Association of Insurance Commissioners, its affiliates or subsidiaries or any successor organization. [PL 2021, c. 24, §1 (NEW).]
24-A M.R.S. § 2163 — ME Code / Title 24-A / Chapter 23 / Section 2163
24-A §2163. Receipt of rebate, illegal inducement prohibited
Status: in_force

1. Limitations. No person may knowingly receive or accept, directly or indirectly: A. Any rebate of premium or part of a premium; [PL 1997, c. 457, §40 (NEW).] B. Any producer's commission on a premium or part of a premium payable on any policy of insurance or annuity contract; [PL 1997, c. 457, §40 (NEW).] C. Any special favor or advantage in the dividend or other benefits to accrue; or [PL 1997, c. 457, §40 (NEW).] D. Anything of value as inducement to any policy of insurance or annuity contract or in connection with any policy of insurance or annuity contract that is not specified, promised or provided for in the policy or contract, except as otherwise provided by law. [PL 1997, c. 457, §40 (NEW).] [PL 1997, c. 457, §40 (NEW).]
24-A M.R.S. § 3475 — ME Code / Title 24-A / Chapter 47 / Section 3475
24-A §3475. Exchange of securities between insurers
Status: in_force

1. Upon application of any domestic insurer, the superintendent is authorized to approve the fairness of the terms and conditions of the issuance by the insurer of any shares of its capital stock or of guaranty capital or bonds or its other securities or obligations in exchange for one or more bona fide outstanding securities, claims or property interest of any other insurer or corporation, domestic or foreign, or partly in such exchange and partly for cash; but only after a hearing has been held by the superintendent upon the fairness of such terms and conditions at which all persons to whom it is proposed to issue securities in such exchange shall have the right to appear and be heard. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. Notice of such hearing and conduct thereof shall be as provided in chapter 3 (the insurance superintendent). [PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 1491 — ME Code / Title 24-A / Chapter 16 / Section 1491
24-A §1491. Short title
Status: in_force

This subchapter may be known and cited as the "Managing General Agents Act." [PL 1997, c. 573, §1 (NEW); PL 1997, c. 573, §2 (AFF).]
24-A M.R.S. § 2246 — ME Code / Title 24-A / Chapter 24-A / Section 2246
24-A §2246. Construction
Status: in_force

Nothing contained in this chapter may be construed to authorize a transfer of structured settlement payment rights in contravention of applicable law or to give effect to a transfer of structured settlement payment rights that is invalid under applicable law. [PL 1999, c. 268, §2 (NEW).]
24-A M.R.S. § 2847-G — ME Code / Title 24-A / Chapter 35 / Section 2847-G
24-A §2847-G. Coverage for contraceptives
Status: in_force

1. Coverage requirements. All group insurance policies and contracts, except accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care and other limited benefit health insurance 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, §7 (AMD); PL 2025, c. 445, §14 (AFF).]

2. Exclusion for religious employer. A religious employer may request and an insurer 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 an insurer 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, §3 (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, §18 (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, §3 (AMD); 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, §3 (AMD); PL 2021, c. 609, §5 (AFF).] C. [PL 2021, c. 609, §3 (RP); PL 2021, c. 609, §5 (AFF).] D. 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, §8 (AMD); PL 2025, c. 445, §14 (AFF).] E. A prescription is not required to obtain a nonprescription oral hormonal contraceptive or nonprescription emergency contraceptive. [PL 2025, c. 445, §8 (NEW); PL 2025, c. 445, §14 (AFF).] F. An insurer 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 to the insurer. [PL 2025, c. 445, §8 (NEW); PL 2025, c. 445, §14 (AFF).] G. 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, §8 (NEW); PL 2025, c. 445, §14 (AFF).] [PL 2025, c. 445, §8 (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, §9 (NEW); PL 2025, c. 445, §14 (AFF).]

Revisor's Note: §2847-G. Coverage for services of certified nurse practitioners; certified nurse midwives (As enacted by PL 1999, c. 396, §3 and affected by §7 is REALLOCATED TO TITLE 24-A, SECTION 2847-H)

Revisor's Note: §2847-G. Coverage for services provided by registered nurse first assistants (As enacted by PL 1999, c. 412, §3 is REALLOCATED TO TITLE 24-A, SECTION 2847-I)
24-A M.R.S. § 3022 — ME Code / Title 24-A / Chapter 41 / Section 3022
24-A §3022. Lien continues on deceased's property; policy descends to estate
Status: in_force

Upon the death of a member, the lien of the insurer remains good on the property insured to the amount due on the deposit note, and the policy descends to the executor or administrator of the deceased for the benefit of the estate during its continuance, unless voluntarily surrendered or forfeited by the charter of the insurer. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3483 — ME Code / Title 24-A / Chapter 47 / Section 3483
24-A §3483. Bulk reinsurance
Status: in_force

1. A domestic insurer may reinsure, and thereby transfer its direct liability as the insurer with respect to, all or substantially all of its business in force, or all or substantially all of a major class thereof, with another insurer, stock or mutual, by an agreement of bulk reinsurance after compliance with this section. Any such agreement is not effective unless filed with the superintendent, or if disapproved by the superintendent. [RR 2021, c. 1, Pt. B, §291 (COR).]

2. The superintendent shall disapprove such agreement within a reasonable time after filing if the superintendent finds: A. That the plan and agreement are unfair and inequitable to any insurer or to policyholders involved; [RR 2021, c. 1, Pt. B, §292 (COR).] B. That the reinsurance, if effectuated, would substantially reduce the protection or service to the policyholders of any domestic insurer involved; [RR 2021, c. 1, Pt. B, §292 (COR).] C. That the agreement does not embody adequate provisions by which the reinsuring insurer becomes liable to the original insureds for any loss or damage occurring under the policies reinsured in accordance with the original terms of such policies; or [PL 1969, c. 132, §1 (NEW).] D. That the assuming reinsurer is not authorized to transact such insurance in this State, or is not qualified as for such authorization or will not appoint the superintendent and the superintendent's successors as its irrevocable attorney for service of process, so long as any policy so reinsured or claim thereunder remains in force or outstanding; [RR 2021, c. 1, Pt. B, §292 (COR).] E. That such reinsurance would materially tend to lessen competition in the insurance business in this State or elsewhere as to the kinds of insurance involved, or would materially tend to create a monopoly as to such business; or [PL 1969, c. 132, §1 (NEW).] F. That the proposed bulk reinsurance is not free of other reasonable objections. [PL 1969, c. 132, §1 (NEW).] [RR 2021, c. 1, Pt. B, §292 (COR).]

3. If the superintendent disapproves the agreement, the superintendent shall forthwith notify in writing each insurer involved, specifying the superintendent's reasons therefor. [RR 2021, c. 1, Pt. B, §293 (COR).]

4. If for reinsurance of all or substantially all of the business in force of an insurer at a time when the insurer's capital, if a stock insurer, or surplus, if a mutual insurer, is not impaired, the plan and agreement of such reinsurance must be approved by a vote of not less than 2/3 of the insurer's outstanding stock having voting rights, if a stock insurer, or of members, if a mutual insurer, voting thereon, at a meeting of stockholders or members called for the purpose pursuant to such reasonable notice and procedure as is provided for in the agreement. If a mutual life insurer, right to vote may be limited to members otherwise entitled to vote and whose policies are other than term policies for terms of less than 20 years, or group policies, and have been in effect for more than one year. [PL 1969, c. 132, §1 (NEW).]

5. No director, officer, agent or employee of any insurer party to such reinsurance, or any other person, shall receive any special compensation for arranging or with respect to, any such reinsurance except as is set forth in the reinsurance agreement filed with the superintendent. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

6. The superintendent may adopt rules, subject to Title 5, chapter 375 , to effectuate this section. [PL 1989, c. 846, Pt. E, §3 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).]
24-A M.R.S. § 4218 — ME Code / Title 24-A / Chapter 56 / Section 4218
24-A §4218. Regulations
Status: in_force

The superintendent may, after notice and hearing pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II , promulgate reasonable rules and regulations as are necessary or proper to carry out this chapter. Such rules and regulations shall be subject to review in accordance with sections 229 to 236 . [PL 1977, c. 694, §435 (AMD).]
24-A M.R.S. § 3557 — ME Code / Title 24-A / Chapter 49 / Section 3557
24-A §3557. Governor's authority; effect of other laws
Status: in_force

The Governor of this State, or the Governor's successor in office, alone has the power to proclaim and declare the fact that a period of "acute emergency" exists at any time or times or has terminated, as such term is defined in this chapter. This chapter may not be construed to affect sections 471 to 479 , to the extent that the latter sections may be inconsistent herewith. [RR 2021, c. 1, Pt. B, §308 (COR).]
24-A M.R.S. § 2706 — ME Code / Title 24-A / Chapter 33 / Section 2706
24-A §2706. Time limit on certain defenses
Status: in_force

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

Time limit on certain defenses: (a) After 3 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of such 3-year period. [PL 1969, c. 132, §1 (NEW).]

1. The foregoing policy provision shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during such initial 3-year period, nor to limit the application of sections 2717 through 2723 in the event of misstatement with respect to age or occupation or other insurance. [PL 1969, c. 132, §1 (NEW).]

2. A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium 1 until at least age 50 or, 2 in the case of a policy issued after age 44, for at least 5 years from its date of issue, may contain in lieu of the foregoing the following provision, from which the clause in parentheses may be omitted at the insurer's option, under the caption "Incontestable:" [PL 1969, c. 132, §1 (NEW).]

After this policy has been in force for a period of 3 years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application. [PL 1969, c. 132, §1 (NEW).]

(b) No claim for loss incurred or disability, as defined in the policy, commencing after 3 years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 1420-A — ME Code / Title 24-A / Chapter 16 / Section 1420-A
24-A §1420-A. Definitions
Status: in_force

As used in this subchapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 2001, c. 259, §24 (NEW).]

1. Business entity. "Business entity" means a corporation, association, partnership, limited liability company, limited liability partnership or other legal entity. [PL 2001, c. 259, §24 (NEW).]

2. Home state. "Home state" means the District of Columbia and any state or territory of the United States that is the location of an insurance producer's principal place of residence or principal place of business, and in which that person is licensed to act as an insurance producer. [PL 2001, c. 259, §24 (NEW).]

3. Insurance. "Insurance" has the same meaning as in section 3 , and as the context may require, means any of the lines of authority in chapter 9, subchapter I . [PL 2001, c. 259, §24 (NEW).]

4. Insurance producer. "Insurance producer" means a person required to be licensed under the laws of this State to sell, solicit or negotiate insurance. [PL 2001, c. 259, §24 (NEW).]

5. Insurer. "Insurer" means a person engaged in the business of entering into contracts of insurance, as defined in section 3 , and includes a health maintenance organization, fraternal benefit society, nonprofit hospital or medical service organization, viatical settlement provider or risk retention group. [PL 2001, c. 259, §24 (NEW).]

6. License. "License" means a document issued by the superintendent authorizing a person to act as an insurance producer for the lines of authority specified in the document. The license itself does not create any authority, actual, apparent or inherent, in the holder to represent or commit an insurance carrier. [PL 2001, c. 259, §24 (NEW).]

7. Limited line credit insurance. "Limited line credit insurance" includes credit life, credit disability, credit property, credit unemployment, involuntary unemployment, mortgage life, mortgage guaranty, mortgage disability, guaranteed automobile protection insurance and any other form of insurance offered in connection with an extension of credit that is limited to partially or wholly extinguishing that credit obligation that the superintendent determines should be designated a form of limited line credit insurance. [PL 2001, c. 259, §24 (NEW).]

8. Limited line credit insurance producer. "Limited line credit insurance producer" means a person who sells, solicits or negotiates one or more forms of limited line credit insurance coverage to individuals through a master, corporate, group or individual policy. [PL 2001, c. 259, §24 (NEW).]

9. Limited lines insurance. "Limited lines insurance" means those lines of insurance defined as limited lines in section 1420‑F, subsection 1 or any other line of insurance that the superintendent determines necessary to recognize for the purposes of complying with section 1420‑G, subsection 5 . [PL 2001, c. 259, §24 (NEW).]

10. Limited lines producer. "Limited lines producer" means a person authorized by the superintendent to sell, solicit or negotiate limited lines insurance. [PL 2001, c. 259, §24 (NEW).]

11. Negotiate. "Negotiate" means the act of conferring directly with or offering advice directly to a purchaser or prospective purchaser of a particular contract of insurance concerning any of the substantive benefits, terms or conditions of the contract, provided that the person engaged in that act either sells insurance or obtains insurance from insurers for purchasers. [PL 2001, c. 259, §24 (NEW).]

12. Person. "Person" means an individual or a business entity. [PL 2001, c. 259, §24 (NEW).]

13. Sell. "Sell" means to exchange a contract of insurance by any means, for money or its equivalent, on behalf of an insurance company. [PL 2001, c. 259, §24 (NEW).]

14. Solicit. "Solicit" means attempting to sell insurance or asking or urging a person to apply for a particular kind of insurance from a particular company. [PL 2001, c. 259, §24 (NEW).]

15. Terminate. "Terminate" means the cancellation of the relationship between an insurance producer and the insurer or the termination of a producer's authority to transact insurance. [PL 2001, c. 259, §24 (NEW).]

16. Uniform business entity application. "Uniform business entity application" means the uniform business entity application for resident and nonresident business entities authorized by the National Association of Insurance Commissioners, or its successor organization. [PL 2001, c. 259, §24 (NEW).]

17. Uniform application. "Uniform application" means the uniform application for resident and nonresident producer licensing authorized by the National Association of Insurance Commissioners or its successor organization. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 2325-B — ME Code / Title 24-A / Chapter 25 / Section 2325-B
24-A §2325-B. Mandatory property and casualty insurance market assistance program
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Basic property and casualty insurance" means policies that insure against loss or damage to real property that is used for residential purposes, is owner-occupied and consists of not more than 4 apartments, and that may also insure against loss or damage to tangible personal property and the legal liability of a natural person or persons for loss of, damage to or injury to persons or property. "Basic property and casualty insurance" may include standard homeowners package property and liability insurance, functional replacement homeowners package insurance, dwelling fire policies and extended coverage policies. "Basic property and casualty insurance" does not include automobile insurance, workers' compensation insurance or insurance primarily covering risks arising from the conduct of a commercial or industrial enterprise. [PL 2003, c. 671, Pt. B, §2 (NEW).] B. "Governing committee" means the committee established to operate the program pursuant to subsection 5 . [PL 2003, c. 671, Pt. B, §2 (NEW).] C. "Member insurer" means an authorized insurer who is required to be a member of the program in accordance with subsection 3 . [PL 2003, c. 671, Pt. B, §2 (NEW).] D. "Modified policy form" means any new or amended policy form developed by member insurers for risks written through the program. [PL 2003, c. 671, Pt. B, §2 (NEW).] E. "Modified rate" means any new or amended rate or rating rule developed by member insurers for risks written through the program. [PL 2003, c. 671, Pt. B, §2 (NEW).] F. "Modified policy form and rate filing" and "modified filing" mean any modified policy form and modified rate filed with the superintendent under subsection 9 . [PL 2003, c. 671, Pt. B, §2 (NEW).] G. "Net direct premiums" means gross direct written premiums on basic property and casualty insurance in this State less return premiums upon cancelled contracts, irrespective of reinsurance assumed or ceded. [PL 2003, c. 671, Pt. B, §2 (NEW).] H. "Program" means the mandatory property and casualty insurance market assistance program described in this section. [PL 2003, c. 671, Pt. B, §2 (NEW).] I. "Underserved areas or risk types," "underserved areas" and "underserved risk types" mean specific geographic areas or property risk types in this State that the superintendent designates by rule as not having reasonable access to basic property and casualty insurance. [PL 2003, c. 671, Pt. B, §2 (NEW).] [PL 2003, c. 671, Pt. B, §2 (NEW).]

2. Authority to establish program. If the superintendent establishes a voluntary market assistance plan in accordance with section 2325‑A to increase the availability of basic property and casualty insurance in this State and the superintendent determines after a public hearing that the number of insurers participating in the voluntary market assistance plan is insufficient or that a sufficient number of risks has not been written through the plan, then the superintendent may establish a mandatory property and casualty insurance market assistance program in accordance with this section. The superintendent shall adopt rules regarding the level of insufficient participation in the voluntary market assistance plan that is necessary for the establishment of a program under this section. The provisions in the rules governing a determination of insufficient participation in the voluntary market assistance plan must take into account the length of time the voluntary market assistance plan is operational. [PL 2003, c. 671, Pt. B, §2 (NEW).]

3. Mandatory insurer participation. All insurers, except eligible surplus lines insurers, authorized to write and engaged in writing in this State, on a direct basis, basic property and casualty insurance shall cooperate in organizing a program as required by subsection 4 . Every such insurer must be a member of the program and remain a member as long as the insurer has net direct premiums on basic property and casualty insurance in this State. [PL 2003, c. 671, Pt. B, §2 (NEW).]

4. Required action by superintendent. If the superintendent determines that a program under this section should be established in accordance with the requirements of subsection 2 , the superintendent shall: A. Order member insurers to cooperate in the organization of the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] B. Appoint the members of the governing committee in accordance with subsection 5 ; [PL 2003, c. 671, Pt. B, §2 (NEW).] C. Order the governing committee to develop a proposed plan of operation for the program in accordance with subsection 6 , including a deadline for the submission of the plan; and [PL 2003, c. 671, Pt. B, §2 (NEW).] D. Initiate rulemaking in accordance with subsection 8 . [PL 2003, c. 671, Pt. B, §2 (NEW).] [PL 2003, c. 671, Pt. B, §2 (NEW).]

5. Governing committee. The governing committee of the program consists of 8 members as follows: A. Five members appointed by the superintendent who are full-time employees of member insurers; [PL 2003, c. 671, Pt. B, §2 (NEW).] B. Two members appointed by the superintendent who are licensed producers with property and casualty authority; and [PL 2003, c. 671, Pt. B, §2 (NEW).] C. The superintendent or the superintendent's designee, who serves as an ex-officio, nonvoting member. [PL 2003, c. 671, Pt. B, §2 (NEW).] The terms of members of the governing committee and process for filling vacancies must be established in the plan of operation pursuant to subsection 6 . [PL 2003, c. 671, Pt. B, §2 (NEW).]

6. Plan of operation. The program must be operated by the governing committee established under subsection 5 pursuant to a plan of operation approved by the superintendent. The governing committee shall develop a plan of operation and submit the plan to the superintendent for approval. If the superintendent disapproves the proposed plan of operation, the governing committee must, within 30 days, submit for review an appropriately revised plan of operation and, if the governing committee fails to submit such a plan or if the revised plan is also disapproved by the superintendent, the superintendent must develop a plan of operation consistent with this section. The governing committee may, on its own initiative or at the request of the superintendent, amend the plan of operation with the approval of the superintendent. The plan of operation must: A. Adopt a mechanism for the equitable apportionment of risks under the program, including the equitable distribution among member insurers of applications for basic property and casualty insurance to cover underserved areas or risk types from eligible applicants who are in good faith entitled to but who are unable to procure basic property and casualty insurance through ordinary methods in the voluntary admitted market; [PL 2003, c. 671, Pt. B, §2 (NEW).] B. Establish a methodology for the calculation and the payment of fees or commissions to producers with respect to eligible risks written through the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] C. Require that member insurers write basic property and casualty insurance for eligible applicants to cover underserved areas or risk types in accordance with each member insurer's underwriting guidelines and rating rules applicable to risks written through the program to the extent not inconsistent with reasonable underwriting and rating rule limitations contained in rules adopted by the superintendent under subsection 8 ; [PL 2003, c. 671, Pt. B, §2 (NEW).] D. Permit the use of rate filings and policy forms by member insurers, including: (1) The ability for member insurers to use existing forms and rates to write basic property and casualty insurance in the program; (2) The authority for member insurers to file modified policy forms and modified rates in accordance with subsection 9 , including permissible surcharges on those policies in accordance with limits established by the superintendent by rule; and (3) The authority for the program to develop uniform policy forms and rates for use by member insurers subject to approval of the superintendent and the requirements of subsection 9 ; [PL 2003, c. 671, Pt. B, §2 (NEW).] E. Establish a procedure for the possible future creation of a risk pooling arrangement or reinsurance program for the distribution of the losses and expenses of basic property and casualty insurance written through the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] F. Provide that a member insurer is entitled to receive credit for voluntarily writing basic property and casualty insurance in underserved areas or on underserved risk types and that the participation in the program of an insurer who does so must be reduced in accordance with the mechanism of apportionment and distribution established under paragraph A ; [PL 2003, c. 671, Pt. B, §2 (NEW).] G. Establish a grievance process for applicants for insurance, insureds and member insurers with the program and a right to appeal those grievances to the superintendent after an initial decision by the governing committee; [PL 2003, c. 671, Pt. B, §2 (NEW).] H. Establish procedures for the inspection of properties by or on behalf of member insurers; [PL 2003, c. 671, Pt. B, §2 (NEW).] I. Establish a uniform process to inform owners of property in underserved areas or of underserved risk types of the specific circumstances and property characteristics that affect the insurability of the property including recommendations for improving the insurability of the property; [PL 2003, c. 671, Pt. B, §2 (NEW).] J. Require that in order for an applicant to purchase basic property and casualty insurance through the program, the applicant must produce proof of 2 declinations from authorized insurers other than eligible surplus lines insurers, to write insurance on the property. The plan of operation must allow one of the declinations to be in the form of a cancellation or nonrenewal notice unless coverage has been ordered to stay in effect pending the outcome of a hearing before the superintendent, in which case the cancellation or nonrenewal notice may only be used as a declination in the person's application to the program if the decision in the hearing is in favor of the insurer; [PL 2003, c. 671, Pt. B, §2 (NEW).] K. Establish a finite list of reasons a policy issued through the program may be cancelled, which may include nonpayment of premium, fraud or material misrepresentation; [PL 2003, c. 671, Pt. B, §2 (NEW).] L. Stipulate that cancellation of policies issued through the program may not be effective less than 20 days after receipt by the insured of the notice of cancellation or, if the cancellation is for nonpayment of premium, may not be effective less than 10 days after receipt by the insured of the notice of cancellation and that a postal certificate of mailing to the named insured at the insured's last known address is conclusive proof of receipt on the 5th calendar day after mailing; [PL 2003, c. 671, Pt. B, §2 (NEW).] M. Establish eligibility criteria for policies issued through the program, except that any eligibility criteria may not be inconsistent with the purposes for establishing the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] N. Establish the limits of liability a member insurer is required to assume, except that for any policy issued through the program, the maximum amount of coverage for a dwelling on a residence premises does not exceed $300,000, the maximum limit for any liability coverage does not exceed $300,000 and any limits of liability for additional coverages, including coverage for loss or damage to other structures or tangible personal property or for loss of use, may not count toward the maximum coverage limits applicable to the dwelling or any liability coverage; [PL 2003, c. 671, Pt. B, §2 (NEW).] O. Establish procedures for the efficient, economical, fair and nondiscriminatory administration of the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] P. Authorize the governing committee to assess member insurers for reasonable expenses incurred in administering the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] Q. Establish procedures to govern a member insurer's withdrawal from the program; and [PL 2003, c. 671, Pt. B, §2 (NEW).] R. Include any other procedures or operational matters considered necessary by the governing committee with the approval of the superintendent. [PL 2003, c. 671, Pt. B, §2 (NEW).] [PL 2003, c. 671, Pt. B, §2 (NEW).]

7. Operation of program contingent upon approval. The program may not become operational until rules have been adopted as required by this section and the superintendent has approved the plan of operation in accordance with subsection 6 . [PL 2003, c. 671, Pt. B, §2 (NEW).]

8. Rulemaking. In accordance with subsection 4 , the superintendent may adopt rules to implement this section. Rules adopted pursuant to this subsection are routine technical rules under Title 5, chapter 375, subchapter 2‑A . Rules adopted under this section may include: A. The designation of underserved areas or risk types; [PL 2003, c. 671, Pt. B, §2 (NEW).] B. Reasonable limitations on underwriting guidelines applicable to all member insurers for the issuance of basic property and casualty insurance through the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] C. A writing level based on net direct premiums under which an insurer may seek to limit its participation or seek exemption from participation in the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] D. Maximum allowable caps on rating surcharges and limitations on rating rules for risks written through the program; [PL 2003, c. 671, Pt. B, §2 (NEW).] E. The process by which the superintendent may suspend or terminate the program; and [PL 2003, c. 671, Pt. B, §2 (NEW).] F. Any other provisions necessary to implement the requirements of this section. [PL 2003, c. 671, Pt. B, §2 (NEW).] [PL 2003, c. 671, Pt. B, §2 (NEW).]

9. Modified policy form and rate filings. A modified policy form and modified rate developed by a member insurer must be filed with the superintendent. A modified rate to be used in connection with an existing policy form that consists solely of a permissible surcharge not in excess of the maximum allowable cap contained in rules adopted under subsection 8 may be used by a member insurer immediately upon filing that modified rate with the superintendent. For any other modified filings, a modified policy form and modified rate must be filed with the superintendent not less than 30 days in advance of the stated effective date. A modified rate filing subject to the 30-day advance filing requirement must include any supplementary rating information to be used in conjunction with a rate and, to the extent available, sufficient supporting information to support a rate. A modified rate may not be excessive, inadequate or unfairly discriminatory with respect to risks written through the program. A modified policy form may only be disapproved for the grounds specified in section 2413 . All modified policy form and rate filings are confidential until approved in accordance with applicable law. [PL 2011, c. 320, Pt. A, §9 (AMD).]

10. Immunity from liability for inspections. There is no liability on the part of, and a cause of action does not arise against, member insurers, the program or the governing committee or agents or employees of any of them or the superintendent or the superintendent's authorized representatives with respect to any inspections to be undertaken by this section or for any acts or omissions in connection with those inspections or for any statements made in a report or communication concerning the insurability of the property. [PL 2003, c. 671, Pt. B, §2 (NEW).]

11. Superintendent's authority to suspend. In the event of impairment or serious financial difficulty of a member insurer, the superintendent may suspend the application of the provisions of this section from applying to the financially distressed member insurer. [PL 2003, c. 671, Pt. B, §2 (NEW).]

12. Expiration of program. A program established by the superintendent pursuant to this section expires 2 years from the date the program becomes operational unless terminated earlier by the superintendent or unless, after a public hearing, the superintendent determines, based on clear and convincing evidence, that continued operation of the program is necessary to address the unavailability of basic property and casualty insurance for underserved areas or risk types. For purposes of this subsection, the program becomes operational on the effective date of the first policy issued through the program. If the superintendent finds that continued operation of the program is necessary, then any person insured under the program must reapply for coverage as new business under the program at the next renewal date occurring after the date of the superintendent's order to continue the program. Any policy written through the program that is in force when the program is terminated continues in force until its stated expiration date in accordance with the terms and conditions of the policy and the provisions in the plan of operation. [PL 2003, c. 671, Pt. B, §2 (NEW).]

13. Powers of superintendent. In addition to any powers conferred upon the superintendent by this or any other law, the superintendent has authority to supervise the program and may: A. Examine and investigate the operation of the program and member insurers through free access to all the books, records, files, papers and documents relating to their operation and may summon, qualify and examine as witnesses all persons having knowledge of such operations, including the governing committee and its officers, employees and agents; [PL 2003, c. 671, Pt. B, §2 (NEW).] B. Require reports from the program, the governing committee and member insurers concerning risks insured through the program as the superintendent considers necessary; [PL 2003, c. 671, Pt. B, §2 (NEW).] C. Approve or disapprove modified policy forms, modified endorsements, modified rates and modified rating and rule manuals for use by member insurers; and [PL 2003, c. 671, Pt. B, §2 (NEW).] D. Suspend or terminate the program in accordance with subsection 12 and any process established by rule. [PL 2003, c. 671, Pt. B, §2 (NEW).] [PL 2003, c. 671, Pt. B, §2 (NEW).]

14. Penalties for violations. The superintendent may take any action permitted under section 12‑A against a member insurer or any other person required to be licensed under this Title who violates this section or any other applicable law or rule. [PL 2003, c. 671, Pt. B, §2 (NEW).]

15. Annual report. On or before March 31st of each year, the governing committee shall submit a report detailing the program's operations for the previous calendar year to the superintendent and the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters. The annual report is a public record within the meaning of Title 1, chapter 13, subchapter 1 . [PL 2003, c. 671, Pt. B, §2 (NEW).]

16. Applicability of provisions. Insurance provided through the program is subject to all other laws relating to that type of insurance, except policies issued through the program are not subject to section 3007 or to chapter 41, subchapter 5 . In the event there is a conflict between any express provision in this section and any other applicable law, then the provisions of this section control. Notwithstanding sections 2162 and 2303 , a member insurer may utilize underwriting guidelines, modified policy forms, modified rates and rating rules that differ from its voluntary business with respect to insurance issued through the program, as long as the program underwriting guidelines, modified policy forms, modified rates and rating rules comply with this section, the plan of operation and the rules adopted by the superintendent. [PL 2003, c. 671, Pt. B, §2 (NEW).]
24-A M.R.S. § 2533-A — ME Code / Title 24-A / Chapter 29 / Section 2533-A
24-A §2533-A. Additional provisions for policies issued after January 1, 1987
Status: in_force

1. This section, in addition to all other applicable sections of the Standard Nonforfeiture Law for Life Insurance, applies to all policies issued on or after January 1, 1987. Any cash surrender value available under the policy in the event of default in a premium payment due on any policy anniversary must be in an amount that does not differ by more than 2/10ths of 1% of either the amount of insurance, if the insurance be uniform in amount, or the average amount of insurance at the beginning of each of the first 10 policy years, from the sum of: A. The greater of zero and the basic cash value specified in subsection 2 ; and [RR 1993, c. 1, §60 (COR).] B. The present value of any existing paid-up additions less the amount of any indebtedness to the company under the policy. [PL 1983, c. 346, §16 (NEW).] [RR 1993, c. 1, §60 (COR).]

2. The basic cash value is equal to the present value, on that anniversary, of the future guaranteed benefits that would have been provided for by the policy, excluding any existing paid-up additions and before deduction of any indebtedness to the insurer, if there had been no default, less the then present value of the nonforfeiture factors, as defined in subsection 3 , corresponding to premiums that would have fallen due on and after that anniversary, except that the effects on the basic cash value of supplemental life insurance or annuity benefits or of family coverage, as described in section 2530 or 2532 , whichever is applicable, must be the same as are the effects specified in section 2530 or 2532 , whichever is applicable on the cash surrender values defined in that section. [RR 1993, c. 1, §60 (COR).]

3. The nonforfeiture factor for each policy year must be an amount equal to a percentage of the adjusted premium for the policy year, as defined in section 2532 or 2532‑A , whichever is applicable. Except as is required by subsection 4, that percentage: A. Must be the same percentage for each policy year between the 2nd policy anniversary and the later of the 5th policy anniversary and the first policy anniversary at which there is available under the policy a cash surrender value in an amount, before including any paid-up additions and before deducting any indebtedness, of at least 2/10ths of 1% of either the amount of insurance, if the insurance be uniform in amount, or the average amount of insurance at the beginning of each of the first 10 policy years; and [PL 1983, c. 346, §16 (NEW).] B. Must be such that no percentage after the later of the 2 policy anniversaries, specified in paragraph A , may apply to fewer than 5 consecutive policy years. [PL 1983, c. 346, §16 (NEW).] [RR 1993, c. 1, §60 (COR).]

4. No basic cash value may be less than the value that would be obtained if the adjusted premiums for the policy, as defined in section 2532 or 2532‑A , whichever is applicable, were substituted for the nonforfeiture factors in the calculation of the basic cash value. [RR 1993, c. 1, §60 (COR).]

5. All adjusted premiums and present values referred to in this section are for a particular policy calculated on the same mortality and interest bases as are used in demonstrating the policy's compliance with the other sections of the Standard Nonforfeiture Law for Life Insurance. The cash surrender values referred to in this section must include any endowment benefits provided for by the policy. [RR 1993, c. 1, §60 (COR).]

6. Any cash surrender value available other than in the event of default in a premium payment due on a policy anniversary, and the amount of any paid-up nonforfeiture benefit available under the policy in the event of default in a premium payment must be determined in manners consistent with the manners specified for determining the analogous minimum amounts in sections 2529 to 2532‑A and section 2533 . The amounts of any cash surrender values and of any paid-up nonforfeiture benefits granted in connection with additional benefits such as those listed in section 2533, subsections 1 to 6 , must conform with the principles of this section. [RR 1993, c. 1, §60 (COR).]
24-A M.R.S. § 2850-C — ME Code / Title 24-A / Chapter 36 / Section 2850-C
24-A §2850-C. Nondiscrimination
Status: in_force

1. Application. This section applies to group medical insurance contracts subject to chapter 35 other than contracts designed to cover specific diseases, hospital indemnity or accidental injury only. [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).]

2. Eligibility and premium contributions. A carrier may not establish rules for eligibility of an individual to enroll, or require an individual to pay a premium or contribution that is greater than that for a similarly situated individual, based on health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability or disability in relation to the individual or a dependent of the individual. Nothing in this section requires a group health plan to provide particular benefits other than those provided under the terms of the plan or restricts the amount an employer may be charged for coverage. Nothing in this section prohibits establishing limitations or restrictions on the amount, level, extent or nature of the benefits for similarly situated individuals enrolled in the plan. Nothing in this section prohibits a carrier from establishing premium discounts or refunds or modifying applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention. [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).]

3. Applicability of section 4320-L. In addition to the requirements of this section, a carrier is subject to section 4320‑L . [PL 2019, c. 5, Pt. C, §1 (NEW).]
24-A M.R.S. § 6209 — ME Code / Title 24-A / Chapter 73 / Section 6209
24-A §6209. Disclosure statement
Status: in_force

1. Disclosure statement required. A provider shall provide a disclosure statement to a prospective subscriber or the person with whom the provider shall enter into an agreement to provide continuing care for the benefit of a prospective subscriber at least 10 days prior to the transfer of any money or other property to the provider by or on behalf of the prospective subscriber. The disclosure statement shall contain the date on which the disclosure was provided to the prospective subscriber and shall be written in a clear and coherent manner using words with common and everyday meanings. [PL 1987, c. 482, §1 (NEW).]

2. Required contents. Each disclosure statement shall contain: A. The name, business address and form of organization of the provider; and [PL 1987, c. 482, §1 (NEW).] B. A statement in bold print at the top of the first page which reads: "This matter involves a substantial financial commitment and a legally binding contract. In evaluating this disclosure statement and this contract prior to any commitment being made by you, it is recommended that you consult with an attorney and financial advisor of your choice, who can review these documents with you." [PL 1987, c. 482, §1 (NEW).] [PL 1987, c. 482, §1 (NEW).]

3. Conditionally required contents. The disclosure statement shall contain the following information, unless such information is already contained in the continuing care agreement or other materials provided to the subscriber or the person with whom the provider will enter into a continuing care agreement: A. The state or foreign jurisdiction and date of the providers' organization, the general character and location of its business and a description of its physical properties or equipment; [PL 1987, c. 482, §1 (NEW).] B. The names and business addresses of the officers, directors and any persons or entities having a 10% or greater equity or beneficial interest in the provider and a description of that person's interest in or occupation with the provider; [PL 1987, c. 482, §1 (NEW).] C. The identity of any 3rd-party operator if the facility is to be managed on a day-to-day basis by some party other than the provider or a person directly employed by the provider; [PL 1987, c. 482, §1 (NEW).] D. A statement of the extent to which any affiliated organization is responsible for the financial and contractual obligations of the provider and a statement of the provisions of the United States Internal Revenue Code, if any, under which the provider or an affiliate is exempt from payment of income tax; [PL 1987, c. 482, §1 (NEW).] E. The location and description of the physical property of the facility, both existing and proposed, and, with respect to a proposed facility or improvement, the estimated completion date, the date construction began or shall begin and the contingencies subject to which construction may be deferred; [PL 1987, c. 482, §1 (NEW).] F. The provisions that have been made or will be made, if any, to provide any type of reserve funding which will enable the provider to fully perform its obligations under contracts to provide continuing care, including, but not limited to, the establishment of escrow accounts, trusts or reserve accounts, the manner in which the funds shall be invested and the names and experience of persons who will make the investment decisions on these funds; [PL 1987, c. 482, §1 (NEW).] G. Certified financial statements of current origin prepared in accordance with generally accepted accounting principles showing the provider's assets, liabilities and surplus position. These financial statements shall include as supplementary data a description of the sources of financial support; [PL 1987, c. 482, §1 (NEW).] H. An examined pro forma projected financial statement for the coming 5 years, including notes of that statement, presented in conformity with guidelines for forecasting as prescribed by the American Institute of Certified Public Accountants and including a narrative description of the basis of assumptions utilized. The pro forma projected financial statement need not be included in the disclosure statement after the facility has commenced operations; [PL 1995, c. 452, §26 (AMD).] I. If the facility is already in operation or, if the provider or operator operates one or more similar facilities within the State, tables showing the frequency and average dollar amount of each increase in periodic rates at each facility for the previous 5 years, or as many years as the facility has been operated by the provider or operator, whichever is less; [PL 1995, c. 452, §27 (AMD).] J. Any other material information that the provider wishes to include in the disclosure statement or that the superintendent or department requires by rule; and [PL 1995, c. 452, §27 (AMD).] K. Whether the provider has misappropriated funds or otherwise breached the terms of a deposit agreement to the detriment of a subscriber. [PL 1995, c. 452, §28 (NEW).] [PL 1995, c. 452, §§26-28 (AMD).]
24-A M.R.S. § 4312 — ME Code / Title 24-A / Chapter 56-A / Section 4312
24-A §4312. Independent external review
Status: in_force

An enrollee or the enrollee's authorized representative has the right to an independent external review of a carrier's adverse health care treatment decision made by or on behalf of a carrier offering or renewing a health plan in accordance with the requirements of this section. An enrollee's failure to obtain authorization prior to receiving an otherwise covered service may not preclude an enrollee from exercising the enrollee's rights under this section. [PL 2023, c. 680, Pt. A, §8 (AMD); PL 2023, c. 680, Pt. A, §10 (AFF).]

1. Request for external review. An enrollee or the enrollee's authorized representative shall make a written request for external review of an adverse health care treatment decision to the bureau. Except as provided in subsection 2 , an enrollee may not make a request for external review under a group plan until the enrollee has exhausted all levels of a carrier's internal grievance procedure and may not make a request for external review under an individual plan until the enrollee has exhausted one level of a carrier's internal grievance procedure. A request for external review must be made within 12 months of the date an enrollee has received a final adverse health care treatment decision under a carrier's internal grievance procedure. An enrollee may not be required to pay any filing fee as a condition of processing a request for external review. [PL 2011, c. 364, §31 (AMD).]

1-A. Request for independent external review by enrollee's authorized representative. A request for an independent external review may be made by an enrollee's authorized representative as defined in section 4301‑A, subsection 2, paragraph D in accordance with this subsection. A. The enrollee's authorized representative shall notify the enrollee in writing at least 14 days prior to filing a request for independent external review and within 7 days after filing the request or withdrawing the request. [PL 2023, c. 680, Pt. A, §9 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).] B. The enrollee may affirmatively object to the request for independent external review at any time prior to the filing of a request by an enrollee's authorized representative and, after a request has been filed, may notify the bureau at any time that the enrollee intends to take the place of the enrollee's authorized representative as a party in the independent external review. [PL 2023, c. 680, Pt. A, §9 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).] [PL 2023, c. 680, Pt. A, §9 (NEW); PL 2023, c. 680, Pt. A, §10 (AFF).]

2. Expedited request for external review. An enrollee or an enrollee's authorized representative is not required to exhaust a carrier's internal grievance procedure in accordance with subsection 1 before filing a request for external review if: A. The carrier has failed to make a decision on an internal grievance within the time period required or has otherwise failed to adhere to all the requirements applicable to the appeal pursuant to state and federal law or the enrollee has applied for expedited external review at the same time as applying for an expedited internal appeal; [PL 2011, c. 364, §32 (AMD).] B. The carrier and the enrollee mutually agree to bypass the internal grievance procedure; [PL 1999, c. 742, §19 (NEW).] C. The life or health of the enrollee is in serious jeopardy; [PL 2011, c. 364, §32 (AMD).] D. The enrollee has died; or [PL 2011, c. 364, §32 (AMD).] E. The adverse health care treatment decision to be reviewed concerns an admission, availability of care, a continued stay or health care services when the claimant has received emergency services but has not been discharged from the facility that provided the emergency services. [PL 2011, c. 364, §32 (NEW).] [PL 2011, c. 364, §32 (AMD).]

3. Notice to enrollees. A carrier shall notify an enrollee of the enrollee's right to request an external review in large type and easy-to-read language in a conspicuous location on the written notice of an adverse health care treatment decision. The notice must include: A. A description of the external review procedure and the requirements for making a request for external review; [PL 1999, c. 742, §19 (NEW).] B. A statement informing an enrollee how to request assistance in filing a request for external review from the carrier; [PL 1999, c. 742, §19 (NEW).] C. A statement informing an enrollee of the right to attend the external review, submit and obtain supporting material relating to the adverse health care treatment decision under review, ask questions of any representative of the carrier and have outside assistance; and [PL 1999, c. 742, §19 (NEW).] D. A statement informing an enrollee of the right to seek assistance or file a complaint with the bureau and the toll-free number of the bureau. [PL 1999, c. 742, §19 (NEW).] [PL 1999, c. 742, §19 (NEW).]

4. Independent external review; bureau oversight. The bureau shall oversee the external review process required under this section and shall contract with approved independent review organizations to conduct an external review and render an external review decision. At a minimum, an independent review organization approved by the bureau shall ensure the selection of qualified and impartial reviewers who are clinical peers with respect to the adverse health care treatment decision under review and who have no professional, familial or financial conflict of interest relating to a carrier, enrollee, enrollee's authorized representative or health care provider involved in the external review. [PL 1999, c. 742, §19 (NEW).]

5. Independent external review decision; timelines. An external review decision must be made in accordance with the following requirements. A. In rendering an external review decision, the independent review organization must give consideration to the appropriateness of the requested covered service based on the following: (1) All relevant clinical information relating to the enrollee's physical and mental condition, including any competing clinical information; (2) Any concerns expressed by the enrollee concerning the enrollee's health status; and (3) All relevant clinical standards and guidelines, including, but not limited to, those standards and guidelines relied upon by the carrier or the carrier's utilization review entity. [PL 1999, c. 742, §19 (NEW).] B. An external review decision must be issued in writing and must be based on the evidence presented by the carrier and the enrollee or the enrollee's authorized representative. An enrollee may submit and obtain evidence relating to the adverse health care treatment decision under review, attend the external review, ask questions of any representative of the carrier present at the external review and use outside assistance during the review process at the enrollee's own expense. [PL 1999, c. 742, §19 (NEW).] C. Except as provided in paragraph D , an external review decision must be rendered by an independent review organization within 30 days of receipt of a completed request for external review from the bureau. [PL 1999, c. 742, §19 (NEW).] D. An external review decision must be made as expeditiously as an enrollee's medical condition requires but in no event more than 72 hours after receipt of a completed request for external review if the time frame for review required under paragraph C would seriously jeopardize the life or health of the enrollee or would jeopardize the enrollee's ability to regain maximum function. [PL 1999, c. 742, §19 (NEW).] E. The carrier shall provide auxiliary telecommunications devices or qualified interpreter services by a person proficient in American Sign Language when requested by an enrollee who is deaf or hard-of-hearing or printed materials in an accessible format, including Braille, large-print materials, computer diskette, audio cassette or a reader when requested by an enrollee who is visually impaired to allow the enrollee to exercise the enrollee's right to an external review under this section. [PL 1999, c. 742, §19 (NEW).] [PL 1999, c. 742, §19 (NEW).]

6. Binding nature of decision. An external review decision is binding on the carrier. An enrollee or the enrollee's authorized representative may not file a request for a subsequent external review involving the same adverse health care treatment decision for which the enrollee has already received an external review decision pursuant to this section. An external review decision made under this section is not considered final agency action pursuant to Title 5, chapter 375, subchapter 7 . [PL 2025, c. 348, §35 (AMD).]

7. Funding. A carrier against which a request for external review has been filed shall pay the cost of the independent external review to the bureau. [PL 1999, c. 742, §19 (NEW).]

7-A. Confidentiality. Except as provided in this subsection, all records of the bureau or an independent review organization relating to an external review request or external review proceeding are confidential and not a public record under Title 1, chapter 13 . A. A party to an external review may obtain from the independent review organization a transcript or recording of the external review hearing and a copy of any evidence introduced by the opposing party. [PL 2013, c. 274, §1 (NEW).] B. The superintendent shall disseminate to the Legislature and to the public aggregate information related to external reviews conducted by independent review organizations on an annual basis, including: (1) The number of external review requests by carrier, the number of decisions in favor of the enrollee, the number of decisions upholding the carrier's benefit determination and the number of external review requests resolved prior to the issuance of a decision; and (2) The categories of external review requests by carrier. The categories may not include personally identifiable information or specific medical condition. The categories must include, but are not limited to, medical necessity, out-of-network referrals, inpatient care, behavioral health, prescription drugs and experimental or investigational treatment. [PL 2013, c. 274, §1 (NEW).] [PL 2013, c. 274, §1 (NEW).]

8. Rules. The bureau may adopt rules necessary to carry out the requirements of this section, including, without limitation, criteria for determining when multiple denials of benefits to the same enrollee for the same or similar reasons are considered the same adverse health care treatment decision. Notwithstanding the requirements of section 4309 , rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 1999, c. 742, §19 (NEW).]

9. Rights. This section may not be construed to remove or limit any legal rights or remedies of an enrollee or other person under state or federal law, including the right to file judicial actions to enforce rights. [PL 1999, c. 742, §19 (NEW).]

10. Applicability. Decisions relating to the following health care services are subject to review pursuant to other review processes provided by applicable federal or state law and may not be reviewed pursuant to this section: A. Health care services provided through Medicaid, Medicare, Title XXI of the Social Security Act or services provided under these programs through contracted health care providers; [PL 1999, c. 742, §19 (NEW).] B. Health care services provided to inmates by the Department of Corrections; or [PL 1999, c. 742, §19 (NEW).] C. Health care services provided pursuant to a health plan not subject to regulation by the State. [PL 1999, c. 742, §19 (NEW).] [PL 1999, c. 742, §19 (NEW).]
24-A M.R.S. § 2850-A — ME Code / Title 24-A / Chapter 36 / Section 2850-A
24-A §2850-A. Gynecological and obstetrical services (REALLOCATED TO TITLE 24-A, SECTION 2847-F)
Status: in_force

(REALLOCATED TO TITLE 24-A, SECTION 2847-F)
24-A M.R.S. § 4206 — ME Code / Title 24-A / Chapter 56 / Section 4206
24-A §4206. Governing body
Status: in_force

1. The governing body of any health maintenance organization may include providers, other individuals, or both. [PL 1975, c. 503 (NEW).]

2. Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions or through the use of other mechanisms. [PL 1975, c. 503 (NEW).]
24-A M.R.S. § 2766-A — ME Code / Title 24-A / Chapter 33 / Section 2766-A
24-A §2766-A. Dental benefit waiting period
Status: in_force

1. Enrollee defined. For the purposes of this section, unless the context otherwise indicates, "enrollee" means a person who is covered under an individual policy or contract provided by an insurer. [PL 2019, c. 605, §5 (NEW); PL 2019, c. 605, §8 (AFF).]

2. No waiting period for enrollee under 19 years of age. An insurer that issues individual dental insurance or health insurance that includes coverage for dental services may not impose a waiting period, as defined in section 2848, subsection 5 , for any dental or oral health service or treatment, except for orthodontic treatment, for an enrollee if the enrollee is under 19 years of age. [PL 2019, c. 605, §5 (NEW); PL 2019, c. 605, §8 (AFF).]
24-A M.R.S. § 478 — ME Code / Title 24-A / Chapter 5 / Section 478
24-A §478. Jurisdiction of courts
Status: in_force

During any emergency insurance period as described in sections 471 and 472 , the superintendent is authorized to issue such directions, rules or orders as in the superintendent's discretion the circumstances may warrant, and any Justice of the Supreme Judicial or Superior Courts has full jurisdiction to enforce this chapter by appropriate decrees. [RR 2021, c. 1, Pt. B, §185 (COR).]
24-A M.R.S. § 4239 — ME Code / Title 24-A / Chapter 56 / Section 4239
24-A §4239. Medical child support
Status: in_force

A health maintenance organization must comply with 42 United States Code, Section 1396g‑1. [PL 1995, c. 418, Pt. C, §4 (NEW).]
24-A M.R.S. § 6201 — ME Code / Title 24-A / Chapter 73 / Section 6201
24-A §6201. Definitions
Status: in_force

As used in this chapter, unless the context indicates otherwise, the following terms have the following meanings. [PL 1987, c. 482, §1 (NEW).]

1. Actuary. "Actuary" means a member of the American Academy of Actuaries who is also a member of the Society of Actuaries or the Casualty Actuarial Society and is qualified to sign a statement of actuarial opinion. [PL 1987, c. 482, §1 (NEW).]

2. Continuing care. "Continuing care" means furnishing shelter for the life of the individual or for a period in excess of one year and either health care, supportive services, or both, under an agreement requiring prepayment as defined in subsection 12 , whether or not the shelter and services are provided at the same location, to 3 or more older individuals not related by blood or marriage to the providers. [PL 1987, c. 482, §1 (NEW).]

3. Continuing care agreement. "Continuing care agreement" means the contract or contracts which create the obligation to provide continuing care, including, but not limited to, mutually terminable contracts. [PL 1987, c. 482, §1 (NEW).]

4. Department. "Department" means the Department of Health and Human Services. [PL 1987, c. 482, §1 (NEW); PL 2003, c. 689, Pt. B, §6 (REV).]

5. Entrance fee. "Entrance fee" means an initial payment of a sum of money or any other consideration that assures a subscriber a place in a facility for a term of years or for life. An accommodation fee, admission fee, entrance loan or other fee of similar form and application, even if refundable in whole or in part at the termination of the subscriber's contract, is considered to be an entrance fee. The purchase price of a condominium, or of a share or shares of or membership in, a consumer cooperative subject to Title 13, chapter 85, subchapter I or a cooperative affordable housing corporation subject to Title 13, chapter 85, subchapter I‑A is not considered an entrance fee. [PL 1995, c. 452, §2 (AMD).]

6. Facility. "Facility" means a physical plant in which continuing care is provided in accordance with this chapter. [PL 1987, c. 482, §1 (NEW).]

7. Fiscal year. "Fiscal year" means the provider's fiscal year. [PL 1987, c. 482, §1 (NEW).]

8. Health care. "Health care" means the provision of any one or more of the following services: A. Physician services; [PL 1987, c. 482, §1 (NEW).] B. Home health services; [PL 1987, c. 482, §1 (NEW).] C. Access to or provision of nursing home care; or [PL 1987, c. 482, §1 (NEW).] D. Hospital care. [PL 1987, c. 482, §1 (NEW).] [PL 1987, c. 482, §1 (NEW).]

9. Home health services. "Home health services" means those services performed by home health care providers required to be licensed under Title 22, chapter 419 . [PL 1987, c. 482, §1 (NEW).]

10. Maintenance fee. "Maintenance fee" means any fee which a subscriber is required to pay to the provider on a regular basis to cover the cost of shelter, health care or supportive services, or any combination thereof, provided to the subscriber. [PL 1987, c. 769, Pt. A, §101 (AMD).]

11. Operational facility. "Operational facility" means a facility for which the provider has obtained a final certificate of authority from the superintendent and 60% of the residential units are occupied by subscribers. [PL 1987, c. 482, §1 (NEW); PL 1989, c. 343, §1 (AMD); PL 1989, c. 343, §23 (AFF).]

11-A. Preliminary marketing. "Preliminary marketing" means, for the purpose of evaluating market demand for a proposed facility: A. Advertising of a proposed facility; [PL 1995, c. 452, §3 (NEW).] B. Entering of reservation agreements, which are cancelable at the option of either the prospective subscriber or the prospective provider; [PL 1995, c. 452, §3 (NEW).] C. Soliciting, collecting or receiving reservation fees, which: (1) Are sums of money not in excess of $1,000 per prospective resident paid by a prospective resident for deposit in escrow in an interest-bearing account with interest accruing for the benefit of the prospective resident and in accordance with section 6203‑B, subsection 1, paragraphs A , C , D , E and F ; (2) Are refundable on request of a prospective subscriber; and (3) Are not considered deposits for purposes of this chapter; and [PL 1995, c. 452, §3 (NEW).] D. Constructing and maintaining a sales office and model units. [PL 1995, c. 452, §3 (NEW).] [PL 1995, c. 452, §3 (NEW).]

12. Prepayment. "Prepayment" means funding shelter, supportive services or health care entirely or in part by entrance fees or by maintenance fees paid more than one year prior to the time the shelter or service is rendered. Prepayment of health care also includes funding by entrance fees or by maintenance fees which do not vary with the level of care provided. [PL 1987, c. 482, §1 (NEW).]

13. Provider. "Provider" means the owner of an institution, building, residence or other place, whether operated for profit or not, in which the owner undertakes to provide continuing care. If the facility is owned by the subscribers, then "provider" means the operator of the facility. [PL 1995, c. 452, §4 (AMD).]

14. Records. "Records" means the financial and other information and personnel data maintained by the provider for the proper operation of the facility pursuant to this chapter. [PL 1987, c. 482, §1 (NEW).]

14-A. Residential unit. [PL 1989, c. 343, §2 (NEW); PL 1989, c. 343, §23 (RP).]

14-B. Residential unit. "Residential unit" means an apartment, room or other area within a facility set aside for the exclusive and independent living use of one or more identified subscribers. [PL 1995, c. 452, §5 (NEW).]

15. Subscriber. "Subscriber" means a purchaser or beneficiary of a continuing care agreement. [PL 1987, c. 482, §1 (NEW).]

16. Supportive services. "Supportive services" means providing assistance in the activities of daily living or other social services, or both. Supportive services does not refer to services of the type commonly provided to tenants in a conventional apartment building. [PL 1987, c. 769, Pt. A, §101 (AMD).]

17. Superintendent. "Superintendent" means the Superintendent of Insurance. [PL 1987, c. 482, §1 (NEW).]
24-A M.R.S. § 3004-A — ME Code / Title 24-A / Chapter 41 / Section 3004-A
24-A §3004-A. Actual cash value
Status: in_force

1. Actual cash value. "Actual cash value", as used in section 3002 , means the replacement cost of an insured item of property at the time of loss, less the value of physical depreciation as to the item damaged. "Physical depreciation" means a value as determined according to standard business practices. [PL 1989, c. 316, §2 (NEW).]
24-A M.R.S. § 3414 — ME Code / Title 24-A / Chapter 47 / Section 3414
24-A §3414. Management, commission, exclusive agency contracts
Status: in_force

1. No domestic insurer shall hereafter make any contract whereby any person is granted or is to enjoy in fact the management of the insurer to the material exclusion of its board of directors or to have the controlling or preemptive right to produce substantially all insurance business for the insurer, or, if an officer, director or otherwise part of the insurer's management, is to receive any commission, bonus or compensation based upon the volume of the insurer's business or transactions, unless the contract is filed with and not disapproved by the superintendent. The contract shall become effective in accordance with its terms unless disapproved by the superintendent within 20 days after date of filing, subject to such reasonable extension of time as the superintendent may require by notice given within such 20 days. Any disapproval shall be delivered to the insurer in writing stating the grounds therefor. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. Any such contract shall provide that any such manager, producer of its business or contract holder shall within 90 days after expiration of each calendar year furnish the insurer's board of directors a written statement of amounts received under or on account of the contract and amounts expended thereunder during such calendar year, with specification of the emoluments received therefrom by the respective directors, officers and other principal management personnel of the manager or producer, and with such classification of items and further detail as the insurer's board of directors may reasonably require. [PL 1969, c. 132, §1 (NEW).]

3. The superintendent shall disapprove any such contract if the superintendent finds that it: A. Subjects the insurer to excessive charges; [RR 2021, c. 1, Pt. B, §275 (COR).] B. Is to extend for an unreasonable length of time; [RR 2021, c. 1, Pt. B, §275 (COR).] C. Does not contain fair and adequate standards of performance; or [PL 1969, c. 132, §1 (NEW).] D. Contains any other inequitable provision or provisions that impair the proper interests of stockholders or members of the insurer. [RR 2021, c. 1, Pt. B, §275 (COR).] [RR 2021, c. 1, Pt. B, §275 (COR).]

4. The superintendent may, after a hearing held thereon, disapprove any such contract theretofore permitted to become effective, if the superintendent finds that the contract should be disapproved on any of the grounds referred to in subsection 3 . [RR 2021, c. 1, Pt. B, §276 (COR).]

5. This section does not apply as to contracts entered into prior to January 1, 1970, or to amendment of such contracts other than extensions thereof. [PL 1973, c. 625, §149 (AMD).]

6. This section may not be construed to prohibit receipt of commissions on insurance written personally by a director or officer who is duly licensed and regularly engaged in business as an insurance agent or broker; or to prohibit receipt of vested commissions by a director or officer based upon insurance business theretofore written by the director or officer. [RR 2021, c. 1, Pt. B, §277 (COR).]
24 M.R.S. § 2320-E — ME Code / Title 24 / Chapter 19 / Section 2320-E
24 §2320-E. Coverage for Pap tests
Status: in_force

All group nonprofit medical service plan contracts and certificates and all nonprofit health care plan contracts and certificates must provide coverage for screening Pap tests recommended by a physician. [PL 2003, c. 517, Pt. A, §2 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]
24-A M.R.S. § 2161 — ME Code / Title 24-A / Chapter 23 / Section 2161
24-A §2161. Exceptions to discrimination, rebates, stock inducements provision -- life, health and annuity contracts
Status: in_force

1. Nothing in sections 2159 and 2160 shall be construed as including within the definition of discrimination or rebates any of the following practices: A. In the case of any contract of life insurance or life annuity, paying bonuses to policyholders or otherwise abating their premiums in whole or in part out of surplus accumulated from nonparticipating insurance, provided that any such bonuses, or abatement of premiums shall be fair and equitable to policyholders and for the best interests of the insurer and its policyholders; [PL 1969, c. 132, §1 (NEW).] B. In the case of life insurance policies issued on the debit plan, making allowance to policyholders who have continuously for a specified period made premium payments directly to an office of the insurer in an amount which fairly represents the saving in collection expense; [PL 1969, c. 132, §1 (NEW).] C. Readjustment of the rate of premium for a group insurance policy based on the loss or expense experience thereunder, at the end of the first or any subsequent policy year of insurance thereunder, which may be made retroactive only for such policy year; [PL 1969, c. 132, §1 (NEW).] D. Reduction of premium rate for policies of large amount, but not exceeding savings in issuance and administration expenses reasonably attributable to such policies as compared with policies of similar plan issued in smaller amounts; [PL 1969, c. 132, §1 (NEW).] E. Reduction in premium rates for life or health insurance policies or annuity contracts on salary savings, payroll deduction, preauthorized check, bank draft or similar plans in amounts reasonably commensurate with the savings made by the use of such plans; [PL 1969, c. 132, §1 (NEW).] F. The issuance of policies of group insurance with or without annuities at rates less than the usual rate of premiums for individual policies or contracts as otherwise provided for by law; [PL 1969, c. 132, §1 (NEW).] G. Allowance to an agent or broker, and receipt by the agent or broker, of commissions with respect to insurance written on the agent or broker. [RR 2021, c. 1, Pt. B, §205 (COR).] [RR 2021, c. 1, Pt. B, §205 (COR).]

2. Nothing in this chapter shall be construed as including within the definition of securities as inducements to purchase insurance the selling or offering for sale, contemporaneously with life insurance or annuities, of mutual fund shares or face amount certificates of regulated investment companies under offerings registered with the Securities and Exchange Commission where such shares or such face amount certificates or such insurance or annuities may be purchased independently of and not contingent upon purchase of the other, at the same price and upon the same terms and conditions as where purchased independently. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2849-B — ME Code / Title 24-A / Chapter 36 / Section 2849-B
24-A §2849-B. Continuity for individual who changes groups
Status: in_force

1. Policies subject to this section. This section applies to all individual, group and blanket medical insurance policies except hospital indemnity, specified accident, specified disease, long-term care and short-term, limited-duration policies issued by insurers or health maintenance organizations. For purposes of this section, a short-term, limited-duration policy is an individual, nonrenewable policy issued for a term that does not extend beyond December 31st of the calendar year in which the policy is issued. This section does not apply to Medicare supplement policies as defined in section 5001, subsection 4 . [PL 2019, c. 330, §2 (AMD); PL 2019, c. 330, §6 (AFF).]

2. Persons provided continuity of coverage. Except as provided in subsection 3 , this section provides continuity of coverage for a person who seeks coverage under an individual, group or blanket insurance policy or health maintenance organization policy if: A. That person was covered under an individual, group or blanket contract or policy issued by a nonprofit hospital or medical service organization, insurer or health maintenance organization or was covered under an uninsured employee benefit plan that provides payment for health services received by employees and their dependents or a governmental program, including, but not limited to, those listed in section 2848, subsection 1‑B, paragraph A , subparagraphs (3) to (10). For purposes of this section, the individual, group or blanket policy under which the person is seeking coverage is the "succeeding policy." The group, blanket or individual contract or policy, uninsured employee benefit plan or governmental program that previously covered the person is the "prior contract or policy"; and [PL 2019, c. 330, §3 (AMD); PL 2019, c. 330, §6 (AFF).] B. Coverage under the prior contract or policy terminated: (1) Within 180 days before the date the person enrolls or is eligible to enroll in the succeeding contract if: (a) Coverage was terminated due to unemployment, as defined in Title 26, section 1043 ; (b) The person was eligible for and received unemployment compensation benefits for the period of unemployment, as provided under Title 26, chapter 13 ; and (c) The person is employed at the time replacement coverage is sought under this provision; or (2) Within 90 days before the date the person enrolls or is eligible to enroll in the succeeding contract. A period of ineligibility for a health plan imposed by terms of employment may not be considered in determining whether the coverage ended within a time period specified under this section. [PL 2007, c. 199, Pt. D, §4 (AMD).] C. [PL 1997, c. 445, §25 (RP); PL 1997, c. 445, §32 (AFF).] D. [PL 1999, c. 36, §3 (RP).] This section does not apply to replacements of group or blanket coverage within the scope of section 2849 or if the succeeding policy is an individual policy and the prior contract or policy was a short-term, limited‑duration policy. [PL 2019, c. 330, §3 (AMD); PL 2019, c. 330, §6 (AFF).]

3. Exception for late enrollees. Notwithstanding subsection 2 , this section does not provide continuity of coverage for a late enrollee except as provided in this subsection. A late enrollee may be excluded from coverage for a waiting period of not more than 12 months based on medical underwriting or preexisting conditions. If a shorter waiting period or no waiting period is imposed, coverage for the late enrollee may exclude preexisting conditions for the lesser of 18 months, reduced by any federally creditable coverage, or 12 months. The exclusion is subject to the limitations set forth in section 2850 . For purposes of this section, a "late enrollee" is a person who requests enrollment in a group plan following the initial enrollment period provided under the terms of the plan, except that a person is not a late enrollee if: A. The request for enrollment is made within 30 days after termination of coverage under a prior contract or policy and the individual did not request coverage initially under the succeeding contract or policy or terminated coverage under the succeeding contract because that individual was covered under a prior contract or policy and: (1) Coverage under that contract or policy ceased because the individual became ineligible for reasons other than fraud or material misrepresentation, including, but not limited to, termination of employment, termination of the group policy or group contract under which the individual was covered, death of a spouse or divorce; or (2) Employer contributions toward that coverage were terminated; [PL 1997, c. 445, §26 (RPR); PL 1997, c. 445, §32 (AFF).] A-1. That person incurs a claim under a prior contract or policy that would meet or exceed that contract or policy’s lifetime limit on all benefits, and a request for enrollment is made not later than 30 days after a claim is denied in whole or in part due to the operation of a lifetime limit on all benefits. [PL 2007, c. 199, Pt. A, §4 (NEW).] B. A court has ordered that coverage be provided for a spouse or minor child under a covered employee's plan and the request for coverage is made within 30 days after issuance of the court order; [PL 1995, c. 332, Pt. F, §5 (AMD).] C. [PL 1997, c. 777, Pt. B, §5 (RP).] C-1. That person was covered by the Children's Health Insurance Program under Title 22, section 3174‑T , and the request for replacement coverage is made while coverage is in effect or within 30 days from the termination of coverage; or [PL 2023, c. 597, §18 (AMD).] D. That person was previously ineligible for coverage and the request for enrollment is made within 30 days of the date the person becomes eligible. [PL 1995, c. 332, Pt. F, §5 (NEW).] [PL 2023, c. 597, §18 (AMD).]

3-A. Prohibition against discontinuity in group policies. Except as provided in this section, in a group policy subject to this section, the insurer or health maintenance organization shall, for any person described in subsection 2 , waive any medical underwriting or preexisting conditions exclusion. The succeeding policy is not required to duplicate any benefits covered by the prior contract or policy. [PL 2009, c. 244, Pt. E, §4 (NEW).]

3-B. Persons subject to a preexisting condition exclusion. [PL 2019, c. 5, Pt. A, §15 (RP).]

4. Prohibition against discontinuity in individual and blanket policies. Except as provided in this section, in an individual or blanket policy subject to this section, the insurer or health maintenance organization must, for any person described in subsection 2 , waive any medical underwriting or preexisting conditions exclusion to the extent that benefits would have been payable under a prior contract or policy if the prior contract or policy were still in effect or to the extent that benefits would have been payable under the prior contract or policy if not for the operation of a lifetime limit on all benefits. The succeeding policy is not required to duplicate any benefits covered by the prior contract or policy. [PL 2009, c. 244, Pt. E, §6 (AMD).]

4-A. Alternative method. The superintendent may adopt rules that substitute for the requirement of subsection 3‑A a requirement that prohibits application of a medical underwriting or preexisting condition exclusion with respect to classes or categories of benefits that are covered under the replaced contract or policy. The rules must define those classes or categories consistent with any federal regulations adopted pursuant to the federal Public Health Service Act, Title XXVII, Section 2701(c)(3)(B). [PL 2009, c. 511, Pt. D, §1 (AMD).]

5. Determination of benefits. When a determination of benefit under the prior contract or policy is required, the issuer of the prior contract or policy shall, at the request of the issuer of the succeeding policy, furnish a statement of benefits available or pertinent information sufficient to permit verification of the benefit determination or the determination itself by the issuer of the succeeding policy. For purposes of this section, benefits of the prior contract or policy are determined in accordance with the definitions, conditions and covered expense provisions of that contract or policy rather than those of the succeeding policy. The benefit determination must be made as if coverage had not been replaced. [PL 1989, c. 867, §8 (NEW); PL 1989, c. 867, §10 (AFF).]

6. Limit on premium increase. For rating purposes, an insurer or health maintenance organization may not charge claims for preexisting conditions of any person subject to this section, during the first 12 months of employment of that person, directly to a group of fewer than 100 insured employees except to the extent that the resulting increase in the premium would be 10% or less. The insurer or health maintenance organization may pool any additional claims among all such groups and subgroups covered by that insurer or health maintenance organization. This requirement also applies to subgroups of fewer than 100 insured employees if the subgroup is treated as a separate unit for rating purposes. [PL 1989, c. 867, §8 (NEW); PL 1989, c. 867, §10 (AFF).]

7. Reinsurance, excess insurance or administrative services. An insurer may only offer, issue or renew reinsurance or excess insurance coverage or offer administrative services to an uninsured employee benefit plan that provides payment for health services received by employees and their dependents when that plan for the payment of health services and reinsurance and excess insurance coverage meets the requirements of continuity of coverage in this chapter. [PL 1993, c. 477, Pt. A, §14 (NEW); PL 1993, c. 477, Pt. F, §1 (NEW).]

8. Short-term, limited-duration insurance. A person eligible for continuity of coverage under subsection 2 may be allowed to purchase coverage under an individual, nonrenewable, short-term, limited‑duration policy. The issuance of a short-term, limited‑duration policy is subject to the following conditions. A. Upon offering an individual short-term, limited‑duration policy for purchase, an insurer or the insurer's agent or broker shall provide written disclosure as required in this paragraph in at least 14‑point type. An insurer or the insurer's agent or broker shall specifically disclose: (1) A summary of plan benefits, limits and exclusions in a standardized format similar to the format required for a qualified health plan under the federal Affordable Care Act that is specific to the exact policy being offered for purchase in this State, including, but not limited to, information about the circumstances in which covered benefits may be subject to balance billing and examples of how charges may be applied toward any cost sharing under the policy and billed to the individual policyholder; and (2) A comparison of the short-term, limited-duration policy to a qualified health plan in the terms, benefits and conditions of the policy, any exclusions, medical loss ratio requirements or the provisions of guaranteed renewal and continuity of coverage. [PL 2019, c. 330, §4 (AMD); PL 2019, c. 330, §6 (AFF).] B. An insurer or the insurer's agent or broker may issue a short-term, limited‑duration policy that replaces a prior short-term, limited‑duration policy as long as the combined term of the new policy and all prior policies does not exceed 24 months and the individual has not been covered under any prior short-term, limited-duration policy for at least 12 months. All individuals making an application for coverage under a short-term, limited‑duration policy must disclose any prior coverage under a short-term, limited‑duration policy and the policy duration. [PL 2019, c. 330, §4 (AMD); PL 2019, c. 330, §6 (AFF).] C. An insurer or the insurer's agent or broker may not issue a short-term, limited-duration policy unless it has been sold through an in-person encounter. [PL 2019, c. 330, §4 (NEW); PL 2019, c. 330, §6 (AFF).] D. An insurer or the insurer's agent or broker may not actively market or sell any short-term, limited-duration policy during any open enrollment period, except for a short-term, limited-duration policy that terminates coverage on December 31st of the calendar year in which it is sold. [PL 2019, c. 330, §4 (NEW); PL 2019, c. 330, §6 (AFF).] E. Upon offering an individual short-term, limited-duration policy for purchase, an insurer or the insurer's agent or broker shall assess an individual making an application for eligibility for an advanced premium tax credit or cost-sharing reduction for coverage under a qualified health plan purchased on the exchange pursuant to the federal Affordable Care Act, as defined in section 2188, subsection 1, paragraph A , and shall provide an estimate of the cost for coverage under a qualified health plan after applying any advanced premium tax credit or cost-sharing reduction. [PL 2019, c. 330, §4 (NEW); PL 2019, c. 330, §6 (AFF).] F. An insurer or the insurer's agent or broker shall make the documents and information required to be disclosed under paragraph A upon offering an individual short-term, limited-duration policy for purchase available through the insurer's publicly accessible website. [PL 2019, c. 330, §4 (NEW); PL 2019, c. 330, §6 (AFF).] G. An insurer or the insurer's agent or broker shall provide, upon the purchase of a short-term, limited-duration policy; upon the expiration of the policy; and, if the policy is in effect during an open enrollment period, on November 1st of the calendar year in which the policy was sold, written notice of the following: (1) Disclosure that a short-term, limited-duration policy is not considered minimum essential coverage under the federal Affordable Care Act and that termination of a policy is not a qualifying event for a special enrollment period; and (2) The dates for the next open enrollment period, the website address for the publicly accessible website of the exchange, as defined in section 2188, subsection 1, paragraph A , and the toll-free telephone number for the exchange. [PL 2019, c. 330, §4 (NEW); PL 2019, c. 330, §6 (AFF).] [PL 2019, c. 330, §4 (AMD); PL 2019, c. 330, §6 (AFF).]
24-A M.R.S. § 5076 — ME Code / Title 24-A / Chapter 68-A / Section 5076
24-A §5076. Incontestability period
Status: in_force

1. Policies or certificates in effect for less than 6 months. For a policy or certificate that has been in effect for less than 6 months, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that was material to the acceptance for coverage. [PL 1999, c. 292, §2 (NEW).]

2. Policies or certificates in effect for more than 6 months but less than 2 years. For a policy or certificate that has been in effect for at least 6 months but less than 2 years, an insurer may rescind a long-term care insurance policy or certificate or deny an otherwise valid long-term care insurance claim upon a showing of misrepresentation that was both material to the acceptance for coverage and that pertains to the condition for which benefits are sought. [PL 1999, c. 292, §2 (NEW).]

3. Policies or certificates in effect for 2 years or more. After a policy or certificate has been in effect for at least 2 years, the policy or certificate may not be contested upon the grounds of misrepresentation alone. The policy or certificate may be contested only upon a showing that the insured knowingly and intentionally misrepresented relevant facts relating to the insured's health. [PL 1999, c. 292, §2 (NEW).]

4. Field-issued policies or certificates. A long-term care insurance policy or certificate may not be field-issued if the compensation to the field issuer is based on the number of policies or certificates issued. For the purposes of this subsection, "field-issued" means a policy or certificate issued by a producer or a 3rd-party administrator pursuant to the underwriting authority granted to the producer or 3rd-party administrator by an insurer using the insurer's underwriting guidelines. [PL 2007, c. 232, §1 (AMD).]

5. Recovery of benefit payments by the insurer. If an insurer has paid benefits under the long-term care insurance policy or certificate, the benefit payments may not be recovered by the insurer if the policy or certificate is rescinded. [PL 1999, c. 292, §2 (NEW).]

6. Death of the insured. Upon the death of the insured, this section does not apply to the remaining death benefit of a life insurance policy that accelerates benefits for long-term care and the remaining death benefits under these policies are governed by sections 2507 and 2615 relating to the incontestability requirements for individual and group life insurance. In all other events, this section applies to life insurance policies that accelerate benefits for long-term care. [PL 1999, c. 292, §2 (NEW).]
24-A M.R.S. § 3420 — ME Code / Title 24-A / Chapter 47 / Section 3420
24-A §3420. Insurance benefits for employees and others
Status: in_force

Pursuant to vote of its board of directors heretofore or hereafter made, any domestic stock or mutual insurer may provide for its officers, employees or full-time insurance agents a plan or plans of insurance, to be issued under group or individual policies. The insurer may pay the cost, in whole or in part, of such insurance; or, if duly authorized by its charter and bylaws, may itself provide such benefits directly as the insurer thereof, without requirement of placement through a licensed insurance agent, and in such case may adjust the premium rate for the insurance to reflect such savings in expense as the insurer may deem applicable. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 746 — ME Code / Title 24-A / Chapter 9 / Section 746
24-A §746. Duties of insurers utilizing the services of a reinsurance intermediary-broker
Status: in_force

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

2. Status of intermediary-broker. An insurer may not employ an individual who is employed by a reinsurance intermediary-broker with which the insurer transacts business, unless such reinsurance intermediary-broker is under common control with the insurer and subject to section 222 . [PL 1991, c. 828, §20 (NEW).]

3. Financial statements. The insurer shall annually obtain a copy of statements of current origin of the financial condition of each reinsurance intermediary-broker with which the insurer transacts business. These statements must be certified reports or reviews performed by a certified public accountant. [PL 1991, c. 828, §20 (NEW).]
24-A M.R.S. § 2736-C — ME Code / Title 24-A / Chapter 33 / Section 2736-C
24-A §2736-C. Individual health plans
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Carrier" means any insurance company, nonprofit hospital and medical service organization or health maintenance organization authorized to issue individual health plans in this State. For the purposes of this section, carriers that are affiliated companies or that are eligible to file consolidated tax returns are treated as one carrier and any restrictions or limitations imposed by this section apply as if all individual health plans delivered or issued for delivery in this State by affiliated carriers were issued by one carrier. For purposes of this section, health maintenance organizations are treated as separate organizations from affiliated insurance companies and nonprofit hospital and medical service organizations. [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] B. "Community rate" means the rate charged to all eligible individuals for individual health plans prior to any adjustments pursuant to subsection 2, paragraphs C and D . [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] C. "Individual health plan" means any hospital and medical expense-incurred policy or health, hospital or medical service corporation plan contract. It includes both individual contracts and certificates issued under group contracts specified in section 2701, subsection 2, paragraph C . "Individual health plan" does not include the following types of insurance: (1) Accident; (2) Credit; (3) Disability; (4) Long-term care or nursing home care; (5) Medicare supplement; (6) Specified disease; (7) Dental or vision; (8) Coverage issued as a supplement to liability insurance; (9) Workers' compensation; (10) Automobile medical payment; (11) Insurance under which benefits are payable with or without regard to fault and that is required statutorily to be contained in any liability insurance policy or equivalent self-insurance; or (12) Short-term, limited‑duration policies, as described in section 2849‑B, subsection 1 . [PL 2019, c. 330, §1 (AMD); PL 2019, c. 330, §6 (AFF).] C-1. "Legally domiciled" means a person who lives in this State and who satisfies the criteria contained in 2 of the following subparagraphs. (1) The person has a motor vehicle operator's license or nondriver identification card from this State. (2) The person has a valid passport or visa and is lawfully admitted to the United States. (3) The person is registered to vote in this State. (4) The person has a permanent dwelling place in this State. (5) The person submits a written sworn affidavit declaring that person's intent to reside in this State. (6) The person files an income tax return for this State that declares the person is a Maine resident. A person may establish that that person is legally domiciled in this State by providing evidence of other relevant criteria associated with residency. A child is legally domiciled in this State if at least one of the child's parents or the child's legal guardian is legally domiciled in this State. A person with a developmental or other disability that prevents that person from obtaining a motor vehicle operator's license, registering to vote or filing an income tax return is legally domiciled in this State by living in this State. [PL 2005, c. 493, §1 (RPR).] C-2. "Resident" means a person who is legally domiciled in this State and has been for at least the last 60 days. [PL 1997, c. 445, §8 (NEW); PL 1997, c. 445, §32 (AFF).] D. "Premium rate" means the rate charged to an individual for an individual health plan. [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] E. "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as amended. [PL 1997, c. 370, Pt. E, §2 (NEW).] [PL 2019, c. 330, §1 (AMD); PL 2019, c. 330, §6 (AFF).]

2. Rating practices. The following requirements apply to the rating practices of carriers providing individual health plans. A. A carrier issuing an individual health plan after December 1, 1993 must file the carrier's community rate and any formulas and factors used to adjust that rate with the superintendent prior to issuance of any individual health plan. [PL 1993, c. 547, §3 (AMD).] B. A carrier may not vary the premium rate due to the gender, health status, occupation or industry, claims experience or policy duration of the individual or any other rating factor not specified in this subsection. [PL 2019, c. 5, Pt. A, §1 (AMD).] C. A carrier may vary the premium rate due to family membership. The premium rate for a family must equal the sum of the premiums for each individual in the family, except that it may not be based on more than 3 dependent children who are less than 21 years of age. [PL 2019, c. 5, Pt. A, §2 (AMD).] C-1. A carrier may vary the premium rate due to geographic area in accordance with the limitation set out in this paragraph. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 1, 2012 and December 31, 2023, the rating factor used by a carrier for geographic area may not exceed 1.5. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2024, the rating factor used by a carrier for geographic area may not exceed 1.25. [PL 2021, c. 655, §1 (AMD).] D. A carrier may vary the premium rate due to age and tobacco use in accordance with the limitations set out in this paragraph. A carrier that varies the premium rate due to age must vary the premium rate according to a uniform age curve. The superintendent shall adopt rules establishing a uniform age curve that is substantially similar to the age curve in effect on January 1, 2019 under the federal Affordable Care Act. Rules adopted under this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . (1) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between December 1, 1993 and July 14, 1994, the premium rate may not deviate above or below the community rate filed by the carrier by more than 50%. (2) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 15, 1994 and July 14, 1995, the premium rate may not deviate above or below the community rate filed by the carrier by more than 33%. (3) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 15, 1995 and June 30, 2012, the premium rate may not deviate above or below the community rate filed by the carrier by more than 20%. (5) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 1, 2012 and December 31, 2013, the maximum rate differential due to age filed by the carrier as determined by ratio is 3 to 1. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (6) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between January 1, 2014 and December 31, 2014, the maximum rate differential due to age filed by the carrier as determined by ratio is 4 to 1 to the extent permitted by the federal Affordable Care Act. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (7) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2015, except as provided in subparagraph (9), the maximum rate differential due to age filed by the carrier as determined by ratio is 5 to 1 to the extent permitted by the federal Affordable Care Act. The limitation does not apply for determining rates for an attained age of less than 19 years of age or more than 65 years of age. (8) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between July 1, 2012 and December 31, 2022, the maximum rate differential due to tobacco use filed by the carrier as determined by ratio is 1.5 to 1, except that the carrier may not apply a rate differential pursuant to this subparagraph when the covered individual is participating in an evidence-based tobacco cessation strategy approved by the United States Department of Health and Human Services, Food and Drug Administration. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State between January 1, 2023 and December 31, 2023, the maximum rate differential due to tobacco use filed by the carrier as determined by ratio is 1.25 to 1, except that the carrier may not apply a rate differential pursuant to this subparagraph when the covered individual is participating in an evidence-based tobacco cessation strategy approved by the United States Department of Health and Human Services, Food and Drug Administration. For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2024, a carrier may not vary the premium rate due to tobacco use. (9) For all policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after the effective date of this subparagraph, the maximum rate differential due to age filed by the carrier as determined by ratio is 3 to 1 for individuals 21 years of age and older on the first day of coverage under the policy, contract or certificate. The variation in rate due to age must be actuarially justified for individuals under 21 years of age consistent with the uniform age rating curve adopted under this paragraph. [PL 2021, c. 344, §1 (AMD).] E. A separate community rate may be established for individuals eligible for Medicare Part A without paying a premium; however, this rate may not be applied if both the Medicare eligibility date and the issue date are prior to July 1, 2000. [PL 1999, c. 44, §1 (AMD); PL 1999, c. 44, §2 (AFF).] F. [PL 2019, c. 5, Pt. A, §4 (RP).] G. [PL 2011, c. 90, Pt. B, §4 (RP); PL 2011, c. 90, Pt. B, §10 (AFF).] H. [PL 2011, c. 90, Pt. A, §4 (RP).] I. [PL 2019, c. 5, Pt. A, §5 (RP).] J. Except for enrollees in grandfathered health plans under the federal Affordable Care Act, beginning January 1, 2014, a carrier shall consider all enrollees in all individual health plans offered by the carrier to be members of a single risk pool to the extent required by the federal Affordable Care Act. [PL 2011, c. 364, §6 (NEW).] [PL 2021, c. 655, §1 (AMD).]

2-A. Reinsurance requirement. [PL 2011, c. 90, Pt. B, §5 (RP); PL 2011, c. 90, Pt. B, §10 (AFF).]

2-B. Optional guaranteed loss ratio. Notwithstanding section 2736, subsection 1 and section 2736‑A , at the carrier's option, rate filings for a carrier's credible block of individual health plans may be filed in accordance with this subsection. Rates filed in accordance with this subsection are filed for informational purposes unless rate review is required pursuant to the federal Affordable Care Act. A. A carrier's individual health plans are considered credible if the anticipated average number of members during the period for which the rates will be in effect meets standards for full or partial credibility pursuant to the federal Affordable Care Act. The rate filing must state the anticipated average number of members during the period for which the rates will be in effect and the basis for the estimate. If the superintendent determines that the number of members is likely to be less than needed to meet the credibility standard, the filing is subject to section 2736, subsection 1 and section 2736‑A . [PL 2011, c. 364, §7 (AMD).] B. On an annual schedule as determined by the superintendent, the carrier shall file a report with the superintendent showing the calculation of rebates as required pursuant to the federal Affordable Care Act, except that the calculation must be based on a minimum medical loss ratio of 80% if the applicable federal minimum for the individual market in this State is lower. If the calculation indicates that rebates must be paid, the carrier must pay the rebates in the same manner as is required for rebates pursuant to the federal Affordable Care Act. [PL 2011, c. 364, §7 (AMD).] [PL 2011, c. 364, §7 (AMD).]

3. Guaranteed issuance and guaranteed renewal. Carriers providing individual health plans must meet the following requirements on issuance and renewal. A. Coverage must be guaranteed to all residents of this State other than those eligible without paying a premium for Medicare Part A. Coverage must be guaranteed to all legally domiciled federally eligible individuals, as defined in section 2848 , regardless of the length of time they have been legally domiciled in this State. Except for federally eligible individuals, coverage need not be issued to an individual whose coverage was terminated for nonpayment of premiums during the previous 91 days or for fraud or intentional misrepresentation of material fact during the previous 12 months. When a managed care plan, as defined by section 4301‑A , provides coverage a carrier may: (1) Deny coverage to individuals who neither live nor reside within the approved service area of the plan for at least 6 months of each year; and (2) Deny coverage to individuals if the carrier has demonstrated to the superintendent's satisfaction that: (a) The carrier does not have the capacity to deliver services adequately to additional enrollees within all or a designated part of its service area because of its obligations to existing enrollees; and (b) The carrier is applying this provision uniformly to individuals and groups without regard to any health-related factor. A carrier that denies coverage in accordance with this subparagraph may not enroll individuals residing within the area subject to denial of coverage or groups or subgroups within that area for a period of 180 days after the date of the first denial of coverage. [PL 2011, c. 621, §1 (AMD).] B. Renewal is guaranteed, pursuant to section 2850‑B . [PL 1997, c. 445, §10 (RPR); PL 1997, c. 445, §32 (AFF).] C. A carrier is exempt from the guaranteed issuance requirements of paragraph A provided that the following requirements are met. (1) The carrier does not issue or deliver any new individual health plans on or after the effective date of this section; (2) If any individual health plans that were not issued on a guaranteed renewable basis are renewed on or after December 1, 1993, all such policies must be renewed by the carrier and renewal must be guaranteed after the first such renewal date; and (3) The carrier complies with the rating practices requirements of subsection 2 . [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] D. Notwithstanding paragraph A , carriers offering supplemental coverage for the Civilian Health and Medical Program for the Uniformed Services, CHAMPUS, are not required to issue this coverage if the applicant for insurance does not have CHAMPUS coverage. [PL 1999, c. 256, Pt. D, §1 (NEW).] E. As part of the application process for individual health coverage, a carrier shall require an individual to complete the health statement developed by the Board of Directors of the Maine Guaranteed Access Reinsurance Association pursuant to section 3955, subsection 1, paragraph E . A carrier may not deny coverage or refuse to renew or cancel an individual health plan on the basis of an individual's complete or incomplete health statement, claims history or risk scores or on the basis of any omission of material information from a health statement or misrepresentation of an individual's health status. The rejection of an application for individual health coverage by a carrier because an individual has not submitted a completed health statement is not a denial of coverage for the purposes of this paragraph. [PL 2011, c. 621, §1 (AMD).] [PL 2011, c. 621, §1 (AMD).]

4. Cessation of business. Carriers that provide individual health plans after the effective date of this section that plan to cease doing business in the individual health plan market must comply with the following requirements. A. Notice of the decision to cease doing business in the individual health plan market must be provided to the bureau 3 months prior to the cessation unless a shorter notice period is approved by the superintendent. If existing contracts are nonrenewed, notice must be provided to the policyholder or contract holder 6 months prior to nonrenewal. [PL 2001, c. 258, Pt. B, §1 (AMD).] B. Carriers that cease to write new business in the individual health plan market continue to be governed by this section. [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] C. Carriers that cease to write new business in the individual health plan market are prohibited from writing new business in that market for a period of 5 years from the date of notice to the superintendent unless the superintendent waives this requirement for good cause shown. [PL 2001, c. 258, Pt. B, §2 (AMD).] [PL 2001, c. 258, Pt. B, §§1, 2 (AMD).]

5. Loss ratios. Except as provided in subsection 2‑B , for all policies and certificates issued on or after the effective date of this section, the superintendent shall disapprove any premium rates filed by any carrier, whether initial or revised, for an individual health policy unless it is anticipated that the medical loss ratio calculated under section 4319 will be at least 80%. [PL 2019, c. 5, Pt. A, §6 (AMD).]

6. Fair marketing standards. Carriers providing individual health plans must meet the following standards of fair marketing. A. Each carrier must actively market individual health plan coverage to individuals in this State. [PL 2023, c. 405, Pt. A, §88 (AMD).] B. A carrier or representative of the carrier may not directly or indirectly engage in the following activities: (1) Encouraging or directing individuals to refrain from filing an application for coverage with the carrier because of any of the rating factors listed in subsection 2 ; or (2) Encouraging or directing individuals to seek coverage from another carrier because of any of the rating factors listed in subsection 2 . [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] C. A carrier may not directly or indirectly enter into any contract, agreement or arrangement with a representative of the carrier that provides for or results in the compensation paid to the representative for the sale of an individual health plan to be varied because of the rating factors listed in subsection 2 . A carrier may enter into a compensation arrangement that provides compensation to a representative of the carrier on the basis of percentage of premium, provided that the percentage does not vary because of the rating factors listed in subsection 2 . [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] D. A carrier may not terminate, fail to renew or limit its contract or agreement of representation with a representative for any reason related to the rating factors listed in subsection 2 . [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] E. Denial by a carrier of an application for coverage from an individual must be in writing and must state the reason or reasons for the denial. [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] F. The superintendent may establish rules setting forth additional standards to provide for the fair marketing and broad availability of individual health plans in this State. [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] G. A violation of this section by a carrier or a representative of the carrier is an unfair trade practice under chapter 23 . If a carrier enters into a contract, agreement or other arrangement with a 3rd-party administrator to provide administrative, marketing or other services related to the offering of individual health plans in this State, the 3rd-party administrator is subject to this section as if it were a carrier. [PL 1993, c. 477, Pt. C, §1 (NEW); PL 1993, c. 477, Pt. F, §1 (AFF).] [PL 2023, c. 405, Pt. A, §88 (AMD).]

7. Applicability. This section applies to all policies, plans, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after December 1, 1993 with the exception of short-term contracts, as defined in section 2849‑B . For purposes of this section, all contracts are deemed renewed no later than the next yearly anniversary of the contract date. [PL 1997, c. 445, §11 (AMD); PL 1997, c. 445, §32 (AFF).]

8. Authority of the superintendent. [PL 2011, c. 90, Pt. F, §1 (RP).]

9. Exemption for certain associations. The superintendent may exempt a group health insurance policy or group nonprofit hospital or medical service corporation contract issued to an association group, organized pursuant to section 2805‑A , from the requirements of subsection 3, paragraph A and subsection 6, paragraph A if: A. Issuance and renewal of coverage under the policy or contract is guaranteed to all members of the association who are residents of this State and to their dependents; [PL 1995, c. 570, §7 (NEW).] B. Rates for the association comply with the premium rate requirements of subsection 2 or are established on a nationwide basis and substantially comply with the purposes of this section, except that exempted associations may be rated separately from the carrier's other individual health plans, if any; [PL 1995, c. 570, §7 (NEW).] C. The group's anticipated loss ratio, as defined in subsection 5 , is at least 75%; [PL 1995, c. 570, §7 (NEW).] D. The association's membership criteria do not include age, health status, medical utilization history or any other factor with a similar purpose or effect; [PL 1995, c. 570, §7 (NEW).] E. The association's group health plan is not marketed to the general public; [PL 1995, c. 570, §7 (NEW).] F. The association does not allow insurance agents or brokers to market association memberships, accept applications for memberships or enroll members, except when the association is an association of insurance agents or brokers organized under section 2805‑A ; [PL 1995, c. 570, §7 (NEW).] G. Insurance is provided as an incidental benefit of association membership and the primary purposes of the association do not include group buying or mass marketing of insurance or other goods and services; and [PL 1995, c. 570, §7 (NEW).] H. Granting an exemption to the association does not conflict with the purposes of this section. [PL 1995, c. 570, §7 (NEW).] Except for individuals with grandfathered health plans under the federal Affordable Care Act, this subsection does not apply to policies, contracts or certificates that are executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 2014. [PL 2023, c. 405, Pt. A, §89 (AMD).]

10. Pilot projects; persons under 30 years of age. The superintendent shall authorize pilot projects in accordance with this subsection that allow a health insurance carrier that offers individual insurance, is marketing an individual insurance policy in this State and has a medical-loss ratio of at least 70% in the individual market to offer individual medical insurance products to persons under 30 years of age beginning July 1, 2009. A. The superintendent shall review pilot project proposals submitted in accordance with rules adopted pursuant to paragraph E. The superintendent shall approve a pilot project proposal if it meets the minimum benefit requirements set forth in rules adopted pursuant to paragraph E and may not approve a proposal that does not provide such minimum benefit requirements. [PL 2007, c. 629, Pt. I, §1 (NEW).] B. Notwithstanding any requirements in this Title for specific health services, specific diseases and certain providers of health care services, the superintendent may adopt minimum benefit requirements that exclude certain benefits if determined by the superintendent to provide affordable and attractive individual health plans for persons under 30 years of age. [PL 2007, c. 629, Pt. I, §1 (NEW).] C. A pilot project approved by the superintendent pursuant to this subsection qualifies as creditable coverage under this Title. Notwithstanding section 2849‑B, subsection 4 , a policy that replaces coverage issued under a pilot project approved under this subsection is not subject to any preexisting conditions exclusion provisions. Each carrier that offers an individual product pursuant to a pilot project approved under this subsection must combine the experience for that product with other individual products offered by that carrier as filed with the bureau when determining premium rates. The experience of a carrier's closed pool may not be taken into account in determining pilot project premium rates. [PL 2007, c. 629, Pt. I, §1 (NEW).] D. Beginning in 2010, the superintendent shall report by March 1st annually to the joint standing committee of the Legislature having jurisdiction over insurance matters on the status of any pilot project approved by the superintendent pursuant to this subsection. The report must include an analysis of the effectiveness of the pilot project in encouraging persons under 30 years of age to purchase insurance and an analysis of the impact of the pilot project on the broader insurance market, including any impact on premiums and availability of coverage. [PL 2007, c. 629, Pt. I, §1 (NEW).] E. The superintendent shall establish by rule procedures and policies that facilitate the implementation of a pilot project pursuant to this subsection, including, but not limited to, a process for submitting a pilot project proposal, minimum requirements for approval of a pilot project and any requirements for minimum benefits. Rules adopted pursuant to this paragraph are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A and must be adopted no later than 90 days after the effective date of this subsection. [PL 2007, c. 629, Pt. I, §1 (NEW).] [PL 2007, c. 629, Pt. I, §1 (NEW).]

11. Open enrollment; rules. Notwithstanding subsection 3 , on or after January 1, 2014, a carrier may restrict enrollment in individual health plans to open enrollment periods and special enrollment periods to the extent not inconsistent with applicable federal law. The superintendent may adopt rules establishing minimum open enrollment dates and minimum criteria for special enrollment periods for all individual health plans offered in this State. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2019, c. 5, Pt. A, §7 (AMD).]
24-A M.R.S. § 3552 — ME Code / Title 24-A / Chapter 49 / Section 3552
24-A §3552. Definitions; interpretation of chapter
Status: in_force

When used in this chapter, the following terms mean and include the following. [RR 2009, c. 2, §69 (COR).]

1. Acting director. Acting director means an acting director elected or appointed in accordance with this chapter. [PL 1969, c. 132, §1 (NEW).]

2. Acting officer. Acting officer means an acting officer appointed in accordance with this chapter. [PL 1969, c. 132, §1 (NEW).]

3. Acute emergency. Acute emergency means a period, as formally declared and proclaimed by the Governor of this State, in which, by reason of loss of life, epidemic disease, destruction or damage of property, contamination of property by radiological, chemical or bacteriological means, or disruption of the means of transportation or communication, resulting from an attack, it is impossible or impractical for the business of insurance in this State to be conducted in strict accord with the provision of law or charters applicable thereto. [PL 1969, c. 132, §1 (NEW).]

4. Attack. Attack means any attack, actual or imminent, or series of attacks by an enemy of a foreign nation upon the United States causing, or which may cause, substantial damage or injury to civilian property or persons in the United States in any manner by sabotage or by the use of bombs, shell fire, or atomic, radiological, chemical, bacteriological or biological means or other weapons or processes. [PL 1969, c. 132, §1 (NEW).]

5. Board. Board means the board of directors, board of trustees, committee or similar body having control of the affairs of an insurance organization. [PL 1969, c. 132, §1 (NEW).]

6. Charter. Charter means the certificate of organization or incorporation or special law incorporating a corporation together with its bylaws, or the agreement establishing a fund or association together with its constitution and bylaws. [PL 1969, c. 132, §1 (NEW).]

7. Superintendent. Superintendent means the State Insurance Superintendent or person duly designated to exercise the powers of that office during an attack or acute emergency. [PL 1973, c. 585, §12 (AMD).]

8. Director. Director means the director, trustee or member of the board. [PL 1969, c. 132, §1 (NEW).]

9. Domestic organization. Domestic organization means any insurance organization which is domiciled in this State. [PL 1969, c. 132, §1 (NEW).]

10. Insurance organization. Insurance organization means any insurer, rating organization, service or advisory organization, joint underwriting association, welfare or pension fund, which is subject, in whole or in part, to the insurance laws of this State. [PL 1969, c. 132, §1 (NEW).]

11. Officer. Officer means an officer of a domestic insurance organization. [PL 1969, c. 132, §1 (NEW).]

12. Quorum. Quorum means the minimum number of directors required by charter and bylaw, exclusive of the provisions of this chapter, to be present for valid action to be taken at a meeting of a board with respect to each particular item of business which may come before such meeting. [PL 1969, c. 132, §1 (NEW).]

This chapter does not and shall not be construed to limit the powers of, or permit or require, any insurance organization which is not domiciled in this State or of any branch office, or agents of such insurance organization, or the directors, officers, members, policyholders or stockholders of any such organization to act, or fail to act, in such fashion as would violate the laws of the jurisdiction wherein such organization has its domicile. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2704 — ME Code / Title 24-A / Chapter 33 / Section 2704
24-A §2704. Required provisions; captions -- omissions -- substitutions
Status: in_force

1. Except as provided in subsection 2 , each such policy delivered or issued for delivery to any person in this State shall contain the provisions specified in sections 2705 to 2716 , in the words in which the same appear; except that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded individually by the applicable caption shown, or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the superintendent may approve. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the superintendent, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of a provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 2271 — ME Code / Title 24-A / Chapter 24-B / Section 2271
24-A §2271. Rules
Status: in_force

The superintendent may adopt rules necessary to carry out the provisions of this chapter. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter 2‑A . [PL 2021, c. 24, §1 (NEW).]
24 M.R.S. § 2318-A — ME Code / Title 24 / Chapter 19 / Section 2318-A
24 §2318-A. Maternity and routine newborn care
Status: in_force

A nonprofit hospital or medical service organization that issues individual and group contracts and certificates providing maternity benefits, including benefits for childbirth, shall provide coverage for services related to maternity and routine newborn care, including coverage for hospital stay, in accordance with the attending physician's or attending certified nurse midwife's determination in conjunction with the mother that the mother and newborn meet the criteria outlined in the "Guidelines for Perinatal Care," published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. For the purposes of this section, "routine newborn care" does not include any services provided after the mother has been discharged from the hospital. For the purposes of this section, "attending physician" includes the obstetrician, pediatrician or other physician attending the mother and newborn. Benefits for routine newborn care required by this section are part of the mother's benefit. The mother and the newborn are treated as one person in calculating the deductible, coinsurance and copayments for coverage required by this section. [PL 2003, c. 517, Pt. B, §2 (AMD).]
24-A M.R.S. § 6613 — ME Code / Title 24-A / Chapter 81 / Section 6613
24-A §6613. Grounds for denial, suspension or revocation of arrangement
Status: in_force

1. Mandatory denial, suspension or revocation. Subject to other provisions of this chapter, the superintendent shall deny, suspend or revoke an arrangement's authorization if the superintendent finds that the arrangement: A. Is impaired within the meaning of section 6601, subsection 3 ; [PL 1993, c. 688, §1 (NEW).] B. Has refused to be examined or to produce its accounts, records and files for examination, or if any of its officers has refused to give information with respect to its affairs or to perform any other legal obligation as to such examination when required by the superintendent; [PL 1993, c. 688, §1 (NEW).] C. Has failed to pay a judgment rendered against it in the State within 30 days after the judgment becomes final; or [PL 1993, c. 688, §1 (NEW).] D. No longer meets the requirements for the authority originally granted. [PL 1993, c. 688, §1 (NEW).] [PL 1993, c. 688, §1 (NEW).]

2. Discretionary denial, suspension or revocation. The superintendent, in the superintendent's discretion, may deny, suspend or revoke the authorization of an arrangement if the superintendent finds that the arrangement: A. Has violated this chapter or a lawful order or rule of the superintendent; [PL 1993, c. 688, §1 (NEW).] B. Has refused to be examined or to produce its accounts, records and files for examination, or if any of its officers have refused to give information with respect to its affairs or to perform any other legal obligation as to such examination when required by the superintendent; or [PL 1993, c. 688, §1 (NEW).] C. Has failed to correct any deficiency determined pursuant to section 6610 . [PL 1993, c. 688, §1 (NEW).] [PL 1993, c. 688, §1 (NEW).]