24-A M.R.S. § 4320-N — ME Code / Title 24-A / Chapter 56-A / Section 4320-N
24-A §4320-N. Step therapy (REALLOCATED FROM TITLE 24-A, SECTION 4320-M)
Status: in_force

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

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Clinical practice guidelines" means a systematically developed statement to assist prescriber and enrollee decisions about appropriate health care for specific clinical circumstances and conditions. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] A-1. "Associated conditions" means the symptoms or side effects associated with metastatic cancer or its treatment and that, in the judgment of the health care practitioner, further jeopardize the health of a patient if left untreated. [PL 2025, c. 448, §1 (NEW).] B. "Clinical review criteria" means the written screening procedures, decision abstracts, clinical protocols and practice guidelines used by a carrier or utilization review organization to determine the medical necessity and appropriateness of health care services. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] C. "Medically necessary," with respect to health services and supplies, means appropriate, under the applicable standard of care, to improve or preserve health, life or function; to slow the deterioration of health, life or function; or for the early screening, prevention, evaluation, diagnosis or treatment of a disease, condition, illness or injury. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] C-1. "Metastatic cancer" means cancer that has spread from the primary or original site of the cancer to nearby tissues, lymph nodes or other areas or parts of the body. [PL 2025, c. 448, §2 (NEW).] D. "Pharmaceutical sample" means a unit of a prescription drug that is not intended to be sold and is intended to promote the sale of the drug. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] D-1. "Serious mental illness" means a mental disorder, as defined in the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders published by the American Psychiatric Association, that results in serious functional impairment that substantially interferes with or limits one or more major life activities. [PL 2021, c. 345, §2 (NEW); PL 2021, c. 345, §6 (AFF).] E. "Stable on a prescription drug" means, with respect to an enrollee, receiving a positive therapeutic outcome on a prescription drug selected by the enrollee's health care provider for the enrollee's medical condition. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] F. "Step therapy override exception determination" means a determination based on a review of an enrollee's or prescriber's request for an override, along with supporting rationale and documentation, that the step therapy protocol should be overridden in favor of immediate coverage of the health care provider's selected prescription drug. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] G. "Step therapy protocol" means a protocol that establishes a specific sequence in which prescription drugs for a specified medical condition are medically necessary for a particular enrollee and are covered under a pharmacy or medical benefit by a carrier, including self‑administered and physician‑administered drugs. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] H. "Utilization review organization" means an entity that conducts a utilization review, other than a carrier performing a utilization review for its own health benefit plans. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] [PL 2025, c. 448, §§1, 2 (AMD).]

2. Clinical review criteria. Clinical review criteria used to establish a step therapy protocol must be based on clinical practice guidelines that: A. Recommend that the prescription drugs be taken in the specific sequence required by the step therapy protocol; [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] B. Are developed and endorsed by a multidisciplinary panel of experts that manages conflicts of interest among the members of the writing and review groups by: (1) Requiring members to disclose any potential conflicts of interest with entities, including carriers and pharmaceutical manufacturers, and recuse themselves from voting if they have a conflict of interest; (2) Using a methodologist to work with writing groups to provide objectivity in data analysis and ranking of evidence through the preparation of evidence tables and facilitating consensus; and (3) Offering opportunities for public review and comments; [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] C. Are based on high‑quality studies, research and medical practice; [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] D. Are created by an explicit and transparent process that: (1) Minimizes biases and conflicts of interest; (2) Explains the relationship between treatment options and outcomes; (3) Rates the quality of the evidence supporting recommendations; and (4) Considers relevant patient subgroups and preferences; and [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] E. Are continually updated through a review of new evidence, research and newly developed treatments. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).]

3. Absence of clinical practice guidelines. In the absence of clinical practice guidelines that meet the requirements in subsection 2 , peer‑reviewed publications may be substituted. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).]

4. Consideration of atypical populations and diagnoses. When establishing a step therapy protocol, a utilization review organization shall also take into account the needs of atypical patient populations and diagnoses when establishing clinical review criteria. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).]

5. Construction. This section may not be construed to require carriers or the State to set up a new entity to develop clinical review criteria used for step therapy protocols. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).]

6. Exceptions process. When coverage of a prescription drug for the treatment of any medical condition is restricted for use by a carrier or utilization review organization through the use of a step therapy protocol, the enrollee and prescriber must have access to a clear, readily accessible and convenient process to request a step therapy override exception determination from that carrier or utilization review organization. A. A carrier or utilization review organization may use its existing medical exceptions process to provide step therapy override exception determinations, and the process established must be easily accessible on the carrier's or utilization review organization's website. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] B. A carrier or utilization review organization shall expeditiously grant a step therapy override exception determination if: (1) The required prescription drug is contraindicated or will likely cause an adverse reaction in or physical or mental harm to the enrollee; (2) The required prescription drug is expected to be ineffective based on the known clinical characteristics of the enrollee and the known characteristics of the prescription drug regimen; (3) The enrollee has tried the required prescription drug while under the enrollee's current or previous health insurance or health plan, or another prescription drug in the same pharmacologic class or with the same mechanism of action, and the prescription drug was discontinued due to lack of efficacy or effectiveness, diminished effect or an adverse reaction; (4) The required prescription drug is not in the best interest of the enrollee, based on medical necessity; (5) The enrollee is stable on a prescription drug selected by the enrollee's health care provider for the medical condition under consideration while on a current or previous health insurance or health plan; or (6) The prescription drug selected by the enrollee's health care provider is intended to assess or treat the enrollee's serious mental illness. Nothing in this paragraph may be construed to encourage the use of a pharmaceutical sample for the sole purpose of meeting the requirements for the granting of a step therapy override exception determination. [PL 2021, c. 345, §§3-5 (AMD); PL 2021, c. 345, §6 (AFF).] C. Upon the granting of a step therapy override exception determination, the carrier or utilization review organization shall authorize coverage for the prescription drug prescribed by the prescriber. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] D. A carrier or utilization review organization shall grant or deny a request for a step therapy override exception determination or an appeal of a determination within 72 hours, or 2 business days, whichever is less, after receipt of the request. If exigent circumstances, as described in section 4311, subsection 1‑A, paragraph B , exist, a carrier or utilization review organization shall grant or deny the request within 24 hours after receipt of the request. The carrier shall provide coverage for the prescription drug prescribed by the prescriber during the pendency of the request for a step therapy override exception determination or an appeal of a determination. If a carrier or utilization review organization does not grant or deny the request within the time required under this paragraph, the exception or appeal is granted. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] E. An enrollee may appeal a step therapy override exception determination. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] F. This section does not prevent: (1) A carrier or utilization review organization from requiring an enrollee to try a generic drug, as defined in Title 32, section 13702‑A, subsection 14 , or an interchangeable biological product, as defined in Title 32, section 13702‑A, subsection 14‑A , prior to providing coverage for the equivalent brand-name prescription drug; or (2) A health care provider from prescribing a prescription drug that is determined to be medically necessary. [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).] [PL 2021, c. 345, §§3-5 (AMD); PL 2021, c. 345, §6 (AFF).]

7. Rules. The superintendent may adopt rules to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2019, c. 295, §1 (NEW); PL 2019, c. 295, §2 (AFF); RR 2019, c. 1, Pt. A, §26 (RAL).]

8. Step therapy for metastatic cancer and associated conditions prohibited. Notwithstanding subsection 6, paragraph B, with respect to coverage of a prescription drug on a carrier's formulary for the treatment of metastatic cancer and associated conditions, a carrier or utilization review organization may not require that the enrollee use a step therapy protocol before the carrier provides coverage of a prescription drug approved by the United States Food and Drug Administration. [PL 2025, c. 448, §3 (NEW).]
24-A M.R.S. § 4233-C — ME Code / Title 24-A / Chapter 56 / Section 4233-C
24-A §4233-C. Mandatory offer of coverage for certain adults with disabilities
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Dependent child" has the same meaning as in section 4233‑B, subsection 1 . [PL 2021, c. 520, §6 (NEW).] B. "Disability" means a physical, mental, intellectual or developmental disability that renders a person incapable of self-sustaining employment. [PL 2021, c. 520, §6 (NEW).] [PL 2021, c. 520, §6 (NEW).]

2. Offer of coverage. An individual or group health maintenance organization contract that offers coverage for a dependent child must offer such coverage, at the option of the parent, for a dependent child with a disability, regardless of age. [PL 2021, c. 520, §6 (NEW).]

3. Proof of disability. A parent shall furnish proof of a dependent child's disability to the insurer within 31 days of the dependent child's attainment of the limiting age established in section 4233‑B, subsection 2 and subsequently as may be required by the insurer, but the insurer may not require proof more frequently than annually after the 2-year period following the dependent child's attainment of the limiting age. [PL 2021, c. 520, §6 (NEW).]
24-A M.R.S. § 2911 — ME Code / Title 24-A / Chapter 39 / Section 2911
24-A §2911. Title
Status: in_force

This subchapter shall be known as the "Maine Automobile Insurance Cancellation Control Act." Unless otherwise specified, all hearings held under this subchapter shall conform to the procedures set forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV . [PL 1977, c. 694, §425 (AMD).]
24-A M.R.S. § 1152 — ME Code / Title 24-A / Chapter 13-A / Section 1152
24-A §1152. Eligibility of investments
Status: in_force

1. Eligible investments. Insurers shall invest in or lend their funds on the security of and shall hold as eligible investments only those as prescribed or permitted in this chapter. [PL 1987, c. 399, §14 (NEW).]

2. Prior investments. Any particular investment held by an insurer on the effective date of this chapter, which was a legal investment at the time it was made, and which the insurer was legally entitled to possess immediately before the effective date of this chapter, shall be considered an eligible investment. [PL 1987, c. 399, §14 (NEW).]

3. Eligibility date. Eligibility of an investment shall be determined as of the date of its making or acquisition, except as stated in subsection 2 , or in section 1153, subsection 3 , or in section 1156, subsection 2, paragraph H , subparagraph (4). [PL 1987, c. 399, §14 (NEW).]

4. Basis for limitation or diversification. Any investment limitation or diversification requirement based upon the amount of the insurer's assets or particular funds must relate to such assets or funds as shown by the insurer's annual or quarterly statement as of the statement date immediately preceding the date of acquisition of the investment by the insurer, or as shown by a current applicable financial statement, prepared on the same basis as that annual or quarterly statement, resulting from merger with another insurer, bulk reinsurance or change in capitalization. [PL 2017, c. 169, Pt. A, §7 (AMD).]

5. Capital loans. Nothing in this chapter prohibits an insurer from advancing funds to another insurer upon the type of agreement provided for in section 3415 , borrowed capital funds, and subject to the terms of that section. [PL 1987, c. 399, §14 (NEW).]
24-A M.R.S. § 5079 — ME Code / Title 24-A / Chapter 68-A / Section 5079
24-A §5079. Penalties
Status: in_force

In addition to any other penalties provided by this Title or the laws of this State, an insurer or insurance producer that violates any requirement of this chapter or rule adopted pursuant to this chapter relating to the regulation of long-term care insurance or the marketing of such insurance is subject to a fine of up to the greater of 3 times the amount of commissions paid for each policy involved in the violation or $10,000. [PL 1999, c. 292, §2 (NEW).]
24-A M.R.S. § 6212 — ME Code / Title 24-A / Chapter 73 / Section 6212
24-A §6212. Discharge of subscriber prior to expiration of agreement
Status: in_force

No agreement for continuing care shall permit dismissal or permanent discharge of the subscriber from the facility providing care prior to the expiration of the agreement without just cause for such a removal and without providing at least 60 days' advance notice in writing to the subscriber. [PL 1987, c. 482, §1 (NEW).]
24-A M.R.S. § 2812-A — ME Code / Title 24-A / Chapter 35 / Section 2812-A
24-A §2812-A. Dividends and experience refunds
Status: in_force

The following requirements apply to all group health insurance with the exception of insurance in which the policyholder is subject to the fiduciary standards of the federal Employee Retirement Income Security Act of 1974, ERISA, 29 United States Code, Section 1001‑1381 (1975). [PL 1991, c. 200, Pt. D, §4 (NEW).]

1. Refunds. The amount by which any dividend, experience refund or rate reduction exceeds the amount of premium contributed by the group policyholder for the same period must be refunded to the employees, members or debtors in proportion to their premium contributions for that period, except as provided in subsection 2 . [PL 1991, c. 200, Pt. D, §4 (NEW).]

2. Refund amounts less than $25 per employee, member or debtor. If the refunds required by subsection 1 would average less than $25 per employee, member or debtor, then the group policyholder may request approval from the superintendent to apply those amounts in a different manner. The superintendent shall approve the request if, in the superintendent's opinion, the manner of application proposed would be for the sole benefit of insured employees, members or debtors. [PL 1991, c. 200, Pt. D, §4 (NEW).]
24-A M.R.S. § 731-B — ME Code / Title 24-A / Chapter 9 / Section 731-B
24-A §731-B. Credit for reinsurance
Status: in_force

1. Except to the extent that the liabilities ceded are secured in accordance with subsection 3 , credit for reinsurance is allowed a domestic ceding insurer as either an asset or a deduction from liability on account of reinsurance ceded only when the reinsurance is ceded to a solvent assuming insurer that: A. Is licensed to transact insurance or reinsurance in this State, provided the assuming insurer maintains surplus as regards policyholders in an amount not less than the sum of paid-in capital stock, if any, and surplus as otherwise required for a certificate of authority for the kinds and amount of insurance and assumed reinsurance the insurer has in force net of any applicable ceded reinsurance. If the assuming insurer is licensed as a special purpose reinsurance vehicle pursuant to section 782 and maintains capital and surplus in accordance with the requirements of section 787 , credit for reinsurance under a special purpose reinsurance vehicle contract, as defined in section 781, subsection 15 , is allowed only to the extent that: (1) The fair value of the assets held by or for the benefit of the ceding insurer equals or exceeds the obligations due and payable to the ceding insurer by the special purpose reinsurance vehicle under the special purpose reinsurance vehicle contract; (2) The assets are held in accordance with the requirements in subchapter 6 ; (3) The assets are administered in the manner and pursuant to arrangements under subchapter 6 ; (4) The assets are held or invested in one or more of the forms allowed in section 795 ; and (5) The contract complies with all other relevant requirements of subchapter 6 ; [PL 2007, c. 386, §1 (AMD).] B. Is domiciled and licensed in a state that employs standards regarding credit for reinsurance substantially similar to those applicable under this section, if the insurer: (1) Submits to the authority of this State to examine its books and records; and (2) Except where reinsurance is ceded and assumed pursuant to pooling arrangements among insurers in the same holding company system, maintains a surplus regarding policyholders in an amount not less than $20,000,000; [PL 1991, c. 828, §16 (AMD).] B-1. Is accredited as a reinsurer in this State, in accordance with the following standards. (1) To apply for accreditation, a reinsurer shall file with the superintendent a written application on a form prescribed by the superintendent, accompanied by the fee prescribed in section 601, subsection 26 and an agreement to submit to the jurisdiction of the courts of this State and to the authority of the superintendent to examine the reinsurer's books and records. (2) An accredited reinsurer must be licensed to transact insurance or reinsurance in at least one state, or in the case of a United States branch of an alien reinsurer, that reinsurer must be entered through and licensed to transact insurance or reinsurance in at least one state. (3) An accredited reinsurer shall file with the superintendent, as part of its application and annually thereafter, a copy of its annual statement filed with the insurance department of its state of domicile or United States port of entry and a copy of its most recent audited financial statement. (4) A reinsurer applying for accreditation that maintains a surplus as regards to policyholders in an amount not less than $20,000,000 is deemed to be accredited if the reinsurer's application is not denied by the superintendent within 90 days after submission of the application. The superintendent has the discretion to grant accreditation to an applicant with a surplus less than $20,000,000 subject to such terms and conditions as the superintendent determines to be necessary and appropriate for the protection of domestic ceding insurers and their policyholders; [PL 2021, c. 16, §6 (AMD).] B-2. Is certified as a reinsurer in this State and secures its obligations in accordance with this paragraph. (1) To be eligible for certification, the assuming insurer must meet the following requirements: (a) The assuming insurer must be domiciled and licensed to transact insurance or reinsurance in a jurisdiction determined by the superintendent to be a qualified jurisdiction pursuant to subparagraph (3); (b) The assuming insurer must maintain minimum capital and surplus, or its equivalent, in an amount to be determined by the superintendent pursuant to rules adopted under subsection 7 ; (c) The assuming insurer must maintain financial strength ratings from 2 or more rating agencies determined by the superintendent to be acceptable pursuant to rules adopted under subsection 7 ; (d) The assuming insurer must agree to submit to the jurisdiction of this State and to appoint an agent for service of process in the same manner as provided for authorized insurers under section 421 and agree to provide security for 100% of the assuming insurer's liabilities attributable to reinsurance ceded by United States ceding insurers if the assuming insurer resists enforcement of a final United States judgment; (e) The assuming insurer must agree to meet applicable information filing requirements as determined by the superintendent, both with respect to an initial application for certification and on an ongoing basis. Documents filed with the superintendent by the assuming insurer are not public records if the documents are confidential under the laws of the assuming insurer's domiciliary jurisdiction; (f) The assuming insurer must pay the application fee prescribed in section 601, subsection 26‑A and, to the extent provided in rules adopted under subsection 7 , must agree to pay reasonable costs of review; and (g) The assuming insurer must satisfy any other requirements for certification established by the superintendent. (2) An association including incorporated and individual unincorporated underwriters may be a certified reinsurer. In order to be eligible for certification, in addition to satisfying the requirements of subparagraph (1): (a) The association may satisfy its minimum capital and surplus requirements through the capital and surplus equivalents, net of liabilities, of the association and its members, which must include a joint central fund that may be applied to any unsatisfied obligation of the association or any of its members, in an amount determined by the superintendent to provide adequate protection; (b) The incorporated members of the association may not be engaged in any business other than underwriting as a member of the association and must be subject to the same level of regulation and solvency control by the association's domiciliary regulator as are the unincorporated members; and (c) Within 90 days after its financial statements are due to be filed with the association's domiciliary regulator, the association shall provide to the superintendent an annual certification by the association's domiciliary regulator of the solvency of each underwriter member of the association or, if a certification is unavailable, financial statements, prepared by independent public accountants, of each underwriter member of the association. (3) The superintendent shall create and publish a list of jurisdictions that are qualified to serve as the domiciliary regulators of certified reinsurers. (a) In order to determine whether the domiciliary jurisdiction of an alien assuming insurer is eligible to be recognized as a qualified jurisdiction, the superintendent shall evaluate the appropriateness and effectiveness of the reinsurance supervisory system of the jurisdiction, both initially and on an ongoing basis, and consider the rights, benefits and the extent of reciprocal recognition afforded by the jurisdiction to reinsurers licensed and domiciled in the United States. To be recognized as qualified, a jurisdiction must agree to share information and cooperate with the superintendent with respect to all certified reinsurers domiciled within that jurisdiction. A jurisdiction may not be recognized as a qualified jurisdiction if the superintendent has determined that the jurisdiction does not adequately and promptly enforce final United States judgments and arbitration awards. The superintendent may consider additional factors. (b) If the National Association of Insurance Commissioners has published a list of recommended qualified jurisdictions, the superintendent shall consider that list in determining qualified jurisdictions. If the superintendent recognizes a jurisdiction as qualified that does not appear on the list published by the National Association of Insurance Commissioners, the superintendent shall make detailed findings of fact supporting the recognition in accordance with criteria to be developed in rules adopted under subsection 7 . (c) United States jurisdictions that are accredited by the National Association of Insurance Commissioners must be recognized as qualified jurisdictions. (d) If a certified reinsurer's domiciliary jurisdiction ceases to be a qualified jurisdiction, the superintendent may suspend the reinsurer's certification indefinitely, in lieu of revocation. (4) The superintendent shall assign a rating to each certified reinsurer, giving due consideration to the financial strength ratings that have been assigned by rating agencies determined to be acceptable pursuant to rules adopted under subsection 7 . The superintendent shall publish a list of all certified reinsurers and their ratings. (5) A certified reinsurer shall secure all obligations assumed from United States ceding insurers under this subsection, and under comparable laws of other states, at a level consistent with its rating and in a form acceptable to the superintendent, in compliance with rules adopted under subsection 7 . (a) If the security is insufficient, the superintendent shall reduce the allowable credit by an amount proportionate to the deficiency and may impose further reductions in allowable credit upon finding that there is a material risk that the certified reinsurer's obligations will not be paid in full when due. (b) The reinsurer may secure its obligations as a certified reinsurer through a multibeneficiary trust that meets the requirements of paragraph C and subsection 2‑A , with the following modifications. (i) The maximum credit allowable may exceed the value of the qualifying security to the extent provided in this subparagraph. (ii) The minimum trusteed surplus is $10,000,000, rather than the amount specified in paragraph C . (iii) If the certified reinsurer also maintains a multibeneficiary trust for obligations required to be fully secured under paragraph C or comparable laws of other states, the certified reinsurer shall maintain separate trust accounts for its obligations incurred under reinsurance agreements issued or renewed with reduced security as permitted by this paragraph or comparable laws of other United States jurisdictions and for its obligations that are required to be fully secured. The trust accounts may not be approved as qualifying security unless the reinsurer has bound itself, by the language of the trust and by agreement with the insurance regulator with principal oversight of each such trust account, to apply, upon termination of any such trust account, the remaining surplus of that trust to the extent necessary to fund any deficiency of any other such trust account. (c) If a certified reinsurer does not secure its obligations through a qualifying multibeneficiary trust, it must secure its obligations to the ceding insurer consistent with the requirements of subsection 3 , except that the maximum credit allowable may exceed the value of the qualifying security to the extent provided in this subparagraph. (d) For purposes of this subparagraph, a certified reinsurer whose certification has been terminated for any reason must be treated as a certified reinsurer required to secure 100% of its obligations, unless the superintendent has continued to assign a higher rating, as permitted by other provisions of this section, to a certified reinsurer in inactive status or to a reinsurer whose certification has been suspended. (6) If an applicant for certification has been certified as a reinsurer in a jurisdiction accredited by the National Association of Insurance Commissioners, the superintendent may defer to that jurisdiction's certification to grant certification in this State and may defer to the rating assigned by that jurisdiction. (7) A certified reinsurer that ceases to assume new business in this State may request to maintain its certification in inactive status in order to continue to qualify for a reduction in security for its in-force business. An inactive certified reinsurer shall continue to comply with all applicable requirements of this subsection, and the superintendent shall assign a rating that takes into account, if relevant, the reasons why the reinsurer is not assuming new business; [PL 2021, c. 16, §6 (AMD).] B-3. Meets each of the conditions established in subparagraphs (2) to (8). (1) For purposes of this paragraph, the following terms have the following meanings. (a) "Covered agreement" means an agreement, entered into pursuant to the federal Dodd-Frank Wall Street Reform and Consumer Protection Act, 31 United States Code, Sections 313 and 314, that is in effect or in a period of provisional application and addresses the elimination, under specified conditions, of collateral requirements as a condition for entering into any reinsurance agreement with a ceding insurer domiciled in this State or for allowing the ceding insurer to recognize credit for reinsurance. (b) "Reciprocal jurisdiction" means a jurisdiction that is: (i) A non-United States jurisdiction that is subject to an in-force covered agreement with the United States, as long as each agreeing jurisdiction is within its legal authority to enter the agreement, or, in the case of a covered agreement between the United States and the European Union, a member state of the European Union; (ii) A United States jurisdiction that meets the requirements for accreditation under the financial regulation standards and accreditation program of the National Association of Insurance Commissioners; or (iii) A qualified jurisdiction, as determined by the superintendent pursuant to paragraph B‑2 , subparagraph (3), that meets certain additional requirements, consistent with the terms and conditions of covered agreements, as specified by the superintendent by rule. (2) The assuming insurer must have its domicile or head office in, and be licensed in, a reciprocal jurisdiction. (3) The assuming insurer must have and maintain on an ongoing basis minimum capital and surplus, or its equivalent, calculated according to the methodology applicable in its domiciliary jurisdiction, in an amount established by rule. If the assuming insurer is an association that includes incorporated and individual unincorporated underwriters, it must have and maintain on an ongoing basis minimum capital and surplus equivalents, net of liabilities, calculated according to the methodology applicable in its domiciliary jurisdiction, and a central fund containing a balance in amounts established by rule. (4) The assuming insurer must have and maintain on an ongoing basis a minimum solvency or capital ratio, as applicable, as established by rule. If the assuming insurer is an association that includes incorporated and individual unincorporated underwriters, it must have and maintain on an ongoing basis a minimum solvency or capital ratio, as applicable, in the jurisdiction where the assuming insurer has its head office or is domiciled, as applicable. (5) The assuming insurer must agree, and provide adequate assurance to the superintendent in a form specified by the superintendent by rule, as follows: (a) The assuming insurer must provide prompt written notice and explanation to the superintendent if it fails to meet the minimum requirements set forth in subparagraph (3) or (4) or if any regulatory action is taken against it for serious noncompliance with applicable law; (b) The assuming insurer must consent in writing to the jurisdiction of the courts of this State and to the appointment of the superintendent as agent for service of process. The superintendent may require the assuming insurer to include such consent in each reinsurance agreement for which credit is taken under this paragraph. This division does not limit or in any way alter the capacity of parties to a reinsurance agreement to agree to alternative dispute resolution mechanisms, except to the extent that such agreements are unenforceable under applicable insolvency or delinquency laws; (c) The assuming insurer must consent in writing to pay all final judgments, wherever enforcement is sought, that are obtained by a ceding insurer or its legal successor and that have been declared enforceable in the jurisdiction where the judgment was obtained; (d) Each reinsurance agreement for which credit is taken under this paragraph must include a provision requiring the assuming insurer to provide security for the full amount of the assuming insurer's liabilities attributable to reinsurance ceded pursuant to that agreement if the assuming insurer resists enforcement of a final judgment that is enforceable under the law of the jurisdiction where the final judgment was obtained or resists enforcement of a properly enforceable arbitration award, whether the judgment or award is obtained by the ceding insurer or by its legal successor on behalf of its resolution estate. As used in this division, "resolution estate" means the estate of an insurer or reinsurer that has been placed into a receivership or comparable legal status; and (e) The assuming insurer must confirm that it is not participating in any solvent scheme of arrangement that involves this State's ceding insurers and must agree to notify the ceding insurer and the superintendent and to provide security for the full amount of the assuming insurer's liabilities to the ceding insurer should the assuming insurer enter into such a solvent scheme of arrangement. Such security must be in a form consistent with the provisions of paragraph B‑2 and subsection 3 and as specified by the superintendent by rule. (6) The assuming insurer or its legal successor must provide, on behalf of itself and any legal predecessors, certain documentation to the superintendent as specified by the superintendent by rule, if requested by the superintendent. (7) The assuming insurer must maintain a practice of prompt payment of claims under reinsurance agreements, pursuant to criteria established by rule. (8) The supervisory authority for insurance for the jurisdiction of the assuming insurer must confirm to the superintendent on an annual basis that, as of the preceding December 31st or the annual date specified in statute for reporting to that supervisory authority in the assuming insurer's jurisdiction, the assuming insurer complies with the requirements of subparagraphs (3) and (4). (9) The assuming insurer may provide additional information on a voluntary basis. (10) The superintendent shall promptly create, publish and administer a list of reciprocal jurisdictions as described in this subparagraph. (a) The superintendent shall include all reciprocal jurisdictions identified in subparagraph (1), division (b), subdivisions (i) and (ii) in the list maintained pursuant to this subparagraph. (b) If the National Association of Insurance Commissioners has published a list of recommended reciprocal jurisdictions, the superintendent shall consider that list and may defer to that list in determining whether a jurisdiction qualifies as a reciprocal jurisdiction pursuant to subparagraph (1), division (b), subdivision (iii). The superintendent may determine that a jurisdiction that does not appear on the recommended list is a reciprocal jurisdiction in accordance with criteria established in rules adopted by the superintendent. (c) If a jurisdiction has been determined to be a reciprocal jurisdiction pursuant to subparagraph (1), division (b), subdivision (iii), the superintendent, in accordance with a process established by rule by the superintendent, may determine that the jurisdiction is no longer a reciprocal jurisdiction and remove it from the list of reciprocal jurisdictions upon a determination that the jurisdiction no longer meets the conditions of this paragraph. Upon removal of a reciprocal jurisdiction from the list, credit for reinsurance ceded to an assuming insurer that has its head office or is domiciled in that jurisdiction is allowed only as otherwise allowed pursuant to this section. (11) The superintendent shall promptly create, publish and administer a list of assuming insurers that have satisfied the conditions set forth in subparagraphs (2) to (8) for recognition for credit for reinsurance. The superintendent may add an assuming insurer to the list if it has been listed under a substantially similar law by a jurisdiction accredited by the National Association of Insurance Commissioners or if, upon a request for recognition of eligibility, the assuming insurer submits the information to the superintendent as required under subparagraph (5) and complies with any additional requirements that the superintendent may impose by rule, except to the extent that those requirements conflict with an applicable covered agreement. (12) If the superintendent determines that an assuming insurer no longer meets one or more of the conditions of this paragraph, the superintendent may suspend or revoke the recognition of the assuming insurer for credit for reinsurance under this paragraph in accordance with procedures established by rule. (a) While an assuming insurer's recognition for credit is suspended, a reinsurance agreement issued, amended or renewed after the effective date of the suspension does not qualify for credit under this paragraph. Credit may be granted only to the extent that the assuming insurer's obligations under the contract are secured in accordance with other provisions of this subsection or with subsection 3 . (b) If an assuming insurer's recognition for credit is revoked, credit for reinsurance may not be granted after the effective date of the revocation with respect to any reinsurance agreements entered into by the assuming insurer, including reinsurance agreements entered into before the date of revocation, except to the extent that the assuming insurer's obligations under the contract are secured in a form acceptable to the superintendent and consistent with other provisions of this subsection or with subsection 3 . (13) If a ceding insurer that has been granted credit under this paragraph is subject to a legal process of rehabilitation, liquidation or conservation, the ceding insurer or its representative may seek and, if determined appropriate by the court in which the proceedings are pending, may obtain an order requiring the assuming insurer to post security for all outstanding ceded liabilities. (14) This paragraph does not limit or in any way alter the capacity of parties to a reinsurance agreement to agree on requirements for security or other terms in that reinsurance agreement, except as expressly prohibited by this section or other applicable law or rule. (15) Credit under this paragraph may be taken only for reinsurance pursuant to reinsurance agreements entered into, renewed or amended on or after the effective date of this paragraph and only with respect to losses incurred or reserves reported on or after the date on which the assuming insurer has met all eligibility requirements pursuant to subparagraphs (2) to (8) or the effective date of the new reinsurance agreement, amendment or renewal, whichever is later. This subparagraph does not alter or impair a ceding insurer's right to take credit for reinsurance, to the extent that credit is not available under this paragraph, as long as the reinsurance qualifies for credit under any other applicable provision of this section. (16) Nothing in this paragraph: (a) Authorizes an assuming insurer to withdraw or reduce the security provided under any reinsurance agreement except as permitted by the terms of the agreement; or (b) Limits, or in any way alters, the capacity of parties to any reinsurance agreement to renegotiate the agreement; [PL 2021, c. 16, §6 (NEW).] C. Maintains a trust fund in a qualified United States financial institution for the payment of the valid claims of its United States ceding insurers, their assigns and successors in interest. (1) The assuming insurer shall report annually to the superintendent information substantially the same as that required to be reported on the National Association of Insurance Commissioners Annual Statement form by licensed insurers to enable the superintendent to determine the sufficiency of the trust fund. (2) In the case of a single assuming insurer, the trust must consist of a trusteed account representing the assuming insurer's liabilities attributable to reinsurance ceded by United States ceding insurers and, in addition, unless the assuming insurer has permanently discontinued underwriting new business secured by the trust for at least 3 full years, must include a trusteed surplus of at least $20,000,000. The trust must provide that after the assuming insurer has permanently discontinued underwriting new business secured by the trust for at least 3 full years, the insurance regulator with principal oversight of the trust may authorize a reduction in the required trusteed surplus, but only after a finding, based on an assessment of the risk, that the new required surplus level is adequate for the protection of United States ceding insurers, policyholders and claimants in light of reasonably foreseeable adverse loss development. The risk assessment may involve an actuarial review, including an independent analysis of reserves and cash flows, and must consider all material risk factors, including when applicable the lines of business involved, the stability of the incurred loss estimates and the effect of the surplus requirements on the assuming insurer's liquidity or solvency. The minimum required trusteed surplus may not be reduced to an amount less than 30% of the assuming insurer's liabilities attributable to reinsurance ceded by United States ceding insurers covered by the trust. (3-A) A group including incorporated and individual unincorporated underwriters may secure its obligations with funds held in trust in compliance with the following standards. (a) For reinsurance ceded under reinsurance agreements with an inception, amendment or renewal date on or after January 1, 1993, the trust must consist of a trusteed account in an amount at least equal to the respective underwriters' several liabilities attributable to reinsurance ceded by United States domiciled ceding insurers to any underwriter that is a member of the group. (b) Notwithstanding the other provisions of this section, for reinsurance ceded under reinsurance agreements with an inception date on or before December 31, 1992 and not amended or renewed after that date, the trust must consist of a trusteed account in an amount not less than the respective underwriters' several insurance and reinsurance liabilities attributable to business written in the United States. (c) In addition, the group shall maintain a trusteed surplus of at least $100,000,000 held jointly for the benefit of the United States domiciled ceding insurers of any member of the group for all years of account. An incorporated member of the group may not be engaged in any business other than underwriting as a member of the group and is subject to the same level of solvency regulation and control by the group's domiciliary regulator as are the unincorporated members. Within 90 days after its financial statements are due to be filed with the group's domiciliary regulator, the group shall provide to the superintendent an annual certification by the group's domiciliary regulator of the solvency of each underwriter member of the group or, if a certification is unavailable, financial statements prepared by independent public accountants. (4-A) The superintendent in rules adopted pursuant to subsection 7 may establish alternative criteria for approval of a reinsurance trust if the superintendent determines that the criteria provide adequate protection to policyholders of United States ceding insurers and are in substantial conformance with standards approved by the National Association of Insurance Commissioners. (5) The trust must be established in a form approved by the superintendent and consistent with any rules adopted by the superintendent pursuant to this section. The form of the trust and any amendments to the trust must also have been approved by the insurance regulatory official of the state where the trust is domiciled or of another state that, pursuant to the terms of the trust instrument, has accepted principal regulatory oversight of the trust. The trust instrument must provide that contested claims are valid and enforceable upon the final order of any court of competent jurisdiction in the United States. The trust must vest legal title to its assets in the trustees of the trust for the benefit of the assuming insurer's United States ceding insurers, their assigns and successors in interest. The trust and the assuming insurer are subject to examination, as determined by the superintendent, at the assuming insurer's expense. The trust must remain in effect for as long as the assuming insurer has outstanding obligations due under the reinsurance agreements subject to the trust. (6) The trustees of the trust shall report to the superintendent in writing by February 28th of each year, setting forth the balance of the trust and listing the trust's investments at the end of the preceding year and certifying the date of termination of the trust, if so planned, or certifying that the trust does not expire before December 31st of the current year. (7) The corpus of the trust is to be valued as any other admitted asset or assets; or [PL 2021, c. 16, §6 (AMD).] D. Does not meet the requirements of paragraph A , B , B‑1 , B‑2 , B‑3 or C , but only with respect to risks located in a jurisdiction where that reinsurance is required by law. The superintendent may waive the requirements of subsections 2 and 5 to the extent that compliance with those requirements is not feasible for compulsory reinsurance subject to this paragraph. The superintendent for good cause after notice and opportunity for hearing may disallow or reduce the credit otherwise permitted under this paragraph. [PL 2021, c. 16, §6 (AMD).] [PL 2021, c. 16, §6 (AMD).]

1-A. The superintendent may suspend or revoke a reinsurer's accreditation or certification under subsection 1 , after notice and opportunity for hearing, for failure to meet the applicable requirements of subsection 1 or on any ground that would warrant similar action against the certificate of authority of an authorized insurer. A. A suspension or revocation under this subsection may not take effect until after the superintendent's order following a hearing, unless: (1) The reinsurer waives its right to a hearing; (2) The superintendent's order is based on regulatory action by the reinsurer's domiciliary jurisdiction or the voluntary surrender or termination of the reinsurer's eligibility to transact insurance or reinsurance business in its domiciliary jurisdiction or in the primary certifying state of the reinsurer under subsection 1, paragraph B‑2 , subparagraph (6); or (3) The superintendent finds that an emergency requires immediate action and a court of competent jurisdiction has not stayed the superintendent's action. [PL 2013, c. 238, Pt. B, §7 (NEW).] B. While a reinsurer's accreditation or certification is suspended pursuant to this subsection, no reinsurance contract issued or renewed after the effective date of the suspension qualifies for credit under subsection 1 except to the extent that the reinsurer's obligations under the contract are secured in accordance with subsection 3 . If a reinsurer's accreditation or certification is revoked pursuant to this subsection, no credit for reinsurance may be granted after the effective date of the revocation except to the extent that the reinsurer's obligations under the contract are secured in accordance with subsection 1, paragraph B‑2 , subparagraph (5) or subsection 3 . [PL 2013, c. 238, Pt. B, §7 (NEW).] C. The superintendent may deny an application for accreditation or certification under subsection 1 , or may impose conditions or restrictions on a reinsurer's accreditation or certification, on any ground for which accreditation or certification may be suspended or revoked. [PL 2013, c. 238, Pt. B, §7 (NEW).] [PL 2013, c. 238, Pt. B, §7 (NEW).]

2. The credit permitted by subsection 1 is not to be allowed unless the assuming insurer agrees in the reinsurance agreements: A. That, if the assuming insurer fails to perform its obligations under the terms of the reinsurance agreement, the assuming insurer, at the request of the ceding insurer: (1) Will submit to the jurisdiction of any court of competent jurisdiction in any state of the United States; (2) Will comply with all requirements necessary to give the court jurisdiction; and (3) Will abide by the final decision of the court or of any Appellate Court in the event of an appeal; and [PL 1989, c. 846, Pt. E, §2 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).] B. To designate the superintendent or an attorney as its attorney upon whom may be served any lawful process in any action, suit or proceeding instituted by or on behalf of the ceding company, as required in section 421 . [PL 1989, c. 846, Pt. E, §2 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).] This provision is not intended to conflict with or override the obligation of the parties to a reinsurance agreement to arbitrate their disputes, if such an obligation is created in the agreement. [PL 1989, c. 846, Pt. E, §2 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).]

2-A. Credit for reinsurance may not be allowed on the basis of a trust maintained pursuant to subsection 1, paragraph C unless the assuming insurer agrees in the trust agreements to the following conditions. A. Notwithstanding any other provisions in the trust instrument, if the trust fund contains an amount less than the amount required by this section, or if the grantor of the trust has been declared insolvent or placed into receivership, rehabilitation, liquidation or similar proceedings under the laws of its state or country of domicile, the trustee shall comply with an order of the commissioner with regulatory oversight over the trust or with an order of a court of competent jurisdiction directing the trustee to transfer to the commissioner with regulatory oversight all of the assets of the trust fund. [PL 2001, c. 47, §5 (NEW).] B. The assets must be distributed by and claims must be filed with and valued by the commissioner with regulatory oversight in accordance with the laws of the state in which the trust is domiciled that are applicable to the liquidation of domestic insurance companies. [PL 2001, c. 47, §5 (NEW).] C. If the commissioner with regulatory oversight determines that the assets of the trust fund or any part of the assets of the trust fund are not necessary to satisfy the claims of the United States ceding insurers of the grantor of the trust, the assets or part of the assets of the trust fund must be returned by the commissioner with regulatory oversight to the trustee for distribution in accordance with the trust agreement. [PL 2001, c. 47, §5 (NEW).] D. The grantor shall waive any right otherwise available to it under United States law that is inconsistent with this subsection. [PL 2001, c. 47, §5 (NEW).] [PL 2001, c. 47, §5 (NEW).]

2-B. Through rules adopted under subsection 7 , the superintendent may establish additional requirements that reinsurance agreements that are subject to this subsection must satisfy to qualify for credit. A. This subsection applies only to reinsurance of: (1) Life insurance policies with guaranteed nonlevel gross premiums or guaranteed nonlevel benefits; (2) Universal life insurance policies with provisions resulting in the ability of a policyholder to keep a policy in force over a secondary guarantee period; (3) Variable annuities with guaranteed death or living benefits; (4) Long-term care insurance policies; or (5) Other life and health insurance and annuity products for which the National Association of Insurance Commissioners adopts model regulatory requirements with respect to credit for reinsurance. [PL 2017, c. 169, Pt. C, §2 (NEW).] B. Requirements established under this subsection may address: (1) The valuation of assets or reserve credits; (2) The amount and forms of acceptable security, in accordance with rules that may supplement or modify the requirements of subsection 3 ; and (3) The circumstances pursuant to which credit will be reduced or eliminated. [PL 2017, c. 169, Pt. C, §2 (NEW).] C. Requirements established under this subsection may take into consideration the results of applying the valuation manual adopted under section 959 to ceded policies whose statutory reserves are calculated according to a prior methodology. [PL 2017, c. 169, Pt. C, §2 (NEW).] D. Requirements established with respect to reinsurance described in paragraph A , subparagraphs (1) and (2) may apply to any treaty for which the risk ceded includes: (1) Policies issued on or after January 1, 2015; or (2) Risk on policies issued before January 1, 2015 and ceded in connection with the treaty, in whole or in part, on or after January 1, 2015. [PL 2017, c. 169, Pt. C, §2 (NEW).] E. This subsection does not apply to cessions to an assuming insurer that: (1) Is certified in this State pursuant to subsection 1, paragraph B‑2 ; (2) Maintains at least $250,000,000 in capital and surplus as determined in accordance with section 901‑A , excluding the impact of any permitted or prescribed practices, and is: (a) Licensed in at least 26 states; or (b) Licensed in at least 10 states and licensed or accredited in a total of at least 35 states; or (3) Is eligible for credit for assumed reinsurance by reciprocity pursuant to subsection 1, paragraph B‑3 . [PL 2021, c. 16, §7 (AMD).] [PL 2021, c. 16, §7 (AMD).]

3. An asset or a reduction from liability for the reinsurance ceded to an assuming insurer not meeting the requirements of subsection 1 is allowed in an amount not exceeding the liabilities carried by the ceding insurer. The reduction must equal the value of funds held by or on behalf of the ceding insurer, including funds held in trust for the ceding insurer, under a reinsurance contract with such assuming insurer as security for the payment of obligations under the contract, if such security is held in the United States subject to withdrawal solely by, and under the exclusive control of, the ceding insurer or, in the case of a trust, held in a qualified United States financial institution. This security may be in the form of: A. Cash; [PL 1989, c. 846, Pt. E, §2 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).] B. Securities listed by the Securities Valuation Office of the National Association of Insurance Commissioners, including those designated as exempt from filing in the purposes and procedures manual of the Securities Valuation Office, and qualifying as admitted assets; [PL 2021, c. 16, §8 (AMD).] C. Clean, irrevocable, unconditional letters of credit, issued or confirmed by a qualified United States financial institution no later than December 31st of the year for which filing is being made and in the possession of the ceding company on or before the filing date of its annual statement. (1) A letter of credit from an issuer determined to be acceptable as of the date of issuance or the date of confirmation of the letter, notwithstanding the issuing or confirming institution's subsequent failure to meet applicable standards of issuer acceptability, continues to be acceptable as security until its expiration, extension, renewal, modification or amendment, whichever first occurs. The ceding insurer shall replace a nonqualifying letter of credit at its earliest opportunity. (2) The letter of credit must indicate that it is not subject to any condition or qualification outside the letter of credit, and that the beneficiary need only draw a sight draft under the letter and present the letter to obtain funds and that no other document need be presented; or [PL 2021, c. 16, §9 (AMD).] D. Any other form of security that the superintendent may permit by rule adopted as set forth in subsection 7 . [PL 2021, c. 16, §10 (NEW).] [PL 2021, c. 16, §§8-10 (AMD).]

4. For purposes of this section, a "qualified United States financial institution" means an institution that: A. Is organized or, in the case of a United States branch or agency office of a foreign banking organization, is licensed under the laws of the United States or any state of the United States; [PL 1991, c. 828, §17 (AMD).] B. Is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies; and [PL 1991, c. 828, §17 (AMD).] C. Has been determined by the superintendent or the Securities Valuation Office of the National Association of Insurance Commissioners to meet standards of financial condition and standing that are considered necessary and appropriate to regulate the quality of financial institutions whose letters of credit will be acceptable to the superintendent. [PL 1991, c. 828, §17 (NEW).] [PL 1991, c. 828, §17 (AMD).]

4-A. "Qualified United States financial institution" means for purposes of those provisions of this section specifying those institutions that are eligible to act as a fiduciary of a trust an institution that: A. Is organized or in the case of a United States branch or agency office of a foreign banking organization licensed under the laws of the United States or any state of the United States and has been granted authority to operate with fiduciary powers; and [PL 1991, c. 828, §18 (NEW).] B. Is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies. [RR 1993, c. 1, §56 (COR).] [RR 1993, c. 1, §56 (COR).]

5. Credit is allowed as an asset or deduction from liability to any ceding insurer only for reinsurance ceded to an assuming insurer qualified under this section, except that no credit is allowed, unless the reinsurance contract provides, in substance, that in the event of the insolvency of the ceding insurer, the reinsurance is payable under a contract or contracts reinsured by the assuming insurer on the basis of reported claims allowed by the court, without diminution because of the insolvency of the ceding insurer. The payments must be made directly to the ceding insurer or to the ceding insurer's domiciliary receiver unless the contract or other written agreement specifically provides another payee in the event of the insolvency of the ceding insurer or unless the assuming insurer, with the consent of the direct insured or insureds, has assumed the policy obligations of the ceding insurer as direct obligations of the assuming insurer to the payees under the reinsured policies and in substitution for the obligations of the ceding insurer to those payees. The reinsurance agreement may condition the payments upon written notice by the ceding insurer's domiciliary receiver to the assuming insurer of the pendency of a claim on the contract reinsured within a reasonable time after the claim is filed in the proceeding where the claim is to be adjudicated. During the pendency of such a claim, any assuming insurer may investigate the claim and interpose, at the assuming insurer's own expense, any defenses in the proceeding that the assuming insurer determines available to the ceding insurer or to the ceding insurer's receiver. The expenses may be filed as a claim against the insolvent ceding insurer to the extent of its proportionate share of the benefit that may accrue to the ceding insurer solely as a result of the defense undertaken by the assuming insurer. When 2 or more assuming insurers are involved in the same claim and a majority in interest elect to interpose a defense to the claim, the expense must be apportioned in accordance with the terms of the reinsurance agreement as though the expense had been incurred by the ceding insurer. [PL 2001, c. 47, §7 (AMD).]

6. [PL 1999, c. 113, §21 (RP).]

7. The superintendent may adopt rules, subject to Title 5, chapter 375 , to implement this section. Rules adopted under this section are routine technical rules pursuant to Title 5, chapter 375, subchapter II‑A . [PL 2001, c. 47, §8 (AMD).]
24-A M.R.S. § 781 — ME Code / Title 24-A / Chapter 9 / Section 781
24-A §781. Definitions
Status: in_force

As used in this subchapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 2003, c. 249, §2 (NEW).]

1. Aggregate limit. "Aggregate limit" means the maximum sum payable to the ceding insurer under a special purpose reinsurance vehicle contract. [PL 2003, c. 249, §2 (NEW).]

2. Catastrophe excess of loss property reinsurance. "Catastrophe excess of loss property reinsurance" means excess of loss reinsurance for a catastrophe layer of a reinsurance program, written on either a per occurrence or aggregate basis. [PL 2003, c. 249, §2 (NEW).]

3. Catastrophe life or health reinsurance. "Catastrophe life or health reinsurance" means reinsurance of life, health or annuity products that transfers mortality, morbidity, survival or other related risks in excess of existing proportional or nonproportional automatic and facultative treaties newly placed or in force on the same risks. [PL 2003, c. 249, §2 (NEW).]

4. Ceding insurer. "Ceding insurer" means an insurer that enters into a special purpose reinsurance vehicle contract with a special purpose reinsurance vehicle and includes a reinsurer retroceding assumed reinsurance to a special purpose reinsurance vehicle. A group of affiliated insurers under common control entering into a special purpose reinsurance vehicle contract on a coordinated basis is considered a single ceding insurer. [PL 2003, c. 249, §2 (NEW).]

5. Control. "Control," including the terms "controlling," "controlled by" and "under common control," means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services, or otherwise, unless the power is the result of an official position with or corporate office held by the person. Control is presumed to exist if any person, directly or indirectly, owns, controls, holds with the power to vote or holds proxies representing 10% or more of the voting securities of any other person. This presumption may be rebutted by a showing that control does not exist. Notwithstanding this subsection, for the purposes of this subchapter, the fact that a special purpose reinsurance vehicle exclusively provides reinsurance to a ceding insurer under a special purpose reinsurance vehicle contract is not by itself sufficient grounds for a finding that the reinsurance vehicle or the special purpose reinsurance vehicle organizer or owner is controlled by or under common control with the ceding insurer. [PL 2003, c. 249, §2 (NEW).]

6. Fair value. "Fair value" means: A. As to cash, the amount of cash; and [PL 2003, c. 249, §2 (NEW).] B. As to an asset other than cash: (1) The amount at which that asset could be bought or sold in a current transaction between arms-length, willing parties; (2) The quoted market price for the asset in active markets must be used if available; and (3) If quoted market prices are not available, a value determined using the best information available considering values of like assets and other valuation methods, such as present value of future cash flows, historical value of the same or similar assets or comparison to values of other asset classes the value of which have been historically related to the subject asset. [PL 2003, c. 249, §2 (NEW).] [PL 2003, c. 249, §2 (NEW).]

7. Fully funded. "Fully funded" means, with respect to a special purpose reinsurance vehicle contract, that the fair value of the assets under the control of the ceding insurer or held in trust for the benefit of the ceding insurer under the special purpose reinsurance vehicle contract on the date on which the special purpose reinsurance vehicle contract is effected, equals or exceeds the aggregate limit as defined in subsection 1 . [PL 2007, c. 386, §2 (AMD).]

7-A. Impairment. "Impairment" or "impaired" means, with respect to a special purpose reinsurance vehicle or any of its protected cells, that either: A. The available capital of the special purpose reinsurance vehicle or protected cell has fallen below the applicable initial capital requirement without the approval of the superintendent; or [PL 2007, c. 386, §3 (NEW).] B. The fair value of the assets under the control of the ceding insurer or held in trust for the benefit of the ceding insurer under a special purpose reinsurance vehicle contract is less than the aggregate limit remaining under the contract as of the time the determination is made. [PL 2007, c. 386, §3 (NEW).] [PL 2007, c. 386, §3 (NEW).]

8. Indemnity trigger. "Indemnity trigger" means a transaction term by which the special purpose reinsurance vehicle's obligation to pay the ceding insurer for losses covered by a special purpose reinsurance vehicle contract is triggered by the ceding insurer incurring a specified level of losses. [PL 2003, c. 249, §2 (NEW).]

9. Insolvency. "Insolvency" or "insolvent" means that the special purpose reinsurance vehicle or one or more of its protected cells is unable to pay its obligations when they are due unless the obligations are the subject of a bona fide dispute. [PL 2007, c. 386, §4 (AMD).]

10. Nonindemnity trigger. "Nonindemnity trigger" means a transaction term by which the special purpose reinsurance vehicle's obligation to pay the ceding insurer under a special purpose reinsurance vehicle contract arises from the occurrence or existence of some event or condition other than the ceding insurer incurring a specified level of losses under its insurance or reinsurance contracts. [PL 2003, c. 249, §2 (NEW).]

11. Permitted investments. "Permitted investments" means those investments that meet the qualifications under section 795 . [PL 2003, c. 249, §2 (NEW).]

11-A. Protected cell. "Protected cell" means a separate account established and maintained by a special purpose reinsurance vehicle for one special purpose reinsurance vehicle contract and the accompanying insurance securitization with a ceding insurer as further provided for in section 784‑A . [PL 2007, c. 386, §5 (NEW).]

12. Qualified United States financial institution. "Qualified United States financial institution" means for purposes of meeting the requirements of a trustee as specified in section 784 a financial institution that is eligible to act as a fiduciary of a trust and: A. Is organized or, in the case of a United States branch or agency office of a foreign banking organization, is licensed under the laws of the United States or any state; and [PL 2003, c. 249, §2 (NEW).] B. Is regulated, supervised and examined by federal or state authorities having regulatory authority over banks and trust companies. [PL 2003, c. 249, §2 (NEW).] [PL 2003, c. 249, §2 (NEW).]

13. Reinsurance vehicle. "Reinsurance vehicle" means a special purpose reinsurance vehicle. [PL 2003, c. 249, §2 (NEW).]

14. Special purpose reinsurance vehicle. "Special purpose reinsurance vehicle" means an entity domiciled in and organized under the laws of this State that has received a limited certificate of authority from the superintendent under this subchapter exclusively for the limited purpose of entering into and effectuating special purpose reinsurance vehicle insurance securitizations, special purpose reinsurance vehicle contracts and other related transactions permitted by this subchapter. [PL 2003, c. 249, §2 (NEW).]

15. Special purpose reinsurance vehicle contract; contract. "Special purpose reinsurance vehicle contract" or "contract" means a contract between the special purpose reinsurance vehicle and the ceding insurer pursuant to which the special purpose reinsurance vehicle agrees to pay the ceding insurer an agreed amount upon the occurrence of a triggering event. [PL 2003, c. 249, §2 (NEW).]

16. Special purpose reinsurance vehicle insurance securitization; insurance securitization. "Special purpose reinsurance vehicle insurance securitization" or "insurance securitization" means a package of related risk transfer instruments, capital market offerings and facilitating administrative agreements by which proceeds are obtained by a special purpose reinsurance vehicle directly or indirectly through the issuance of securities and are held in trust or under the control of the ceding insurer pursuant to the requirements of this subchapter to secure the obligations of the special purpose reinsurance vehicle under one or more special purpose reinsurance vehicle contracts with one or more ceding insurers, when investment risk to the holders of these securities is contingent upon the obligations of the special purpose reinsurance vehicle to the ceding insurer or ceding insurers under the special purpose reinsurance vehicle contract in accordance with the transaction terms. [PL 2007, c. 386, §6 (AMD).]

17. Special purpose reinsurance vehicle organizer; organizer. "Special purpose reinsurance vehicle organizer" or "organizer" means one or more persons that have organized or intend to organize a special purpose reinsurance vehicle under authority obtained as specified in this subchapter. [PL 2003, c. 249, §2 (NEW).]

18. Special purpose reinsurance vehicle securities; securities. "Special purpose reinsurance vehicle securities" or "securities" means the securities issued by a special purpose reinsurance vehicle. [PL 2003, c. 249, §2 (NEW).]

19. Triggering event. "Triggering event" means an event or condition that if and when it occurs or exists obligates the special purpose reinsurance vehicle to make a payment to the ceding insurer under the provisions of a special purpose reinsurance vehicle contract. [PL 2003, c. 249, §2 (NEW).]
24-A M.R.S. § 7404-A — ME Code / Title 24-A / Chapter 95 / Section 7404-A
24-A §7404-A. Responsibilities of peer-to-peer car sharing programs
Status: in_force

1. General disclosures. Each car sharing program agreement made in the State must disclose to the shared vehicle owner and the shared vehicle driver: A. Any right of the peer-to-peer car sharing program to seek indemnification from the shared vehicle owner or the shared vehicle driver for economic loss sustained by the peer-to-peer car sharing program resulting from a breach of the terms and conditions of the car sharing program agreement; [PL 2021, c. 352, §10 (NEW).] B. That a motor vehicle liability insurance policy issued to the shared vehicle owner for the shared vehicle or to the shared vehicle driver does not provide a defense or indemnification for any claim asserted by the peer-to-peer car sharing program; [PL 2021, c. 352, §10 (NEW).] C. That the peer-to-peer car sharing program's insurance coverage on the shared vehicle owner and the shared vehicle driver is in effect only during each car sharing period and that, for any use of the shared vehicle by the shared vehicle driver after the car sharing termination time, the shared vehicle driver and the shared vehicle owner may not have insurance coverage; [PL 2021, c. 352, §10 (NEW).] D. The daily rate, fees and, if applicable, any insurance or protection package costs that are charged to the shared vehicle owner or the shared vehicle driver; [PL 2021, c. 352, §10 (NEW).] E. That the shared vehicle owner's motor vehicle liability insurance may not provide coverage for a shared vehicle; [PL 2021, c. 352, §10 (NEW).] F. An emergency telephone number to personnel capable of fielding roadside assistance and other customer service inquiries; and [PL 2021, c. 352, §10 (NEW).] G. If there are conditions under which a shared vehicle driver must maintain a personal motor vehicle insurance policy with certain applicable coverage limits on a primary basis in order to arrange for use of a shared vehicle. [PL 2021, c. 352, §10 (NEW).] [PL 2021, c. 352, §10 (NEW).]

2. Notification of implications of lien. At the time a vehicle owner registers as a shared vehicle owner with a peer-to-peer car sharing program and prior to the time when the shared vehicle owner makes a shared vehicle available for car sharing with the peer-to-peer car sharing program, the peer-to-peer car sharing program shall notify the shared vehicle owner that, if the shared vehicle has a lien against it, the use of the shared vehicle through a peer-to-peer car sharing program, including use without physical damage coverage, may violate the terms of the contract with the lienholder. [PL 2021, c. 352, §10 (NEW).]

3. Motor vehicle safety recalls. This subsection applies to motor vehicle safety recalls of shared vehicles. A. At the time a vehicle owner registers as a shared vehicle owner with a peer-to-peer car sharing program and prior to the time when the shared vehicle owner makes a shared vehicle available for car sharing with the peer-to-peer car sharing program, the peer-to-peer car sharing program shall: (1) Verify that the shared vehicle does not have any safety recalls on the vehicle for which the repairs have not been made; and (2) Notify the shared vehicle owner of the requirements under paragraph B . [PL 2021, c. 352, §10 (NEW).] B. If the shared vehicle owner has received an actual notice of a safety recall on the vehicle, a shared vehicle owner may not make a vehicle available as a shared vehicle with a peer-to-peer car sharing program until the safety recall repair has been made. (1) When the notice of a safety recall is received while the shared vehicle is made available with the peer-to-peer car sharing program, the shared vehicle owner shall remove the shared vehicle as available with the peer-to-peer car sharing program, as soon as practicably possible after receiving the notice of the safety recall and until the safety recall repair has been made; and (2) When the notice of a safety recall is received while the shared vehicle is being used in the possession of a shared vehicle driver, as soon as practicably possible after receiving the notice of the safety recall the shared vehicle owner shall notify the peer-to-peer car sharing program about the safety recall so that the shared vehicle owner may address the safety recall repair. [PL 2021, c. 352, §10 (NEW).] [PL 2021, c. 352, §10 (NEW).]

4. Recordkeeping; use of vehicle in car sharing. A peer-to-peer car sharing program shall collect and verify records pertaining to the use of a vehicle, including, but not limited to, times used, car sharing period pick up and drop off locations, fees paid by the shared vehicle driver and revenues received by the shared vehicle owner, and shall provide that information upon request to the shared vehicle owner, the shared vehicle owner's insurer or the shared vehicle driver's insurer to facilitate a claim coverage investigation, settlement, negotiation or litigation. The peer-to-peer car sharing program shall retain the records for a time period not less than the applicable personal injury statute of limitations. [PL 2021, c. 352, §10 (NEW).]

5. Driver's license verification and data retention. A peer-to-peer car sharing program may not enter into a peer-to-peer car sharing program agreement with a driver unless the driver who will operate the shared vehicle: A. Holds a driver's license issued under Title 29‑A, section 1251 that authorizes the driver to operate vehicles of the class of the shared vehicle; or [PL 2021, c. 352, §10 (NEW).] B. Is a nonresident who: (1) Has a driver's license issued by the state or country of the driver's residence that authorizes the driver in that state or country to drive vehicles of the class of the shared vehicle; and (2) Is at least the same age as that required of a resident of the State to drive; or [PL 2021, c. 352, §10 (NEW).] C. Otherwise is specifically authorized by Title 29‑A, section 1251 to drive vehicles of the class of the shared vehicle. [PL 2021, c. 352, §10 (NEW).] A peer-to-peer car sharing program shall keep a record of the name and address of the shared vehicle driver; the number of the driver's license of the shared vehicle driver and each other person, if any, who will operate the shared vehicle; and the place of issuance of the driver's license. [PL 2021, c. 352, §10 (NEW).]

6. Responsibility for equipment. A peer-to-peer car sharing program has sole responsibility for any equipment, such as a GPS system or other special equipment that is put in or on the vehicle to monitor or facilitate the car sharing transaction, and shall agree to indemnify and hold harmless the vehicle owner for any damage to or theft of such equipment during the sharing period not caused by the vehicle owner. The peer-to-peer car sharing program has the right to seek indemnity from the shared vehicle driver for any loss or damage to such equipment that occurs during the sharing period. [PL 2021, c. 352, §10 (NEW).]
24-A M.R.S. § 1159 — ME Code / Title 24-A / Chapter 13-A / Section 1159
24-A §1159. Special investments; separate accounts
Status: in_force

1. Special investments. Except as may be provided with respect to reserves for guaranteed benefits and funds referred to in subsection 2 : A. Amounts allocated to any separate account established by the insurer pursuant to section 2537 , separate accounts and accumulations on those accounts may be invested and reinvested without regard to any requirements or limitations prescribed by this chapter except for the provisions of section 1156, subsection 1 ; and [PL 1987, c. 399, §14 (NEW).] B. Except as provided in subsection 2, paragraph B , the investments in that separate account or accounts may not be taken into account in applying the investment limitations otherwise applicable to the investments of the insurer. [PL 1987, c. 399, §14 (NEW).] [PL 1987, c. 399, §14 (NEW).]

2. Separate accounts. Except with the approval of the superintendent and under such conditions as to investments and other matters as the superintendent may prescribe, which must recognize the guaranteed nature of the benefits provided, an insurer may not guarantee the value of the assets allocated to a separate account, or any interest in that account, or the investment results of that account, or the income from that account, to a contract holder, without limitation of liability under all those guarantees to the extent of the interest of the contract holder in assets allocated to that separate account, unless: A. To the extent that the applicable agreements provide that the assets in that separate account are not chargeable with liabilities arising out of any other business of the insurer, the assets allocated to that separate account are invested subject to the requirements and limitations on investments imposed by section 1156, subsection 2 , as though the aggregate assets allocated to that separate account were the insurer's total admitted assets; or [RR 2021, c. 1, Pt. B, §192 (COR).] B. The assets allocated to that separate account are invested subject to the requirements and limitations on investments imposed by section 1156, subsection 2 , as though they were part of the general assets of the insurer. [PL 1987, c. 399, §14 (NEW).] [RR 2021, c. 1, Pt. B, §192 (COR).]
24-A M.R.S. § 2847-K — ME Code / Title 24-A / Chapter 35 / Section 2847-K
24-A §2847-K. Coverage for general anesthesia for dentistry (REALLOCATED FROM TITLE 24-A, SECTION 2847-J)
Status: in_force

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

1. Enrollee defined. For the purposes of this section, unless the context otherwise indicates, "enrollee" means a person who is covered under a group health insurance contract provided by an insurer. [RR 2001, c. 1, §33 (RAL).]

2. General anesthesia and associated facility charges. An insurer that issues group health insurance contracts shall provide coverage for general anesthesia and associated facility charges for dental procedures rendered in a hospital when the clinical status or underlying medical condition of an enrollee requires dental procedures that ordinarily would not require general anesthesia to be rendered in a hospital. The insurer may require prior authorization of general anesthesia and associated charges required for dental care procedures in the same manner that prior authorization is required for other covered diseases or conditions. [RR 2001, c. 1, §33 (RAL).]

3. Limitations on coverage. This section applies only to general anesthesia and associated facility charges for only the following enrollees if the enrollees meet the criteria in subsection 2 : A. Enrollees, including infants, exhibiting physical, intellectual or medically compromising conditions for which dental treatment under local anesthesia, with or without additional adjunctive techniques and modalities, can not be expected to provide a successful result and for which dental treatment under general anesthesia can be expected to produce a superior result; [RR 2001, c. 1, §33 (RAL).] B. Enrollees demonstrating dental treatment needs for which local anesthesia is ineffective because of acute infection, anatomic variation or allergy; [RR 2001, c. 1, §33 (RAL).] C. Extremely uncooperative, fearful, anxious or uncommunicative children or adolescents with dental needs of such magnitude that treatment should not be postponed or deferred and for whom lack of treatment can be expected to result in dental or oral pain or infection, loss of teeth or other increased oral or dental morbidity; and [RR 2001, c. 1, §33 (RAL).] D. Enrollees who have sustained extensive oral-facial or dental trauma for which treatment under local anesthesia would be ineffective or compromised. [RR 2001, c. 1, §33 (RAL).] [RR 2001, c. 1, §33 (RAL).]

4. Dental procedures and dentist's fee not covered. This section does not require an insurer that issues group contracts to cover any charges for the dental procedure itself, including, but not limited to, the professional fee of the dentist. Coverage for anesthesia and associated facility charges pursuant to this section is subject to all other terms and conditions of the group contract that apply generally to other benefits. [RR 2001, c. 1, §33 (RAL).]

5. Coordination of benefits with dental insurance. If an enrollee eligible for coverage under this section is also eligible for coverage for general anesthesia and associated facility charges under a dental insurance policy or contract, the nonprofit health care service organization or insurer providing dental insurance is the primary payer responsible for those charges and the insurer providing group health insurance is the secondary payer. [RR 2001, c. 1, §33 (RAL).]

6. Application. The requirements of this section apply to all group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. B, §22 (NEW).]
24-A M.R.S. § 2709 — ME Code / Title 24-A / Chapter 33 / Section 2709
24-A §2709. Notice of claim
Status: in_force

1. There shall be a provision as follows: Notice of claim: Written notice of claim must be given to the insurer within 20 days after the occurrence or commencement of any loss covered by the policy, or as soon thereafter as is reasonably possible. Notice given by or on behalf of the insured or the beneficiary to the insurer at (insert the location of such office as the insurer may designate for the purpose), or to any authorized agent of the insurer, with information sufficient to identify the insured, shall be deemed notice to the insurer. [PL 1969, c. 132, §1 (NEW).]

2. In a policy providing a loss-of-time benefit that may be payable for at least 2 years, an insurer may at its option insert the following between the first and 2nd sentence of the above provision: Subject to the qualifications set forth below, if the insured suffers loss of time on account of disability for which indemnity may be payable for at least 2 years, the insured shall, at least once in every 6 months after having given notice of the claim, give to the insurer notice of continuance of such disability, except in the event of legal incapacity. The period of 6 months following any filing of proof by the insured or any payment by the insurer on account of such claim or any denial of liability in whole or in part by the insurer must be excluded in applying this provision. Delay in the giving of such notice does not impair the insured's right to any indemnity that would otherwise have accrued during the period of 6 months preceding the date on which such notice is actually given. [RR 2021, c. 1, Pt. B, §238 (COR).]
24-A M.R.S. § 7057 — ME Code / Title 24-A / Chapter 90 / Section 7057
24-A §7057. Travel protection plans
Status: in_force

A travel protection plan composed of combined features may be offered for one price if: [PL 2021, c. 354, §14 (NEW).]

1. Disclosures. The travel protection plan clearly discloses to the consumer, at or prior to the time of purchase, that it includes travel insurance, travel assistance services and cancellation fee waivers, as applicable, and provides information and an opportunity, at or prior to the time of purchase, for the consumer to obtain additional information regarding the features and pricing of each; and [PL 2021, c. 354, §14 (NEW).]

2. Fulfillment material requirements. The fulfillment materials must: A. Describe and delineate the travel insurance, travel assistance services and cancellation fee waivers in the travel protection plan; and [PL 2021, c. 354, §14 (NEW).] B. Include the travel insurance disclosures under subsection 1 and the contact information for persons providing travel assistance services and cancellation fee waivers, as applicable. [PL 2021, c. 354, §14 (NEW).] [PL 2021, c. 354, §14 (NEW).]
24-A M.R.S. § 3021 — ME Code / Title 24-A / Chapter 41 / Section 3021
24-A §3021. Lien on insured real estate
Status: in_force

Any fire insurer shall have a lien against the insured, on the buildings insured and the land appurtenant thereto, for the amount at any time due on the note referred to in section 3020 , to commence from the time of the recording of the same, and to continue 60 days after the expiration of the policy on which such note is given, if the insurer causes a certificate of its claim to such lien, signed by the secretary, to be recorded by the register of deeds for the county or district. During the pendency of such lien, an attachment of such property, in a civil action on the note in favor of the insurer, has priority of all other attachments or claims. Execution, when recovered, may be levied on it accordingly. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 6219 — ME Code / Title 24-A / Chapter 73 / Section 6219
24-A §6219. Investments
Status: in_force

The provider shall conform its investment strategy to the standards adopted by the superintendent by rule. [PL 1987, c. 482, §1 (NEW).]
24-A M.R.S. § 6211 — ME Code / Title 24-A / Chapter 73 / Section 6211
24-A §6211. Waiver of certain continuing care agreement provisions prohibited
Status: in_force

No act, agreement or statement of any subscriber constitutes a valid waiver of any of the provisions of this chapter, or any rules under this chapter, intended for the benefit or protection of the subscriber. [PL 1987, c. 482, §1 (NEW).]
24-A M.R.S. § 3701 — ME Code / Title 24-A / Chapter 52 / Section 3701
24-A §3701. Purpose
Status: in_force

The Maine Employers' Mutual Insurance Company is established for the purposes of providing workers' compensation insurance and employers' liability insurance incidental to and written in connection with workers' compensation coverage to employers of this State at the highest level of service and savings consistent with reasonable applicable actuarial standards and the sound financial integrity of the company. It is also the purpose of the company to encourage employer involvement and to be responsive to employer experience and advice. [PL 2001, c. 350, §1 (AMD).]
24-A M.R.S. § 4385 — ME Code / Title 24-A / Chapter 57 / Section 4385
24-A §4385. Federal receivership
Status: in_force

1. Whenever in the superintendent's opinion liquidation of a domestic insurer or an alien insurer domiciled in this State would be facilitated by a federal receivership, and when any ground exists upon which the superintendent might petition the court for an order of rehabilitation or liquidation of the insurer under this chapter, or if such an order has already been entered, the superintendent may request another superintendent or other resident of another state to petition any appropriate federal district court for the appointment of a federal receiver. The superintendent may intervene in any such action to support or oppose the petition, and may accept appointment as the receiver if so designated. This chapter applies to the receivership except to the extent that the court determines that the insurance rehabilitation and liquidation laws of another state are applicable in any part. Upon the superintendent's motion, the courts of this State shall relinquish all jurisdiction over the insurer for purposes of rehabilitation or liquidation. No federal law governing proceedings in bankruptcy may be applied to proceedings under this section. [PL 1991, c. 828, §32 (AMD).]

2. If the superintendent is appointed receiver under this section, the superintendent shall comply with requirements necessary to give the superintendent title to and control over the assets and affairs of the insurer. [RR 2021, c. 1, Pt. B, §380 (COR).]
24-A M.R.S. § 3858 — ME Code / Title 24-A / Chapter 53 / Section 3858
24-A §3858. Power of attorney
Status: reserved

1. The rights and powers of the attorney of a reciprocal insurer shall be as provided in the power of attorney given it by the subscribers. [PL 1969, c. 132, §1 (NEW).]

2. The power of attorney must set forth: A. The powers of the attorney; [PL 1969, c. 132, §1 (NEW).] B. If a domestic reciprocal insurer, that the attorney is empowered to accept service of process on behalf of the insurer in actions against the insurer upon contracts exchanged; [PL 1969, c. 132, §1 (NEW).] C. The general services to be performed by the attorney; [PL 1969, c. 132, §1 (NEW).] D. The maximum amount to be deducted from advance premiums or deposits to be paid to the attorney and the general items of expense in addition to losses, to be paid by the insurer; and [PL 1969, c. 132, §1 (NEW).] E. Except as to nonassessable policies, a provision for a contingent several liability of each subscriber in a specified amount which amount shall be not less than one nor more than 10 times the premium or premium deposit stated in the policy. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]

3. The power of attorney may: A. Provide for the right of substitution of the attorney and revocation of the power of attorney and rights thereunder; [PL 1969, c. 132, §1 (NEW).] B. Impose such restrictions upon the exercise of the power as are agreed upon by the subscribers; [PL 1969, c. 132, §1 (NEW).] C. Provide for the exercise of any right reserved to the subscribers directly or through their advisory committee; and [PL 1969, c. 132, §1 (NEW).] D. Contain other lawful provisions deemed advisable. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]

4. The terms of any power of attorney or agreement collateral thereto shall be reasonable and equitable, and no such power or agreement shall be used or be effective in this State until approved by the superintendent. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24 M.R.S. § 2332-B — ME Code / Title 24 / Chapter 19 / Section 2332-B
24 §2332-B. Acquired Immune Deficiency Syndrome
Status: in_force

1. Definitions. As used in this section, "HIV" and "antibody to HIV" have the same meanings as set out in Title 5, section 19201 . [PL 1991, c. 3, §2 (NEW).]

2. Prohibitions. No individual or group hospital, medical or health care service contract delivered or issued for delivery in this State, other than a contract that provides benefits for specific diseases or accidental injuries only, may provide more restrictive coverage for Acquired Immune Deficiency Syndrome, or AIDS, AIDS Related Complex, or ARC, HIV-related diseases or for related services, than for any other disease or sickness, or exclude coverage for AIDS, ARC or HIV-related diseases, except through an exclusion under which all diseases and sicknesses are treated equally. [PL 1991, c. 3, §2 (NEW).]

3. Test results. No nonprofit hospital or medical services organization or nonprofit health care plan may request any person to reveal whether the person has obtained a test for the presence of antibodies to HIV or a test to measure the virus or to reveal the results of such tests taken prior to an application for coverage. [PL 1991, c. 3, §2 (NEW).]
24-A M.R.S. § 2411-A — ME Code / Title 24-A / Chapter 27 / Section 2411-A
24-A §2411-A. Payment of fees for filings
Status: in_force

The superintendent may require insurers to pay filing fees for form and rate approval on a quarterly, biannual or annual basis. [PL 1997, c. 457, §42 (NEW).]
24-A M.R.S. § 415 — ME Code / Title 24-A / Chapter 5 / Section 415
24-A §415. Continuation of certificate of authority
Status: in_force

1. A certificate of authority continues in force as long as the insurer is entitled under this Title and until suspended or revoked by the superintendent or terminated at the insurer's request. A. [PL 1995, c. 544, §3 (RP).] B. [PL 1995, c. 544, §3 (RP).] C. [PL 1995, c. 544, §3 (RP).] [PL 1995, c. 544, §3 (AMD).]

2. [PL 1995, c. 544, §4 (RP).]

3. The superintendent may, upon the insurer's request made within 3 months after suspension, reinstate a certificate of authority that the superintendent suspended due to the insurer's failure to pay the annual fee upon payment by the insurer of the fee for reinstatement specified in section 601 . Otherwise the insurer may be granted another certificate of authority only after filing application therefor and meeting all other requirements as for an original certificate of authority in this State. [PL 1997, c. 592, §11 (AMD).]

4. [PL 1997, c. 592, §11 (RP).]

5. [PL 1997, c. 592, §11 (RP).]
24-A M.R.S. § 4260 — ME Code / Title 24-A / Chapter 56 / Section 4260
24-A §4260. 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 or group contract provided by a health maintenance organization. [PL 2019, c. 605, §7 (NEW); PL 2019, c. 605, §8 (AFF).]

2. No waiting period for enrollee under 19 years of age. A health maintenance organization that issues individual or group dental insurance or individual or group contracts that include 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, §7 (NEW); PL 2019, c. 605, §8 (AFF).]
24-A M.R.S. § 1908 — ME Code / Title 24-A / Chapter 18 / Section 1908
24-A §1908. Criminal convictions
Status: in_force

Any administrator and any individual listed on the application, as required by section 1903 , who is convicted of a crime punishable by imprisonment for more than one year shall report that conviction to the superintendent within 30 days after judgment is entered. Within that 30-day period, the administrator shall also provide the superintendent with a copy of the judgment and any commitment order and any other relevant documents relating to disposition of the criminal action. [PL 1989, c. 846, Pt. D, §2 (NEW); PL 1989, c. 846, Pt. E, §4 (AFF).]
24-A M.R.S. § 4204-A — ME Code / Title 24-A / Chapter 56 / Section 4204-A
24-A §4204-A. Surplus requirements
Status: in_force

1. Initial minimum surplus. To qualify for authority as a health maintenance organization, an organization shall have an initial minimum surplus of $1,500,000. [PL 1989, c. 842, §14 (NEW).]

2. Surplus maintained. Except as provided in this section, every health maintenance organization must maintain a minimum surplus equal to the greater of: A. One million dollars; [PL 1989, c. 842, §14 (NEW).] B. Two percent of the first $150,000,000 of annual premium revenues as reported in the most recent annual financial statement filed with the superintendent by the health maintenance organization, plus 1% of annual premium in excess of $150,000,000; [PL 2017, c. 169, Pt. A, §10 (AMD).] C. An amount equal to the sum of 3 months' uncovered health care expenditures as reported in the most recent annual financial statement filed with the superintendent by the health maintenance organization; [PL 2017, c. 169, Pt. A, §10 (AMD).] D. An amount equal to 8% of the health maintenance organization's annual health care expenditures, except those paid on a capitated basis, as reported in the most recent annual financial statement filed with the superintendent by the health maintenance organization; or [PL 2017, c. 169, Pt. A, §10 (AMD).] E. An amount equal to the company action level risk-based capital as defined in chapter 79 . [PL 2001, c. 88, §5 (NEW).] [PL 2017, c. 169, Pt. A, §10 (AMD).]

2-A. Additional surplus. A health maintenance organization that otherwise possesses surplus funds as required under this section shall also maintain surplus in a reasonable amount as determined by the superintendent in relation to indemnity risks assumed through the issuance of a point-of-service product, net of any applicable reinsurance. [PL 1991, c. 709, §4 (NEW).]

3. Exceptions. A health maintenance organization licensed before the effective date of this section must maintain a minimum surplus of: A. Forty percent of the amount required by subsection 2 until December 31, 1991; [PL 1989, c. 842, §14 (NEW).] B. Sixty percent of the amount required by subsection 2 until December 31, 1992; [PL 1989, c. 842, §14 (NEW).] C. Eighty percent of the amount required by subsection 2 until December 31, 1993; and [PL 1989, c. 842, §14 (NEW).] D. One hundred percent of the amount required by subsection 2 until December 31, 1994. [PL 1989, c. 842, §14 (NEW).] [PL 1989, c. 842, §14 (NEW).]

4. Subordinated debt. Any health maintenance organization that issues a subordinated debt instrument shall structure the debt as follows. A. In determining surplus, debt may not be considered fully subordinated unless the subordination clause is in a form approved by the superintendent. Any interest obligation relating to the repayment of any subordinated debt must be similarly subordinated. [PL 1989, c. 842, §14 (NEW).] B. Any debt incurred by a note that meets the requirements of this section, and is otherwise acceptable to the superintendent, may not be considered a liability and must be recorded as equity. [PL 1989, c. 842, §14 (NEW).] [PL 1989, c. 842, §14 (NEW).]
24-A M.R.S. § 2847-P — ME Code / Title 24-A / Chapter 35 / Section 2847-P
24-A §2847-P. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 2847-N)
Status: in_force

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

All group health insurance policies, contracts and certificates must provide coverage for amino acid-based elemental infant formula for children 2 years of age and under in accordance with this section. [PL 2007, c. 695, Pt. C, §15 (RAL).]

1. Determination of medical necessity. Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has submitted documentation that the amino acid-based elemental infant formula is medically necessary health care as defined in section 4301‑A, subsection 10‑A , that the amino acid-based elemental infant formula is the predominant source of nutritional intake at a rate of 50% or greater and that other commercial infant formulas, including cow milk-based and soy milk-based formulas have been tried and have failed or are contraindicated. A licensed physician may be required to confirm and document ongoing medical necessity at least annually. [PL 2007, c. 695, Pt. C, §15 (RAL).]

2. Method of delivery. Coverage for amino acid-based elemental infant formula must be provided without regard to the method of delivery of the formula. [PL 2007, c. 695, Pt. C, §15 (RAL).]

3. Required diagnosis. Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has diagnosed and through medical evaluation has documented one of the following conditions: A. Symptomatic allergic colitis or proctitis; [PL 2007, c. 695, Pt. C, §15 (RAL).] B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis; [PL 2007, c. 695, Pt. C, §15 (RAL).] C. A history of anaphylaxis; [PL 2007, c. 695, Pt. C, §15 (RAL).] D. Gastroesophageal reflux disease that is nonresponsive to standard medical therapies; [PL 2007, c. 695, Pt. C, §15 (RAL).] E. Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by a medical provider; [PL 2007, c. 695, Pt. C, §15 (RAL).] F. Cystic fibrosis; or [PL 2007, c. 695, Pt. C, §15 (RAL).] G. Malabsorption of cow milk-based or soy milk-based infant formula. [PL 2007, c. 695, Pt. C, §15 (RAL).] [PL 2007, c. 695, Pt. C, §15 (RAL).]

4. Health savings accounts. Coverage for amino acid-based elemental infant formula under a health insurance policy, contract or certificate issued in connection with a health savings account as authorized under Title XII of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the same deductible and out-of-pocket limits that apply to overall benefits under the policy, contract or certificate. [PL 2007, c. 695, Pt. C, §15 (RAL).]
24-A M.R.S. § 2164 — ME Code / Title 24-A / Chapter 23 / Section 2164
24-A §2164. Stock operations and advisory board contracts
Status: in_force

No person shall issue or deliver or permit its agents, officers, or employees to issue or deliver agency company stock or other capital stock, or benefit certificates or shares in any common law corporation, or securities or any special or advisory board contracts or other contracts of any kind promising returns and profits as an inducement to insurance. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 789 — ME Code / Title 24-A / Chapter 9 / Section 789
24-A §789. Records and financial reports
Status: in_force

1. Records. The records of the special purpose reinsurance vehicle must be maintained in this State and must be available for examination by the superintendent at any time. No later than 5 months after the end of the fiscal year of the reinsurance vehicle, the reinsurance vehicle shall file with the superintendent an audit by a certified public accounting firm of the financial statements of the reinsurance vehicle and the trust accounts referred to in section 784, subsection 2 , paragraph E. [PL 2003, c. 249, §2 (NEW).]

2. Statement of operation. Each special purpose reinsurance vehicle organized under this subchapter shall file with the superintendent no later than March 1st of each year a statement of operations, including a statement of income, a balance sheet and a detailed listing of invested assets, including identification of assets held in trust to secure the reinsurance vehicle's obligations under the special purpose reinsurance vehicle contract, for the year ending the prior December 31st. The statements must be prepared in accordance with statutory accounting principles consistent with section 901‑A on forms required by the superintendent. If one or more protected cells have been established, the statement must detail the financial experience of the general account and each protected cell separately, in addition to providing the combined financial experience of the special purpose reinsurance vehicle and all protected cells. [PL 2007, c. 386, §17 (AMD).]

3. Financial statement. The special purpose reinsurance vehicle shall keep its books and records in such manner that its financial condition, affairs and operations can be ascertained and so that its financial statements filed with the superintendent can be readily verified and its compliance with the provisions of this subchapter determined. The books and records may be photographed, reproduced on film or stored and reproduced electronically. [PL 2003, c. 249, §2 (NEW).]

4. Preservation. All books, records, documents, accounts and vouchers must be preserved and kept available in this State for the purpose of examination and until authority to destroy or otherwise dispose of the records is secured from the superintendent. The original records may, however, be kept and maintained outside this State if, according to a plan adopted by the special purpose reinsurance vehicle's board of directors and approved by the superintendent, it maintains suitable records in lieu of the original records. [PL 2003, c. 249, §2 (NEW).]
24-A M.R.S. § 2837-A — ME Code / Title 24-A / Chapter 35 / Section 2837-A
24-A §2837-A.  Coverage for screening mammograms and diagnostic and supplemental breast examinations
Status: in_force

1. Definition. [PL 2023, c. 338, §6 (RP); PL 2023, c. 338, §13 (AFF).]

1-A. Definitions. For the purposes of this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Cost-sharing requirements" means a deductible, coinsurance, copayment or out-of-pocket expense and any maximum limitation on the deductible, coinsurance, copayment or other out-of-pocket expense. [PL 2023, c. 338, §7 (NEW); PL 2023, c. 338, §13 (AFF).] B. "Diagnostic breast examination" means a medically necessary examination of the breast, including an examination using diagnostic mammography, magnetic resonance imaging or ultrasound, that is: (1) Used to evaluate an abnormality seen on or suspected from a screening mammogram; or (2) Used to evaluate an abnormality detected by another means of examination. [PL 2023, c. 338, §7 (NEW); PL 2023, c. 338, §13 (AFF).] C. "Screening mammogram" means a radiologic procedure that is provided to an asymptomatic individual for the purpose of early detection of breast cancer and that consists of 2 radiographic views per breast. A screening mammogram also includes an additional radiologic procedure recommended by a provider when the results of an initial radiologic procedure are not definitive. [PL 2023, c. 338, §7 (NEW); PL 2023, c. 338, §13 (AFF).] D. "Supplemental breast examination" means a medical examination of the breast, including an examination using diagnostic mammography, magnetic resonance imaging or ultrasound, to screen for breast cancer when there is no abnormality seen or suspected, but, based on personal or family medical history or other additional factors, the individual has an increased risk of breast cancer. [PL 2023, c. 338, §7 (NEW); PL 2023, c. 338, §13 (AFF).] [PL 2023, c. 338, §7 (NEW); PL 2023, c. 338, §13 (AFF).]

2. Required coverage. All group insurance policies that cover radiologic procedures, except those policies that cover only dental procedures, accidental injury or specific diseases, must provide coverage for screening mammograms performed by providers that meet the standards established by the Department of Health and Human Services rules relating to radiation protection. The policies must reimburse for screening mammograms performed at least once a year for women 40 years of age and over. A. [PL 1997, c. 408, §5 (RP); PL 1997, c. 408, §8 (AFF).] B. [PL 1997, c. 408, §5 (RP); PL 1997, c. 408, §8 (AFF).] [PL 1997, c. 408, §5 (RPR); PL 1997, c. 408, §8 (AFF); PL 2003, c. 689, Pt. B, §6 (REV).]

2-A. No cost-sharing requirements. A group insurance policy may not impose any cost-sharing requirements on a screening mammogram, diagnostic breast examination or supplemental breast examination performed by a provider in accordance with this section. This subsection does not apply to a group policy offered for use with a health savings account unless the federal Internal Revenue Service determines that the requirements in this subsection are permissible in a high deductible health plan as defined in the federal Internal Revenue Code, Section 223(c)(2). [PL 2023, c. 338, §8 (NEW); PL 2023, c. 338, §13 (AFF).]

3. Application. This section applies to all policies, contracts and certificates that cover radiologic procedures, except those policies that cover only dental procedures, accidental injury or specific diseases, executed, delivered, issued for delivery, continued or renewed in this State on or after March 1, 1991. For purposes of this section, all policies and contracts are deemed to be renewed no later than the next yearly anniversary of the policy or contract date. [PL 1991, c. 156, §2 (AMD).]

4. Reports. Each insurer that issues policies subject to this section shall report to the superintendent its experience for each calendar year beginning with 1991 not later than April 30th of the following calendar year. The report must include the information required and be presented in the form prescribed by the superintendent. The report must include the amount of claims paid in this State for services required by this section. The superintendent shall compile this data in an annual report and submit the report to the joint standing committee of the Legislature having jurisdiction over banking and insurance matters. [PL 1991, c. 701, §9 (AMD).]
24-A M.R.S. § 2384-B — ME Code / Title 24-A / Chapter 25 / Section 2384-B
24-A §2384-B. Statistical recording and reporting
Status: in_force

1. Collection and reporting system. The statistical advisory organization designated pursuant to section 2382‑B, subsection 2 shall develop and file with the superintendent a plan that includes a comprehensive data collection and reporting system for insurers. The purpose of the system is to permit the superintendent, in a timely manner, to analyze insurance rates and claims practices of insurers. [PL 2011, c. 83, §1 (AMD).]

2. Data collected. The data collection and reporting system must contain, at a minimum, the following: A. Basic information on each claim, including: (1) Name, address and identification information of the employee, employer and insurer or self-insurer; (2) File identification number or numbers, insurance policy number and occupation and classification codes; (3) Date of hire, age of employee at injury and employee's prior workers' compensation claim history; and (4) Attorney, if any, and date of involvement; [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. Claims history information on each claim, including: (1) Date of injury or exposure to disease, date of first report, type of injury or exposure disclosure and affected body part; (2) Preinjury wage history, date of initial payment and date of notice of controversy, if any, together with the reason for denial; (3) Date of maximum medical improvement; (4) Identification of cumulative or opened claims; and (5) Duration of wage loss period or periods; [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] C. Information concerning former Workers' Compensation Commission and Workers' Compensation Board proceedings, including: (1) For each informal conference, mediation and arbitration, the date, commissioner, hearing officer, mediator or arbitrator for the proceeding, involvement of attorney or other designated representative and the resolution; and (2) For each hearing, the date, commissioner, hearing officer, involvement of attorney or other designated representative and the decision of the commissioner or the hearing officer. If a disputed claim results in multiple hearing dates, the decision must be reported for the last hearing date; and [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] D. Cost of payment information on each claim, identified as open or closed, including: (1) Aggregate payments to date to any physician, hospital or other medical provider. The superintendent may require information on payments to date to any physician, hospital, medical rehabilitation provider or other medical provider, together with a description of the services, the name of the provider, the amount of payment and the date of service; (2) Payments made to date for weekly compensation, impairment benefits, death benefits, funeral expenses, employee legal expenses, employer legal expenses, lump sums, witness fees, penalties, employment rehabilitation services with a description of the services and name of the rehabilitation provider, and any other type of payments under former Title 39 or Title 39‑A ; (3) With respect to open claims, an estimate of total outstanding liability and separately stated outstanding liability for medical care, indemnity, employment rehabilitation and any other type of payments; and (4) Identification, both on payments and outstanding liabilities, of benefit offsets for Social Security, unemployment insurance, employer-provided pensions and any other source. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] For medical only claims, the superintendent may establish a claim threshold under which the detailed claim reporting requirements of this subsection do not apply. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

3. Special data calls. The superintendent may, with prior notice, require the insurer and self-insurer statistical advisory organizations to conduct special data calls to collect information usable to evaluate the costs or operations of the workers' compensation system. Any special data call imposed by the superintendent under this provision must give due consideration to the information collected and maintained by insurers and self-insurers. Requests for information not being collected on the effective date of this subsection must be prospective. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

4. Other data collection systems. The statistical advisory organization may rely on data collected and reported by other data gathering organizations or agencies, such as the Workers' Compensation Board or the Department of Labor. If the statistical advisory organization is to incorporate data from other sources, it must satisfy itself that the data is sufficiently complete and accurate for the purposes for which it is to be used. The Workers' Compensation Board and the Department of Labor shall assist the statistical advisory organization in the development and maintenance of a comprehensive data base by recording and making available information within the custody and control of each, respectively, pursuant to the request of the statistical advisory organization. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

5. Noncompliance penalties. The statistical advisory organization must include as part of its plan a means of monitoring member or subscriber compliance with the reporting requirements and must include a schedule of monetary penalties for failure to comply with reporting requirements. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

6. Reports. The superintendent shall prescribe the frequency of and schedule for reports by the statistical advisory organization. Reports must be required on at least an annual basis. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

7. Rules. The superintendent shall have the authority to adopt reasonable rules with respect to the recording and reporting of claim information, including the recording and reporting of expense or experience items that are not specifically applicable to the State but require an allocation of experience or expenses to the State. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

8. Confidentiality. Any report of information relating to a particular claim is confidential and may not be revealed by the superintendent, except that the superintendent may make compilations including this experience. Any information provided to the superintendent regarding self-insurance is confidential to the extent protected by Title 39‑A, section 403 . [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

9. Accuracy. The statistical advisory organization shall take all reasonable steps to ensure the accuracy of the information provided to it and reported by it. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

10. Claims covered. This section applies to all claims occurring on or after January 1, 1989 and prior to January 1, 1993 and to all death, permanent total and major permanent partial claims occurring between January 1, 1987 and December 31, 1988; and to a reasonable sample, as approved by the superintendent, of all other indemnity claims occurring between January 1, 1987 and December 31, 1988. The superintendent may suspend the reporting requirements of specific items for periods when information that is to be obtained from the Workers' Compensation Board is temporarily unavailable. [PL 1995, c. 462, Pt. B, §5 (AMD).]
24-A M.R.S. § 3308-A — ME Code / Title 24-A / Chapter 47 / Section 3308-A
24-A §3308-A. Filing by the Secretary of State
Status: in_force

1. Duty to file. If a document delivered to the office of the Secretary of State for filing pursuant to this chapter satisfies the requirements of Title 13‑C and this chapter, the Secretary of State shall file the document. [PL 2013, c. 299, §4 (AMD).]

2. Recording as filed; acknowledgment. The Secretary of State files a document pursuant to subsection 1 by recording it as filed on the date of receipt. After filing a document, the Secretary of State shall deliver to the corporation or its representative a copy of the document with an acknowledgment of the date of filing. [PL 2009, c. 56, §18 (NEW).]

3. Evidentiary effect of copy of filed document. A certificate from the Secretary of State delivered with a copy of a document filed by the Secretary of State is conclusive evidence that the original document is on file with the Secretary of State. [PL 2009, c. 56, §18 (NEW).]
24-A M.R.S. § 2833-B — ME Code / Title 24-A / Chapter 35 / Section 2833-B
24-A §2833-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
Status: in_force

1. Dependent child; definition. As used in this section, "dependent child" means the child of a person covered under a group health insurance policy. A. [PL 2019, c. 5, Pt. A, §13 (RP).] B. [PL 2019, c. 5, Pt. A, §13 (RP).] C. [PL 2019, c. 5, Pt. A, §13 (RP).] D. [PL 2007, c. 514, §8 (RP).] [PL 2019, c. 5, Pt. A, §13 (AMD).]

2. Offer of coverage. Notwithstanding section 2822 , a group health insurance policy that offers coverage for a dependent child must offer such coverage, at the option of the parent, until the dependent child attains 26 years of age. If the dependent child has a disability, the policy must offer coverage in accordance with section 2833‑C . [PL 2021, c. 520, §3 (AMD).]

3. Notice. [PL 2007, c. 514, §10 (NEW); MRSA T. 24-A §2833-B, sub-§3 (RP).]
24-A M.R.S. § 2202 — ME Code / Title 24-A / Chapter 24 / Section 2202
24-A §2202. Purpose
Status: in_force

The purpose of this chapter is to establish standards for the collection, use and disclosure of information gathered in connection with insurance transactions; to maintain a balance between insurance carriers' need for information and the public's need for fair information practices that respect privacy; to establish a regulatory mechanism to enable insurance consumers to ascertain what information is being collected about them and to verify its accuracy; to limit the distribution of information collected in connection with insurance transactions; and to enable consumers to obtain the reasons for adverse underwriting decisions. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
24-A M.R.S. § 3958 — ME Code / Title 24-A / Chapter 54-A / Section 3958
24-A §3958. Reinsurance; premium rates
Status: in_force

1. Reinsurance amount. A member insurer offering an individual health plan under section 2736‑C must be reinsured by the association to the level of coverage provided in this subsection and is liable to the association for any applicable reinsurance premium at the rate established in accordance with subsection 2 . For calendar year 2023 and subsequent calendar years, the association shall also reinsure member insurers for small group health plans issued under section 2808‑B , unless otherwise provided in rules adopted by the superintendent pursuant to section 2792, subsection 5 . A. Beginning July 1, 2012, except as otherwise provided in paragraph A‑1 , the association shall reimburse a member insurer for claims incurred with respect to a person designated for reinsurance by the member insurer pursuant to section 3959 after the insurer has incurred an initial level of claims for that person of $7,500 for covered benefits in a calendar year. In addition, the insurer is responsible for 10% of the next $25,000 of claims paid during a calendar year. The amount of reimbursement is 90% of the amount incurred between $7,500 and $32,500 and 100% of the amount incurred in excess of $32,500 for claims incurred in that calendar year with respect to that person. For calendar year 2012, only claims incurred on or after July 1st are considered in determining the member insurer's reimbursement. With the approval of the superintendent, the association may annually adjust the initial level of claims and the maximum limit to be retained by the insurer to reflect changes in costs, utilization, available funding and any other factors affecting the sustainable operation of the association. [PL 2019, c. 653, Pt. B, §18 (AMD).] A-1. In any plan year in which a pooled market is operating in accordance with section 2792 , the association shall operate a retrospective reinsurance program providing coverage to member insurers for all individual and small group health plans issued in this State in that plan year. For plan years beginning in 2022, if the pooled market has not been implemented pursuant to section 2792, subsection 5 , the association may operate a retrospective reinsurance program for individual health plans, subject to the approval of the superintendent. (1) The association shall reimburse member insurers based on the total eligible claims paid during a calendar year for a single individual in excess of the attachment point specified by the board. The board may establish multiple layers of coverage with different attachment points and different percentages of claims payments to be reimbursed by the association. (2) Eligible claims by all individuals enrolled in individual or small group health plans in this State may not be disqualified for reimbursement on the basis of health conditions, predesignation by the member insurer or any other differentiating factor. (3) The board shall annually review the attachment points and coinsurance percentages and make any adjustments that are necessary to ensure that the retrospective reinsurance program operates on an actuarially sound basis. (4) The board shall ensure that any surplus in the retrospective reinsurance program at the conclusion of a plan year is used to lower attachment points, increase coinsurance rates or both for that plan year, consistent with its responsibility to ensure that the program operates on an actuarially sound basis. [PL 2019, c. 653, Pt. B, §18 (NEW).] B. A member insurer shall apply all managed care, utilization review, case management, preferred provider arrangements, claims processing and other methods of operation without regard to whether claims paid for coverage are reinsured under this subsection. A member insurer shall report for each plan year the name of each high-priced item or service for which its payment exceeded the amount allowed for eligible claims and the name of the provider that received this payment. The association shall annually compile and publish a list of all reported names. [PL 2019, c. 653, Pt. B, §18 (AMD).] [PL 2021, c. 361, §5 (AMD).]

2. Premium rates. The association, as part of the plan of operation under section 3953, subsection 3 , shall establish a methodology for determining premium rates to be charged member insurers to reinsure persons eligible for coverage under this chapter. The methodology must include a system for classification of persons eligible for coverage that reflects the types of case characteristics used by insurers for individual health plans pursuant to section 2736‑C , together with any additional rating factors the association determines to be appropriate. The methodology must provide for the development of base reinsurance premium rates, subject to approval of the superintendent, set at levels that, together with other funds available to the association, will be sufficient to meet the anticipated costs of the association. The association shall periodically review the methodology established under this subsection and may make changes to the methodology as needed with the approval of the superintendent. The association may consider adjustments to the premium rates charged for reinsurance to reflect the use of effective cost containment and managed care arrangements by an insurer. This subsection does not apply to reinsurance with respect to any calendar year for which the association operates a retrospective reinsurance program under subsection 1, paragraph A‑1 . With the approval of the superintendent, the association's plan of operation for a retrospective reinsurance program may include a provision for charging premium on an equitable basis to all member insurers. [PL 2019, c. 653, Pt. B, §18 (AMD).]
24-A M.R.S. § 231 — ME Code / Title 24-A / Chapter 3 / Section 231
24-A §231. Conduct of hearing
Status: in_force

1. The superintendent may hold a hearing in Augusta or any other place of convenience to parties and witnesses, as the superintendent determines. The superintendent or the superintendent's designee shall preside at the hearing and shall expedite the hearing and all procedures involved therein. Adjudicatory hearings shall be governed by the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter IV . [PL 1989, c. 269, §6 (AMD).]

2. [PL 1989, c. 269, §6 (RP).]

3. [PL 1989, c. 269, §6 (RP).]

4. [PL 1989, c. 269, §6 (RP).]

5. The hearing shall be public, unless the superintendent or hearing officer determines that a private hearing would be in the public interest, in which case the hearing shall be private, subject to Title 1, section 405, subsection 6 . [PL 1989, c. 269, §6 (AMD).]

6. [PL 1989, c. 269, §6 (RP).]

7. The validity of any hearing held in accordance with the notice thereof, or waiver of notice, shall not be affected by the failure of any person to attend or remain in attendance. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2412-A — ME Code / Title 24-A / Chapter 27 / Section 2412-A
24-A §2412-A. Large commercial contracts
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Contract of insurance" means a contract of insurance, as defined in section 3 , that provides for property or casualty insurance coverages or a combination of property or casualty insurance, excluding workers' compensation, medical malpractice, life, health and disability insurance. [PL 1999, c. 328, §1 (NEW).] B. "Large commercial policyholder" means an insurance contract holder that is a corporation, partnership, trust, sole proprietorship or other business or public entity and that has certified that it meets: (1) At least 2 of the following 3 criteria: (a) A net worth of $10,000,000 as certified by a certified public accountant or public accountant authorized to do business in this State; (b) Net revenue or sales of $5,000,000 as certified by a certified public accountant or public accountant authorized to do business in this State; or (c) A total of more than 25 employees per individual company or more than 50 employees per holding company; and (2) The following criteria: (a) The use of an employed or retained risk manager to procure insurance. For purposes of this division, "risk manager" means a chartered property and casualty underwriter, a certified insurance counselor, an associate in risk management, a certified risk manager or a licensed insurance consultant; and (b) Aggregate property and casualty insurance premiums, excluding workers' compensation, medical malpractice, life, health and disability insurance premiums as follows: (i) Until December 31, 2000, $90,000; (ii) From January 1, 2001 until December 31, 2001, $75,000; (iii) From January 1, 2002 until December 31, 2002, $60,000; and (iv) After January 1, 2003, $50,000. "Large commercial policyholder" also includes a nonprofit or public entity with an annual budget or assets of $25,000,000 or more that meets the criteria listed in subparagraph (2) and a municipality with a population of 20,000 or more that meets the premium criteria listed in subparagraph (2), division (b). A commercial policyholder that meets the premium criteria listed in subparagraph (2), division (b) but that does not meet 3 of the qualifying criteria listed in either subparagraph (1) or subparagraph (2), division (a) may petition the superintendent for a waiver of the remaining criteria. The superintendent may grant a waiver if the superintendent determines that the applicant for a waiver is sufficiently qualified to act as a large commercial policyholder. [PL 2001, c. 3, §1 (AMD).] [PL 2001, c. 3, §1 (AMD).]

2. Regulation of policy; establishing rates. The provisions of section 2412, subsections 1 to 5 and subsection 8 ; sections 2413 , 2418 , 2421 and 2438 to 2445 ; and chapter 25, subchapter 1 , except for section 2303, subsection 1, paragraph B , as the provisions relate to the filing, approval and fixing of or establishing rates, do not apply to any contract of insurance issued to a large commercial policyholder pursuant to this section. Section 2004, subsection 4 also does not apply to any contract of insurance issued pursuant to this section to a large commercial policyholder. [PL 1999, c. 538, §2 (AMD); PL 1999, c. 538, §3 (AFF).]

3. Underwriting files. Notwithstanding subsection 2 , an insurer issuing contracts of insurance to large commercial policyholders shall maintain underwriting files; premium, loss and expense statistics; claims files and records; written certification from the large commercial policyholder that it meets the criteria for a large commercial policyholder under subsection 1, paragraph B ; and financial and other records with regard to such contracts that are subject to examination by the superintendent. A large commercial policyholder shall annually file a certification as a large commercial policyholder with the insurer. [PL 1999, c. 328, §1 (NEW).]

4. Disclaimer required. Each policy issued to a large commercial policyholder pursuant to this section must include a disclaimer with language similar to the following: "The contract provisions, rates and rating plans provided for in this policy are exempt from the filing and approval requirements of the Bureau of Insurance." [PL 1999, c. 328, §1 (NEW).]

5. Suspension of program by superintendent. If the superintendent finds at any time that a sufficient degree of competition does not exist for a particular line, class or type of insurance, then the superintendent may deem the provisions of this section waived for so long as a sufficient degree of competition does not exist. After waiver by the superintendent, upon the request of 5 or more interested parties, the superintendent, within 45 days of the request, shall hold a hearing at which interested parties may present evidence as to whether a sufficient degree of competition exists for the particular line, class or type of insurance. [PL 1999, c. 328, §1 (NEW).]

6. Annual report. An insurer that issues policies pursuant to this section shall report annually to the superintendent beginning on February 1, 2001 and continuing until February 1, 2005. The report must be made on a form prescribed by the superintendent and must include information relating to the number of policies issued each year sorted by line of insurance; the number of policies renewed each year sorted by line of insurance; and any other pertinent information required by the superintendent. [PL 1999, c. 328, §1 (NEW).]

7. Bureau report. On or before March 1, 2005, the superintendent shall report to the joint standing committee of the Legislature have jurisdiction over insurance matters on the effects of this section. The report must contain the superintendent's recommendations as to any changes in the criteria established in this section to qualify as a large commercial policyholder. [PL 1999, c. 328, §1 (NEW).]
24-A M.R.S. § 4320-L — ME Code / Title 24-A / Chapter 56-A / Section 4320-L
24-A §4320-L. Nondiscrimination
Status: in_force

1. Nondiscrimination. An individual may not, on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability, be excluded from participation in, be denied benefits of or otherwise be subjected to discrimination under any health plan offered in accordance with this Title. A carrier may not in offering, providing or administering a health plan: A. Deny, cancel, limit or refuse to issue or renew a health plan or other health-related coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability; [PL 2019, c. 5, Pt. C, §2 (NEW).] B. Have or implement marketing practices or benefit designs that discriminate on the basis of race, color, national origin, sex, sexual orientation, gender identity, age or disability in a health plan or other health-related coverage; [PL 2019, c. 5, Pt. C, §2 (NEW).] C. Deny or limit coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage for any health services that are ordinarily or exclusively available to individuals of one sex to a transgender individual based on the fact that the individual's sex assigned at birth, gender identity or gender otherwise recorded is different from the one to which such health services are ordinarily or exclusively available; [PL 2019, c. 5, Pt. C, §2 (NEW).] D. Have or implement a categorical coverage exclusion or limitation for all health services related to gender transition; or [PL 2019, c. 5, Pt. C, §2 (NEW).] E. Otherwise deny or limit coverage, deny or limit coverage of a claim or impose additional cost sharing or other limitations or restrictions on coverage for specific health services related to gender transition if such denial, limitation or restriction results in discrimination against a transgender individual. [PL 2019, c. 5, Pt. C, §2 (NEW).] Nothing in this subsection is intended to determine or restrict a carrier from determining whether a particular health service is medically necessary or otherwise meets applicable coverage requirements in any individual case. [PL 2019, c. 5, Pt. C, §2 (NEW).]

2. Meaningful access for individuals with limited English proficiency. A carrier shall take reasonable steps to provide meaningful access to each enrollee or prospective enrollee under a health plan who has limited proficiency in English. [PL 2019, c. 5, Pt. C, §2 (NEW).]

3. Effective communication for persons with disabilities. A carrier shall take reasonable steps to ensure that communication with an enrollee or prospective enrollee in a health plan who is an individual with a disability is as effective as communication with other enrollees or prospective enrollees. [PL 2019, c. 5, Pt. C, §2 (NEW).]
24-A M.R.S. § 2383-A — ME Code / Title 24-A / Chapter 25 / Section 2383-A
24-A §2383-A. Monitoring competition
Status: in_force

1. Monitoring. The superintendent shall monitor the degree of competition in the workers' compensation insurance market. The superintendent shall utilize existing relevant information and analytical techniques and may cause or participate in the development of new relevant information, analytical techniques and other sources. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

2. Consideration of factors. The superintendent shall consider, in addition to any other relevant factors, the following: A. The number of insurers actively engaged in providing coverage; [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. Market shares and changes in market shares; [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] C. Ease of entry and exit by insurers in and out of the workers' compensation insurance market; and [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] D. Tests relating to market structure, market performance and market conduct. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

3. Degree of competition. The superintendent shall consider approved self-insured employers when evaluating the degree of competition in the insurance market. The superintendent shall report by November 1, 1994 and annually thereafter on the status of the market to the Governor and to the joint standing committee of the Legislature having jurisdiction over workers' compensation insurance rate regulation matters. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]
24-A M.R.S. § 4349-B — ME Code / Title 24-A / Chapter 56-C / Section 4349-B
24-A §4349-B. Plan sponsor access to claims data; right to audit (REALLOCATED FROM TITLE 24-A, SECTION 4349-A)
Status: in_force

(REALLOCATED FROM TITLE 24-A, SECTION 4349-A)

1. Prescription drug data. Within 30 business days of a request from a plan sponsor that has certified its compliance with the use and disclosure requirements of 45 Code of Federal Regulations, Section 164.504(f), a pharmacy benefits manager shall provide data to the plan sponsor regarding the actual amounts directly or indirectly paid by the pharmacy benefits manager to a pharmacy or pharmacist on behalf of the plan sponsor for a prescription drug and any dispensing fee for a prescription drug. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]

2. Claims data; right to audit. Notwithstanding section 4350‑C , a pharmacy benefits manager that contracts with a plan sponsor to provide prescription drug coverage shall permit a plan sponsor to perform a post-payment audit of claims paid to ensure compliance with the contract at least once in a calendar year as long as the request is not earlier than 6 months following a previously requested audit. Upon request of a plan sponsor as part of an audit, a pharmacy benefits manager shall disclose within 30 business days to a plan sponsor who has certified its compliance with the use and disclosure requirements of 45 Code of Federal Regulations, Section 164.504(f), or, to the extent permitted by law and if requested by the plan sponsor, to the plan sponsor's designated business associate the following information specific to the plan sponsor: A. Rebate amounts, identified by the drug and therapeutic category, secured on prescription drugs provided by a pharmaceutical manufacturer that are generated by claims processed through the plan maintained by the plan sponsor and administered by the pharmacy benefits manager; [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).] B. Prescription drug and device claims received by the pharmacy benefits manager via electronic claims transactions on any current standardized claim form approved by the Federal Government for these services. The form or transaction may be modified only as necessary to comply with the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and the federal Health Information Technology for Economic and Clinical Health Act of 2009, Title XIII, Subtitle D, Public Law 111‑5, and any regulations promulgated under those laws; [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).] C. Prescription drug and device claims payments, electronic funds transfers or remittance advice notices provided by the pharmacy benefits manager as electronic files. The files may be modified only as necessary to comply with the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and the federal Health Information Technology for Economic and Clinical Health Act of 2009, Title XIII, Subtitle D, Public Law 111-5, and any regulations promulgated under those laws; and [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).] D. Any other revenue and fees derived by the pharmacy benefits manager from the contract, including all direct or indirect remuneration from pharmaceutical manufacturers regardless of whether the remuneration is classified as a rebate, fee or other classification. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).] [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]

3. No conditions or fees on audit. A pharmacy benefits manager may not impose on a plan sponsor: A. Any fees relating to an audit request under this section that exceed the direct expenses properly and actually incurred by the pharmacy benefits manager to provide the data; or [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).] B. Any conditions that would restrict a plan sponsor's right to conduct an audit under this section, including, but not limited to, restrictions on: (1) The time period covered by the audit, except that any request pursuant to this section must be made within 24 months of the end of each plan year to be audited; (2) The number of claims analyzed; (3) The type of analysis conducted; (4) The data elements used in the analysis; (5) The means by which an auditor is compensated by a plan sponsor; or (6) The plan sponsor's choice of auditor as long as the plan sponsor certifies that the auditor has adequate conflict of interest protection provisions to prevent conflicts of interest from adversely affecting the outcome of the audit. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).] [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]

4. Nondisclosure and data use agreement. A pharmacy benefits manager may require that the plan sponsor and the plan sponsor's designated business associate execute a nondisclosure and data use agreement that reasonably restricts the auditor's use of data provided by the pharmacy benefits manager to the sole purpose of conducting an audit on behalf of a plan sponsor. The coverage limits of any cybersecurity insurance or liability insurance policy required under the nondisclosure and data use agreement may not exceed the pharmacy benefits manager's limit of liability under the services agreement between the plan sponsor and the pharmacy benefits manager, if such limit applies. In addition, a pharmacy benefits manager is not required to provide data to an auditor selected by a plan sponsor if the auditor has previously breached a nondisclosure and data use agreement with that pharmacy benefits manager or refuses to execute a nondisclosure and data use agreement. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]

5. Compliance with federal law. Information provided by a pharmacy benefits manager to a plan sponsor in accordance with this section must comply with any applicable requirements of the federal Health Insurance Portability and Accountability Act of 1996, Public Law 104-191, and the federal Health Information Technology for Economic and Clinical Health Act of 2009, Title XIII, Subtitle D, Public Law 111-5, and any regulations promulgated under those laws. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]

6. Application. An administrator or pharmacy benefits manager may not enter into, issue, amend or renew any contract or network services agreement with a plan sponsor on or after January 1, 2026 that contains any provision that violates this section. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]

7. Exclusive enforcement; violation. Notwithstanding section 12‑A , a violation of this section is subject to exclusive enforcement under the Maine Unfair Trade Practices Act, including any of the remedies provided for in the Act. A violation is committed each time a prohibited act under this section occurs. Investigations of violations by pharmacy benefits managers may include a 3rd party that may possess evidence supporting such investigation. [PL 2025, c. 487, §3 (NEW); RR 2025, c. 1, Pt. A, §34 (RAL).]
24-A M.R.S. § 2165-A — ME Code / Title 24-A / Chapter 23 / Section 2165-A
24-A §2165-A. Cease and desist orders; actions against defined and undefined unfair and deceptive practices
Status: in_force

1. Emergency cease and desist orders issued pursuant to section 12‑A, subsection 2‑A may not be imposed for violations under this section. [PL 1991, c. 298, §12 (NEW).]

2. The superintendent may issue a cease and desist order pursuant to section 12‑A, subsection 2 if, after a hearing, the superintendent finds that any person in this State has engaged or is engaging in any act or practice defined or prohibited under this chapter or rules adopted pursuant to this chapter or that a resident of this State has so engaged or is so engaging in another state. [PL 1991, c. 298, §12 (NEW).]

3. The superintendent may issue a cease and desist order pursuant to section 12‑A, subsection 2 if, after a hearing, the superintendent finds that any person in the State has engaged or is engaging, or that a resident of the State has engaged or is engaging in another state, in an unfair or deceptive practice not defined in this chapter or in rules adopted pursuant to this chapter. For any undefined practice, the civil penalties set forth in section 12‑A, subsection 1 may not be imposed for practice engaged in prior to the issuance and service of a valid cease and desist order. [PL 1991, c. 298, §12 (NEW).]
24-A M.R.S. § 2902-C — ME Code / Title 24-A / Chapter 39 / Section 2902-C
24-A §2902-C. Refusal to issue insurance prohibited
Status: in_force

No insurer may refuse to issue motor vehicle liability insurance to an applicant solely because the applicant is 65 years of age or older. [PL 1991, c. 106 (NEW).]
24-A M.R.S. § 2152-A — ME Code / Title 24-A / Chapter 23 / Section 2152-A
24-A §2152-A. Life insurance solicitation
Status: in_force

It shall be an unfair practice under this chapter for any insurer, agent or broker to solicit, negotiate or procure the purchase of life insurance within this State, except in compliance with life insurance cost disclosure rules which shall be adopted in accordance with the Maine Administrative Procedure Act Title 5, chapter 375 , by the superintendent by July 1, 1980. [PL 1979, c. 447 (NEW).]
24-A M.R.S. § 4318-B — ME Code / Title 24-A / Chapter 56-A / Section 4318-B
24-A §4318-B. Access to lower-priced services
Status: in_force

1. Services from out-of-network provider; lower prices. Beginning January 1, 2019, if an enrollee covered under a health plan other than a health maintenance organization plan elects to obtain a covered comparable health care service as defined in section 4318‑A, subsection 1, paragraph A from an out-of-network provider at a price that is the same or less than the statewide average for the same covered health care service based on data reported on the publicly accessible health care costs website of the Maine Health Data Organization, the carrier shall allow the enrollee to obtain the service from the out-of-network provider at the provider's charge and, upon request by the enrollee, shall apply the payments made by the enrollee for that comparable health care service toward the enrollee's deductible and out-of-pocket maximum as specified in the enrollee's health plan as if the health care services had been provided by an in-network provider. A carrier may use the average price paid to a network provider for the covered comparable health care service under the enrollee's health plan in lieu of the statewide average price on the Maine Health Data Organization's publicly accessible website as long as the carrier uses a reasonable method to calculate the average price paid and the information is available to enrollees through a website accessible to the enrollee and a toll-free telephone number that provide, at a minimum, information relating to comparable health care services. The enrollee is responsible for demonstrating to the carrier that payments made by the enrollee to the out-of-network provider should be applied toward the enrollee's deductible or out-of-pocket maximum pursuant to this section. The carrier shall provide a downloadable or interactive online form to the enrollee for the purpose of making such a demonstration and may require that copies of bills and proof of payment be submitted by the enrollee. For the purposes of this section, "out-of-network provider" means a provider located in Massachusetts, New Hampshire or this State that is enrolled in the MaineCare program and participates in Medicare. [PL 2017, c. 232, §9 (NEW).]

2. Rules. The superintendent may adopt rules as necessary to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2017, c. 232, §9 (NEW).]

3. Repeal. [PL 2023, c. 224, §2 (RP).]
24-A M.R.S. § 6609 — ME Code / Title 24-A / Chapter 81 / Section 6609
24-A §6609. Liability of participants
Status: in_force

1. Liability of each employer participant. The liability of each employer participant for the obligations of the multiple-employer welfare arrangement is joint and several. [PL 1993, c. 688, §1 (NEW).]

2. Contingent assessment liability. Each employer participant has a contingent assessment liability pursuant to section 6610 for payment of actual losses and expenses incurred while the participation agreement was in force. [PL 1993, c. 688, §1 (NEW).]

3. Statement of contingent liability. Each participation agreement or contract issued by the arrangement must contain a statement of the contingent liability of employer participants. Both the application for participation and the participation agreement must contain, in contrasting color and not less than 10-point type, the following statement: "This is a fully assessable contract. In the event the arrangement is unable to pay its obligations, participating employers will be required to contribute through an equitable assessment the money necessary to meet any unfulfilled obligations." [PL 1993, c. 688, §1 (NEW).]
24-A M.R.S. § 6204 — ME Code / Title 24-A / Chapter 73 / Section 6204
24-A §6204. Withdrawal plan
Status: in_force

Any provider who has obtained a certificate of authority from the superintendent and who plans neither to renew existing agreements nor to offer new agreements shall submit a withdrawal plan to the superintendent at least 60 days prior to implementing its proposed plan. The plan shall include, but not be limited to, requirements and procedures for meeting the provider's existing contractual obligations, providing security in the event of a subsequent insolvency and meeting any applicable statutory obligations. The plan shall also comply with any further terms and conditions which are prescribed by rules adopted by the superintendent. The plan shall not be implemented without the approval of the superintendent. [RR 2015, c. 2, §16 (COR).]
24-A M.R.S. § 1952 — ME Code / Title 24-A / Chapter 18-A / Section 1952
24-A §1952. Licensure
Status: in_force

A private purchasing alliance may not market, sell, offer or arrange for a package of one or more health benefit plans underwritten by one or more carriers without first being licensed by the superintendent. The superintendent shall specify by rule standards and procedures for the issuance and renewal of licenses for private purchasing alliances. A rule may require an application fee of not more than $400 and an annual license fee of not more than $100. A license may not be issued until the rulemaking required by this chapter has been undertaken and all required rules are in effect. Dirigo Health, as established in chapter 87 , is exempt from the licensure requirements of this section as an independent executive agency of the State. [PL 2003, c. 469, Pt. E, §8 (AMD).]
24-A M.R.S. § 4243 — ME Code / Title 24-A / Chapter 56 / Section 4243
24-A §4243. Limits on priority liens; subrogation
Status: in_force

An individual or group contract subject to this chapter may not provide for subrogation or priority over the enrollee of payment for any hospital, nursing, medical or surgical services or of any expenses paid or reimbursed under the coverage, in the event the enrollee is entitled to receive payment or reimbursement from any other person as a result of legal action or claim, except as provided in this section. [PL 1997, c. 369, §3 (NEW).]

The coverage may contain a provision that allows the payments, if that provision is approved by the superintendent and if that provision required the prior written approval of the insured and allows such payments only on a just and equitable basis and not on the basis of a priority lien. A "just and equitable basis" means that any factors that diminish the potential value of the enrollee's claim may likewise reduce the share in the claim for those claiming payment for services or reimbursement. Such factors include, but are not limited to: [PL 1997, c. 369, §3 (NEW).]

1. Legal defenses. Questions of liability and comparative negligence or other legal defenses; [PL 1997, c. 369, §3 (NEW).]

2. Exigencies of trial. Exigencies of trial that reduce a settlement or award in order to resolve the claim; and [PL 1997, c. 369, §3 (NEW).]

3. Limits of coverage. Limits on the amount of applicable insurance coverage that reduce the claim to an amount recoverable by the insured. [PL 1997, c. 369, §3 (NEW).]

In the event of a dispute as to the application of any such provision or the amount available for payment to those claiming payment for services or reimbursement, that dispute must be determined, if the action is pending, before the court in which it is pending; or if no action is pending, by filing an action in any court for determination of the dispute. [PL 1997, c. 369, §3 (NEW).] Revisor's Note: §4243. Coverage for prostate cancer screening (As enacted by PL 1997, c. 754, §4 is REALLOCATED TO TITLE 24-A, SECTION 4244)
24-A M.R.S. § 2307 — ME Code / Title 24-A / Chapter 25 / Section 2307
24-A §2307. Limitation of disapproval power
Status: in_force

A manual of classifications, rule or rating plan or any modification of any of the foregoing that establishes standards for measuring variations in hazards or expense provisions, or both, and that has been filed pursuant to section 2304‑A may not be disapproved if the rates produced meet the requirements of this chapter and chapter 23 . [RR 2021, c. 2, Pt. A, §71 (COR).]
24-A M.R.S. § 2532 — ME Code / Title 24-A / Chapter 29 / Section 2532
24-A §2532. Adjusted premiums for policies issued before the operative date of section 2532-A
Status: in_force

1. This section shall not apply to policies issued on or after the operative date of section 2532‑A as defined therein. [PL 1983, c. 346, §12 (RPR).]

2. Except as provided in subsection 4 , the adjusted premiums for any policy shall be calculated on an annual basis and shall be the uniform percentage of the respective premiums specified in the policy for each policy year, excluding any extra premiums charged because of cover impairments or special hazards, that the present value, at the date of issue of the policy, of all those adjusted premiums shall be equal to the sum of: A. The then present value of the future guaranteed benefits provided for by the policy; [PL 1983, c. 346, §12 (NEW).] B. Two percent of the amount of insurance, if the insurance be uniform in amounts, or of the equivalent uniform amount, as hereinafter defined, if the amount of insurance varies with duration of the policy; [PL 1983, c. 346, §12 (NEW).] C. Forty percent of the adjusted premium for the first policy year; and [PL 1983, c. 346, §12 (NEW).] D. Twenty-five percent of either the adjusted premium for the first policy year or the adjusted premium for a whole life policy of the same uniform or equivalent uniform amount with uniform premiums for the whole of life issued at the same age for the same amount of insurance, whichever is less. [PL 1983, c. 346, §12 (NEW).] In applying the percentages specified in paragraphs C and D , no adjusted premium may be deemed to exceed 4% of the amount of insurance or uniform amount equivalent thereto. The date of issue of a policy for the purpose of this section shall be the date as of which the rated age of the insured is determined. [PL 1983, c. 346, §12 (RPR).]

3. In the case of a policy providing an amount of insurance varying with duration of the policy, the equivalent uniform amount thereof for the purpose of this section shall be deemed to be the uniform amount of insurance provided by an otherwise similar policy, containing the same endowment benefit or benefits, if any, issued at the same age and for the same term, the amount of which does not vary with duration and the benefits under which have the same present value at the date of issue as the benefits under the policy, provided that in the case of a policy providing a varying amount of insurance issued on the life of a child under age 10, the equivalent uniform amount may be computed as though the amount of insurance provided by the policy prior to the attainment of age 10 were the amount provided by that policy at age 10. [PL 1983, c. 346, §12 (RPR).]

4. The adjusted premiums for any policy providing term insurance benefits by rider or supplemental policy provision shall be equal to: A. The adjusted premiums for an otherwise similar policy issued at the same age without those term insurance benefits, increased, during the period for which premiums for those term insurance benefits are payable, by [PL 1983, c. 346, §12 (NEW).] B. The adjusted premiums for that term insurance. [PL 1983, c. 346, §12 (NEW).] Paragraphs A and B shall be calculated separately and as specified in subsections 2 and 3 , except that, for purposes of subsection 2, paragraphs B , C and D , the amount of insurance or equivalent uniform amount of insurance used in the calculation of the adjusted premiums referred to in paragraph B of this subsection shall be equal to the excess of the corresponding amount determined for the entire policy over the amount used in the calculation of the adjusted premiums in paragraph A . [PL 1983, c. 346, §12 (RPR).]

5. Except as provided in subsection 6 and in section 2532‑A , all adjusted premiums and present values referred to in sections 2529 to 2534 shall for all policies of ordinary insurance be calculated on the basis of the Commissioners 1958 Standard Ordinary Mortality Table, provided that, for any category of ordinary insurance issued on female risks, adjusted premiums and present values may be calculated according to an age not more than 3 years younger than the actual age of the insured, and those calculations for all policies of industrial insurance shall be made on the basis of the Commissioners 1961 Standard Industrial Mortality Table. All calculations shall be made on the basis of the rate of interest specified in the policy for calculating cash surrender values and paid-up nonforfeiture benefits, provided that that rate of interest shall not exceed 3 1/2% each year, except that a rate of interest not exceeding 4% each year may be used for policies issued on or after December 31, 1975. In calculating the present value of any paid-up term insurance with accompanying pure endowment, if any, offered as a nonforfeiture benefit for ordinary insurance, the rates of mortality assumed may not be more than those shown in the Commissioners 1958 Extended Term Insurance Table and for industrial insurance rates of mortality may not be more than those shown in the Commissioners 1961 Industrial Extended Term Insurance Table. For insurance issued on a substandard basis, the calculation of any such adjusted premiums and present values may be based on such other table of mortality as may be specified by the insurer and approved by the superintendent. [PL 1983, c. 346, §12 (RPR).]

6. In the case of policies issued on or after January 1, 1980, adjusted premiums and present values for any category of ordinary insurance issued on female risks may be calculated according to an age not more than 6 years younger than the actual age of the insured. All calculations for all policies of ordinary and industrial insurance shall be made on the basis of the rate of interest specified on the policy for calculating cash surrender values and paid-up nonforfeiture benefits, provided that the rate of interest shall not exceed 5 1/2% each year. [PL 1983, c. 346, §12 (NEW).]
24-A M.R.S. § 2514 — ME Code / Title 24-A / Chapter 29 / Section 2514
24-A §2514. Beneficiary, industrial policies
Status: in_force

An industrial life insurance policy shall have the name of the beneficiary designated thereon or in the application or other form if attached to the policy, with a reservation of the right to designate or change the beneficiary after the issuance of the policy, unless such beneficiary be irrevocably designated. The policy may also provide that no designation or change of beneficiary shall be binding on the insurer until endorsed on the policy by the insurer, and that the insurer may refuse to endorse the name of any proposed beneficiary who does not appear to the insurer to have an insurable interest in the life of the insured. The policy may also provide that if the beneficiary designated in the policy does not make a claim under the policy or does not surrender the policy with due proof of death within the period stated in the policy, which shall not be less than 30 days after the death of the insured, or if the beneficiary is the estate of the insured, or is a minor, or dies before the insured, or is not legally competent to give a valid release, then the insurer may make any payment thereunder to the executor or administrator of the insured, or to any relative of the insured by blood or legal adoption or connection by marriage, or to any person appearing to the insurer to be equitably entitled thereto by reason of having been named beneficiary, or by reason of having incurred expense for the maintenance, medical attention or burial of the insured. The policy may also include a similar provision applicable to any other payment due under the policy. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2803 — ME Code / Title 24-A / Chapter 35 / Section 2803
24-A §2803. Requirements
Status: in_force

A policy of group health insurance may not be delivered in this State, nor may any certificate of group health insurance that derives from a policy issued in another state be delivered in this State unless the group policyholder conforms to one of the descriptions set forth in sections 2804 to 2808 . [PL 2011, c. 238, Pt. G, §1 (AMD).]
24-A M.R.S. § 2530 — ME Code / Title 24-A / Chapter 29 / Section 2530
24-A §2530. Cash surrender value
Status: in_force

1. Any cash surrender value available under the policy in the event of default in a premium payment due on any policy anniversary, whether or not required by section 2529 , shall be an amount not less than the excess, if any, of the present value, on that anniversary, of the future guaranteed benefits which would have been provided for by the policy, including any existing paid-up additions, if there had been no default, over the sum of: A. Present value of adjusted premiums. The then present value of the adjusted premiums as defined in sections 2532 and 2532‑A , corresponding to premiums which would have fallen due on and after that anniversary; and [PL 1983, c. 346, §11 (NEW).] B. Amount of indebtedness. The amount of any indebtedness to the insurer on the policy. [PL 1983, c. 346, §11 (NEW).] [PL 1983, c. 346, §11 (RPR).]

2. For any policy issued on or after the operative date of section 2532‑A as defined therein, which provides supplemental life insurance or annuity benefits at the option of the insured and for an identifiable additional premium by rider or supplemental policy provision, the cash surrender value referred to in subsection 1 shall be an amount not less than the sum of the cash surrender value as defined in that subsection for an otherwise similar policy issued at the same age without that rider or supplemental policy provision and the cash surrender value as defined in that subsection for a policy which provides only the benefits otherwise provided by that rider or supplemental policy provision. [PL 1983, c. 346, §11 (RPR).]

3. For any family policy issued on or after the operative date of section 2532‑A as defined therein, which defines a primary insured and provides term insurance on the life of the spouse of the primary insured expiring before the spouse's age 71, the cash surrender value referred to in subsection 1 shall be an amount not less than the sum of the cash surrender value as defined in that subsection for an otherwise similar policy issued at the same age without that term insurance on the life of the spouse and the cash surrender value as defined in that subsection for a policy which provides only the benefits otherwise provided by that term insurance on the life of the spouse. [PL 1983, c. 346, §11 (NEW).]

4. Any cash surrender value available within 30 days after any policy anniversary under any policy paid-up by completion of all premium payments or any policy continued under any paid-up nonforfeiture benefit, whether or not required by section 2529 , shall be an amount not less than the present value, on that anniversary, of the future guaranteed benefits provided for by the policy, including any existing paid-up additions, decreased by any indebtedness to the insurer on the policy. [PL 1983, c. 346, §11 (NEW).]
24-A M.R.S. § 5073 — ME Code / Title 24-A / Chapter 68-A / Section 5073
24-A §5073. Extraterritorial jurisdiction; group long-term care insurance
Status: in_force

1. Groups other than employer, union, trustee and association groups. A group long-term care insurance policy may not be offered to a resident of this State under a group policy issued in another state to a group other than an employer group as described in section 2804 , a labor union group as described in section 2805 , a trustee group as described in section 2806 or an association group as described in section 2805‑A unless the superintendent has made a determination that the requirements of this chapter have been met. [PL 1999, c. 292, §2 (NEW).]

2. Trustee groups. Group long-term care insurance may not be offered to an employee of an employer covered under a group policy issued in another state to a trustee group as described in section 2806 if a plurality of the employer's employees are based in this State unless the superintendent has made a determination that the requirements of this chapter have been met. [PL 1999, c. 292, §2 (NEW).]

3. Association groups. The following applies to group long-term care insurance coverage issued to association groups. A. Group long-term care insurance coverage may not be offered to a resident of this State under a group policy issued in another state to an association group as described in section 2805‑A , other than an association of employers, unless the superintendent has made a determination that the requirements of this chapter have been met. [PL 1999, c. 292, §2 (NEW).] B. Group long-term care insurance may not be offered to an employee of an employer covered under a group policy issued in another state to an association of employers if a plurality of the employer's employees are based in this State unless the superintendent has made a determination that the requirements of this chapter have been met. [PL 1999, c. 292, §2 (NEW).] [PL 1999, c. 292, §2 (NEW).]
24-A M.R.S. § 4440 — ME Code / Title 24-A / Chapter 57 / Section 4440
24-A §4440. Assessment of member insurers
Status: in_force

1. Proportion. The assessments of each member insurer provided for under section 4438 must be in the proportion that the net direct written premiums of the member insurer for the calendar year preceding the assessment on the kinds of insurance in the account bears to the net direct written premiums of all member insurers for the same calendar year on the kinds of insurance in the account, except that assessments to cover a shortfall in any account are determined in accordance with section 4440‑A . In the case of a withdrawn insurer, the average of its net direct written premium for the 5 calendar years prior to withdrawal, excluding premium on business written as a workers' compensation residual market servicing carrier for assessments made on or after January 1, 1996, must be used as its assessment base for any year following withdrawal in which the insurer has no net direct written premium. [PL 1995, c. 289, §16 (AMD).]

2. Notification. Each member insurer shall be notified of the assessment not later than 30 days before it is due. [PL 1969, c. 561 (NEW).]

3. Limitation; types of assessments. Assessments shall be made as follows. A. Each member insurer may be assessed in any calendar year on any account an amount up to 2% of that member insurer's net direct written premiums for the next preceding calendar year on the kinds of insurance in the account for purposes of paying claims and expenses of that account. [PL 1989, c. 67, §7 (NEW).] B. To the extent that the maximum 2% has not been assessed, an assessment of up to that member's proportionate share of the applicable maximum as set forth in this paragraph shall be assessed when immediately necessary for the payment of claims and expenses. Any amount drawn by the association under any line of credit shall be considered a payment toward the member insurer's obligation provided for in this section. The maximum line of credit or preinsolvency assessment for each account shall be as follows: Account Maximum Workers' compensation $2,000,000 Automobile $1,700,000 All other $1,300,000 (1) The association shall obtain a line of credit for the benefit of each account, in an amount not to exceed the applicable maximum to ensure the immediate availability of funds for purposes of future claims and expenses attributable to an insurer insolvency in that account. The line of credit shall be obtained from qualified financial institutions. At no time may a qualified financial institution participate in the line of credit in excess of 20% of its equity capital. The line of credit shall provide for a 30-day notice of termination or nonrenewal to the superintendent and the association and shall provide funding to the association within one business day of receipt of written notice from the superintendent of an insolvent insurer in that account as defined in section 4435, subsection 5 . Each member insurer upon receipt of notice from the association shall make immediate payment for its proportionate share of the amount borrowed based on the premium for the preceding calendar year. The line of credit provided for in this paragraph shall be subject to prior review and approval by the superintendent at the time of origination and any subsequent renewal. (2) If the association cannot obtain a line of credit, a member insurer may obtain a line of credit from a qualified financial institution or may extend a line of credit itself directly to and for the benefit of the member insurer's account by submitting to the association a duly authorized and executed line of credit agreement providing that the member insurer shall provide funding to the association under the line of credit within one business day of receipt of a written notice from the superintendent of an insolvent insurer as defined in section 4435, subsection 5 , and receipt of a written request from the association for a drawdown under the line of credit. The line of credit agreement shall be subject to prior review and approval by the superintendent at the time of origination and any subsequent renewal. It shall include such commercially reasonable provisions as the association or the superintendent may deem advisable, including a provision that the line of credit is irrevocable or for a stated period of time and provides for a 30-day notice to the association and the superintendent that the line is being terminated or not renewed. Any line of credit issued under this paragraph may be replaced with another line of credit and the existing line of credit shall be released by the association once a substitute line of credit has been provided or the assessment provided for in this paragraph has been paid. (3) If a line of credit is not given as provided for in subparagraph (2), the member insurer shall be responsible for payment of an assessment of up to that member's proportionate share of the applicable maximum as set forth in this paragraph which shall be paid into a preinsolvency assessment fund in each account. Funds in each account shall only be used for the payment of claims and expenses of an insolvent insurer in that account. (4) All materials and information submitted or considered under this paragraph shall be matters of public record. [PL 1989, c. 67, §7 (NEW).] [PL 1989, c. 67, §7 (RPR).]

4. Exemptions. The association may exempt or defer, in whole or in part, the assessment of any member insurer, if the assessment would cause the member insurer's financial statement to reflect amounts of capital or surplus less than the minimum amounts required for a certificate of authority by any jurisdiction in which the member insurer is authorized to transact insurance. It is a condition of any deferral that during the period of deferment no dividends may be paid by the member insurer to its shareholders or policyholders. A deferred assessment is paid when payment will not reduce capital or surplus below required levels, and the association shall then refund to its other member insurers an amount equal to the deferred assessment in the proportions corresponding to the increases in their assessments by virtue of that deferment. [PL 1985, c. 279, §6 (AMD).]

5. Set off. Each member insurer may set off against any assessment, authorized payments made on covered claims and expenses incurred in the payment of such claims by the member insurer, if they are chargeable to the account for which the assessment is made. [PL 1969, c. 561 (NEW).]

6. Delinquency. Delinquent assessments, except as provided in subsection 4 , shall bear interest at the rate of 8% per annum, computed from the due date of the assessment. [PL 1969, c. 561 (NEW).]
24-A M.R.S. § 3710 — ME Code / Title 24-A / Chapter 52 / Section 3710
24-A §3710. Funding; surplus
Status: in_force

1. Initial funding. [PL 1997, c. 661, §9 (RP).]

2. Ongoing funding. The company: A. [PL 2001, c. 350, §4 (RP).] B. May assess its policyholders for additional funds to meet operating needs or as required by law; and [PL 1995, c. 551, §5 (AMD).] C. May provide premium payment plans and premium financing programs. [PL 2001, c. 350, §4 (AMD).] [PL 2001, c. 350, §4 (AMD).]

3. Transition surplus, premium levels. [PL 2001, c. 350, §4 (RP).]
24 M.R.S. § 2332-A — ME Code / Title 24 / Chapter 19 / Section 2332-A
24 §2332-A. Coordination of benefits
Status: in_force

1. Authorization. Provisions contained in group and nongroup nonprofit hospital, medical service or health care subscriber contracts relating to coordination of benefits payable under the contract and under other plans of insurance or of health care coverage under which the subscriber or the subscriber's dependents may be covered must conform to rules adopted by the superintendent. The rules may establish uniformity in the permissive use of coordination of benefits provisions to ensure that the subscriber receives full benefits for covered medical services, to enhance cost containment through avoidance of windfall payments and to avoid claim delays and misunderstandings that otherwise result from the use of inconsistent or incompatible provisions among the several insurers and nonprofit hospital, medical service and health care plans. [PL 1993, c. 666, Pt. B, §1 (NEW).]

1-A. Coordination with Medicare. Coordination of benefits is governed by the following provisions. A. The contract may not coordinate benefits with Medicare Part A unless: (1) The insured is enrolled in Medicare Part A; (2) The insured was previously enrolled in Medicare Part A and voluntarily disenrolled; (3) The insured stated on an application or other document that the insured was enrolled in Medicare Part A; or (4) The insured is eligible for Medicare Part A without paying a premium and the contract states that it will not pay benefits that would be payable under Medicare even if the insured fails to exercise the insured's right to premium-free Medicare Part A coverage. [PL 1997, c. 604, Pt. G, §1 (NEW).] B. The contract may not coordinate benefits with Medicare Part B unless: (1) The insured is enrolled in Medicare Part B; (2) The insured was previously enrolled in Medicare Part B and voluntarily disenrolled; (3) The insured stated on an application or other document that the insured was enrolled in Medicare Part B; or (4) The insured is eligible for Medicare Part A without paying a premium and the insurer provided prominent notification to the insured both when the contract was issued and, if applicable, when the insured becomes eligible for Medicare due to age. The content of the notification must be approved by the bureau. The notification must state that the contract will not pay benefits that would be payable under Medicare even if the insured fails to enroll in Medicare Part B and state that the insured may contact the bureau, the Health Insurance Consumer Assistance Program established in Title 24‑A, section 4326 or another relevant organization or agency for assistance in understanding coordination of benefits with Medicare Part B under the insured's contract. [PL 2023, c. 104, §1 (AMD).] C. Coordination is not permitted with Medicare coverage for which the insured is eligible but not enrolled except as provided in paragraphs A and B . [PL 1997, c. 604, Pt. G, §1 (NEW).] [PL 2023, c. 104, §1 (AMD).]

2. Medicaid and Children's Health Insurance Program. Nonprofit service organizations may not consider the availability or eligibility for medical assistance under 42 United States Code, Section 13969, referred to as "Medicaid," or Title 22, section 3174‑T, referred to as the "Children's Health Insurance Program," when considering coverage eligibility or benefit calculations for subscribers and covered family members. A. To the extent that payment for coverage expenses has been made under the Medicaid program or the Children's Health Insurance Program for health care items or services furnished to an individual, the State is considered to have acquired the rights of the covered subscriber or family member to payment by the nonprofit service organization for those health care items or services. Upon presentation of proof that the Medicaid program or the Children's Health Insurance Program has paid for covered items or services, the nonprofit service organization shall make payment to the Medicaid program or the Children's Health Insurance Program according to the coverage provided in the contract or certificate. [PL 2023, c. 597, §16 (AMD).] B. A nonprofit service organization may not impose requirements on a state agency that has been assigned the rights of an individual eligible for Medicaid or Children's Health Insurance Program coverage and covered by a subscriber contract that are different from requirements applicable to an agent or assignee of any other covered individual. [PL 2023, c. 597, §16 (AMD).] [PL 2023, c. 597, §16 (AMD).]

3. Credit toward deductible. When an insured is covered under more than one expense-incurred health plan, payments made by the primary plan, payments made by the insured and payments made from a health savings account or similar fund for benefits covered under the secondary plan must be credited toward the deductible of the secondary plan. This subsection does not apply if the secondary plan is designed to supplement the primary plan. [PL 2005, c. 121, Pt. D, §1 (NEW).]
24-A M.R.S. § 2414 — ME Code / Title 24-A / Chapter 27 / Section 2414
24-A §2414. Standard provisions, in general
Status: in_force

1. Insurance contracts shall contain such standard or uniform provisions as are required by the applicable provisions of this Title pertaining to contracts of particular kinds of insurance. The superintendent may waive the required use of a particular provision in a particular insurance policy form if: A. The superintendent finds such provision unnecessary for or unrelated to the protection of the insured and inconsistent with the purposes of the policy; and [RR 2021, c. 1, Pt. B, §213 (COR).] B. The policy is otherwise approved by the superintendent. [RR 2021, c. 1, Pt. B, §214 (COR).] [RR 2021, c. 1, Pt. B, §§213, 214 (COR).]

2. A policy may not contain any provision inconsistent with or contradictory to any standard or uniform provision used or required to be used, but the superintendent may approve any substitute provision which is, in the superintendent's opinion, not less favorable in any particular to the insured or beneficiary than the provisions otherwise required. [RR 2021, c. 1, Pt. B, §215 (COR).]

3. In lieu of the provisions required by this Title for contracts for particular kinds of insurance, substantially similar provisions required by the law of the domicile of a foreign or alien insurer may be used when approved by the superintendent. [PL 1973, c. 585, §12 (AMD); PL 1969, c. 132, §1 (NEW).]

4. A policy issued by a domestic insurer for delivery in another jurisdiction may contain or omit any provisions as required or permitted by the laws of such jurisdiction. [PL 1969, c. 132, §1 (NEW).]

5. This section does not apply as to the standard fire policy. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3957 — ME Code / Title 24-A / Chapter 54-A / Section 3957
24-A §3957. Assessments against insurers
Status: in_force

1. Assessments. For the purpose of providing the funds necessary to carry out the powers and duties of the association under section 3955 , the board shall assess insurers at such a time and for such amounts as the board finds necessary. Assessments are due not less than 30 days after written notice to the insurers and accrue interest at 12% per annum on and after the due date. [PL 2011, c. 90, Pt. B, §8 (NEW).]

2. Maximum assessment. The board shall assess each insurer an amount not to exceed $4 per month per covered person enrolled in medical insurance insured, reinsured or administered by the insurer. An insurer may not be assessed on policies or contracts insuring federal or state employees except for policies or contracts insuring Legislators and their dependents. For policies or contracts insuring Legislators and their dependents, Legislators shall pay the amount of the assessment to the insurer. [PL 2011, c. 452, §1 (AMD).]

3. Determination of assessment. The board shall make reasonable efforts to ensure that each covered person is counted only once with respect to an assessment. For that purpose, the board shall require each insurer that obtains excess or stop loss insurance to include in its count of covered persons all persons whose coverage is insured, in whole or in part, through excess or stop loss coverage. The board shall allow a reinsurer to exclude from its number of covered persons those who have been counted by the primary insurer or by the primary reinsurer or primary excess or stop loss insurer for the purpose of determining its assessment under this subsection. The board may verify the amount of each insurer's assessment based on annual statements and other reports determined to be necessary by the board. The board may use any reasonable method of estimating the number of covered persons of an insurer if the specific number is not reported. [PL 2011, c. 90, Pt. B, §8 (NEW).]

4. Organizational assessments. The board may assess insurers for the purpose of organizing the association. Organizational assessments must be equal in amount for all insurers but may not exceed $500 per insurer for all such assessments. [PL 2011, c. 90, Pt. B, §8 (NEW).]

5. Assessments to cover net losses. In addition to the assessment described in subsections 1 to 3 , the board shall assess insurers at such a time and for such amounts as the board finds necessary to cover any net loss in an amount not to exceed $2 per month per covered person enrolled in medical insurance insured, reinsured or administered by the insurer in accordance with this subsection. A. Before April 1st of each year, the association shall determine and report to the superintendent the association's net losses for the previous calendar year, including administrative expenses and incurred losses for the year, taking into account investment income and other appropriate gains and losses and an estimate of the assessments needed to cover the losses incurred by the association in the previous calendar year. [PL 2011, c. 90, Pt. B, §8 (NEW).] B. [PL 2011, c. 621, §3 (RP).] C. The association shall impose a penalty of interest on insurers for late payment of assessments. [PL 2011, c. 90, Pt. B, §8 (NEW).] D. An insurer may not be assessed on policies or contracts insuring federal or state employees, except for policies or contracts insuring Legislators and their dependents. Any assessment required under this subsection on policies or contracts insuring Legislators and their dependents must be paid as provided in subsection 2 . [PL 2011, c. 452, §2 (NEW).] [PL 2011, c. 621, §3 (AMD).]

6. Deferral of assessment. An insurer may apply to the superintendent for a deferral of all or part of an assessment imposed by the association under this section. The superintendent may defer all or part of the assessment if the superintendent determines that the payment of the assessment would place the insurer in a financially impaired condition. If all or part of the assessment is deferred, the amount deferred must be assessed against other insurers in a proportionate manner consistent with this section. The insurer that receives a deferral remains liable to the association for the amount deferred and is prohibited from reinsuring any person through the association until such time as the insurer pays the assessments. [PL 2011, c. 90, Pt. B, §8 (NEW).]

7. Excess funds. If assessments and other receipts by the association, board or administrator selected pursuant to section 3956 exceed the actual losses and administrative expenses of the association, the board shall hold the excess at interest and shall use those excess funds to offset future losses or to make adjustments to a reinsurance program operated pursuant to section 3953 . As used in this subsection, "future losses" includes reserves for claims incurred but not reported. [PL 2021, c. 361, §4 (AMD).]

8. Failure to pay assessment. The superintendent may suspend or revoke, after notice and hearing, the certificate of authority to transact insurance in this State of any member insurer that fails to pay an assessment. As an alternative, the superintendent may levy a penalty on any insurer that fails to pay an assessment when due. In addition, the superintendent may use any power granted to the superintendent by this Title to collect any unpaid assessment. [PL 2011, c. 90, Pt. B, §8 (NEW).]

9. Federal funding; reduction of assessment. [PL 2019, c. 653, Pt. B, §17 (RP).]
24-A M.R.S. § 7 — ME Code / Title 24-A / Chapter 1 / Section 7
24-A §7. "State" defined
Status: in_force

When in context signifying other than this State, "state" means any state, district, territory, commonwealth or possession of the United States of America. [PL 1995, c. 329, §3 (AMD).]
24-A M.R.S. § 1116 — ME Code / Title 24-A / Chapter 13 / Section 1116
24-A §1116. Trustees' or receivers' obligations
Status: in_force

An insurer may invest in certificates, notes or other obligations issued by trustees or receivers of any institution created or existing under the laws of the United States or of any state, district or territory thereof, which, or the assets of which, are being administered under the direction of any court having jurisdiction, if such obligation is adequately secured as to principal and interest. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2012 — ME Code / Title 24-A / Chapter 19 / Section 2012
24-A §2012. Surplus lines authority
Status: in_force

1. Any person while licensed in this State as a resident producer who is determined by the superintendent to be competent and trustworthy with respect to the handling of surplus lines, and while maintaining an office at a designated location in this State, may be licensed as a producer with surplus lines authority. [PL 1997, c. 592, §58 (AMD).]

2. Application for the authority must be made to the superintendent on forms as designated and furnished by the superintendent. [PL 1997, c. 592, §58 (AMD).]

3. The application and authority fee must be as specified in section 601 . [PL 1997, c. 592, §58 (AMD).]

4. The producer with surplus lines authority is subject to the applicable provisions of chapter 16 . [PL 1997, c. 592, §58 (AMD).]

5. A nonresident producer who is considered by the superintendent to be competent and trustworthy with respect to the handling of surplus lines may apply for surplus lines authority under the following circumstances: A. If the nonresident maintains a business location within this State and maintains all records of surplus lines transactions within this State; [PL 2001, c. 259, §47 (AMD).] B. If the nonresident transacts only liability insurance business and only on behalf of a purchasing group registered with the superintendent and the nonresident agrees to produce surplus lines records in this State within 14 days from a request of the superintendent; or [PL 2001, c. 259, §47 (AMD).] C. The license is to be issued on a reciprocal basis pursuant to sections 1420‑G and 1420‑O . [PL 2001, c. 259, §48 (NEW).] [PL 2001, c. 259, §§47, 48 (AMD).]
24-A M.R.S. § 4445 — ME Code / Title 24-A / Chapter 57 / Section 4445
24-A §4445. Examination of the association
Status: in_force

The association shall be subject to examination and regulation by the superintendent. The board of directors shall submit, not later than March 30th of each year, a financial report for the preceding calendar year in a form approved by the superintendent. [PL 1969, c. 561 (NEW); PL 1973, c. 585, §12 (AMD).]

The association is also subject to audit, enforcement and monitoring by the Workers' Compensation Board with respect to workers' compensation claims as provided for in the Maine Workers' Compensation Act of 1992. Notwithstanding any other provision of law, the association is liable for the payment of any compensation, interest, penalty or other obligation determined to be due by the Workers' Compensation Board as provided for in the Maine Workers' Compensation Act of 1992. The Workers' Compensation Board may not assess the association penalties for the acts or omissions of insolvent insurers. [PL 2005, c. 603, §2 (NEW).]
24-A M.R.S. § 2385-F — ME Code / Title 24-A / Chapter 25 / Section 2385-F
24-A §2385-F. Coverage denial
Status: in_force

Workers' compensation coverage may not be issued to an employer or continued if it has been issued until the employer pays any undisputed premiums or assessments to a previous workers' compensation insurer, including a domestic mutual insurer established pursuant to section 3703 , a group self-insurer approved pursuant to Title 39‑A, section 403, subsection 4 , or the workers' compensation residual market mechanism. If a premium or assessment is subject to a good faith dispute at the time of termination of a policy or if such a dispute becomes known as a result of a post-termination audit review or other reason after replacement coverage has been issued and if the premium or assessment remains unpaid upon resolution of the dispute by the bureau, this replacement coverage must be cancelled. [PL 1999, c. 121, §1 (AMD).]
24-A M.R.S. § 6 — ME Code / Title 24-A / Chapter 1 / Section 6
24-A §6. "Domestic," "foreign," "alien" insurer defined
Status: in_force

1. Domestic insurer. A "domestic" insurer is one formed under the laws of this State. [PL 1969, c. 132, §1 (NEW).]

2. Foreign insurer. A "foreign" insurer is one formed under the laws of any jurisdiction other than this State. [PL 1969, c. 132, §1 (NEW).]

3. Alien insurer. An "alien" insurer is a foreign insurer formed under the laws of any country other than the United States of America, its states, districts, commonwealths and possessions. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4615 — ME Code / Title 24-A / Chapter 62 / Section 4615
24-A §4615. Examination of the association; annual report
Status: in_force

The association shall be subject to examination and regulation by the superintendent. The board of directors shall submit to the superintendent, not later than May 1st of each year, a financial report for the preceding calendar year in a form approved by the superintendent and a report of its activities during the preceding calendar year. [PL 1983, c. 846 (NEW).]