24-A M.R.S. § 2859 — ME Code / Title 24-A / Chapter 37 / Section 2859
24-A §2859. Premium rates; refunds; accounts credited when insurance not issued
Status: in_force

1. Rates filed; life and health. Any insurer may revise its schedules of premium rates from time to time, and shall file such revised schedules with the superintendent; however, no upward revision in insurance charges to debtors may be made in connection with closed-end credit that would apply to debtors whose credit insurance is already in force. In the case of open-end credit, the debtor must be given a 31-day notice prior to an upward revision unless a waiver of that notice is obtained from the superintendent, in which case the notice of the upward revision must be given at the next regular billing cycle. An insurer may not issue any credit life insurance policy or credit health insurance policy for which the premium rate exceeds that determined by the schedules of such insurer as then on file with the superintendent. [PL 2001, c. 138, §12 (AMD).]

1-A. Rates filed; property and casualty. All rates charged in connection with credit property insurance or credit involuntary unemployment insurance must be filed in accordance with section 2304‑A . An insurer may not issue any credit property insurance or credit involuntary unemployment insurance policy for which the premium rate exceeds those rates then on file with the superintendent. [PL 2001, c. 138, §12 (NEW).]

1-B. Rating standards. The superintendent may by rules adopted pursuant to section 2865 or chapter 40‑A establish specific rating standards for particular types of consumer credit insurance. [PL 2001, c. 138, §12 (NEW).]

2. Refund. Each individual policy or group certificate shall provide that in the event of termination of the insurance prior to the scheduled maturity date of the indebtedness, any refund of an amount paid by the debtor for insurance must be paid or credited promptly to the debtor. The superintendent shall prescribe a minimum refund and no refund that would be less than such minimum need be made. The formula to be used in computing such refund must be filed with and approved by the superintendent. [PL 2001, c. 138, §12 (AMD).]

3. Accounts credited where insurance not issued. If a creditor requires a debtor to make any payment for consumer credit insurance and an individual policy or group certificate of insurance is not issued, the creditor shall immediately give written notice to such debtor and shall promptly make an appropriate credit to the account. [PL 2001, c. 138, §12 (AMD).]

4. Termination. Any policy for consumer credit insurance issued subsequent to the enactment of this section must contain a provision that the insurance provided for may be terminated under only the following conditions: A. The date the indebtedness is discharged, renewed or refinanced; [PL 1977, c. 672, §4 (NEW).] B. Upon written request of a debtor; [PL 1977, c. 672, §4 (NEW).] C. When a debtor is insured under an individual or group policy, nonpayment by such a debtor of any required premium over 31 days past due, provided that at least 10 days prior to termination the debtor has been given a notice of the right to cure in substantially the same form required by Title 9‑A, section 5‑110, subsection 3 ; [PL 1993, c. 149, §1 (AMD).] D. In the case where debtors are insured under group policies, the group policy may be terminated after 31 days prior notice to the debtor from the creditor: (1) In a noncontributory policy, at the option of the creditor; (2) At the time the insurance risk is transferred to a succeeding insurance carrier; or (3) If the group policyholder fails to pay the premium; [PL 2001, c. 138, §12 (AMD).] E. In the case where credit is extended on open-ended basis: (1) At attainment by the debtor of an age determined in advance by the contract of insurance; or (2) If the creditor elects to terminate all insurance on credit extended on an open-ended basis; [PL 2001, c. 138, §12 (AMD).] F. If credit is extended on a closed-end basis, coverage for an individual insured under the policy may be terminated upon expiration of the term of the loan or term for which a charge was paid; or [PL 1993, c. 149, §2 (AMD).] G. When consumer credit insurance is paid for by the debtor in a single premium at the inception of the debt, if the debt is placed in charged-off status by the creditor because the debt is uncollectible, the insurance coverage may be terminated by the creditor and any refund of premium must be applied against any outstanding indebtedness. The creditor shall give notice of the termination of insurance coverage to the debtor at the debtor's last known address. [PL 2001, c. 138, §12 (AMD).] [PL 2001, c. 138, §12 (AMD).]
24-A M.R.S. § 2529 — ME Code / Title 24-A / Chapter 29 / Section 2529
24-A §2529. Nonforfeiture provisions
Status: in_force

1. In the case of policies issued on or after January 1, 1970, no policy of life insurance, except as stated in section 2534 , may be delivered or issued for delivery in this State, unless it shall contain in substance the following provisions, or corresponding provisions which in the opinion of the superintendent are at least as favorable to the defaulting or surrendering policyholder as are the minimum requirements hereinafter specified and which are essentially in compliance with section 2533‑A : A. Paid-up nonforfeiture benefit. That, in the event of default in any premium payment, the insurer will grant, upon proper request not later than 60 days after the due date of the premium in default, a paid-up nonforfeiture benefit on a plan stipulated in the policy, effective as of that due date, of such amount as may be hereinafter specified. In lieu of the stipulated paid-up nonforfeiture benefit, the insurer may substitute, upon proper request not later than 60 days after the due date of the premium in default, an actuarially equivalent alternative paid-up nonforfeiture benefit which provides a greater amount or longer period of death benefits or, if applicable, a greater amount or earlier payment of endowment benefits; [PL 1983, c. 346, §10 (AMD).] B. Cash surrender value. That, upon surrender of the policy within 60 days after the due date of any premium payment in default after premiums have been paid for at least 3 full years in the case of ordinary insurance or 5 full years in the case of industrial insurance, the insurer will pay, in lieu of any paid-up nonforfeiture benefit, a cash surrender value of such amount as may be hereinafter specified; [PL 1983, c. 346, §10 (AMD).] C. Effective date of benefit. That a specified paid-up nonforfeiture benefit shall become effective as specified in the policy unless the person entitled to make such election elects another available option not later than 60 days after the due date of the premium in default; [PL 1983, c. 346, §10 (AMD).] D. Cash surrender value if policy paid up. That, if the policy shall have become paid up by completion of all premium payments or if it is continued under any paid-up nonforfeiture benefit which became effective on or after the 3rd policy anniversary in the case of ordinary insurance or the 5th policy anniversary in the case of industrial insurance, the insurer will pay, upon surrender of the policy within 30 days after any policy anniversary, a cash surrender value of such amount as may be hereinafter specified; [PL 1983, c. 346, §10 (AMD).] E. Mortality table and interest rate used. In the case of policies which cause, on a basis guaranteed in the policy, unscheduled changes in benefits or premiums, or which provide an option for changes in benefits or premiums other than a change to a new policy, a statement of the mortality table, interest rate, and method used in calculating cash surrender values and the paid-up nonforfeiture benefits available under the policy. In the case of all other policies, a statement of the mortality table and interest rate used in calculating the cash surrender values and the paid-up nonforfeiture benefits available under the policy, together with a table showing the cash surrender value, if any, and paid-up nonforfeiture benefit, if any, available under the policy on each policy anniversary either during the first 20 policy years or during the term of the policy, whichever is shorter, those values and benefits to be calculated upon the assumption that there are no dividends or paid-up additions credited to the policy and that there is no indebtedness to the insurer on the policy; and [PL 1983, c. 346, §10 (AMD).] F. Method used in computing value and benefit. A statement that the cash surrender values and the paid-up nonforfeiture benefits available under the policy are not less than the minimum values and benefits required by or pursuant to the insurance law of the state in which the policy is delivered; an explanation of the manner in which the cash surrender values and the paid-up nonforfeiture benefits are altered by the existence of any paid-up additions credited to the policy or any indebtedness to the insurer on the policy; if a detailed statement of the method of computation of the values and benefits shown in the policy is not stated therein, a statement that such method of computation has been filed with the insurance supervisory official of the state in which the policy is delivered; and a statement of the method to be used in calculating the cash surrender value and paid-up nonforfeiture benefit available under the policy on any policy anniversary beyond the last anniversary for which such values and benefits are consecutively shown in the policy. [PL 1983, c. 346, §10 (AMD).] [PL 1983, c. 346, §10 (AMD).]

2. Any of the foregoing provisions or portions thereof not applicable by reason of the plan of insurance may, to the extent inapplicable, be omitted from the policy. [PL 1969, c. 132, §1 (NEW).]

3. The insurer shall reserve the right to defer the payment of any cash surrender value for a period of 6 months after demand therefor with surrender of the policy. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 3851 — ME Code / Title 24-A / Chapter 53 / Section 3851
24-A §3851. "Reciprocal" insurance defined
Status: in_force

"Reciprocal" insurance is that resulting from an interchange among persons, known as "subscribers," of reciprocal agreements of indemnity, the interchange being effectuated through an "attorney-in-fact" common to all such persons. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2823 — ME Code / Title 24-A / Chapter 35 / Section 2823
24-A §2823. Notice of claim
Status: in_force

There shall be a provision that written notice of sickness or of injury must be given to the insurer within 30 days after the date when such sickness or injury occurred. Failure to give notice within such time shall not invalidate nor reduce any claim, if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4374 — ME Code / Title 24-A / Chapter 57 / Section 4374
24-A §4374. Termination of rehabilitation
Status: in_force

If at any time the court finds, after hearing in open court, upon petition of the superintendent or of the insurer or of the court's own motion, that the objectives of an order to rehabilitate a domestic insurer or an alien insurer domiciled in this State have been accomplished, and that the insurer can be returned to its own management without further jeopardy to the insurer and its creditors or policyholders or stockholders or to the public, the court may, upon a full report and accounting by the superintendent relative to the conduct of the insurer's affairs during the rehabilitation and of the insurer's current financial condition, terminate the rehabilitation and by order return the insurer, its assets and affairs, to the insurer's management. [RR 2021, c. 1, Pt. B, §370 (COR).]
24-A M.R.S. § 952-A — ME Code / Title 24-A / Chapter 11 / Section 952-A
24-A §952-A. Actuarial opinion of reserves
Status: in_force

1. General. An insurer doing business in this State subject to this subchapter shall appoint a qualified actuary, in accordance with any applicable requirements of the valuation manual or rules adopted by the superintendent, and annually submit the opinion of the appointed actuary as to whether the reserves and related actuarial items of that insurer held in support of the policies and contracts specified by the superintendent by rule are computed appropriately, are based on assumptions that satisfy contractual provisions, are consistent with prior reported amounts and comply with applicable laws of this State. Before the operative date of the valuation manual, the superintendent by rule shall define the specifics of the opinion. On and after the operative date of the valuation manual, if the valuation manual has prescribed specific requirements applicable to the opinion, the opinion must comply with those requirements. The superintendent by rule may add any other items considered necessary to the scope of the opinion. [PL 2013, c. 238, Pt. C, §5 (AMD).]

2. Actuarial analysis of reserves and assets supporting those reserves. Except as otherwise authorized or required in accordance with rules adopted by the superintendent or applicable provisions of the valuation manual, an insurer subject to this subchapter shall include in the opinion required by subsection 1 an opinion of the appointed actuary as to whether the reserves and related actuarial items held in support of the policies and contracts specified by the superintendent by rule, when considered in light of the assets held by the insurer with respect to the reserves and related actuarial items, including, but not limited to, the investment earnings on the assets and the considerations anticipated to be received and retained under the policies and contracts, adequately provide for the insurer's obligations under the policies and contracts, including, but not limited to, the benefits under and expenses associated with the policies and contracts. The superintendent may provide by rule for a transition period for establishing any higher reserves that the appointed actuary may consider necessary in the opinion required by this subsection. [PL 2013, c. 238, Pt. C, §5 (AMD).]

3. Requirement for opinion under subsection 2. An opinion required by subsection 2 is governed by the following provisions. A. A memorandum, in form and substance acceptable to the superintendent as specified in the valuation manual or by rule, must be prepared to support the actuarial opinion. [PL 2013, c. 238, Pt. C, §5 (AMD).] B. If the insurer fails to provide a supporting memorandum at the request of the superintendent within a period specified in the valuation manual or by rule or the superintendent determines that the supporting memorandum provided by the insurer fails to meet the prescribed standards or is otherwise unacceptable to the superintendent, the superintendent may engage a qualified actuary at the expense of the insurer to review the opinion and the basis for the opinion and prepare a supporting memorandum as required by the superintendent. [PL 2013, c. 238, Pt. C, §5 (AMD).] [PL 2013, c. 238, Pt. C, §5 (AMD).]

4. Requirement for all opinions. An opinion required pursuant to subsection 1 or 2 is governed by the following provisions. A. The opinion must be submitted with the annual statement reflecting the valuation of reserve liabilities for each year ending on or after December 31, 1995. [PL 1993, c. 634, Pt. B, §1 (NEW); PL 1993, c. 634, Pt. B, §4 (AFF).] B. The opinion must apply to all business in force, including individual and group health insurance plans, in a form and substance acceptable to the superintendent. [PL 2013, c. 238, Pt. C, §5 (AMD).] B-1. The opinion must comply with the requirements of any applicable rules and, on and after the operative date of the valuation manual, must comply with all applicable requirements of the valuation manual. [PL 2013, c. 238, Pt. C, §5 (NEW).] C. The opinion must be based on standards adopted by the Actuarial Standards Board or its successor and, to the extent applicable, on any additional standards prescribed by the valuation manual or prescribed by the superintendent by rule. [PL 2013, c. 238, Pt. C, §5 (AMD).] D. In the case of an opinion required to be submitted by a foreign or alien insurer, the superintendent may accept the opinion filed by that insurer with the insurance supervisory official of another state if the superintendent determines that the opinion reasonably meets the requirements applicable to an insurer domiciled in this State. [PL 1993, c. 634, Pt. B, §1 (NEW); PL 1993, c. 634, Pt. B, §4 (AFF).] E. [PL 2013, c. 238, Pt. C, §5 (RP).] F. Except in cases of fraud or willful misconduct, the appointed actuary is not liable for damages to any person, other than the insurer and the superintendent, for any act, error, omission, decision or conduct with respect to the appointed actuary's opinion. [PL 2013, c. 238, Pt. C, §5 (AMD).] G. The superintendent may take disciplinary action against the insurer or the appointed actuary pursuant to section 12‑A for knowing violations of this section and may establish additional grounds for disciplinary action by rule. [PL 2013, c. 238, Pt. C, §5 (AMD).] H. [PL 2013, c. 238, Pt. C, §5 (RP).] I. [PL 2013, c. 238, Pt. C, §5 (RP).] J. [PL 2013, c. 238, Pt. C, §5 (RP).] K. [PL 2013, c. 238, Pt. C, §5 (RP).] L. [PL 2013, c. 238, Pt. C, §5 (RP).] M. [PL 2013, c. 238, Pt. C, §5 (RP).] [PL 2013, c. 238, Pt. C, §5 (AMD).]

5. Applicability to health carriers. A health carrier not otherwise subject to this section or section 993 shall file an actuarial opinion in accordance with the applicable National Association of Insurance Commissioners annual statement instructions. For purposes of this section, "health carrier" means an insurer, health maintenance organization, nonprofit corporation subject to Title 24 or fraternal benefit society that provides health insurance or comparable health benefits. This section and rules adopted pursuant to this section apply to health carriers to the extent provided in the valuation manual. Before the operative date of the valuation manual, this section and rules adopted pursuant to this section apply to health carriers to the extent that they specifically refer to health carriers or impose requirements that are consistent with and no more stringent than the annual statement instructions. [PL 2013, c. 238, Pt. C, §5 (AMD).]
24-A M.R.S. § 2741-A — ME Code / Title 24-A / Chapter 33 / Section 2741-A
24-A §2741-A. Mandated offer of domestic partner benefits
Status: in_force

1. Definition. [PL 2021, c. 567, §30 (RP).]

2. Mandated offer of domestic partner benefits. All individual health insurance policies or contracts issued by any insurer operating pursuant to this chapter must make available to policyholders the option for additional benefits for the domestic partner of a policyholder, at appropriate rates and under the same terms and conditions as those benefits or options for benefits are provided to spouses of married policyholders. [PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]

3. Financial dependency. Financial dependency of a domestic partner on the policyholder may not be required as a condition for eligibility for coverage. [PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]

4. Evidence of domestic partnership. As a condition of eligibility for coverage, an insurer may require a policyholder and the policyholder's domestic partner to sign an affidavit attesting that the policyholder and the policyholder's domestic partner meet the definition of domestic partner under Title 1, section 72, subsection 2‑C and to show documentation of joint ownership or occupancy of real property, such as a joint deed, joint mortgage or a joint lease, or the existence of a joint credit card, joint bank account or powers of attorney in which each domestic partner is authorized to act for the other. [PL 2021, c. 567, §31 (AMD).]

5. Preexisting conditions. A domestic partner is subject to the same provisions on coverage of preexisting conditions as any spouse or dependent of a policyholder. [PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]

6. Termination of domestic partner benefits. An insurer may terminate coverage in accordance with other applicable provisions of this Title for the domestic partner of a policyholder upon notification by the policyholder that the domestic partner relationship has terminated. [PL 2021, c. 567, §32 (AMD).]

7. Construction. This section does not prohibit an insurer from negotiating a policy providing domestic partner benefits to a policyholder that does not comply with the requirements of this section. [PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]

8. Exemption. This section does not apply to accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care and other limited benefit health insurance policies. [PL 2001, c. 347, §2 (NEW); PL 2001, c. 347, §5 (AFF).]
24-A M.R.S. § 12-A — ME Code / Title 24-A / Chapter 1 / Section 12-A
24-A §12-A. Civil penalty and enforcement provisions
Status: in_force

1. Civil penalty. Civil penalties may be assessed against any person who: A. Violates any provision of this Title, Title 24 or any other law enforced by the superintendent; [PL 1997, c. 634, Pt. B, §1 (RPR).] B. Violates any rule lawfully adopted by the superintendent; or [PL 1997, c. 634, Pt. B, §1 (RPR).] C. Violates any lawful order of the superintendent that has not been stayed by order of the superintendent or the Superior Court. [PL 1997, c. 634, Pt. B, §1 (RPR).] The Superior Court, upon an action brought by the Attorney General, may assess a civil penalty of not less than $500 and not more than $5,000 for each violation in the case of an individual and not less than $2,000 and not more than $15,000 for each violation in the case of a corporation or other entity other than an individual, unless the applicable law specifies a different civil penalty. The superintendent, following an adjudicatory hearing, may assess a civil penalty of up to $500 for each violation in the case of an individual and a civil penalty of up to $10,000 for each violation in the case of a corporation or other entity other than an individual, unless the applicable law specifies a different civil penalty. The superintendent shall notify the Attorney General or the Attorney General's designee of any such adjudicatory hearing at the time that the notice of hearing is issued by the superintendent. The superintendent may not assess a civil penalty if the Attorney General notifies the superintendent that the Attorney General intends to pursue an action in Superior Court to seek civil penalties for the same conduct. If the Attorney General elects to pursue the noticed action in Superior Court, the Attorney General shall notify the superintendent of that decision no later than 7 days prior to the hearing. [PL 2005, c. 41, §1 (AMD).]

1-A. Equitable relief; actual damages. In addition to a civil penalty awarded pursuant to subsection 1 , the Superior Court may award to any injured insured or applicant for insurance who is represented by the Attorney General reasonable equitable relief and actual damages. [PL 1989, c. 826 (NEW).]

2. Cease and desist orders. The superintendent may issue a cease and desist order following an adjudicatory hearing held in conformance with Title 5, chapter 375, subchapter IV , if the superintendent finds that any person has engaged in or is engaging in any act or practice in violation of any law administered or enforced by the superintendent, any rules promulgated under that law or any lawful order of the superintendent. A. A cease and desist order is effective when issued, unless the order specifies a later effective date or is stayed pursuant to Title 5, section 11004 . [PL 1991, c. 298, §1 (AMD).] B. In the event an appeal is taken, the court shall issue its own order for compliance to the extent that the superintendent's order is affirmed. [PL 1989, c. 269, §3 (NEW).] C. Violation of any cease and desist order shall be punishable as a violation of this Title in accordance with this section. [PL 1989, c. 269, §3 (NEW).] [PL 1991, c. 298, §1 (AMD).]

2-A. Emergency cease and desist. The superintendent may issue an emergency cease and desist order, without prior notice and hearing, if the complaint shows that a person is engaging in unlicensed insurance activities or is engaging in conduct that creates an immediate danger to the public safety or is causing or is reasonably expected to cause significant, imminent and irreparable public injury. A. A request for an emergency cease and desist order must be in writing in the form of a verified complaint. [PL 1991, c. 298, §2 (NEW).] B. An emergency cease and desist order is effective immediately and will continue in force and effect until further order by the superintendent or unless stayed by the superintendent or by a court of competent jurisdiction. [PL 1991, c. 298, §2 (NEW).] C. Upon issuance of an emergency cease and desist order, the superintendent shall serve on the person affected by the order, by registered or certified mail to the person's last known address, an order that contains a statement of the charges and a notice of hearing. The hearing, held in conformance with Title 5, chapter 375, subchapter IV , must be held within 10 days of the effective date of the emergency order, unless a later time is agreed upon by all parties. [PL 1991, c. 298, §2 (NEW).] D. At the hearing, the superintendent shall affirm, modify or set aside, in whole or in part, the emergency cease and desist order and may combine and employ any other enforcement or penalty provisions available to the superintendent to arrive at a final order. [PL 1991, c. 298, §2 (NEW).] E. The superintendent's order after hearing is a final order in all respects and is subject to subsection 2, paragraph A and section 236 . [PL 1991, c. 298, §2 (NEW).] [PL 1991, c. 298, §2 (NEW).]

3. Reprimand or censure. The superintendent may issue a letter of reprimand or censure to any licensee, but only after opportunity for hearing has been provided to any and all persons who are subjects of the reprimand. [PL 1989, c. 269, §3 (NEW).]

4. Refunds of overcharges. In the event that any insurer, fraternal benefit society, nonprofit hospital service plan, nonprofit medical service plan, nonprofit health care plan, health maintenance organization or preferred provider organization makes charges to any person that are not in conformity with a filing that it is required to submit for approval or disapproval by this Title or Title 24 , the superintendent may order that refunds of any overcharges be made. [PL 2009, c. 13, §1 (AMD).]

5. Election of enforcement options. The superintendent may elect to utilize any or all of the enforcement options provided by this section, in combination or in sequence, as the superintendent deems appropriate. The penalties and provisions of this section are in addition to any other penalty provided by law. [PL 1989, c. 269, §3 (NEW).]

6. Restitution. The superintendent may order restitution for any insured or applicant for insurance injured by a violation for which a civil penalty may be assessed pursuant to this section. [PL 1989, c. 826 (NEW).]
24-A M.R.S. § 4127-A — ME Code / Title 24-A / Chapter 55 / Section 4127-A
24-A §4127-A. Suspension, revocation or refusal of license of foreign or alien society
Status: in_force

The superintendent may suspend, revoke or refuse the license of a foreign or alien society transacting or applying to transact business in this State as set out in this section. [PL 2009, c. 13, §5 (NEW).]

1. Investigation. If, upon investigation, the superintendent finds that a foreign or alien society transacting or applying to transact business in this State has exceeded its powers, has failed to comply with any of the provisions of this chapter, is not fulfilling its contracts in good faith or is conducting its business fraudulently or in a manner hazardous to its members or creditors or the public, the superintendent shall notify the society of the deficiency or deficiencies and state in writing the reasons that warrant suspension, revocation or refusal of the society's license. The notice must require that the deficiency or deficiencies be corrected. After receipt of the notice, the society has 30 days to comply with the superintendent's request for correction, and if the society fails to comply, the superintendent shall notify the society of the findings of noncompliance and require the society to show cause, on a date set by the superintendent, why its license should not be suspended, revoked or refused. If on that date the society does not present good and sufficient reason why its authority to do business in this State should not be suspended, revoked or refused, the superintendent may suspend or refuse the license of the society to do business in this State until satisfactory evidence is furnished to the superintendent that the suspension or refusal should be withdrawn or the superintendent may revoke the authority of the society to do business in this State. [PL 2009, c. 13, §5 (NEW).]

2. Continue contracts. Nothing in this section may be construed as preventing any foreign or alien society from continuing in good faith all contracts made in this State during the time the society was legally authorized to transact business in this State. [PL 2009, c. 13, §5 (NEW).]

3. Enforcement action. Nothing in this section may be construed as limiting the superintendent's authority to take enforcement action under section 12‑A in connection with violations of applicable provisions of this Title. [PL 2009, c. 13, §5 (NEW).]
24-A M.R.S. § 4551 — ME Code / Title 24-A / Chapter 61 / Section 4551
24-A §4551. Disposition of unclaimed funds
Status: in_force

All unclaimed money held and owing by any life insurer doing business in this State must be disposed of according to Title 33, chapter 45 . Before disposing of any unclaimed money in accordance with Title 33, chapter 45 , a life insurer doing business in this State shall comply with this section. [PL 2019, c. 498, §14 (AMD).]

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Contract" means an annuity contract. "Contract" does not include an annuity used to fund an employment-based retirement plan or program in which the insurer does not perform the record-keeping services or the insurer is not committed by terms of the annuity contract to pay death benefits to the beneficiaries of specific plan participants. [PL 2017, c. 129, §1 (NEW).] B. "Death master file" means the United States Social Security Administration's death master file or any other database or service that is at least as comprehensive as the United States Social Security Administration's death master file that is used for determining and recording that a person has been reported to have died. [PL 2017, c. 129, §1 (NEW).] C. "Death master file match" means a search of the death master file that results in a match of the social security number or the name and date of birth of an insured, an annuity owner or a retained asset account holder. [PL 2017, c. 129, §1 (NEW).] D. "Knowledge of death" means the receipt of an original or valid copy of a certified death certificate or a death master file match validated by the insurer in accordance with this section. [PL 2017, c. 129, §1 (NEW).] E. "Policy" means any policy or certificate of life insurance that provides a death benefit. "Policy" does not include: (1) Any policy or certificate of life insurance that provides a death benefit under an employee benefit plan subject to the federal Employee Retirement Income Security Act of 1974, as amended; (2) Any policy or certificate of life insurance that provides a death benefit under any federal employee benefit program; (3) Any policy or certificate of life insurance that is used to fund a pre-need funeral contract or prearrangement; (4) Any policy or certificate of credit life or accidental death insurance; or (5) Any policy issued to a group master policyholder for which the insurer does not provide record-keeping services. [PL 2017, c. 129, §1 (NEW).] F. "Record-keeping services" means those circumstances under which the insurer has agreed with a group policy or contract customer to be responsible for obtaining, maintaining and administering in its own or its agents' systems at least the following information about each individual insured under an insured's group insurance contract or a line of coverage thereunder: the individual insured's social security number or name and date of birth, beneficiary designation information, coverage eligibility, benefit amount and premium payment status. [PL 2017, c. 129, §1 (NEW).] G. "Retained asset account" means an account in which the settlement of proceeds payable under a policy or contract occurs when the insurer, or an entity acting on behalf of the insurer, deposits the proceeds into an account with check or draft writing privileges and those proceeds are retained by the insurer or its agent pursuant to a supplementary contract not involving annuity benefits other than death benefits. [PL 2017, c. 129, §1 (NEW).] [PL 2017, c. 129, §1 (NEW).]

2. Insurer conduct. An insurer shall perform a comparison of its insureds' in-force policies, contracts and retained asset accounts against a death master file, on at least a semiannual basis, by using the death master file once for each insured and thereafter using the death master file update files for future comparisons to identify potential matches of the insurer's insureds. For those potential matches identified as a result of a death master file match, the insurer shall: A. Within 90 days of a death master file match, complete a good faith effort, which must be documented by the insurer, to confirm the death of an insured, an annuity owner or retained asset account holder against other available records and information; and [PL 2017, c. 475, Pt. A, §41 (AMD).] B. Determine whether benefits are due in accordance with the applicable policy or contract and, if benefits are due in accordance with the applicable policy or contract: (1) Use good faith efforts, which must be documented by the insurer, to locate the beneficiary or beneficiaries; and (2) Provide the appropriate claim forms or instructions to the beneficiary or beneficiaries, including notice of the necessity of providing an official death certificate, if applicable under the policy or contract. [PL 2017, c. 129, §1 (NEW).] With respect to group life insurance, the insurer shall confirm the death of an insured when the insurer maintains at least the following information about each insured covered under a policy or certificate: the insured's social security number or name and date of birth, beneficiary designation information, coverage eligibility, benefit amount and premium payment status. [PL 2017, c. 475, Pt. A, §41 (AMD).]

3. Required procedures. As part of its record-keeping procedures, an insurer shall implement procedures to account for: A. Common nicknames, initials used in lieu of a first or middle name and use of a middle name; [PL 2017, c. 129, §1 (NEW).] B. Compound first and middle names and interchanged first and middle names; [PL 2017, c. 129, §1 (NEW).] C. Compound last names, maiden or married names and hyphens or blank spaces; [PL 2017, c. 129, §1 (NEW).] D. Apostrophes in last names; [PL 2017, c. 129, §1 (NEW).] E. Transposition of the month and date portions of the date of birth; and [PL 2017, c. 129, §1 (NEW).] F. Incomplete social security numbers. [PL 2017, c. 129, §1 (NEW).] [PL 2017, c. 129, §1 (NEW).]

4. Disclosure of personal information. To the extent permitted by law, an insurer may disclose the minimum necessary personal information about an insured or beneficiary to a person the insurer reasonably believes may be able to assist the insurer in locating a beneficiary or a person otherwise entitled to payment of the claims proceeds. [PL 2017, c. 129, §1 (NEW).]

5. No fees. An insurer or its service provider may not charge any beneficiary or other authorized representative for any fees or costs associated with a death master file search or verification of a death master file match conducted pursuant to this section. [PL 2017, c. 129, §1 (NEW).]

6. Payment of benefits. The benefits from a policy, a contract or a retained asset account, plus any applicable accrued contractual interest, is payable to a designated beneficiary or annuity owner. In the event a beneficiary or owner cannot be found after good faith efforts to contact the beneficiary or owner pursuant to this section have been carried out and documented, the insurer shall dispose of any unclaimed money according to Title 33, chapter 41 . [PL 2017, c. 129, §1 (NEW).]
24-A M.R.S. § 6203 — ME Code / Title 24-A / Chapter 73 / Section 6203
24-A §6203. Requirements for issuance of certificate
Status: in_force

1. Preliminary certificate of authority. The superintendent shall issue a preliminary certificate of authority, which shall be valid for no more than 12 months, but which the superintendent may extend for such reasonable time as necessary when the following conditions have been met. A. The provider has submitted to the department an application for a certificate of need, if required under Title 22, section 329 , and the department has submitted a preliminary report of a recommendation for approval of a certificate of need and the provider has applied for any other licenses or permits required prior to operation. [PL 2003, c. 510, Pt. A, §22 (AMD).] B. The provider has submitted an application in duplicate to the superintendent. The superintendent shall immediately forward one copy to the department. The application shall consist of the following items: (1) A copy of the provider's continuing care agreement; (2) A copy of the disclosure statement required by section 6209 ; (3) Financial statements of current origin prepared in accordance with generally accepted accounting principles showing the provider's assets, liabilities and surplus position. These financial statements shall include as supplementary data a description of the sources of financial support. A copy of the provider's most recent regular certified financial statement shall be deemed to satisfy this requirement, unless the superintendent directs that additional or more recent financial information is required for the proper administration of this chapter; (4) A copy of the basic organizational document of the provider such as articles of incorporation, articles of agreement, certificate of organization or incorporation or charter and all amendments thereto; (5) A copy of the provider's bylaws, certified by the corporate secretary; (6) A list of the names and addresses of stockholders and those persons who hold official positions responsible for the conduct of the affairs of the provider, including all members of the board of directors, the principal officers and persons having a 10% or greater equity or beneficial interest in the provider. Section 222 , including the requirement of approval of the superintendent, the submission of tender offers or acquisitions materials, information as to acquisitions or tender offers and examination of accounts, records, documents and transactions, is also applicable in the event of either: (a) Any tender offer for, or a request or invitation for tenders of, or an agreement to exchange securities for, or otherwise acquire any voting security of a provider or of any person controlling a provider if, as a result of the consummation thereof, the person making the tender offer, request or agreement would directly or indirectly acquire control of the provider or controlling person; or (b) Any purchase, exchange, merger or acquisition of control of a provider; (7) A description of any action within the past 10 years for which the provider or any of the persons described in subparagraph (6): (a) Is presently under indictment or has been convicted of a Class A, B, C or D crime that relates to the business activities, including health care activities of the provider or that person; or (b) Has had any state or federal license or permit related to the business activities, including health care activities of the provider or that person, suspended or revoked as a result of an action brought by a governmental agency or department; (8) All principal officers and directors of the provider shall disclose in statements attested under oath any real or potential conflict of interest. This disclosure shall extend to provider - management relationships, although such relationships may be a part of the operational plan. Any employment contracts, deferred compensation contracts or other pecuniary interests shall be listed in this regard; (9) A copy of any management agreement between the provider and the person or persons responsible for the daily management of the facility, if other than the provider; (10) All contracts executed by the provider with 3rd parties which provide for the performance of health care or supportive services for the benefit of subscribers; (11) A descriptive statement of the provider's proposed operation, including an organizational chart setting out the position classifications of personnel responsible for health care and administration; (12) Proof of fidelity bonding of all individuals who handle the funds of continuing care retirement communities. The actual amount of the fidelity bonding required will be determined by the superintendent, but the face amount of the bond may not be less than $100,000; (13) A description of the proposed method of marketing the plan for continuing care and a copy of any market research study performed; (14) A copy of all advertising materials; (15) A description of the mechanism by which subscribers will be afforded participation in policy matters of the organization; (16) A description of the procedures developed by the provider to provide for the resolution of complaints initiated by subscribers concerning health care services and general operating procedures; (17) A power of attorney duly executed by the provider, if not domiciled in the State, appointing an agent for service of process in any legal action brought; (18) An actuarial study, certified by an actuary, demonstrating that the anticipated revenues and other available financial resources will be sufficient to provide the services promised by the contract and indicating the method by which the reserve required by section 6215‑A will be calculated; (19) A demonstration of the provider's ability to respond to claims for malpractice, employer's liability, workers' compensation coverages and all property and liability insurance relating to the facility, including fidelity bonds; (20) Pro forma projected financial statements for the provider for the coming 10 years, including notes of the statements, presented in conformity with guidelines for forecasting as prescribed by the American Institute of Certified Public Accountants; (21) A copy of any application form which prospective subscribers will be required to complete; (23) A copy of the preliminary deposit agreement described in subsection 3, paragraph B , subparagraph (1); and (24) A copy of the escrow agreement described in subsection 3, paragraph E . [PL 1997, c. 592, §75 (AMD).] C. The superintendent has determined that the continuing care agreement meets the requirements of section 6206, subsection 1 . [PL 1987, c. 482, §1 (NEW).] D. The superintendent has approved the application form, escrow agreement and the preliminary deposit agreement. [PL 1987, c. 482, §1 (NEW); PL 1989, c. 343, §5 (AMD); PL 1989, c. 343, §23 (AFF).] E. The provider has met all other requirements for a preliminary certificate of authority which the superintendent may prescribe in rules promulgated pursuant to this chapter. [PL 1987, c. 482, §1 (NEW).] F. The department has certified that: (1) The advertising materials related to the continuing care agreements are not untrue or misleading; (2) The proposed continuing care agreement meets the requirement of section 6206, subsection 2 ; and (3) The disclosure statement meets the requirement of section 6209 . [PL 1987, c. 482, §1 (NEW).] G. The department has approved the adequacy of all services proposed under the continuing care agreement not otherwise reviewed under the certificate of need process. [PL 1995, c. 452, §11 (NEW).] H. The superintendent finds that the provider has met the requirements under this chapter and that the provider has furnished evidence satisfactory to the superintendent that the provider's methods of operation do not make its proposed operation hazardous to the public or its subscribers in this State. [PL 1995, c. 452, §11 (NEW).] I. The department certifies to the superintendent that the provider has demonstrated the willingness and potential ability to ensure that the health care services or supportive services, or both, will be provided in a manner to ensure availability, accessibility and continuity of services. [PL 1995, c. 452, §11 (NEW).] [PL 2003, c. 510, Pt. A, §22 (AMD).]

2. Final certificate of authority. The superintendent shall issue a final certificate of authority, subject to annual renewal, when: A. The provider has obtained any required certificate of need or other permits or licenses required prior to construction of the facility; [PL 1987, c. 482, §1 (NEW).] B. [PL 1995, c. 452, §12 (RP).] C. The superintendent is satisfied that the provider has demonstrated that it is financially responsible and shall reasonably be expected to meet its obligations to subscribers or prospective subscribers; [PL 1987, c. 482, §1 (NEW).] C-1. [PL 1989, c. 343, §6 (NEW); PL 1989, c. 343, §23 (RP).] D. The superintendent has determined that the provider's continuing care agreement meets the requirements of section 6206, subsection 3 , and the rules promulgated in this chapter; and [PL 1995, c. 452, §13 (AMD).] E. [PL 1995, c. 452, §14 (RP).] F. [PL 1995, c. 452, §15 (RP).] G. The provider certifies to the superintendent either: (1) That preliminary continuing care agreements have been entered and deposits of not less than 10% of the entrance fee have been received either: (a) From subscribers with respect to 70% of the residential units, including names and addresses of the subscribers, for which entrance fees will be charged; or (b) From subscribers with respect to 70% of the total entrance fees due or expected at full occupancy of the community; or (2) That preliminary continuing care agreements have been entered and deposits of not less than 25% of the entrance fee received from either: (a) Subscribers with respect to 60% of the residential units, including names and addresses of the subscribers, for which entrance fees will be charged; or (b) Subscribers with respect to 60% of the total entrance fees due or expected at full occupancy of the community. [PL 1995, c. 452, §16 (RPR).] Within 120 days after determining that the application to the superintendent and the department is complete, the superintendent shall issue or deny a final certificate of authority to the provider, unless a certificate of need is required, in which case the final certificate of authority shall be issued or denied in accordance with the certificate of need schedule. [PL 1995, c. 452, §§12-16 (AMD).]

3. Deposits. Deposits shall apply as follows. A. A provider who has applied for a preliminary certificate of authority may advertise, solicit and collect deposits, not to exceed $1,000 per prospective subscriber, provided that: (1) The provider shall furnish the prospective subscriber a signed receipt stating that: (a) The deposit, with interest earned on it, will be refunded in full if: (i) The preliminary or final certificate of authority is not granted or if the continuing care retirement community does not become operational; (ii) The prospective subscriber requests a refund for any reason; or (iii) The provider determines that the subscriber is ineligible for entrance into the facility because of the subscriber's physical, mental or financial condition; (b) There is a nonrefundable application fee and the amount of that fee; and (c) Neither the continuing care agreement nor the disclosure statement has been approved by the superintendent and both are subject to change; (2) At least 10 days prior to collecting an initial deposit, the provider shall furnish the prospective subscriber: (a) A copy of the proposed continuing care agreement; (b) A copy of the proposed disclosure statement described in section 6209 ; (c) An unsigned copy of the receipt described in subparagraph (1); and (d) A copy of the escrow agreement required by paragraph E ; and (3) The superintendent has approved the receipt required by subparagraph (1) and the escrow agreement required by paragraph E . [PL 1987, c. 563, §1 (AMD); PL 1989, c. 343, §9 (RP); PL 1989, c. 343, §23 (AFF).] B. A provider who has been issued a preliminary certificate of authority may advertise, solicit and collect deposits of not less than 10% nor more than 50% of the entrance fee, if: (1) The provider furnishes the prospective subscriber a signed deposit agreement stating that: (a) The provider has a preliminary certificate of authority and the deposit is received subject to the issuance by the superintendent to the provider of a final certificate of authority; (b) Both the proposed continuing care agreement and the disclosure statement are subject to change; (c) The provider will refund the prospective subscriber's deposit with interest earned on it: (i) Within one month of notification of the superintendent's decision not to issue the final certificate of authority; (ii) At the request of the prospective subscriber any time 3 years or more after the deposit was paid, if the community has not become operational; (iii) If the prospective subscriber requests a refund due to a material difference between the proposed continuing care agreement furnished at the time the deposit is paid and the agreement as finally approved by the superintendent; (iv) In the event of the death of the prospective subscriber prior to the execution of the continuing care agreement, unless the surviving spouse is also a prospective subscriber and still wishes to occupy the unit; or (v) If the provider determines that the subscriber is ineligible for entrance into the facility because of the subscriber's physical, mental or financial condition; (d) The provider will refund the deposit, without interest, if the community becomes operational and the subscriber chooses not to join for any reason other than that listed in division (c) and the refund will be paid on the receipt by the provider of the same percentage deposit of the entrance fee from another subscriber for a residential unit that is the same as or similar to the residential unit to which the cancelled deposit agreement applied; (e) There is a nonrefundable application fee and the amount of that fee; and (f) The subscriber may cancel the deposit agreement by written notice to the provider within 10 days from the date on which the subscriber signed the deposit agreement, in which event the provider will refund the prospective subscriber's deposit in full together with any interest earned on the deposit; and (2) At least 10 days prior to collecting a preliminary deposit, the provider furnishes the prospective subscriber: (a) A copy of the proposed continuing care agreement; (b) A copy of the proposed disclosure statement described in section 6209 ; (c) An unsigned copy of the preliminary deposit agreement described in subparagraph (1); and (d) A copy of the escrow agreement required by paragraph E . [RR 1995, c. 2, §54 (COR).] C. After the community is operational, the provider may advertise, solicit and collect deposits of not less than 10% of the entrance fee and not to exceed 50% of the entrance fee, provided that: (1) The provider shall furnish the prospective subscriber a signed deposit agreement stating that: (a) The provider will refund the deposit, without interest, if the subscriber chooses not to join for any reason other than those listed in division (b), and the refund will be paid on the receipt by the provider of the same percentage deposit of the entrance fee from another subscriber for a residential unit that is the same as or similar to the residential unit to which the cancelled deposit agreement applied; (b) The provider will refund the deposit with interest earned on it: (i) In the event of the death of the prospective subscriber prior to the execution of the final continuing care agreement, unless the surviving spouse is also a subscriber and still wishes to occupy the unit; or (ii) If the provider determines, prior to occupation by the subscriber, that the subscriber is ineligible for entrance into the facility because of the subscriber's physical, mental or financial condition; (c) There is a nonrefundable application fee and the amount of that fee; and (d) The subscriber may cancel the deposit agreement by written notice to the provider within 10 days from the date on which the subscriber signed the deposit agreement, in which event the provider will refund the prospective subscriber's deposit in full together with any interest earned on the deposit; and (2) At least 10 days prior to collecting a deposit, the provider furnishes the prospective subscriber: (a) A copy of the continuing care agreement; (b) A copy of the disclosure statement described in section 6209 ; (c) An unsigned copy of the deposit agreement described in subparagraph (1); and (d) A copy of the escrow agreement required by paragraph E . [RR 1995, c. 2, §55 (COR).] D. At the time the prospective subscriber first makes an initial, preliminary or other deposit, the provider may also collect a nonrefundable application fee not to exceed $500. [PL 1987, c. 482, §1 (NEW); PL 1989, c. 343, §12 (AMD); PL 1989, c. 343, §23 (AFF).] E. Any deposit must be deposited to an interest-bearing escrow account. The escrow agreement establishing the terms of deposit of funds shall be filed with and approved by the superintendent prior to collection of funds. The provider shall furnish the superintendent with documentation of the name of the institution with which the provider has established the escrow account and the account number. The escrowed money shall not be applied until a final certificate of authority has been issued, the facility is operational and the subscriber has occupied the unit. When a subscriber's deposit and interest earned on it are applied, the interest shall be credited to reduce the unpaid portion of that subscriber's entrance fee. [PL 1987, c. 563, §4 (AMD); PL 1989, c. 343, §13 (AMD); PL 1989, c. 343, §23 (AFF).] F. Payments in excess of those deposits and fees under paragraphs A to D may be collected from a subscriber after a final certificate of authority has been issued by the superintendent and the subscriber has occupied the unit. Payments collected before the facility is operational must be held in the escrow account until the facility becomes operational. [PL 1987, c. 482, §1 (NEW); PL 1989, c. 343, §14 (RP); PL 1989, c. 343, §23 (AFF).] G. [PL 1989, c. 343, §15 (NEW); PL 1989, c. 343, §23 (RP).] H. Notwithstanding paragraph E and section 6203‑B , deposits may be released from escrow to a provider that is organized as a nonprofit corporation subject to Title 13‑B , as a consumer cooperative subject to Title 13, chapter 85, subchapter I or as a cooperative affordable housing corporation subject to Title 13, chapter 85, subchapter I‑A , and any such provider may pledge the deposits as security for a loan to acquire, construct and develop a facility or may use the deposits to pay costs to acquire, construct and develop a facility, if: (1) Either of the following applies: (a) Deposits for at least 10% of the entrance fee have been received from prospective subscribers for not less than 70% of the facility's residential units for which entrance fees will be charged or not less than 70% of the total entrance fees due or expected at full occupancy and the prospective subscribers have agreed in writing to such use of the deposits; or (b) Deposits for at least 25% of the entrance fee have been received from prospective subscribers for not less than 60% of the facility's residential units for which entrance fees will be charged or not less than 60% of the total entrance fees due or expected at full occupancy and the prospective subscribers have agreed in writing to such use of the deposits; (2) The superintendent has issued a final certificate of authority to the provider; (3) The superintendent is satisfied that the provider has demonstrated an ability to finance and complete construction in a reasonable manner, without limitation, by showing that: (a) The deposits together with other funds held by or loaned to the provider are reasonably expected to be sufficient to pay for all costs of construction and equipping of the facility; and (b) The provider has obtained or has the benefit of performance and payment bonds with respect to construction of the facility; and (4) The superintendent is satisfied that the provider has obtained all necessary governmental permits and approvals necessary to construct the facility in accordance with all applicable laws, regulations, building codes and ordinances. [PL 1995, c. 452, §19 (NEW).] [RR 1995, c. 2, §§54, 55 (COR).]

4. Separate facilities. If the provider intends to provide continuing care at more than one facility, the provider must obtain a separate certificate of authority for each facility at which the provider intends to provide continuing care. With the exception of unencumbered surplus funds, funds collected by one facility may not be expended for the benefit of any other facility. [PL 1987, c. 482, §1 (NEW).]

5. Material changes. Within 60 days prior to any change in the approved continuing care agreement, any other approved form or the health care or supportive services offered, the provider shall submit the proposed change in duplicate to the superintendent for approval. The superintendent shall forward one copy to the department. [PL 1987, c. 482, §1 (NEW).]

6. Provision of services to nonresidents. The final certificate of authority must state whether any skilled nursing facility that is part of a life-care community or a continuing care retirement community may provide services to persons who have not been bona fide residents of the community prior to admission to the skilled nursing facility. If the life-care community or the continuing care retirement community admits to its skilled nursing facility only persons who have been bona fide residents of the community prior to admission to the skilled nursing facility, then the community is exempt from the provisions of Title 22, chapter 103‑A , but is subject to the licensing provisions of Title 22, chapter 405 , and is entitled to only one skilled nursing facility bed for every 4 residential units in the community. Any community exempted under Title 22, chapter 103‑A may admit nonresidents of the community to its skilled nursing facility only during the first 3 years of operation. For purposes of this subsection, a "bona fide resident" means a person who has been a resident of the community for a period of not less than 180 consecutive days immediately preceding admission to the nursing facility or has been a resident of the community for less than 180 consecutive days but who has been medically admitted to the nursing facility resulting from an illness or accident that occurred subsequent to residence in the community. Any community exempted under Title 22, chapter 103‑A is not entitled to and may not seek any reimbursement or financial assistance under the MaineCare program from any state or federal agency and, as a consequence, that community must continue to provide nursing facility services to any person who has been admitted to the facility. Notwithstanding this subsection, a life-care community that holds a final certificate of authority from the superintendent and that was operational on November 18, 2002 and that is barred from seeking reimbursement or financial assistance under the MaineCare program from a state or federal agency may continue to admit nonresidents of the community to its skilled nursing facility after its first 3 years of operation with the approval of the superintendent. A life-care community that admits nonresidents to its skilled nursing facility as permitted under this subsection may continue to admit nonresidents after its first 3 years of operation only for such period as approved by the superintendent after the superintendent's consideration of the financial impact on the life-care community and the impact on the contractual rights of subscribers of the community. [PL 2003, c. 155, §1 (AMD).]
24-A M.R.S. § 721 — ME Code / Title 24-A / Chapter 9 / Section 721
24-A §721. Limits of risk
Status: in_force

1. No insurer shall retain any risk on any one subject of insurance, whether located or to be performed in this State or elsewhere, in an amount exceeding 10% of its surplus to policyholders. [PL 1969, c. 132, §1 (NEW).]

2. A "subject of insurance" for the purposes of this section, as to insurance against fire and hazards other than windstorm, earthquake and other catastrophic hazards, includes all properties insured by the same insurer which are customarily considered by underwriters to be subject to loss or damage from the same fire or the same occurrence of any other hazard insured against. [PL 1969, c. 132, §1 (NEW).]

3. Reinsurance ceded as authorized by subchapter 3 must be deducted in determining risk retained. As to surety risks, deduction must be made of the amount assumed by any authorized cosurety and the value of any security deposited, pledged or held subject to the surety's consent and for the surety's protection. [PL 2023, c. 405, Pt. A, §83 (AMD).]

4. As to alien insurers, this section shall relate only to risks and surplus to policyholders of the insurer's United States branch. [PL 1969, c. 132, §1 (NEW).]

5. "Surplus to policyholders" for the purposes of this section, in addition to the insurer's capital and surplus, shall be deemed to include any voluntary reserves which are not required pursuant to law, and shall be determined from the last sworn statement of the insurer on file with the superintendent, or by the last report of examination of the insurer, whichever is the more recent at time of assumption of risk. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

6. This section shall not apply to life or health insurance, annuities, title insurance, insurance of wet marine and transportation risks, workers' compensation insurance, employers' liability coverages, nor to any policy or type of coverage as to which the maximum possible loss to the insurer is not readily ascertainable on issuance of the policy. [PL 1987, c. 769, Pt. A, §89 (AMD).]

7. Limits of risk as to newly formed domestic mutual insurers shall be as provided in section 3352 . [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2736-A — ME Code / Title 24-A / Chapter 33 / Section 2736-A
24-A §2736-A. Hearing
Status: in_force

If at any time the superintendent has reason to believe that a filing does not meet the requirements that rates not be excessive, inadequate or unfairly discriminatory or that the filing violates any of the provisions of chapter 23 , the superintendent shall cause a hearing to be held. If a filing proposes an increase in rates in an individual health plan as defined in section 2736‑C , the superintendent shall cause a hearing to be held at the request of the Attorney General. In any hearing conducted under this section, the insurer has the burden of proving rates are not excessive, inadequate or unfairly discriminatory. [PL 2011, c. 364, §2 (AMD).]

Hearings held under this section must conform to the procedural requirements set forth in the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter 4 . [PL 2003, c. 469, Pt. E, §11 (AMD).]
24-A M.R.S. § 4136 — ME Code / Title 24-A / Chapter 55 / Section 4136
24-A §4136. Examination of foreign and alien societies
Status: in_force

The superintendent, or any person whom the superintendent may appoint, may examine any foreign or alien society transacting or applying for admission to transact business in this State. The superintendent may employ assistants and the superintendent, or any person the superintendent may appoint, has free access to all books, papers and documents that relate to the business of the society. The superintendent may in the superintendent's discretion accept, in lieu of such examination, the examination of the insurance department of the state, territory, district, province or country where such society is organized. The compensation and actual expenses of the examiners making any examination or general or special valuation must be paid by the society examined or by the society whose certificate obligations have been valued, upon statements furnished by the superintendent. [RR 2021, c. 1, Pt. B, §338 (COR).]
24-A M.R.S. § 1123 — ME Code / Title 24-A / Chapter 13 / Section 1123
24-A §1123. Collateral loans
Status: in_force

An insurer may lend and thereby invest its funds upon the pledge of securities eligible for investment under this chapter. As at date made, no such loan shall exceed in amount 90% of the market value of such collateral pledged. The amount so loaned shall be included pro rata in determining the maximum percentage of funds permitted under this chapter to be invested in the respective categories of securities so pledged. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 216 — ME Code / Title 24-A / Chapter 3 / Section 216
24-A §216. Records; inspection; destruction
Status: in_force

1. The superintendent shall carefully preserve in the bureau and in permanent form a correct account of all the superintendent's transactions and of all fees and money received by the superintendent by virtue of the superintendent's office, together with all financial statements, examination reports, correspondence, filings and documents duly received by the bureau. The superintendent shall hand the same over to the superintendent's successor in office. [RR 2021, c. 1, Pt. B, §160 (COR).]

2. All records of the bureau are subject to public inspection, except as otherwise expressly provided by law as to particular matters; and except that records, correspondence and reports of investigation in connection with actual or claimed violations of this Title or prosecution or disciplinary action for those violations are confidential. The confidential nature of any such record, correspondence or report may not limit or affect use of the same by the superintendent in any such prosecution or action. This subsection does not preclude participation by the superintendent in the establishment of an interstate complaint handling system that may involve the sharing of information with insurance regulatory officials in other jurisdictions and with the National Association of Insurance Commissioners, as long as the names of the complainant and insured remain confidential. This subsection does not preclude the dissemination of aggregate ratios of consumer complaints to the public by the superintendent. Only complaints received in writing are included in the calculation of the complaint ratio. A complaint received by electronic means is considered a written complaint. For the purposes of this subsection, a "consumer complaint" means any written complaint that results in the need for the bureau to conduct further investigation or to communicate in writing with a regulated entity for a response or resolution to the complaint. The superintendent shall adopt rules necessary to define the method for calculating complaint ratios. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 2001, c. 165, Pt. A, §1 (AMD).]

3. All records and documents of the bureau are subject to subpoena by a court of competent jurisdiction. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

4. The superintendent may destroy unneeded or obsolete records and filings in the bureau in accordance with provisions and procedures applicable to administrative agencies of the State in general. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

5. In order to assist the superintendent in the regulation of insurers in this State, it is the duty of the superintendent to maintain as confidential a document or information received from the National Association of Insurance Commissioners or International Association of Insurance Supervisors, public officials of other jurisdictions and members of supervisory colleges in which the superintendent participates pursuant to section 222, subsection 7‑B , agencies of the Federal Government, the Financial Industry Regulatory Authority, the National Association of Registered Agents and Brokers or political subdivisions or other agencies of this State, if the document or the information has been provided to the superintendent with notice that it is confidential under the laws of the jurisdiction that is the source of the document or information. A. Any information furnished pursuant to this subsection by or to the superintendent that has been designated confidential by the official, agency or other entity furnishing the information remains the property of the agency furnishing the information and must be held as confidential by the recipient of the information, except as authorized by the official, agency or other entity furnishing the information to the superintendent, with prior notice to interested parties and consistent with other applicable laws. The authority of the superintendent, pursuant to paragraph B , to permit further disclosure to a 3rd party or to the public of information shared by the superintendent is subject to the same requirements and conditions that apply if the superintendent discloses the information directly to a 3rd party or to the public. [PL 2013, c. 238, Pt. A, §1 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] B. The superintendent may share information, including otherwise confidential information, with the National Association of Insurance Commissioners or International Association of Insurance Supervisors, public officials of other jurisdictions and members of supervisory colleges in which the superintendent participates pursuant to section 222, subsection 7‑B , agencies of the Federal Government, the Financial Industry Regulatory Authority, the National Association of Registered Agents and Brokers or political subdivisions or other agencies of this State, if the recipient of the information agrees to maintain the same level of confidentiality as is available under Maine law and has demonstrated that it has the legal authority to do so. [PL 2017, c. 115, §1 (AMD).] B-1. The superintendent may authorize a contractor retained pursuant to section 208 , or any other person outside the bureau that is otherwise designated to act on behalf of the superintendent, to receive confidential information. The recipient of confidential information is under the direction and control of the superintendent, is subject to the same confidentiality standards and requirements as the superintendent and shall act in a purely advisory capacity. The recipient of confidential information shall comply with the requirements of this paragraph. (1) Access to confidential information may not be granted unless the recipient agrees in writing that: (a) The recipient will maintain the confidentiality of any confidential information that the superintendent has authorized the recipient to access, and establish appropriate procedures to protect such information from unauthorized access or use; (b) Ownership of any confidential information shared by the superintendent pursuant to this paragraph remains with the superintendent and that the use of such information by the recipient is subject to the direction of the superintendent; (c) The recipient will not store confidential information obtained or created under the contract in a permanent file or database after the work involving the information is completed; (d) The recipient will provide prompt notice to the superintendent of any subpoena, request for disclosure or request for production of confidential information; and (e) The recipient will consent to intervention by an insurer in any judicial or administrative action in which the recipient may be required to disclose confidential information about the insurer that has been shared pursuant to this paragraph. (2) The recipient of confidential information shall confirm in writing to the superintendent that the recipient is free from conflicts of interest and will conduct ongoing monitoring for conflicts of interest for the duration of the work involving the confidential information. [PL 2021, c. 521, §3 (NEW).] C. The superintendent may enter into one or more written agreements with the National Association of Insurance Commissioners governing sharing and using information under this subsection that: (1) Specify procedures and protocols regarding the confidentiality and security of information shared with the National Association of Insurance Commissioners pursuant to this paragraph, including procedures and protocols for sharing by the National Association of Insurance Commissioners with other state, federal or international insurance regulators; (2) Specify that ownership of information shared with the National Association of Insurance Commissioners pursuant to this paragraph remains with the superintendent and that the use of information by the National Association of Insurance Commissioners is subject to the direction of the superintendent; (2-A) Prohibit the National Association of Insurance Commissioners from storing confidential information in a permanent file or database after the analysis of the confidential information is completed, other than liquidity stress test information obtained pursuant to section 222, subsection 8, paragraph B‑1 , subparagraph (3); (3) Require prompt notice to be given by the National Association of Insurance Commissioners to any insurer whose confidential information is in the possession of the National Association of Insurance Commissioners pursuant to this paragraph when that information is the subject of a request or subpoena for disclosure or production; and (4) Require the National Association of Insurance Commissioners to consent to intervention by an insurer in any judicial or administrative action in which the National Association of Insurance Commissioners may be required to disclose confidential information about the insurer shared with the National Association of Insurance Commissioners pursuant to this paragraph. [PL 2021, c. 521, §4 (AMD).] D. This subsection does not alter prohibitions or restrictions applicable to ex parte contacts in the course of an adjudicatory proceeding in which a state agency is a party. [PL 2013, c. 238, Pt. A, §1 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] E. For purposes of this subsection, "other agencies of this State" includes bureau personnel and consultants designated as serving in an advocacy capacity in an adjudicatory proceeding before the superintendent. [PL 2013, c. 238, Pt. A, §1 (NEW); PL 2013, c. 238, Pt. A, §34 (AFF).] [PL 2021, c. 521, §§3, 4 (AMD).]
24-A M.R.S. § 4123 — ME Code / Title 24-A / Chapter 55 / Section 4123
24-A §4123. Reinsurance
Status: in_force

A domestic society may, by a reinsurance agreement, cede any individual risk or risks in whole or in part to an insurer, other than another fraternal benefit society, having the power to make such reinsurance and authorized to do business in this State, or if not so authorized, one which is approved by the superintendent, but no such society may reinsure substantially all of its insurance in force without the written permission of the superintendent. It may take credit for the reserves on such ceded risks to the extent reinsured, but no credit shall be allowed as an admitted asset or as a deduction from liability, to a ceding society for reinsurance made, ceded, renewed, or otherwise becoming effective after January 1, 1970, unless the reinsurance is payable by the assuming insurer on the basis of the liability of the ceding society under the contract or contracts reinsured without diminution because of the insolvency of the ceding society. [PL 1973, c. 625, §154 (AMD).]
24-A M.R.S. § 4220 — ME Code / Title 24-A / Chapter 56 / Section 4220
24-A §4220. Fees
Status: in_force

1. Every health maintenance organization subject to this chapter shall pay to the superintendent the following fees: A. For filing an initial application for a certificate of authority, $500; [PL 1975, c. 503 (NEW).] B. For filing each annual report, $50. [PL 1975, c. 503 (NEW).] [PL 1975, c. 503 (NEW).]

2. Fees charged under this section shall be distributed as follows: 50% to the superintendent and 50% to the Commissioner of Health and Human Services. [PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
24-A M.R.S. § 2201 — ME Code / Title 24-A / Chapter 24 / Section 2201
24-A §2201. Short title
Status: in_force

This chapter may be known and cited as the "Insurance Information and Privacy Protection Act." [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
24-A M.R.S. § 2262 — ME Code / Title 24-A / Chapter 24-B / Section 2262
24-A §2262. Construction
Status: in_force

This chapter establishes standards for data security and exclusive standards for the investigation of and notification to the superintendent regarding a cybersecurity event applicable to licensees. This chapter may not be construed to create or imply a private cause of action for violation of its provisions or to curtail a private cause of action that would otherwise exist in the absence of this chapter. [PL 2021, c. 24, §1 (NEW).]
24-A M.R.S. § 4234-D — ME Code / Title 24-A / Chapter 56 / Section 4234-D
24-A §4234-D. Off-label use of prescription drugs for cancer
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Medically accepted indication" includes any use of a drug that has been approved by the federal Food and Drug Administration and includes another use of the drug if that use is supported by one or more citations in the standard reference compendia or if the health maintenance organization involved, based upon guidance provided by the federal Department of Health and Human Services Medicare program pursuant to 42 United States Code, Section 1395x(t), determines that that use is medically accepted based on supportive clinical evidence in peer-reviewed medical literature. [PL 1997, c. 701, §4 (NEW).] B. "Off-label use" means the prescription and use of drugs for medically accepted indications other than those stated in the labeling approved by the federal Food and Drug Administration. [PL 1997, c. 701, §4 (NEW).] C. "Peer-reviewed medical literature" means scientific studies published in at least 2 articles from major peer-reviewed medical journals that present data that supports the proposed off-label use as generally safe and effective. [PL 1997, c. 701, §4 (NEW).] D. "Standard reference compendia" means: (1) The United States Pharmacopeia Drug Information or information published by its successor organization; or (2) The American Hospital Formulary Service Drug Information or information published by its successor organization. [PL 1997, c. 701, §4 (NEW).] [PL 1997, c. 701, §4 (NEW).]

2. Required coverage for off-label use. All health maintenance organization individual and group contracts that provide coverage for prescription drugs must provide coverage for off-label use in accordance with the following. A. Health maintenance organization individual and group contracts that provide coverage for prescription drugs may not exclude coverage of any such drug used for the treatment of cancer for a medically accepted indication on the grounds that the drug has not been approved by the federal Food and Drug Administration for that indication, as long as that use of that drug is a medically accepted indication for the treatment of cancer. [PL 1997, c. 701, §4 (NEW).] B. Coverage of a drug required by this subsection also includes medically necessary services associated with the administration of the drug. [PL 1997, c. 701, §4 (NEW).] C. This subsection may not be construed to require coverage for a drug when the federal Food and Drug Administration has determined its use to be contraindicated for treatment of the current indication. [PL 1997, c. 701, §4 (NEW).] D. A drug use that is covered pursuant to paragraph A may not be denied coverage based on a "medical necessity" requirement except for a reason that is unrelated to the legal status of the drug use. [PL 1997, c. 701, §4 (NEW).] E. A contract that provides coverage of a drug as required by this subsection may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the same extent that these provisions are applicable to coverage of all prescription drugs and are not inconsistent with the requirements of this subsection. [PL 1997, c. 701, §4 (NEW).] [PL 1997, c. 701, §4 (NEW).]

3. Application. The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State on or after January 1, 1999. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 1997, c. 701, §4 (NEW).]
24-A M.R.S. § 2909 — ME Code / Title 24-A / Chapter 39 / Section 2909
24-A §2909. Insurance for dealers and transporters
Status: in_force

1. As used in this section, "owner" means the owner of a motor vehicle, the owner's agent, employee or independent contractor. [PL 1989, c. 261, §1 (NEW).]

2. The superintendent may not approve any policy required pursuant to Title 29‑A, section 1612 , unless coverage is provided for both the owner and operator of the motor vehicle. [PL 1995, c. 65, Pt. A, §70 (AMD); PL 1995, c. 65, Pt. A, §153 (AFF); PL 1995, c. 65, Pt. C, §15 (AFF).]

3. The owner's policy must provide primary coverage up to the limits specified in Title 29‑A, section 1612 . Any other valid and collectible insurance policy available to an operator who is not the owner must provide excess coverage. [PL 1995, c. 65, Pt. A, §70 (AMD); PL 1995, c. 65, Pt. A, §153 (AFF); PL 1995, c. 65, Pt. C, §15 (AFF).]
24-A M.R.S. § 6091 — ME Code / Title 24-A / Chapter 72-A / Section 6091
24-A §6091. Short title
Status: in_force

This chapter shall be known and may be cited as the Maine Liability Risk Retention Act. [PL 1987, c. 481, §3 (NEW).]
24-A M.R.S. § 3043 — ME Code / Title 24-A / Chapter 41 / Section 3043
24-A §3043. Coverage for rental equipment permitted
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Covered rental agreement" means a written agreement with a term of 30 continuous days or fewer setting forth the terms and conditions governing the use of covered rental equipment provided by a rental company. [PL 2015, c. 77, §8 (NEW).] B. "Covered rental equipment" means equipment rented pursuant to a covered rental agreement for personal or household purposes. [PL 2015, c. 77, §8 (NEW).] C. "Rental company" means a person or organization, including a franchisee, in the business of renting equipment to the public. [PL 2015, c. 77, §8 (NEW).] [PL 2015, c. 77, §8 (NEW).]

2. Coverage for rental equipment permitted. Notwithstanding any other provision of this Title, a rental company may offer for sale an insurance policy insuring against the loss of or damage to covered rental equipment under a covered rental agreement. [PL 2015, c. 77, §8 (NEW).]
24-A M.R.S. § 1410 — ME Code / Title 24-A / Chapter 16 / Section 1410
24-A §1410. Prelicensing requirements
Status: in_force

1. Written examination. Unless exempt, prior to filing an application for a license with the superintendent, an individual applying for a resident insurance producer, adjuster or consultant license must pass a written examination. The examination must test the knowledge of the individual concerning the kinds of insurance for which the application is made, the duties and responsibilities of an insurance producer, adjuster or consultant and the insurance laws and rules of this State. [PL 2001, c. 259, §11 (NEW).]

2. Examination content. The examination may be administered as a 2-part examination. If a 2-part examination is administered, one part of the examination must test the applicant's knowledge as to the kinds of insurance for which the application is made and the other part must test the individual's knowledge of the duties and responsibilities of an insurance producer, adjuster or consultant and the insurance laws and rules of this State. The producer examination must be administered in accordance with subchapter II‑A , the consultant examination in accordance with subchapters III and V and the adjuster examination in accordance with subchapters III and VI . [PL 2001, c. 259, §11 (NEW).]

3. Outside testing service. The superintendent may make arrangements, including contracting with an outside testing service, for administering examinations. The applicant shall pay any fees for the services of any independent testing service designated by the superintendent. An individual who fails to appear for the examination as scheduled or fails to pass the examination shall reapply for an examination and remit all required fees and forms before being rescheduled for another examination. [PL 2001, c. 259, §11 (NEW).]

4. Education requirements. [PL 2007, c. 51, §1 (RP).]

5. Experience required. An applicant for examination for a consultant license must have had not less than 5 years of actual experience with respect to the kinds of insurance and contracts to be covered by the license. [PL 2001, c. 259, §11 (NEW).]

6. Examination results. Within 30 days after an individual completes the examination, the superintendent or any independent testing service designated by the superintendent shall inform the individual whether or not the individual has passed. An individual who fails the examination must remit the required fees before being rescheduled for another examination. An individual who fails one part of a 2-part examination must pay the full examination fee but need only be examined on the part of the examination that the individual failed. An individual who does not apply for a license within 2 years after passing one part or all of an examination must register and pay the fee for a subsequent examination. [PL 2001, c. 259, §11 (NEW).]

7. Separate examination for each category. An applicant for more than one kind of license or for more than one authority under a license must be separately examined for each category of license or authority and shall pay a separate examination fee for each examination. Nothing in this section prohibits the giving of all required examinations to a particular applicant on the same day. [PL 2001, c. 259, §11 (NEW).]

8. Variable contract license. An applicant for a variable contract license, in addition to passing an examination required for a resident producer's license with life authority in accordance with subchapter II‑A , must have successfully completed the minimum requirements of a national association of securities dealers for the sale of variable contracts. [PL 2001, c. 259, §11 (NEW).]

9. Multiple peril crop insurance adjuster examination. An individual applying for a resident multiple peril crop insurance adjuster license must either pass a crop adjuster examination administered by the superintendent under this section or provide proof of federal crop insurance certification pursuant to a process that includes passing a crop adjuster proficiency examination. [PL 2009, c. 511, Pt. C, §4 (NEW).]
24-A M.R.S. § 6951 — ME Code / Title 24-A / Chapter 87 / Section 6951
24-A §6951. Maine Quality Forum
Status: repealed

(CONTAINS TEXT WITH VARYING EFFECTIVE DATES)

The Maine Quality Forum, referred to in this subchapter as "the forum," is established within Dirigo Health. The forum is governed by the board with advice from the Maine Quality Forum Advisory Council pursuant to section 6952 . The forum must be funded, at least in part, through the savings offset payments made pursuant to former section 6913 and the access payment pursuant to section 6917 . Except as provided in section 6907, subsection 2 , information obtained by the forum is a public record as provided by Title 1, chapter 13, subchapter 1 . The forum shall perform the following duties. [PL 2009, c. 359, §5 (AMD); PL 2009, c. 359, §8 (AFF).]

1. Research dissemination. The forum shall collect and disseminate research regarding health care quality, evidence-based medicine and patient safety to promote best practices. [PL 2003, c. 469, Pt. A, §8 (NEW).]

2. Quality and performance measures. The forum shall adopt a set of measures to evaluate and compare health care quality and provider performance. The measures must be adopted with guidance from the advisory council pursuant to section 6952 . The quality measures adopted by the forum must be the basis for the rules for the collection of quality data adopted by the Maine Health Data Organization pursuant to Title 22, section 8708‑A . [PL 2003, c. 469, Pt. A, §8 (NEW).]

3. Data coordination. The forum shall coordinate the collection of health care quality data in the State. The forum shall work with the Maine Health Data Organization and other entities that collect health care data to minimize duplication and to minimize the burden on providers of data. [PL 2003, c. 469, Pt. A, §8 (NEW).]

4. Reporting. The forum shall work collaboratively with the Maine Health Data Organization, health care providers, health insurance carriers and others to report in useable formats comparative health care quality information to consumers, purchasers, providers, insurers and policy makers. The forum shall produce annual quality reports in conjunction with the Maine Health Data Organization pursuant to Title 22, section 8712 . No later than September 1, 2010, the forum shall make provider-specific information regarding quality of services available on its publicly accessible website. [PL 2009, c. 350, Pt. A, §2 (AMD).]

5. Consumer education. The forum shall conduct education campaigns to help health care consumers make informed decisions and engage in healthy lifestyles. [PL 2003, c. 469, Pt. A, §8 (NEW).]

6. Technology assessment. The forum shall conduct technology assessment reviews to guide the use and distribution of new technologies in this State. The forum shall make recommendations to the certificate of need program under Title 22, chapter 103‑A . [PL 2003, c. 469, Pt. A, §8 (NEW).]

7. Electronic data. The forum shall encourage the adoption of electronic technology and assist health care practitioners to implement electronic systems for medical records and submission of claims. The assistance may include, but is not limited to, practitioner education, identification or establishment of low-interest financing options for hardware and software and system implementation support. [PL 2003, c. 469, Pt. A, §8 (NEW).]

8. State health plan. [PL 2011, c. 90, Pt. J, §23 (RP).]

9. Annual report. The forum shall make an annual report to the public. The forum shall provide the report to the joint standing committees of the Legislature having jurisdiction over appropriations and financial affairs, health and human services matters and insurance and financial services matters. [PL 2003, c. 469, Pt. A, §8 (NEW).]

10. Health care provider-specific data. The forum shall submit to the Legislature, by January 30th each year beginning in 2009, a health care provider-specific performance report. The report must be based on health care quality data, including health care-associated infection quality data, that is submitted by providers to the Maine Health Data Organization pursuant to Title 22, section 8708‑A . The forum and the Maine Center for Disease Control and Prevention shall make the report available to the citizens of the State through a variety of means, including, but not limited to, the forum’s publicly accessible website and the distribution of written reports and publications. [PL 2007, c. 594, §1 (NEW).]

11. Infection prevention activities. The forum and the Maine Center for Disease Control and Prevention shall, by January 30th of each year beginning in 2009, report to the joint standing committee of the Legislature having jurisdiction over health and human services matters on statewide collaborative efforts with health care infection control professionals in the State to control or prevent health care-associated infections. [PL 2007, c. 594, §2 (NEW).]

12. Primary care reporting. [PL 2025, c. 218, §1 (RP).]

12-A. (TEXT EFFECTIVE UNTIL 1/15/31) (TEXT REPEALED 1/15/31) Primary care reporting. Beginning January 15, 2026 and annually thereafter, the forum shall submit to the Department of Health and Human Services and the joint standing committees of the Legislature having jurisdiction over health and human services matters and health coverage and health insurance matters a report on at least one of the following key measures reflecting the status of primary care in the State: A. Annual primary care expenditures as a percentage of overall health care spending and investment; [PL 2025, c. 218, §2 (NEW).] B. Annual utilization of primary care services as a percentage of overall utilization of health care services; [PL 2025, c. 218, §2 (NEW).] C. The capacity of the primary care provider workforce to care for all residents of the State; [PL 2025, c. 218, §2 (NEW).] D. The ability of residents of the State to have timely access to primary care services; and [PL 2025, c. 218, §2 (NEW).] E. The overall health of residents of the State using metrics that reflect the use of preventive and screening services. [PL 2025, c. 218, §2 (NEW).] This subsection is repealed January 15, 2031. [PL 2025, c. 218, §2 (NEW).]

13. Behavioral health care reporting. Beginning January 15, 2023 and annually thereafter, the forum shall submit to the Department of Health and Human Services and the joint standing committee of the Legislature having jurisdiction over health coverage and health insurance matters a report on behavioral health care spending using claims data from the Maine Health Data Organization and information on the methods used to reimburse behavioral health care providers requested annually from payors. As used in this subsection, "payor" has the same meaning as in Title 22, section 8702, subsection 8 . The report must include: A. Of their respective total medical expenditures, the percentage paid for behavioral health care by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust and the average percentage of total medical expenditures paid for behavioral health care across all payors; [PL 2021, c. 603, Pt. A, §2 (NEW).] B. The total behavioral health care-related nonclaims-based payments and associated member months; [PL 2021, c. 603, Pt. A, §2 (NEW).] C. The total payments associated with substance use disorder services that are redacted from the payor’s claims data submissions to the Maine Health Data Organization as required under 42 Code of Federal Regulations, Part 2, the methods used to redact the substance use disorder claims, the specific code lists that are used for procedure codes, revenue codes and diagnosis codes, provider types and any other detail on the claim that is required to select the substance use disorder redacted claim; and [PL 2021, c. 603, Pt. A, §2 (NEW).] D. The methods used by commercial insurers, the MaineCare program, Medicare, the organization that administers health insurance for state employees and the Maine Education Association benefits trust to pay for behavioral health care. [PL 2021, c. 603, Pt. A, §2 (NEW).] Within 60 days of a request from the Maine Health Data Organization, a payor shall provide the supplemental datasets specific to payments for behavioral health care services necessary to provide the information required in paragraphs B and C . In its request to a payor, the organization shall specify the time period for which the data is requested and define the datasets requested to ensure uniformity in the data submitted by payors. [PL 2021, c. 603, Pt. A, §2 (NEW).]

14. (TEXT EFFECTIVE UNTIL 1/15/31) (TEXT REPEALED 1/15/31) Primary Care Advisory Council. The Primary Care Advisory Council, referred to in this subsection as "the advisory council," is established. The forum shall convene and staff the council. For purposes of this subsection, "primary care" means physicians, nurse practitioners and physician associates practicing in family medicine, general pediatric medicine, general internal medicine, obstetrics and gynecology and geriatric medicine. A. The advisory council shall identify specific actions required to create a sustainable high-functioning primary care system in the State. The advisory council shall, at a minimum: (1) Assess the overall status of primary care in the State using available data, including, but not limited to, timely access to primary care services, utilization of services, quality of care, equity and the adequacy and sustainability of the State's primary care workforce; (2) Identify gaps in the status of primary care in the State and potential approaches to address those gaps; and (3) Make recommendations for specific policy changes to address identified gaps that will: (a) Ensure sufficient investment in primary care services that will result in better health for residents of the State and lower overall health expenditures; (b) Ensure a sufficient number and geographic distribution of primary care providers so that each resident of the State has a primary care provider near that resident's home, with a focus on ensuring equity in all counties; (c) Ensure a resident's ability to access services from a primary care provider in a timely manner; and (d) Improve the health of residents by ensuring adequate access to preventive and screening services. Beginning January 15, 2026 and annually thereafter, the advisory council shall submit a report detailing its activities and recommendations under this paragraph to the Department of Health and Human Services and the joint standing committee of the Legislature having jurisdiction over health coverage and health insurance matters. [PL 2025, c. 218, §3 (NEW).] B. The advisory council consists of the following 18 members: (1) Seven members representing primary care providers licensed in the State, appointed by the board of directors of the Maine Health Data Organization established under Title 22, section 8703. At least 3 members must be actively practicing primary care clinicians, working at least 20 or more clinical hours per week, and at least one member must be a nurse practitioner or physician asssociate. Appointments under this subparagraph must be made as follows: (a) One member must be appointed from nominations provided by a statewide association of physicians; (b) One member must be appointed from nominations provided by a statewide association of osteopaths; (c) One member must be a provider working in an independently owned practice setting; (d) One member must be appointed from nominations provided by a statewide association of community health centers, and that member must be working at a federally qualified health center; (e) One member must be appointed from nominations provided by a statewide association of nurse practitioners; (f) One member must be appointed from nominations provided by a statewide association of physician associates; and (g) One member must be appointed from nominations provided by a statewide association of hospitals; (2) Five members must represent stakeholder groups with an interest in primary care as follows: (a) Two members must represent 3rd-party payors and must be appointed from a list of 3rd-party payors provided by a statewide association of health plans providing or administering health insurance coverage; (b) One member must represent employers and must be appointed from a list of employers provided by a statewide association of health care purchasers; and (c) Two members must represent consumers and must be appointed from a list provided by a statewide association that advocates for access to affordable health care. For the purposes of this division, "consumer" means a person who is not affiliated with or employed by a 3rd-party payor, a provider or an association representing 3rd-party payors or providers; and (3) Four members must be appointed as follows: (a) Two members must be appointed by the Commissioner of Health and Human Services, one representing the office of MaineCare services and one representing the office of the commissioner; (b) One member of the Senate, appointed by the President of the Senate; and (c) One member of the House of Representatives, appointed by the Speaker of the House. The Superintendent of Insurance or the superintendent's designee and the executive director of the Permanent Commission on the Status of Racial, Indigenous and Tribal Populations or the executive director's designee serve as ex officio members. In the event of a vacancy in the advisory council membership, the vacancy must be filled in the manner of the original appointment for the remainder of the term. For the purposes of reappointment, any partial term filled after a vacancy must be considered a full term. [PL 2025, c. 218, §3 (NEW); PL 2025, c. 316, §3 (REV).] C. Except for members who are Legislators and the ex officio members, members of the advisory council serve 3-year terms. A member may not serve more than 2 consecutive terms. The terms of Legislators serving as members of the advisory council coincide with those members' legislative terms of office. [PL 2025, c. 218, §3 (NEW).] D. Except for members who are Legislators, members of the advisory council are eligible for compensation as provided under Title 5, chapter 379 . [PL 2025, c. 218, §3 (NEW).] E. A quorum is a majority of the members of the advisory council. [PL 2025, c. 218, §3 (NEW).] F. The advisory council shall choose one of its members to serve as chair for a 2-year term. [PL 2025, c. 218, §3 (NEW).] G. The advisory council shall meet at least 4 times a year at regular intervals and may meet at other times at the call of the chair. Meetings of the advisory council are public proceedings under Title 1, chapter 13, subchapter 1 . [PL 2025, c. 218, §3 (NEW).] This subsection is repealed January 15, 2031. [PL 2025, c. 218, §3 (NEW); PL 2025, c. 316, §3 (REV).]
24-A M.R.S. § 7301 — ME Code / Title 24-A / Chapter 93 / Section 7301
24-A §7301. Short title
Status: in_force

This chapter may be known and cited as "the Transportation Network Company Insurance Act." [PL 2015, c. 279, §1 (NEW).]
24-A M.R.S. § 7004 — ME Code / Title 24-A / Chapter 89 / Section 7004
24-A §7004. Authority of vendors
Status: in_force

1. Requirements for employees and authorized representatives of vendors. An employee or authorized representative of a vendor may sell or offer portable electronic device insurance to a customer and is not subject to licensure as an insurance producer under this chapter if: A. The vendor obtains a limited lines license to authorize its employees or authorized representatives to sell or offer portable electronic device insurance pursuant to this section; [PL 2011, c. 297, §5 (NEW).] B. The insurer issuing the portable electronic device insurance either directly supervises or appoints a supervising entity to supervise the administration of the sale of insurance, including development of a training program for employees and authorized representatives of the vendors. The training required by this paragraph must comply with the following: (1) The training must be delivered to all employees and authorized representatives of the vendor who are directly engaged in the activity of selling or offering portable electronic device insurance. The training may be provided in electronic form. If conducted in electronic form the supervising entity shall implement a supplemental education program that is conducted and overseen by licensed employees of the supervising entity to supplement the electronic training; and (2) Each employee and authorized representative must receive basic instruction about the portable electronic device insurance offered to customers and the disclosures required under section 7003, subsection 1 ; and [PL 2011, c. 297, §5 (NEW).] C. The employee or authorized representative of the vendor does not advertise, represent or otherwise hold that employee or authorized representative out as a nonlimited lines licensed insurance producer. [PL 2011, c. 297, §5 (NEW).] [PL 2011, c. 297, §5 (NEW).]

2. Charges. The charges for portable electronic device insurance coverage may be billed and collected by the vendor. Any charge to the customer for coverage that is not included in the cost associated with the purchase or lease of a portable electronic device or related services must be separately itemized on the customer's bill. If the portable electronic device insurance coverage is included with the purchase or lease of a portable electronic device or related services, the vendor shall clearly and conspicuously disclose to the customer that the portable electronic device insurance coverage is included with the portable electronic device or related services. A vendor billing and collecting charges for coverage is not required to maintain those funds in a segregated account as long as the vendor is authorized by the insurer to hold such funds in an alternative manner and remits the funds to the supervising entity within 60 days of receipt. All funds received by a vendor from a customer for the sale of portable electronic device insurance are considered funds held in trust by the vendor in a fiduciary capacity for the benefit of the insurer. A vendor may receive compensation for billing and collection services. [PL 2011, c. 297, §5 (NEW).]
24-A M.R.S. § 1420-E — ME Code / Title 24-A / Chapter 16 / Section 1420-E
24-A §1420-E. Application for license
Status: in_force

1. Uniform application. An individual applying for a resident insurance producer license shall apply to the superintendent on the uniform application and declare under penalty of refusal, suspension or revocation of the license that the statements made in the application are true, correct and complete to the best of the individual's knowledge and belief. Before approving the application, the superintendent must find that the individual: A. Is at least 18 years of age; [PL 2001, c. 259, §24 (NEW).] B. Has not committed any act that is a ground for denial, suspension or revocation set forth in section 1420‑K ; [PL 2001, c. 259, §24 (NEW).] C. [PL 2007, c. 51, §2 (RP).] D. Has paid any required fees set forth in section 601 ; and [PL 2001, c. 259, §24 (NEW).] E. Has successfully passed the examinations for the lines of authority for which the person has applied. [PL 2001, c. 259, §24 (NEW).] [PL 2007, c. 51, §2 (AMD).]

2. Uniform business entity application. A business entity acting as an insurance producer is required to obtain an insurance producer license. Application must be made using the uniform business entity application. Before approving the application, the superintendent must find that: A. The business entity has paid any required fees set forth in section 601 ; and [PL 2001, c. 259, §24 (NEW).] B. The business entity has designated a licensed producer responsible for the business entity's compliance with the insurance laws, rules and regulations of this State. [PL 2001, c. 259, §24 (NEW).] [PL 2001, c. 259, §24 (NEW).]

3. Verification. The superintendent may require any documents reasonably necessary to verify the information contained in an application. [PL 2001, c. 259, §24 (NEW).]

4. Instruction. Each insurer that sells, solicits or negotiates any form of limited line credit insurance shall provide to each individual whose duties will include selling, soliciting or negotiating limited line credit insurance a program of instruction that may be approved by the superintendent. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 6308 — ME Code / Title 24-A / Chapter 75 / Section 6308
24-A §6308. Funding of the program
Status: in_force

The amount of funds available for the program is determined as follows. [PL 1991, c. 734, §5 (AMD).]

1. Available funds. The amount available for the program for policy years beginning on or after July 1, 1990, but before July 1, 1991, is 1/2 of the amount of the assessment determined under section 6305 for that year. For policy years beginning on or after July 1, 1991, the Bureau of Insurance shall determine the amount available, except that the amount may be no less than the assessment determined for that year. [PL 1991, c. 734, §5 (AMD).]

2. Determination of participants in the program. The superintendent shall apply the standards of prioritization adopted by the Commissioner of Health and Human Services to determine the physicians who are eligible for the program. The funding available for each qualified physician is the amount equal to the difference between the physician's medical malpractice insurance premiums with obstetrical care coverage and the physician's premiums without obstetrical care coverage; however, the funding must be at least $5,000 but may not be more than $15,000 as determined by the superintendent. Program payments must be made to the individual or entity paying the medical malpractice premium for the qualified physician. [PL 2005, c. 122, §9 (AMD).]
24-A M.R.S. § 3875 — ME Code / Title 24-A / Chapter 53 / Section 3875
24-A §3875. Merger or conversion
Status: in_force

1. A domestic reciprocal insurer upon affirmative vote of not less than 2/3 of its subscribers who vote on such merger pursuant to due notice and the approval of the superintendent of the terms therefor, may merge with another reciprocal insurer or be converted to a stock or mutual insurer. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. Such a stock or mutual insurer shall be subject to the same capital or surplus requirements and shall have the same rights as a like domestic insurer transacting like kinds of insurance. [PL 1969, c. 132, §1 (NEW).]

3. The superintendent may not approve any plan for such merger or conversion that is inequitable to subscribers, or that, if for conversion to a stock insurer, does not give each subscriber preferential right to acquire stock of the proposed insurer proportionate to the subscriber's interest in the reciprocal insurer as determined in accordance with section 3874 and a reasonable length of time within which to exercise such right. [RR 2021, c. 1, Pt. B, §321 (COR).]
24-A M.R.S. § 603 — ME Code / Title 24-A / Chapter 7 / Section 603
24-A §603. Record, remittance of fees
Status: in_force

The superintendent shall keep a correct account of all fees and moneys received by the superintendent by virtue of the superintendent's office, and shall pay the same over to the Treasurer of State forthwith. [RR 2021, c. 1, Pt. B, §186 (COR).]
24-A M.R.S. § 4237-A — ME Code / Title 24-A / Chapter 56 / Section 4237-A
24-A §4237-A.  Coverage for screening mammograms and diagnostic and supplemental breast examinations
Status: in_force

1. Definition. [PL 2023, c. 338, §10 (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, §11 (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, §11 (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, §11 (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, §11 (NEW); PL 2023, c. 338, §13 (AFF).] [PL 2023, c. 338, §11 (NEW); PL 2023, c. 338, §13 (AFF).]

2. Required coverage. All individual and group coverage subject to this chapter 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. [PL 1997, c. 408, §7 (NEW); PL 1997, c. 408, §8 (AFF); PL 2003, c. 689, Pt. B, §6 (REV).]

2-A. No cost-sharing requirements. All individual and group coverage subject to this chapter 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 individual or group coverage 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, §12 (NEW); PL 2023, c. 338, §13 (AFF).]

3. Application. The requirements of this section apply to all individual and group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. B, §25 (NEW).]
24-A M.R.S. § 1420-D — ME Code / Title 24-A / Chapter 16 / Section 1420-D
24-A §1420-D. Application for examination
Status: in_force

1. Written examination. A resident individual applying for an insurance producer license must pass a written examination unless exempt pursuant to section 1420‑H . The examination must test the knowledge of the individual concerning the lines of authority applied for, the duties and responsibilities of an insurance producer and the insurance laws and regulations of this State. The superintendent may adopt rules regarding the development and administration of examinations required by this section. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 2001, c. 259, §24 (NEW).]

2. Outside testing service. The superintendent may make arrangements, including contracting with an outside testing service, for administering examinations and collecting any applicable fee set forth in section 601 . [PL 2001, c. 259, §24 (NEW).]

3. Fees. Each individual applying for an examination shall remit any applicable fee as prescribed by the superintendent as set forth in section 601 . [PL 2001, c. 259, §24 (NEW).]

4. Rescheduling. An individual who fails to appear for the examination as scheduled or fails to pass the examination may reapply for an examination and must remit all required fees and forms before being rescheduled for another examination. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 4226 — ME Code / Title 24-A / Chapter 56 / Section 4226
24-A §4226. Federal legislation
Status: in_force

Nothing in this chapter shall prohibit any health maintenance organization from meeting the requirements of any federal law which would authorize such health maintenance organization to receive federal financial assistance or certification or to enroll beneficiaries assisted by federal funds. [PL 1975, c. 503 (NEW).]
24-A M.R.S. § 4204 — ME Code / Title 24-A / Chapter 56 / Section 4204
24-A §4204. Issuance of certificate of authority
Status: in_force

1. Procedure upon receipt of an application for issuance of a certificate of authority. A. Concurrently with filing an application for issuance of certificate of authority with the superintendent, the applicant shall also file an application for a certificate of need pursuant to Title 22, chapter 103‑A . [PL 2003, c. 510, Pt. A, §20 (AMD).] B. The superintendent may not take final action with regard to the application until the superintendent has been informed by the Department of Health and Human Services whether or not the application for the certificate of need has been approved, denied or determined not to be required. The Department of Health and Human Services shall transmit to the superintendent a copy of its written decision on the application for a certificate of need. [RR 2021, c. 1, Pt. B, §342 (COR).] [RR 2021, c. 1, Pt. B, §342 (COR).]

2. [PL 1981, c. 501, §50 (RP).]

2-A. The superintendent shall issue or deny a certificate of authority to any person filing an application pursuant to section 4203 within 50 business days of receipt of the notice from the Department of Health and Human Services that the applicant has been granted a certificate of need or, if a certificate of need is not required, within 50 business days of receipt of notice from the Department of Health and Human Services that the applicant is in compliance with the requirements of paragraph B . Issuance of a certificate of authority shall be granted upon payment of the application fee prescribed in section 4220 if the superintendent is satisfied that the following conditions are met. A. The Commissioner of Health and Human Services certifies that the health maintenance organization has received a certificate of need or that a certificate of need is not required pursuant to Title 22, chapter 103‑A . [PL 2003, c. 510, Pt. A, §21 (AMD); PL 2003, c. 689, Pt. B, §7 (REV).] B. If the Commissioner of Health and Human Services has determined that a certificate of need is not required, the commissioner makes a determination and provides a certification to the superintendent that the following requirements have been met. (4) The health maintenance organization must establish and maintain procedures to ensure that the health care services provided to enrollees are rendered under reasonable standards of quality of care consistent with prevailing professionally recognized standards of medical practice. These procedures must include mechanisms to ensure availability, accessibility and continuity of care. (5) The health maintenance organization must have an ongoing internal quality assurance program to monitor and evaluate its health care services including primary and specialist physician services, ancillary and preventive health care services across all institutional and noninstitutional settings. The program must include, at a minimum, the following: (a) A written statement of goals and objectives that emphasizes improved health outcomes in evaluating the quality of care rendered to enrollees; (b) A written quality assurance plan that describes the following: (i) The health maintenance organization's scope and purpose in quality assurance; (ii) The organizational structure responsible for quality assurance activities; (iii) Contractual arrangements, in appropriate instances, for delegation of quality assurance activities; (iv) Confidentiality policies and procedures; (v) A system of ongoing evaluation activities; (vi) A system of focused evaluation activities; (vii) A system for reviewing and evaluating provider credentials for acceptance and performing peer review activities; and (viii) Duties and responsibilities of the designated physician supervising the quality assurance activities; (c) A written statement describing the system of ongoing quality assurance activities including: (i) Problem assessment, identification, selection and study; (ii) Corrective action, monitoring evaluation and reassessment; and (iii) Interpretation and analysis of patterns of care rendered to individual patients by individual providers; (d) A written statement describing the system of focused quality assurance activities based on representative samples of the enrolled population that identifies the method of topic selection, study, data collection, analysis, interpretation and report format; and (e) Written plans for taking appropriate corrective action whenever, as determined by the quality assurance program, inappropriate or substandard services have been provided or services that should have been furnished have not been provided. (6) The health maintenance organization shall record proceedings of formal quality assurance program activities and maintain documentation in a confidential manner. Quality assurance program minutes must be available to the Commissioner of Health and Human Services. (7) The health maintenance organization shall ensure the use and maintenance of an adequate patient record system that facilitates documentation and retrieval of clinical information to permit evaluation by the health maintenance organization of the continuity and coordination of patient care and the assessment of the quality of health and medical care provided to enrollees. (8) Enrollee clinical records must be available to the Commissioner of Health and Human Services or an authorized designee for examination and review to ascertain compliance with this section, or as considered necessary by the Commissioner of Health and Human Services. (9) The organization must establish a mechanism for periodic reporting of quality assurance program activities to the governing body, providers and appropriate organization staff. The Commissioner of Health and Human Services shall make the certification required by this paragraph within 60 days of the date of the written decision that a certificate of need was not required. If the commissioner certifies that the health maintenance organization does not meet all of the requirements of this paragraph, the commissioner shall specify in what respects the health maintenance organization is deficient. [PL 2013, c. 588, Pt. A, §29 (AMD).] C. The health maintenance organization conforms to the definition under section 4202‑A, subsection 10 . [PL 1991, c. 709, §3 (AMD).] D. The health maintenance organization is financially responsible, complies with the minimum surplus requirements of section 4204‑A and, among other factors, can reasonably be expected to meet its obligations to enrollees and prospective enrollees. (1) In a determination of minimum surplus requirements, the following terms have the following meanings. (a) "Admitted assets" means assets recognized by the superintendent pursuant to section 901‑A . For purposes of this chapter, the asset value is that contained in the annual statement of the corporation as of December 31st of the year preceding the making of the investment or contained in any audited financial report, as defined in section 221‑A , of more current origin. (b) "Reserves" means those reserves held by corporations subject to this chapter for the protection of subscribers. For purposes of this chapter, the reserve value is that contained in the annual statement of the corporation as of December 31st of the preceding year or any audited financial report, as defined in section 221‑A , of more current origin. (2) In making the determination whether the health maintenance organization is financially responsible, the superintendent may also consider: (a) The financial soundness of the health maintenance organization's arrangements for health care services and the schedule of charges used; (b) The adequacy of working capital; (c) Any agreement with an insurer, a nonprofit hospital or medical service corporation, a government or any other organization for insuring or providing the payment of the cost of health care services or the provision for automatic applicability of an alternative coverage in the event of discontinuance of the plan; (d) Any agreement with providers for the provision of health care services that contains a covenant consistent with subsection 6 ; and (e) Any arrangements for insurance coverage or an adequate plan for self-insurance to respond to claims for injuries arising out of the furnishing of health care services. [PL 2007, c. 466, Pt. D, §7 (AMD).] E. The enrollees are afforded an opportunity to participate in matters of policy and operation pursuant to section 4206 . [PL 1981, c. 501, §51 (NEW).] F. Nothing in the proposed method of operation, as shown by the information submitted pursuant to section 4203 or by independent investigation, is contrary to the public interest. [PL 1981, c. 501, §51 (NEW).] G. Any director, officer, employee or partner of a health maintenance organization who receives, collects, disburses or invests funds in connection with the activities of that organization shall be responsible for those funds in a fiduciary relationship to the organization. [PL 1989, c. 842, §10 (NEW).] H. The health maintenance organization shall maintain in force a fidelity bond or fidelity insurance on those employees and officers of the health maintenance organization who have duties as described in paragraph G , in an amount not less than $250,000 for each health maintenance organization or a maximum of $5,000,000 in aggregate maintained on behalf of health maintenance organizations owned by a common parent corporation, or such sum as may be prescribed by the superintendent. [PL 1989, c. 842, §10 (NEW).] I. If any agreement, as set forth in paragraph D , subparagraph (2), division (c), is made by the health maintenance organization, the entity executing the agreement with the health maintenance organization must demonstrate to the superintendent's satisfaction that the entity has sufficient unencumbered surplus funds to cover the assured payments under the agreement, otherwise the superintendent shall disallow the agreement. In considering approval of such an agreement, the superintendent shall consider the entity's record of earnings for the most recent 3 years, the risk characteristics of its investments and whether its investments and other assets are reasonably liquid and available to make payments for health services. [PL 1995, c. 332, Pt. O, §2 (AMD).] J. [PL 2001, c. 410, Pt. A, §8 (RP).] K. The health maintenance organization provides a spectrum of providers and services that meet patient demand. [PL 1993, c. 702, Pt. B, §1 (NEW).] L. The health maintenance organization meets the requirements of section 4303, subsection 1 . [PL 1995, c. 673, Pt. D, §3 (RPR).] M. The health maintenance organization demonstrates a plan for providing services for rural and underserved populations and for developing relationships with essential community providers within the area of the proposed certificate. The health maintenance organization must make an annual report to the superintendent regarding the plan. [PL 1993, c. 702, Pt. B, §1 (NEW).] N. [PL 2011, c. 90, Pt. F, §6 (RP).] O. Each health maintenance organization shall provide basic health care services. [PL 1999, c. 222, §2 (NEW).] The applicant shall furnish, upon request of the superintendent, any information necessary to make any determination required pursuant to this subsection. [PL 2013, c. 588, Pt. A, §29 (AMD).]

3. [PL 1989, c. 842, §11 (RP).]

3-A. Investments. The health maintenance organization shall invest funds only in accordance with chapter 13‑A , except as follows. A. The health maintenance organization shall maintain asset valuation reserves consistent with industry standards for management of investments by life and health insurers. [PL 1993, c. 702, Pt. A, §12 (NEW).] B. Notwithstanding any limitation stated in section 1156, subsection 2, paragraph D , a health maintenance organization may invest in real property or interests in real property located in the United States, held directly or evidenced by partnership interests, stock of corporations, trust certificates or other instruments and acquired: (1) As an investment for the production of income or to be improved or developed for that investment purpose; or (2) For the convenient accommodation of the organization's business. After giving effect to any of those investments, the aggregate amount of investments made under subparagraph (1) may not exceed 20% of the health maintenance organization's total admitted assets; the aggregate amount of investments made under subparagraph (2) may not exceed 15% of the organization's total admitted assets; and the aggregate amount of investments made under this paragraph may not exceed 25% of the organization's total admitted assets. Investments under subparagraph (1) in any single property, including improvements on that property, may not in the aggregate exceed 2% of the corporation's total admitted assets. [PL 1993, c. 702, Pt. A, §12 (NEW).] C. In addition to the investments permitted under paragraph B , a health maintenance organization may invest in real estate, including leasehold estates, for the convenient accommodation of its business, including hospitals, medical clinics, medical professional buildings and any other facility that is to be used in the provision of health care services, or real estate for rental to an affiliated health care provider or any other health care provider under contract with the health maintenance organization to provide health care services, and that facility must be used in the provision of health care services to members of the health maintenance organization by that provider. (1) A parcel of real estate acquired under this subsection may include excess space for rent to others if it is reasonably anticipated that that excess will be required by the health maintenance organization for expansion or if the excess is reasonably required in order to have one or more buildings that function as an economic unit. (2) Real estate subject to this subsection may be subject to a mortgage. (3) The admitted value of the investment may not exceed the greater of the health maintenance organization's equity or 20% of the corporation's admitted assets, and the aggregate investment in real estate held under paragraph B and under this paragraph may not exceed 40% of the corporation's admitted assets, except with the approval of the superintendent if the superintendent finds that those percentages of the corporation's admitted assets are insufficient to provide for the convenient accommodation of the health maintenance organization's business. Investments under this subsection in any single property, including improvements on that property, may not in the aggregate exceed 5% of the corporation's total admitted assets. [PL 1993, c. 702, Pt. A, §12 (NEW).] D. Notwithstanding any provisions of this section and chapter 13‑A allowing other investments, a health maintenance organization shall maintain cash or investment grade obligations, as defined in section 1151‑A , that at all times have a fair market value of not less than 100% of the organization's liability for claims payable and incurred, but not reported, claims, unearned premiums, unpaid claims adjustment expenses and, as applicable, any statutory, special or additional reserves provided by the health maintenance organization for the benefit of members as of the most recent calendar quarter prepared on the basis of statutory accounting principles. If the organization's liability for claims payable and incurred, but not reported, claims increased more than 10% prior to the end of the calendar quarter, the organization must, within 10 days of the determination, reallocate its investments to ensure compliance with this paragraph. The investments required by this paragraph constitute admitted assets of the organization. [PL 1999, c. 715, §19 (AMD).] E. The superintendent may establish risk-based capital standards for health maintenance organizations, their subsidiaries and controlled affiliates that engage in health care related business activities that the parent corporation conducts. [PL 1993, c. 702, Pt. A, §12 (NEW).] [PL 1999, c. 715, §19 (AMD).]

4. Uncovered expenditures involving deposit. A health maintenance organization shall deposit with the superintendent or, at the discretion of the superintendent, with any organization or trustee acceptable to the superintendent through which a custodial or controlled account is maintained, cash or securities that are acceptable to the superintendent and that at all times are maintained in a fair market value of not less than an amount equal to the greater of $100,000 or 120% of the health maintenance organization's liability for uncovered expenditures for enrollees as of the end of the most recent calendar quarter, including but not limited to, liability for incurred but not reported claims. If the health maintenance organization's liability for uncovered expenditures increases more than 10% prior to the end of the calendar quarter, the health maintenance organization must, within 10 days of the determination, deposit an amount sufficient to ensure compliance with this section. In the case of domestic health maintenance organizations, "enrollees" for purposes of this subsection means all enrollees of the organization regardless of residence. In the case of foreign health maintenance organizations, "enrollees" for purposes of this subsection means only those enrollees who are residents of this State. A. The deposit required by this subsection constitutes an admitted asset of the health maintenance organization for purposes of determination of surplus. [PL 1989, c. 842, §13 (NEW).] B. A health maintenance organization that has made a deposit may withdraw that deposit or any part thereof after making a substitute deposit of cash or securities of equal amount and value. There may also be withdrawn any part of the deposit in excess of the fair market value of the amount of the required deposit. Deposits, substitutions or withdrawals may be made only with the prior written approval of the superintendent. [PL 1989, c. 842, §13 (NEW).] C. The deposit required by this subsection must be held in trust and must be used only as provided under this section. The superintendent may use the deposit of an insolvent health maintenance organization for administrative costs associated with administering the deposit and payment of claims of enrollees for uncovered expenditures. [PL 1989, c. 842, §13 (NEW).] D. The superintendent may by rule or order require a health maintenance organization to file annual, quarterly or more frequent reports of a health maintenance organization's liability for uncovered expenditures. The superintendent may require that the reports include an audit opinion. [PL 1989, c. 842, §13 (NEW).] E. The superintendent may reduce or eliminate the deposit required by this subsection if the health maintenance organization deposits cash or securities with the Treasurer of State, an insurance supervisory official in the state or jurisdiction of domicile or other official body of that state for the protection of all subscribers and enrollees in a manner substantially similar to that required by this subsection and delivers to the superintendent a certificate to that effect, authenticated by the appropriate state official holding the deposit. [PL 1989, c. 842, §13 (NEW).] F. The superintendent may require a health maintenance organization to continue to maintain the deposit required under this subsection after the health maintenance organization has withdrawn from the market in accordance with section 415‑A . [PL 2001, c. 88, §1 (NEW).] [PL 2001, c. 88, §1 (AMD).]

5. Liabilities. Every health maintenance organization shall, when determining liabilities, include an amount estimated in the aggregate to provide for any unearned premium and for the payment of all claims for health care expenditures that have been incurred, whether reported or unreported, that are unpaid, and for which the organization is or may be liable, and to provide for the expense of adjustment or settlement of those claims. These liabilities must be computed in accordance with rules promulgated by the superintendent upon reasonable consideration of the ascertained experience and character of the health maintenance organization. [PL 1989, c. 842, §13 (NEW).]

6. Hold harmless. Every contract between a health maintenance organization and a participating provider of health care services must be in writing and must set forth that in the event the health maintenance organization fails to pay for health care services as set forth in the contract, the subscriber or enrollee may not be liable to the provider for any sums owed by the health maintenance organization. A. If the participating provider contract has not been reduced to writing as required by this subsection or the contract fails to contain the required prohibition, the participating provider may not collect or attempt to collect from the subscriber or enrollee sums owed by the health maintenance organization. [PL 1989, c. 842, §13 (NEW).] B. No participating provider or agent, trustee or assignee of the participating provider, may maintain any action at law against a subscriber or enrollee to collect sums owed by the health maintenance organization. [PL 1989, c. 842, §13 (NEW).] C. In addition to the other provisions in this subsection, if a petition to liquidate an insolvent health maintenance organization is filed with a court of competent jurisdiction, then after the date of filing the petition for liquidation: (1) Any provider who has rendered a covered service for a subscriber or enrollee of the insolvent health maintenance organization is prohibited from collecting or attempting to collect from the subscriber or enrollee amounts normally payable by the insolvent health maintenance organization; and (2) A provider or agent, trustee or assignee of the provider may not maintain any action at law against a subscriber or enrollee of the insolvent health maintenance organization to collect amounts for covered services normally payable by the insolvent health maintenance organization. Nothing in this subsection prohibits a provider from collecting or attempting to collect from a subscriber or enrollee any amounts for services not normally payable by the insolvent health maintenance organization, including applicable copayments or deductibles. [PL 2001, c. 88, §2 (NEW).] [PL 2001, c. 88, §2 (AMD).]

7. Continuation of benefits. The superintendent shall require that each health maintenance organization have a plan for handling insolvency that allows for continuation of benefits for the duration of the contract period for which premiums have been paid and continuation of benefits to covered persons who are confined on the date of insolvency in an inpatient facility until those covered persons are discharged or upon expiration of benefits. In considering such a plan, the superintendent may require: A. Insurance adequate to cover the expenses to be paid for continued benefits after an insolvency; [PL 1989, c. 842, §13 (NEW).] B. That the provider contract obligate the provider to provide services for the duration of the period after the health maintenance organization's insolvency for which premium payment has been made and until the enrollees' discharge from inpatient facilities; [PL 1989, c. 842, §13 (NEW).] C. That insolvency reserves be provided and maintained for that period of claims exposure of a health maintenance organization during which a provider's termination of services is pending pursuant to subsection 8 ; and [PL 1989, c. 842, §13 (NEW).] D. Any other arrangements to ensure that benefits are continued as specified in this section. [PL 1989, c. 842, §13 (NEW).] [PL 1989, c. 842, §13 (NEW).]

8. Notice of termination. An agreement to provide health care services between a provider and a health maintenance organization must require that, if the provider terminates that agreement, the provider shall give the health maintenance organization not less than 60 days' notice in advance of termination. That agreement must not require more than 90 days' notice after an initial participation period not to exceed 6 months. If the health maintenance organization has a net loss of 5 or more primary care physicians in any county in any 30-day period, the health maintenance organization shall notify the Bureau of Insurance in writing within 10 days of acquiring knowledge of that loss. [PL 1989, c. 842, §13 (NEW).]

9. Denial. A certificate of authority may be denied only after compliance with the requirements of section 4219 . [PL 1989, c. 842, §13 (NEW).]
24 M.R.S. § 2321-A — ME Code / Title 24 / Chapter 19 / Section 2321-A
24 §2321-A. Standards for when filings are inadequate
Status: in_force

In reviewing rates and rate modifications filed by a nonprofit hospital and medical service organization in accordance with this Title, the superintendent may not require the organization to charge rates that, taking into account investment income and the appropriate level of subscriber reserves, are inadequate to enable it to recover reasonably anticipated claims and administrative expenses and make reasonable contributions to subscriber reserves. [PL 1997, c. 344, §7 (NEW).]
24-A M.R.S. § 3103 — ME Code / Title 24-A / Chapter 43 / Section 3103
24-A §3103. Premiums on bonds
Status: in_force

Any court or officer whose duty it is to pass upon the account of any person required by law to give a bond may, whenever such person has given any such surety insurer as surety upon the bond, allow in the settlement of such account a reasonable sum for the expense of procuring such surety. The premiums on account of all official bonds required by law to be given by county officials shall be paid from the treasuries of their several counties. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 208 — ME Code / Title 24-A / Chapter 3 / Section 208
24-A §208. Independent technical, professional services
Status: in_force

The superintendent may from time to time contract for such additional actuarial, examination, rating and other technical and professional services as may be required for discharge of the superintendent's duties. If a contractor retained pursuant to this section has access to confidential information, the contract must require the contractor to comply with the requirements of section 216, subsection 5, paragraph B‑1 . [PL 2021, c. 521, §2 (AMD).]
24-A M.R.S. § 423-D — ME Code / Title 24-A / Chapter 5 / Section 423-D
24-A §423-D. Annual report supplement
Status: in_force

1. Annual report supplement required. Each health insurer and health maintenance organization shall file an annual report supplement on or before March 1st of each year, or within any reasonable extension of time that the superintendent for good cause may have granted on or before March 1st. The superintendent shall adopt rules regarding specifications for the annual report supplement. The annual report supplements must provide the public with general, understandable and comparable financial information relative to the in-state operations and results of authorized insurers and health maintenance organizations. Such information must include, but is not limited to, medical claims expense, administrative expense and underwriting gain for each line segment of the market in this State in which the insurer participates. The annual report supplements must contain sufficient detail for the public to understand the components of cost incurred by authorized health insurers and health maintenance organizations as well as the annual cost trends of these carriers. The superintendent shall develop standardized definitions of each reported measure. Rules adopted pursuant to this section are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2003, c. 469, Pt. E, §2 (NEW).]

2. Exemption. If an insurer is engaged in the type of health insurance business identified as an exception to the definition of health insurance in section 704, subsection 2 and is not engaged in health insurance in this State as defined in that section, then the insurer is not subject to the requirements of this section for the filing of annual report supplements. [PL 2003, c. 469, Pt. E, §2 (NEW).]
24-A M.R.S. § 1420-Q — ME Code / Title 24-A / Chapter 16 / Section 1420-Q
24-A §1420-Q. Apprentice insurance producer license
Status: in_force

Beginning January 1, 2026, the superintendent may issue an apprentice insurance producer license in accordance with this section and section 1420‑J without requiring an examination. An applicant for a license as an apprentice insurance producer shall apply to the superintendent in the form and manner determined by the superintendent. [PL 2025, c. 238, §1 (NEW).]

1. Licensing requirements. An apprentice insurance producer license may not be issued unless an applicant: A. Is 18 years of age or older; [PL 2025, c. 238, §1 (NEW).] B. Is employed by a licensed resident insurance producer who has certified to the superintendent on a form prescribed by the superintendent that the licensed resident insurance producer will supervise the apprentice insurance producer licensee and will assume responsibility for all acts of the apprentice insurance producer licensee; [PL 2025, c. 238, §1 (NEW).] C. Has submitted an application for an insurance producer license and meets the requirements for an insurance producer license, except for passage of any required examination. The applicant and sponsor shall provide any information requested by the superintendent as part of the review of the application; [PL 2025, c. 238, §1 (NEW).] D. Has not previously held or been denied an insurance producer license under this Title in this State or a comparable insurance producer license in any other jurisdiction and has not previously been issued or denied an apprentice insurance producer license; [PL 2025, c. 238, §1 (NEW).] E. Is a resident of this State at the time of application and remains a resident of this State throughout the apprenticeship; and [PL 2025, c. 238, §1 (NEW).] F. Has paid the temporary licensing fee required by section 601, subsection 5, paragraph C and any applicable application fee. [PL 2025, c. 238, §1 (NEW).] [PL 2025, c. 238, §1 (NEW).]

2. Sponsor required. An apprentice insurance producer license may not be issued without the sponsorship of a licensed resident insurance producer. A sponsor shall complete an application required by the superintendent. The sponsor may not have any restriction on the sponsor's producer license, including, but not limited to, being on probation or having any disciplinary reporting requirements to the superintendent. The sponsor must have held a Maine producer license in good standing for at least one year prior to applying to be a sponsor and must meet any other requirements established by the superintendent. The superintendent may revoke a sponsor's authorization to employ an apprentice insurance producer for failing to comply with any requirements of the sponsorship and for any of the reasons for disciplinary action under section 1420‑K . [PL 2025, c. 238, §1 (NEW).]

3. Legal responsibility. A sponsor who employs an apprentice insurance producer licensee assumes all legal responsibility for all acts of the apprentice insurance producer licensee who is employed by the sponsor. [PL 2025, c. 238, §1 (NEW).]

4. License duration; nonrenewable. An apprentice insurance producer license may not be authorized for more than 180 days. After having completed 180 days as an apprentice insurance producer, the apprentice insurance producer may not engage in any insurance activities requiring an insurance producer license without obtaining an insurance producer license in accordance with the requirements of this subchapter. [PL 2025, c. 238, §1 (NEW).]

5. Activities limited to risks located in this State. An apprentice insurance producer may perform only activities that would otherwise require an insurance producer license for risks located in this State and only for those activities for which the sponsor is authorized under the sponsor's licensing authority. [PL 2025, c. 238, §1 (NEW).]

6. Appointment required. An apprentice insurance producer may not act as an agent of an insurer unless appointed by the insurer pursuant to section 1420‑M . [PL 2025, c. 238, §1 (NEW).]

7. Activities limited to those not requiring additional training or authority. An apprentice insurance producer may not perform any activities that require training or authority in addition to an insurance producer license, including activities under the federal Affordable Care Act, long-term care insurance and annuities. In addition, an apprentice insurance producer may not perform any activities otherwise requiring a producer license involving life insurance. [PL 2025, c. 238, §1 (NEW).]

8. Limitations. The superintendent may limit the issuance of apprentice insurance producer licenses to no more than 2 active apprentice insurance producer licenses per sponsor during a calendar year. The superintendent may limit the authority of an apprentice insurance producer licensee in any way determined necessary, in addition to those specified in this subsection, to protect insureds and the public and may by order revoke an apprentice insurance producer license if the interest of insureds or the public is endangered or for any cause in section 1420‑K, subsection 1 . [PL 2025, c. 238, §1 (NEW).]

9. Reporting of actions. An apprentice insurance producer and a sponsor shall report in a timely manner any actions involving the apprentice insurance producer in the same manner as required of a producer by section 1420‑P . [PL 2025, c. 238, §1 (NEW).]

10. Termination of apprenticeship. If an apprentice insurance producer is no longer employed by a sponsor prior to the end of the apprenticeship, or if the sponsor terminates the sponsorship prior to the end of the 180-day period under subsection 4 , the sponsor and the apprentice insurance producer shall notify the superintendent within 5 business days of the end of employment or end of the sponsorship. [PL 2025, c. 238, §1 (NEW).]

11. Rulemaking. The superintendent may issue guidance by rule or otherwise setting forth any additional requirements and limitations for apprentice insurance producer licensing and sponsorship, including eligible and ineligible lines of insurance and limitations or standards for commissions. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [RR 2025, c. 1, Pt. A, §33 (COR).]
24-A M.R.S. § 13 — ME Code / Title 24-A / Chapter 1 / Section 13
24-A §13. Retention of unpaid premium
Status: in_force

Any insurance company, broker or agent may retain an amount equal to any undisputed unpaid premium due on the policy under which a claim is being presented, in connection with claims by and settled with an insured, as long as the unpaid premium remains unpaid 60 days after the effective date of that policy or the date of the original billing for the unpaid premium, whichever occurs later. The unpaid premium may not be retained as against any loss payee or mortgagee named in the policy up to the amount of the unpaid balance owed to that loss payee or mortgagee on the date the loss that gave rise to the claim occurred. This section does not apply to a health insurance policy. [PL 1993, c. 117, §1 (NEW).]
24-A M.R.S. § 962 — ME Code / Title 24-A / Chapter 11 / Section 962
24-A §962. Confidentiality
Status: in_force

1. Information subject to this section. For purposes of this section, "protected valuation information" means: A. A memorandum in support of an opinion submitted under section 952‑A and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the superintendent or any other person in connection with the memorandum; [PL 2013, c. 238, Pt. C, §9 (NEW).] B. All documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the superintendent or any other person in the course of an examination made under section 959, subsection 4 that would be confidential under section 225, subsection 3 if they had been prepared or obtained under section 221 ; [PL 2013, c. 238, Pt. C, §9 (NEW).] C. Any reports, documents, materials and other information developed by an insurer in support of, or in connection with, an annual certification of internal controls under section 960, subsection 3, paragraph B and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the superintendent or any other person in connection with such reports, documents, materials and other information; [PL 2013, c. 238, Pt. C, §9 (NEW).] D. Any principle-based valuation report developed under section 960, subsection 3, paragraph C and any other documents, materials and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the superintendent or any other person in connection with such a report; [PL 2013, c. 238, Pt. C, §9 (NEW).] E. Any documents, materials, data and other information submitted by an insurer under section 961 , referred to in this paragraph as "experience data," and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created or produced in connection with such experience data that include any potentially insurer-identifying or personally identifiable information and that are provided to or obtained by the superintendent or any other person and any other documents, materials, data and other information, including, but not limited to, all working papers, and copies thereof, created, produced or obtained by or disclosed to the superintendent or any other person in connection with such experience data and materials; and [PL 2013, c. 238, Pt. C, §9 (NEW).] F. Any information received by the superintendent from the Actuarial Board for Counseling and Discipline or its successor related to a memorandum or report described in paragraph A or D , if the information has been provided with notice or the understanding that it is confidential or privileged under applicable law. [PL 2013, c. 238, Pt. C, §9 (NEW).] [PL 2013, c. 238, Pt. C, §9 (NEW).]

2. Confidentiality of information subject to this section. Except as provided in this subsection, all protected valuation information is confidential, must be kept confidential by the superintendent, is not a public record and is not subject to subpoena or discovery or admissible in evidence in any private civil action. The superintendent may use the documents, materials or other information in the furtherance of any regulatory or legal action brought as a part of the superintendent's official duties, including sharing the information on a confidential basis under section 216, subsection 5 . A. Neither the superintendent nor any person who receives documents, materials or other information while acting under the authority of the superintendent is permitted or required to testify in any private civil action concerning any protected valuation information. [PL 2013, c. 238, Pt. C, §9 (NEW).] B. Disclosure to the superintendent under this section or as a result of sharing of documents, materials or other information pursuant to section 216 does not constitute a waiver of any applicable privilege or claim of confidentiality with regard to the documents, materials or other information. [PL 2013, c. 238, Pt. C, §9 (NEW).] C. The superintendent may share protected valuation information described in subsection 1, paragraphs A and D with the Actuarial Board for Counseling and Discipline or its successor upon a request stating that the information is required for the purpose of professional disciplinary proceedings and that the disciplinary entity agrees, and has the legal authority to agree, to maintain the confidentiality and privileged status of the information in the same manner and to the same extent as required for the superintendent. The superintendent may request and receive confidential information described in subsection 1, paragraph F from the Actuarial Board for Counseling and Discipline or its successor. The superintendent may enter into information-sharing agreements to facilitate the exchange of information under this paragraph. [PL 2013, c. 238, Pt. C, §9 (NEW).] D. For protected valuation information described in subsection 1, paragraphs A and D , the confidentiality provided by this subsection may be limited or terminated as follows: (1) The information may be subject to subpoena for the purpose of defending an action seeking damages from the appointed actuary submitting the actuarial memorandum or principle-based valuation report; (2) The information may be released with the written consent of the insurer; and (3) If any portion of an actuarial memorandum or principle-based valuation report is cited by the insurer in its marketing or is publicly volunteered by the insurer before a governmental agency other than a state insurance agency or is released by the insurer to the news media, all portions of the memorandum or report become public records. [PL 2013, c. 238, Pt. C, §9 (NEW).] [PL 2013, c. 238, Pt. C, §9 (NEW).]
24-A M.R.S. § 5001 — ME Code / Title 24-A / Chapter 67 / Section 5001
24-A §5001. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 1981, c. 234, §4 (NEW).]

1. Applicant. "Applicant" means: A. In the case of an individual Medicare supplement policy, the person who seeks to contract for insurance benefits; and [PL 1991, c. 740, §1 (AMD).] B. In the case of a group Medicare supplement policy, the proposed certificate holder. [PL 1991, c. 740, §1 (AMD).] [PL 1991, c. 740, §1 (AMD).]

2. Certificate. "Certificate" means any certificate delivered or issued for delivery in this State under a group Medicare supplement policy. [PL 1991, c. 740, §1 (AMD).]

2-A. Certificate form. "Certificate form" means the form on which the certificate is delivered or issued for delivery by the issuer. [PL 1991, c. 740, §1 (NEW).]

2-B. Issuer. "Issuer" includes insurance companies, fraternal benefit societies, health care service plans, health maintenance organizations and any other entity delivering or issuing for delivery in this State Medicare supplement policies or certificates. [PL 1991, c. 740, §1 (NEW).]

3. Medicare. "Medicare" means the "Health Insurance for the Aged Act," Title XVIII of the Social Security Amendments of 1965, as amended. [PL 1991, c. 740, §1 (AMD).]

4. Medicare supplement policy. "Medicare supplement policy" means a group or individual policy of accident and sickness insurance or a subscriber contract of a nonprofit hospital or medical service organization or nonprofit health care plan or health maintenance organization other than a policy issued pursuant to a contract under the federal Social Security Act, 42 United States Code, Section 1395, et seq. or Section 1876 or an issued policy under a demonstration project specified in the 42 United States Code, Section 1395ss(g)(1), which is advertised, marketed or designed primarily as a supplement to reimbursements under Medicare for the hospital, medical or surgical expenses of persons eligible for Medicare. A. [PL 1991, c. 740, §1 (RP).] B. [PL 1991, c. 740, §1 (RP).] C. [PL 1991, c. 740, §1 (RP).] [PL 1995, c. 332, Pt. E, §1 (AMD).]

4-A. Policy form. "Policy form" means the form on which the policy is delivered or issued for delivery by the issuer. [PL 1991, c. 740, §1 (NEW).]

4-B. Open enrollment period. "Open enrollment period" means the 6-month period beginning when an individual of any age first enrolls for benefits under Medicare Part B and the 6-month period beginning on the 65th birthday of an individual who has enrolled for benefits under Medicare Part B before turning 65 years of age. [PL 2001, c. 258, Pt. F, §1 (NEW).]

5. Superintendent. "Superintendent" means the Superintendent of Insurance. [PL 1981, c. 234, §4 (NEW).]
24-A M.R.S. § 6098 — ME Code / Title 24-A / Chapter 72-A / Section 6098
24-A §6098. Notice and registration requirements of purchasing groups
Status: in_force

1. Notice. A purchasing group that intends to do business in this State shall, prior to doing business, pay the appropriate fee at the rate specified in section 601 and furnish notice to the superintendent to: A. Identify the state in which the group is domiciled; [PL 1987, c. 481, §3 (NEW).] B. Specify the lines and classifications of liability insurance that the purchasing group intends to purchase; [PL 1993, c. 221, §30 (AMD).] C. Identify the insurance company from which the group intends to purchase its insurance and the domicile of that company; [PL 1987, c. 481, §3 (NEW).] D. Specify the method by which, and the person or persons, if any, through whom insurance will be offered to its members whose risks are resident or located in this State; [PL 1987, c. 481, §3 (NEW).] E. Identify the principal place of business of the group; and [PL 1987, c. 481, §3 (NEW).] F. Provide such other information as may be required by the superintendent to verify that the purchasing group is qualified under section 6093, subsection 11 to determine where the purchasing group is located and to determine appropriate tax treatment. [PL 1993, c. 313, §37 (AMD).] [PL 1993, c. 313, §37 (AMD).]

2. Registration. The purchasing group shall register with the superintendent and designate the superintendent as its agent solely for the purpose of receiving service of legal documents or process, except that the requirements do not apply in the case of a purchasing group: A. That in any state of the United States: (1) Was domiciled before April 2, 1986; and (2) Is domiciled on and after October 27, 1986; [PL 1997, c. 592, §74 (AMD).] B. That: (1) Before October 27, 1986, purchased insurance from an insurance carrier licensed in any state; and (2) Since October 27, 1986, purchased its insurance from an insurance carrier licensed in any state; [PL 1997, c. 592, §74 (AMD).] C. That was a purchasing group under the requirements of the Product Liability Retention Act of 1981 before October 27, 1986; and [PL 1997, c. 592, §74 (AMD).] D. That does not purchase insurance that was not authorized for purposes of an exemption under that Act, as in effect before October 27, 1986. That designation shall be subject to section 421 . [PL 1997, c. 592, §74 (AMD).] [PL 2013, c. 238, Pt. E, §4 (AMD).]

3. Application of law. Any purchasing group which was doing business in this State prior to the enactment of this Act shall within 30 days after the effective date of this Act furnish notice to the superintendent pursuant to the requirement of subsection 1 and shall comply with the requirements of subsection 2 . [PL 1987, c. 481, §3 (NEW).]

4. Notice of change. A purchasing group that intends to do business or is doing business in this State shall notify the superintendent within 10 days of any subsequent changes in any information or other items provided pursuant to this section. [PL 1993, c. 313, §38 (AMD).]
24 M.R.S. § 2325-A — ME Code / Title 24 / Chapter 19 / Section 2325-A
24 §2325-A. Mental health services coverage
Status: in_force

1. Findings. The Legislature finds that: A. Mental illness affects nearly 170,000 Maine people each year, resulting in anguish, grief, desperation, fear, isolation and a sense of hopelessness of significant levels among victims and families; [PL 1983, c. 515, §4 (NEW).] B. Consequences of mental illness include the expenditure of millions of dollars of public funds for treatment and losses of millions of dollars by Maine businesses in accidents, absenteeism, nonproductivity and turnover. Excessive stress and anxiety and other forms of mental illness clearly contribute to general health problems and costs; [PL 1983, c. 515, §4 (NEW).] C. Typical health coverage in this State discriminates against mental illness, the victims and affected families with nonexistent or limited benefits compared to provisions for other illnesses; and [PL 1983, c. 515, §4 (NEW).] D. Experience in this State and several other states demonstrates that the risk of mental illness can be insured at reasonable cost and with adequate controls on quality and utilization of treatment. [PL 1983, c. 515, §4 (NEW).] [PL 1983, c. 515, §4 (NEW).]

2. Policy and purpose. The Legislature declares that it is the policy of this State to: A. Promote equitable and nondiscriminatory health coverage benefits for all forms of illness, including mental and emotional disorders, which are of significant consequence to the health of Maine people and which can be treated in a cost-effective manner; [PL 1983, c. 515, §4 (NEW).] B. Assure that victims of mental and other illnesses have access to and choice of appropriate treatment at the earliest point of illness in least restrictive settings; [PL 1983, c. 515, §4 (NEW).] C. Assure that costs of treatment of mental illness are supported through an equitable combination of public and private responsibilities; and [PL 1983, c. 515, §4 (NEW).] D. Assure that the Legislature reasonably exercises its legal responsibility for insurance policy in this State by prescribing types of illnesses and treatment for which benefits shall be provided. [PL 1983, c. 515, §4 (NEW).] [PL 1983, c. 515, §4 (NEW).]

3. Definitions. For purposes of this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Day treatment services" includes psychoeducational, physiological, psychological and psychosocial concepts, techniques and processes to maintain or develop functional skills of clients, provided to individuals and groups for periods of more than 2 hours but less than 24 hours per day. [PL 1983, c. 515, §4 (NEW).] A-1. "Diagnostic and statistical manual" means the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, published by the American Psychiatric Association. [PL 2003, c. 20, Pt. VV, §1 (NEW); PL 2003, c. 20, Pt. VV, §25 (AFF).] A-2. "Home health care services" means those services rendered by a licensed provider of mental health services to provide medically necessary health care to a person suffering from a mental illness in the person's place of residence if: (1) Hospitalization or confinement in a residential treatment facility would otherwise have been required if home health care services were not provided; (2) Hospitalization or confinement in a residential treatment facility is not required as an antecedent to the provision of home health care services; and (3) The services are prescribed in writing by a licensed allopathic or osteopathic physician or a licensed psychologist who is trained and has received a doctorate in psychology specializing in the evaluation and treatment of mental illness. [PL 2003, c. 20, Pt. VV, §1 (NEW); PL 2003, c. 20, Pt. VV, §25 (AFF).] B. "Inpatient services" includes a range of physiological, psychological and other intervention concepts, techniques and processes in a community mental health psychiatric inpatient unit, general hospital psychiatric unit or psychiatric hospital licensed by the Department of Health and Human Services or accredited public hospital to restore psychosocial functioning sufficient to allow maintenance and support of the client in a less restrictive setting. [PL 1983, c. 515, §4 (NEW); PL 2003, c. 689, Pt. B, §6 (REV).] B-1. "Medically necessary health care" has the same meaning as in Title 24‑A, section 4301‑A, subsection 10‑A . [PL 2003, c. 20, Pt. VV, §2 (NEW); PL 2003, c. 20, Pt. VV, §25 (AFF).] C. "Outpatient services" includes screening, evaluation, consultations, diagnosis and treatment involving use of psychoeducational, physiological, psychological and psychosocial evaluative and interventive concepts, techniques and processes provided to individuals and groups. [PL 1983, c. 515, §4 (NEW).] D. "Person suffering from a mental illness" means a person whose psychobiological processes are impaired severely enough to manifest problems in the areas of social, psychological or biological functioning. Such a person has a disorder of thought, mood, perception, orientation or memory that impairs judgment, behavior, capacity to recognize or ability to cope with the ordinary demands of life. The person manifests an impaired capacity to maintain acceptable levels of functioning in the areas of intellect, emotion or physical well-being. [PL 2003, c. 20, Pt. VV, §3 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).] E. "Provider" means those individuals included in Title 24‑A, section 2744, subsection 1 , and a licensed physician, an accredited public hospital or psychiatric hospital or a community agency licensed at the comprehensive service level by the Department of Health and Human Services. All agency or institutional providers named in this paragraph shall ensure that services are supervised by a psychiatrist or licensed psychologist. [PL 1999, c. 256, Pt. O, §1 (AMD); PL 2001, c. 354, §3 (AMD); PL 2003, c. 689, Pt. B, §6 (REV).] [PL 2003, c. 20, Pt. VV, §§1-3 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF); PL 2003, c. 689, Pt. B, §6 (REV).]

4. Requirement. Every nonprofit hospital and medical service organization that issues group health care contracts providing coverage to residents of this State shall provide benefits as required in this section to any subscriber or other person covered under those contracts for conditions arising from mental illness. [PL 2003, c. 20, Pt. VV, §4 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).]

5. Services. Each group contract must provide for medically necessary health care for a person suffering from mental illness. Medically necessary health care includes, but is not limited to, the following services for a person suffering from a mental illness: A. Inpatient care; [PL 1983, c. 515, §4 (NEW).] B. Day treatment services; [PL 2003, c. 20, Pt. VV, §4 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).] C. Outpatient services; and [PL 2003, c. 20, Pt. VV, §4 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).] D. Home health care services; and [PL 2003, c. 20, Pt. VV, §4 (NEW); PL 2003, c. 20, Pt. VV, §25 (AFF).] [PL 2003, c. 20, Pt. VV, §4 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).]

5-A. Exceptions. This section shall not apply to employee group insurance contracts issued to employers with 20 or fewer employees insured under the group contract or to group contracts designed primarily to supplement the Civilian Health and Medical Program of the Uniformed Services, as defined in the United States Code, Title 10, Section 1072, subsection 4. [PL 1989, c. 490, §1 (AMD).]

5-B. Coverage for certain mental illness treatment. [PL 1991, c. 881, §8 (RP).]

5-C. Coverage for treatment for certain mental illnesses. Coverage for medical treatment for mental illnesses listed in paragraph A‑1 is subject to this subsection. A. [PL 2003, c. 20, Pt. VV, §5 (RP); PL 2003, c. 20, Pt. VV, §25 (AFF).] A-1. All group contracts must provide, at a minimum, benefits according to paragraph B , subparagraph (1) for a person receiving medical treatment for any of the following categories of mental illness as defined in the Diagnostic and Statistical Manual, except for those that are designated as "V" codes by the Diagnostic and Statistical Manual: (1) Psychotic disorders, including schizophrenia; (2) Dissociative disorders; (3) Mood disorders; (4) Anxiety disorders; (5) Personality disorders; (6) Paraphilias; (7) Attention deficit and disruptive behavior disorders; (8) Pervasive developmental disorders; (9) Tic disorders; (10) Eating disorders, including bulimia and anorexia; and (11) Substance use disorders. For the purposes of this paragraph, the mental illness must be diagnosed by a licensed allopathic or osteopathic physician or a licensed psychologist who is trained and has received a doctorate in psychology specializing in the evaluation and treatment of mental illness. [PL 2017, c. 407, Pt. A, §93 (AMD).] B. All policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State must provide benefits that meet the requirements of this paragraph. (1) The contracts must provide benefits for the treatment and diagnosis of mental illnesses under terms and conditions that are no less extensive than the benefits provided for medical treatment for physical illnesses. (2) At the request of a nonprofit hospital and medical service organization, a provider of medical treatment for mental illness shall furnish data substantiating that initial or continued treatment is medically necessary health care. When making the determination of whether treatment is medically necessary health care, the provider shall use the same criteria for medical treatment for mental illness as for medical treatment for physical illness under the group contract. (3) If benefits and coverage for treatment of physical illness are provided on an expense-incurred basis, the benefits and coverage required under this subsection may be delivered separately under a managed care system. (4) A policy or contract may not have separate maximums for physical illness and mental illness, separate deductibles and coinsurance amounts for physical illness and mental illness, separate out-of-pocket limits in a benefit period of not more than 12 months for physical illness and mental illness or separate office visit limits for physical illness and mental illness. (5) A health benefit plan may not impose a limitation on coverage or benefits for mental illness unless that same limitation is also imposed on the coverage and benefits for physical illness covered under the policy or contract. (6) Copayments required under a policy or contract for benefits and coverage for mental illness must be actuarially equivalent to any coinsurance requirements or, if there are no coinsurance requirements, may not be greater than any copayment or coinsurance required under the policy or contract for a benefit or coverage for a physical illness. (7) For the purposes of this section, a medication management visit associated with a mental illness must be covered in the same manner as a medication management visit for the treatment of a physical illness and may not be counted in the calculation of any maximum outpatient treatment visit limits. [PL 2003, c. 20, Pt. VV, §5 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).] This subsection does not apply to policies, contracts and certificates covering employees of employers with 20 or fewer employees, whether the group policy is issued to the employer, to an association, to a multiple-employer trust or to another entity. [PL 2017, c. 407, Pt. A, §93 (AMD).]

5-D. Mandated offer of coverage for certain mental illnesses. Except as otherwise provided, coverage for medical treatment for mental illnesses listed in paragraph A by all individual and group nonprofit hospital and medical service organization health care plan contracts is subject to this subsection. A. All individual and group contracts must make available coverage providing, at a minimum, benefits according to paragraph B , subparagraph (1) for a person receiving medical treatment for any of the following mental illnesses diagnosed by a licensed allopathic or osteopathic physician or a licensed psychologist who is trained and has received a doctorate in psychology specializing in the evaluation and treatment of mental illness: (1) Schizophrenia; (2) Bipolar disorder; (3) Pervasive developmental disorder, or autism; (4) Paranoia; (5) Panic disorder; (6) Obsessive-compulsive disorder; or (7) Major depressive disorder. [PL 2003, c. 20, Pt. VV, §6 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).] B. Every nonprofit hospital and medical service organization and nonprofit health care plan must make available coverage in all individual and group policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State that provides benefits meeting the requirements of this paragraph. (1) The offer of coverage must provide benefits for the treatment and diagnosis of mental illnesses under terms and conditions that are no less extensive than the benefits provided for medical treatment for physical illnesses. (2) At the request of a nonprofit hospital and medical service organization, a provider of medical treatment for mental illness shall furnish data substantiating that initial or continued treatment is medically necessary health care. When making the determination of whether treatment is medically necessary health care, the provider shall use the same criteria for medical treatment for mental illness as for medical treatment for physical illness under the individual or group contract. [PL 2003, c. 20, Pt. VV, §6 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).] [PL 2003, c. 20, Pt. VV, §6 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).]

6. Contracts; providers. Subject to the approval by the Superintendent of Insurance pursuant to section 2305 , a nonprofit hospital and a medical service organization incorporated under this chapter shall offer contracts to providers authorizing the provision of mental health services within the scope of the provider's licensure. [PL 2003, c. 20, Pt. VV, §7 (AMD); PL 2003, c. 20, Pt. VV, §25 (AFF).]

7. Limits; coinsurance; deductibles. Any policy or contract which provides coverage for the services required by this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section. [PL 1983, c. 515, §4 (NEW).]

8. Reports to the Superintendent of Insurance. Every nonprofit hospital or medical service organization subject to this section shall report its experience for each calendar year to the superintendent not later than April 30th of the following year. The report must be in a form prescribed by the superintendent and include the amount of claims paid in this State for the services required by this section and the total amount of claims paid in this State for group health care contracts, both separated between those paid for inpatient, day treatment and outpatient services. The superintendent shall compile this data for all nonprofit hospital or medical service organizations in an annual report. [PL 1995, c. 407, §3 (AMD).]

9. Application; expiration. [PL 1995, c. 407, §4 (RP).]

10. Application. Except as otherwise provided in this section, the requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date. [PL 2003, c. 517, Pt. B, §6 (NEW).]
24-A M.R.S. § 6722 — ME Code / Title 24-A / Chapter 83 / Section 6722
24-A §6722. Conversion to or merger with reciprocal insurer
Status: in_force

1. Authority for conversion or merger. A captive insurance company, association captive insurance company or industrial insured captive insurance company formed as a stock or mutual insurer may convert to or merge with a reciprocal insurer with the approval of the superintendent in accordance with a plan of operation and with the requirements of this section. Any plan for conversion or merger must provide a fair and equitable mechanism for purchasing, retiring or otherwise extinguishing the interests of stockholders and policyholders of a stock insurer and the interests of members and policyholders of a mutual insurer, including a fair and equitable provision for the rights and remedies of dissenting stockholders, members or policyholders. [PL 2009, c. 335, §22 (NEW).]

2. Conversion. The superintendent may not approve a plan of conversion unless the plan: A. Provides notice of the opportunity to request a hearing to directors, officers, stockholders, members and policyholders of the captive insurance company. If no request for a hearing is received, the superintendent is not required to hold a hearing in the superintendent's discretion; [PL 2009, c. 335, §22 (NEW).] B. Provides a fair and equitable plan for the conversion of stockholder, member or policyholder interests into subscriber interests in the resulting reciprocal insurer in a substantially proportionate manner to the corresponding interest in the stock or mutual insurer except that the resulting reciprocal insurer is not precluded from applying underwriting criteria that may affect ongoing ownership interests; [PL 2009, c. 335, §22 (NEW).] C. In the case of a stock insurer, has been approved by a majority of voting shares represented in person or by proxy at a duly called regular or special meeting at which a quorum is present; and [PL 2009, c. 335, §22 (NEW).] D. In the case of a mutual insurer, has been approved by a majority of the voting interests of policyholders represented in person or by proxy at a duly called regular or special meeting at which a quorum is present. [PL 2009, c. 335, §22 (NEW).] The superintendent shall approve a plan of conversion if the superintendent finds that the conversion will promote the general good of the State in conformity with this chapter. If the superintendent approves the plan, the superintendent shall amend the converting insurer's certificate of authority to reflect conversion to a reciprocal insurer and issue the amended certificate of authority to the converting insurer's designated attorney. The conversion is effective upon the issuance of the amended certificate of authority by the superintendent. Upon the conversion, the corporate existence of the converting insurer ceases and the resulting reciprocal insurer shall notify the Secretary of State of the conversion. [PL 2009, c. 335, §22 (NEW).]

3. Merger. A plan of merger may not be approved by the superintendent unless the plan of merger satisfies the same requirements in subsection 2, paragraphs A to D . The superintendent may permit the formation, without surplus, of a captive insurance company organized as a reciprocal insurer into which an existing captive insurance company may be merged for the purpose of facilitation of a transaction under this section except that no more than one authorized insurance company may survive the merger. An alien insurer may be a party to a merger authorized under this section if the requirements of this Title for a merger between a domestic and foreign insurer are met. For the purposes of this section, the alien insurer is treated as a foreign insurer and the jurisdiction of the alien insurer is considered a state. [PL 2009, c. 335, §22 (NEW).]

4. Effect. A conversion or merger pursuant to this section has all of the effects of a conversion or merger approved pursuant to this Title to the extent that such effects are not inconsistent with the provisions of this chapter. [PL 2009, c. 335, §22 (NEW).]
24-A M.R.S. § 6908 — ME Code / Title 24-A / Chapter 87 / Section 6908
24-A §6908. Powers and duties of Dirigo Health
Status: in_force

1. Powers. Subject to any limitations contained in this chapter or in any other law, Dirigo Health may: A. Take any legal actions necessary or proper to recover or collect payments due Dirigo Health or that are necessary for the proper administration of Dirigo Health; [PL 2007, c. 629, Pt. M, §12 (AMD).] B. Make and alter bylaws, not inconsistent with this chapter or with the laws of this State, for the administration and regulation of the activities of Dirigo Health; [PL 2003, c. 469, Pt. A, §8 (NEW).] C. Have and exercise all powers necessary or convenient to effect the purposes for which Dirigo Health is organized or to further the activities in which Dirigo Health may lawfully be engaged, including the establishment of the Dirigo Health Program; [PL 2005, c. 400, Pt. C, §5 (AMD).] D. Engage in legislative liaison activities, including gathering information regarding legislation, analyzing the effect of legislation, communicating with Legislators and attending and giving testimony at legislative sessions, public hearings or committee hearings; [PL 2003, c. 469, Pt. A, §8 (NEW).] E. Take any legal actions necessary to avoid the payment of improper claims against Dirigo Health or the coverage provided by or through Dirigo Health, to recover any amounts erroneously or improperly paid by Dirigo Health, to recover any amounts paid by Dirigo Health as a result of mistake of fact or law and to recover other amounts due Dirigo Health; [PL 2003, c. 469, Pt. A, §8 (NEW).] F. Enter into contracts with qualified 3rd parties both private and public for any service necessary to carry out the purposes of this chapter; [PL 2003, c. 469, Pt. A, §8 (NEW).] G. Conduct studies and analyses related to the provision of health care, health care costs and quality; [PL 2003, c. 469, Pt. A, §8 (NEW).] H. Establish and administer a revolving loan fund to assist health care practitioners and health care providers in the purchase of hardware and software necessary to implement the requirements for electronic submission of claims. Dirigo Health may solicit matching contributions to the fund from each health insurance carrier licensed to do business in this State; [PL 2003, c. 469, Pt. A, §8 (NEW).] I. Apply for and receive funds, grants or contracts from public and private sources; [PL 2003, c. 469, Pt. A, §8 (NEW).] J. Contract with the Maine Health Data Organization and other organizations with expertise in health care data, including a nonprofit health data processing entity in this State, to assist the Maine Quality Forum established in section 6951 in the performance of its responsibilities; [PL 2003, c. 469, Pt. A, §8 (NEW).] K. Provide staff support and other assistance to the Maine Quality Forum established in section 6951 , including assigning a director and other staff as needed to conduct the work of the Maine Quality Forum; and [PL 2003, c. 469, Pt. A, §8 (NEW).] L. In accordance with the limitations and restrictions of this chapter, cause any of its powers or duties to be carried out by one or more organizations organized, created or operated under the laws of this State. [PL 2003, c. 469, Pt. A, §8 (NEW).] [PL 2007, c. 629, Pt. M, §12 (AMD).]

2. Duties. Dirigo Health shall: A. Establish administrative and accounting procedures as recommended by the State Controller for the operation of Dirigo Health in accordance with Title 5 ; [PL 2003, c. 469, Pt. A, §8 (NEW).] B. Collect the savings offset payments provided in former section 6913 and the access payment provided in section 6917 ; [PL 2009, c. 359, §1 (AMD); PL 2009, c. 359, §8 (AFF).] C. Determine the comprehensive services and benefits to be included in the Dirigo Health Program and develop the specifications for the Dirigo Health Program in accordance with the provisions in section 6910 . Within 30 days of its determination of the benefit package to be offered through the Dirigo Health Program, the board shall report on the benefit package, including the estimated premium and applicable coinsurance, deductibles, copayments and out-of-pocket maximums, to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs, the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters and the joint standing committee of the Legislature having jurisdiction over health and human services matters; [PL 2005, c. 400, Pt. C, §6 (AMD).] D. Develop and implement a program to publicize the existence of Dirigo Health and the Dirigo Health Program and the eligibility requirements and the enrollment procedures for the Dirigo Health Program and to maintain public awareness of Dirigo Health and the Dirigo Health Program; [PL 2005, c. 400, Pt. C, §6 (AMD).] E. Arrange the provision of Dirigo Health Program benefit coverage to eligible individuals and eligible employees through contracts with one or more qualified bidders in accordance with section 6910 or through the Dirigo Health Self-administered Plan authorized pursuant to section 6981 ; [PL 2007, c. 447, §6 (AMD).] F. [PL 2007, c. 629, Pt. L, §2 (RP).] G. Establish and operate the Maine Quality Forum in accordance with the provisions of section 6951 ; and [PL 2007, c. 629, Pt. L, §3 (AMD).] H. On a quarterly basis no less than 60 days from the end of each quarter, collect and report on: (1) The total enrollment in the Dirigo Health Program, including the number of enrollees previously underinsured or uninsured, the number of enrollees previously insured, the number of individual enrollees and the number of enrollees enrolled through small employers; (2) The number of new participating employers in the Dirigo Health Program; (3) The number of employers ceasing to offer coverage through the Dirigo Health Program; (4) The duration of employers' participation in the Dirigo Health Program; and (5) A comparison of actual enrollees in the Dirigo Health Program to projected enrollees. Dirigo Health shall submit the quarterly reports required under this subsection to the superintendent, to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters and to the joint standing committee of the Legislature having jurisdiction over health and human services matters. [PL 2007, c. 629, Pt. L, §4 (NEW).] [PL 2009, c. 359, §1 (AMD); PL 2009, c. 359, §8 (AFF).]

3. Budget. The revenues and expenditures of Dirigo Health are subject to legislative approval in the biennial budget process. At the direction of the board, the executive director shall prepare the budget for the administration and operation of Dirigo Health in accordance with the provisions of law that apply to departments of State Government. [PL 2003, c. 469, Pt. A, §8 (NEW).]

4. Audit. Dirigo Health must be audited annually by the State Auditor. The board may, in its discretion, arrange for an independent audit to be conducted. A copy of the audit must be provided to the State Controller, to the superintendent, to the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters and to the joint standing committee of the Legislature having jurisdiction over health and human services matters. [PL 2003, c. 469, Pt. A, §8 (NEW).]

5. Rulemaking. Dirigo Health may adopt rules as necessary for the proper administration and enforcement of this chapter, pursuant to the Maine Administrative Procedure Act. Unless otherwise specified, rules adopted pursuant to this chapter are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2003, c. 469, Pt. A, §8 (NEW).]

6. Annual report. Beginning September 1, 2004, and annually thereafter, the board shall report on the impact of Dirigo Health on the small group and individual health insurance markets in this State and any reduction in the number of uninsured individuals in the State. The board shall also report on membership in Dirigo Health, the administrative expenses of Dirigo Health, the extent of coverage, the effect on premiums, the number of covered lives, the number of Dirigo Health Program policies issued or renewed and Dirigo Health Program premiums earned and claims incurred by health insurance carriers offering coverage under the Dirigo Health Program. The board shall submit the report to the Governor, the joint standing committee of the Legislature having jurisdiction over appropriations and financial affairs, the joint standing committee of the Legislature having jurisdiction over health insurance and financial services matters and the joint standing committee of the Legislature having jurisdiction over health and human services matters. [PL 2005, c. 400, Pt. C, §7 (AMD).]

7. Technical assistance from other state agencies. Other state agencies, including, but not limited to, the bureau, the Department of Health and Human Services, Maine Revenue Services and the Maine Health Data Organization, shall provide technical assistance and expertise to Dirigo Health upon request. [PL 2003, c. 469, Pt. A, §8 (NEW); PL 2003, c. 689, Pt. B, §6 (REV).]

8. Legal counsel. The Attorney General, when requested, shall furnish any legal assistance, counsel or advice Dirigo Health requires in the discharge of its duties. [PL 2003, c. 469, Pt. A, §8 (NEW).]

9. Coordination with federal, state and local health care systems. Dirigo Health shall institute a system to coordinate the activities of Dirigo Health with the health care programs of the Federal Government and state and municipal governments. [PL 2003, c. 469, Pt. A, §8 (NEW).]

10. Initial staffing. Upon request from the board, the Governor shall provide staffing assistance to Dirigo Health in the initial phases of its operation. [PL 2003, c. 469, Pt. A, §8 (NEW).]

11. Advisory committees. Dirigo Health may appoint advisory committees to advise and assist Dirigo Health. Members of an advisory committee serve without compensation but may be reimbursed by Dirigo Health for necessary expenses while on official business of the advisory committee. [PL 2003, c. 469, Pt. A, §8 (NEW).]

12. Legislative jurisdiction. Notwithstanding any provision of law to the contrary, legislative jurisdiction for oversight of Dirigo Health is governed by the Joint Rules of the Legislature. In adopting the joint rules, the Legislature shall give consideration to ensuring that legislative oversight of Dirigo Health is thorough and ongoing, that normal budgetary procedures and controls are exercised and that committee jurisdiction is consistent with the subject matter jurisdiction of the joint standing committees. [PL 2005, c. 394, §3 (NEW).]

12. (TEXT REALLOCATED TO T. 24-A, §6908, sub-§13) Report; jurisdiction. [PL 2005, c. 400, Pt. A, §5 (NEW); PL 2005, c. 683, Pt. B, §20 (RAL).]

13. (TEXT REALLOCATED FROM T. 24-A, §6908, sub-§12) Report; jurisdiction. Dirigo Health shall report twice annually, once in January and once during the last month of the regular legislative session, to the joint standing committee of the Legislature having jurisdiction over insurance and financial services matters on the Dirigo Health Program and budget. Minutes of meetings of the Board of Trustees of Dirigo Health must be provided to each member of the joint standing committees of the Legislature having jurisdiction over insurance and financial services matters, health and human services matters and appropriations and financial affairs. [PL 2007, c. 447, §7 (AMD).]
24-A M.R.S. § 787 — ME Code / Title 24-A / Chapter 9 / Section 787
24-A §787. Capitalization
Status: in_force

A special purpose reinsurance vehicle must have minimum initial capital of not less than $5,000. All of the initial capital must be received by the reinsurance vehicle in cash. The minimum initial capital required and all other funds of the reinsurance vehicle in excess of its minimum initial capital, including funds held in trust to secure the obligations of the reinsurance vehicle pursuant to its special purpose reinsurance vehicle contracts, must be invested as provided in section 795 . [PL 2003, c. 249, §2 (NEW).]
24-A M.R.S. § 4205 — ME Code / Title 24-A / Chapter 56 / Section 4205
24-A §4205. Powers of health maintenance organizations
Status: in_force

1. The powers of health maintenance organizations include, but are not limited to the following: A. Subject to such licensure laws or regulations as are applicable, the purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the organization; [PL 1975, c. 503 (NEW).] B. The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees; [PL 1975, c. 503 (NEW).] C. The furnishing of health care services through providers which are under contract with or employed by the health maintenance organization; [PL 1975, c. 503 (NEW).] D. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration; [PL 1975, c. 503 (NEW).] E. The contracting with an insurance company licensed in this State for the provision of insurance or indemnity or with a nonprofit hospital or medical service organization for reimbursement against the cost of health care services provided by the health maintenance organization; [PL 1975, c. 503 (NEW).] F. The offering, in addition to basic health care services, of: (1) Additional health care services; (2) Indemnity benefits covering out-of-area services; (3) Indemnity benefits, in addition to those relating to out-of-area services. [PL 1975, c. 503 (NEW).] [PL 1975, c. 503 (NEW).]