24 M.R.S. § 2317-B — ME Code / Title 24 / Chapter 19 / Section 2317-B
24 §2317-B. Applicability of provisions
Status: in_force

The following provisions of Title 24‑A are applicable to each nonprofit hospital or medical service organization or health care plan licensed under this Title. [PL 1999, c. 256, Pt. M, §10 (NEW).]

1. Title 24-A, section 707, subsection 3. Employee benefit excess insurance, Title 24‑A, section 707, subsection 3 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

1-A. Title 24-A, section 423-C. Reports of material transactions, Title 24‑A, section 423‑C ; [PL 2017, c. 169, Pt. A, §2 (NEW).]

1-B. Title 24-A, section 423-G. Corporate governance annual disclosure, Title 24‑A, section 423‑G ; [PL 2017, c. 169, Pt. A, §2 (NEW).]

2. Title 24-A, section 2436. Interest on overdue payments, Title 24‑A, section 2436 ; [PL 1999, c. 790, Pt. A, §27 (AMD).]

3. Title 24-A, section 2437. The practice of dentistry, Title 24‑A, section 2437 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

4. Title 24-A, sections 2438 to 2445. Policy language simplification, Title 24‑A, sections 2438 to 2445 ; [PL 1999, c. 790, Pt. A, §27 (AMD).]

5. Title 24-A, section 2450. Diethylstilbestrol, commonly referred to as DES, Title 24‑A, section 2450 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

6. Title 24-A, sections 2713-A and 2823-A. Minor children, Title 24‑A, sections 2713‑A and 2823‑A ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

7. Title 24-A, section 2729. Renewability, Title 24‑A, section 2729 ; [PL 2015, c. 329, Pt. A, §12 (AMD).]

7-A. Title 24-A, sections 2735-A and 2839-A. Notice of rate filings and rate increases, Title 24‑A, sections 2735‑A and 2839‑A ; [PL 2001, c. 432, §1 (NEW).]

8. Title 24-A, section 2736-C. Individual health plans, Title 24‑A, section 2736‑C ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

9. Title 24-A, sections 2744 and 2835. Mental health services, Title 24‑A, sections 2744 and 2835 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

10. Title 24-A, section 2747. Arbitration of disputed claims, Title 24‑A, section 2747 ; [PL 2001, c. 258, Pt. G, §1 (AMD).]

11. Title 24-A, sections 2748 and 2840-A. Coverage for chiropractic services, Title 24‑A, sections 2748 and 2840‑A ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

12. Title 24-A, section 2752. Any legislative measure that proposes a mandated health benefit applicable to nonprofit hospital or medical services organizations, to the extent the requirements apply to proposals applicable to insurers governed by Title 24‑A, section 2752 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

12-A. Title 24-A, sections 2759 and 2847-J. Hospice care, palliative care and end-of-life care, Title 24‑A, sections 2759 and 2847‑J ; [PL 2001, c. 358, Pt. LL, §1 (NEW); PL 2001, c. 358, Pt. LL, §5 (AFF).]

12-B. Title 24-A, sections 2762, 2847-O and 4255. Coverage for hearing aids, Title 24‑A, sections 2762 , 2847‑O and 4255 ; [PL 2007, c. 695, Pt. C, §11 (AMD).]

12-C. Title 24-A, sections 2763, 2847-N and 4254. [PL 2007, c. 695, Pt. C, §12 (RP).]

12-D. Title 24-A, sections 2764, 2847-P and 4256. Coverage for medically necessary infant formula, Title 24‑A, sections 2764 , 2847‑P and 4256 ; [RR 2007, c. 2, §10 (COR).]

12-E. Title 24-A, sections 2765, 2847-Q and 4257. Coverage for services provided by independent practice dental hygienists or dental hygienists, Title 24‑A, sections 2765 , 2847‑Q and 4257 ; [PL 2025, c. 478, §1 (AMD).]

12-F. Title 24-A, sections 2766 and 2847-R. Enrollment of dependent children in dental coverage, Title 24‑A, sections 2766 and 2847‑R ; [PL 2011, c. 420, Pt. A, §18 (RPR).]

12-G. Title 24-A, sections 2767, 2847-S and 4258. Coverage for children's early intervention services, Title 24‑A, sections 2767 , 2847‑S and 4258 ; [PL 2011, c. 420, Pt. A, §19 (NEW).]

12-H. Title 24-A, sections 2768, 2847-T and 4259. Coverage for diagnosis and treatment of autism spectrum disorders, Title 24‑A, sections 2768 , 2847‑T and 4259 ; [PL 2011, c. 420, Pt. A, §20 (NEW).]

12-I. Title 24-A, sections 2770-A, 2847-X and 4261. Fees for covered dental care services, Title 24‑A, sections 2770‑A , 2847‑X and 4261 ; [PL 2025, c. 298, §1 (NEW).]

13. Title 24-A, section 2803. Categories of group health insurance, Title 24‑A, section 2803 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

14. Title 24-A, section 2803-A. Provision of loss information, Title 24‑A, section 2803‑A ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

15. Title 24-A, section 2808-B. Small group health plans, Title 24‑A, section 2808‑B ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

15-A. Title 24-A, section 2809-A. Conversion on termination of policy or eligibility, Title 24‑A, section 2809‑A ; [PL 2003, c. 428, Pt. B, §1 (AMD).]

16. Title 24-A, section 2834-B. Dependent special enrollment, Title 24‑A, section 2834‑B ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

16-A. Title 24-A, section 2845. Cardiac rehabilitation coverage; Title 24‑A, section 2845 ; [PL 2001, c. 258, Pt. G, §2 (NEW).]

16-B. Title 24-A, chapter 11. Assets and liabilities, Title 24‑A, chapter 11 ; [PL 2017, c. 169, Pt. A, §3 (NEW).]

17. Title 24-A, chapter 32. Preferred provider arrangements, Title 24‑A, chapter 32 ; [PL 1999, c. 790, Pt. A, §27 (AMD).]

18. Title 24-A, chapter 36. Continuity of health insurance coverage, Title 24‑A, chapter 36 ; [PL 1999, c. 256, Pt. M, §10 (NEW).]

19. Title 24-A, chapter 67. Medicare supplement insurance policies, Title 24‑A, chapter 67 ; [PL 2013, c. 575, §2 (AMD).]

20. Title 24-A, chapters 68 and 68-A. Long-term care insurance, nursing home care insurance and home health care insurance, Title 24‑A, chapters 68 and 68‑A ; [PL 2019, c. 274, §2 (AMD).]

21. Title 24-A, sections 2765-A and 2847-U. The practice of dental therapy by a dental therapist, Title 24‑A, sections 2765‑A and 2847‑U ; [PL 2019, c. 605, §2 (RPR).]

22. Title 24-A, section 4320-M. Coverage for abortion services, Title 24‑A, section 4320‑M ; and [PL 2019, c. 605, §3 (AMD).]

23. Title 24-A, sections 2766-A and 2847-W. The prohibition on a dental benefit waiting period for persons under 19 years of age, Title 24‑A, sections 2766‑A and 2847‑W . [PL 2019, c. 605, §4 (NEW).]
24-A M.R.S. § 2916-A — ME Code / Title 24-A / Chapter 39 / Section 2916-A
24-A §2916-A. Nonrenewal -- reasons
Status: in_force

A notice of nonrenewal may not be issued unless it is based upon a reason for which the policy could have been cancelled or unless it is based upon one or more of the following grounds that occurred during the 36-month period preceding the yearly anniversary date of the policy. A nonrenewal is effective only on the policy's yearly anniversary date. [PL 2007, c. 188, Pt. C, §6 (AMD).]

1. Convictions. When a named insured or any operator who either resides in the same household or customarily operates an automobile insured under the policy is convicted of any of the following: A. Operating a motor vehicle while intoxicated or impaired by the consumption of alcohol or drugs; [PL 1979, c. 336, §1 (NEW).] B. Homicide or assault arising out of the use of the operation of a motor vehicle, criminal negligence in the use or operation of a motor vehicle resulting in the injury or death of another person or use or operation of a motor vehicle directly or indirectly in the commission of a felony; [PL 1979, c. 336, §1 (NEW).] C. Operating a motor vehicle in excess of the speed limit or in a reckless manner where injury or death results therefrom; [PL 1979, c. 336, §1 (NEW).] D. Operating a motor vehicle in excess of the speed limit or reckless driving or any combination thereof on 3 or more occasions; [PL 1979, c. 336, §1 (NEW).] E. Operating a motor vehicle insured under the policy without a valid license or registration in effect, except when the person convicted had possessed a valid license or registration which had expired and was subsequently renewed, or during a period of revocation or suspension thereof or in violation of the limitations set forth on the operator's license; [PL 1979, c. 336, §1 (NEW).] F. Operating a motor vehicle while attempting to avoid apprehension or arrest by a law enforcement officer; [PL 1979, c. 336, §1 (NEW).] G. Filing or attempting to file a false or fraudulent automobile insurance claim or knowingly aiding or abetting in the filing or attempted filing of any such claim; [PL 1979, c. 336, §1 (NEW).] H. Leaving the scene of an accident without reporting; [PL 1979, c. 336, §1 (NEW).] I. Filing a false document with the Secretary of State or the Bureau of Motor Vehicles or using a license or registration obtained by filing a false document with the Secretary of State or the Bureau of Motor Vehicles; [PL 1991, c. 837, Pt. A, §50 (AMD).] J. Operating a motor vehicle in a race or speed test; or [PL 1979, c. 336, §1 (NEW).] K. Knowingly permitting or authorizing an unlicensed driver to operate a motor vehicle insured under the policy. [PL 1979, c. 336, §1 (NEW).] [PL 1991, c. 837, Pt. A, §50 (AMD).]

2. Accidents. When a named insured or any other person who operates a motor vehicle insured under the policy is individually or are aggregately involved in 2 or more vehicle accidents while operating a motor vehicle insured under the policy or under another policy issued by the same insurer for a motor vehicle in the same household, resulting in either personal injury or property damage in excess of the amount defined as a reportable accident under Title 29‑A, section 2251, subsection 1 . For the purpose of this subsection any of the following occurrences involving a motor vehicle operated by a named insured or such other person is not considered an accident when: A. The motor vehicle was struck from the rear; [PL 1979, c. 336, §1 (NEW).] B. The motor vehicle was struck while parked; [PL 1979, c. 336, §1 (NEW).] C. Only the operator of another motor vehicle involved in the accident was convicted of a crime, offense or violation contributing to the accident; or [PL 1979, c. 336, §1 (NEW).] D. The named insured or other operator of the motor vehicle insured under the policy or the insurer of the policy, was reimbursed by or on behalf of, a person responsible for the accident or has a judgment against that person. [PL 1999, c. 617, §2 (AMD).] When more than one motor vehicle in a household is insured by the same insurer, the aggregate number of accidents that would permit nonrenewal of the policy or policies insuring those vehicles must be increased by one for each additional motor vehicle insured. [PL 2003, c. 26, §1 (AMD).]

3. Insurability. When there is a material change in the type of motor vehicle insured which so substantially increases the hazard insured against as to render the motor vehicle uninsurable in accordance with the insurer's underwriting standards in effect at the time the policy was issued or last renewed; provided that if the insured motor vehicle is uninsurable for physical damage coverages only, the insurer shall offer to renew the policy without the physical damage coverages. [PL 1979, c. 336, §1 (NEW).]
24-A M.R.S. § 2804-B — ME Code / Title 24-A / Chapter 35 / Section 2804-B
24-A §2804-B. Group disability income protection plan
Status: in_force

An employer may offer its employees an employer-sponsored group disability income protection plan in accordance with the requirements of section 2804 . As used in this section, "disability income protection plan" means a group short-term disability policy or a group long-term disability policy instituted by an employer that provides income benefits to an employee who is unable to work for an extended period of time because of sickness or an accident. For the purpose of Title 26, section 629, subsection 1 , the premium paid by an employee for an employer-sponsored group disability income protection plan issued pursuant to this section is considered a premium that the employee has agreed to pay if the group disability income protection plan provides for appropriate disclosure regarding the plan chosen by the employer, a method of enrollment that allows employees to opt out of coverage and an appropriate time period for employees to voluntarily terminate coverage. An employee must be provided information regarding the employer-sponsored group disability income protection plan at least 30 days prior and a 2nd time at least 10 days prior to the initial payroll deduction of that employee's premiums. The information provided must include a statement of the employee's right to opt out of coverage, the process by which the employee may exercise the right to opt out of coverage and any deadline to opt out of coverage. [PL 2015, c. 490, §1 (NEW).]
24-A M.R.S. § 2745-B — ME Code / Title 24-A / Chapter 33 / Section 2745-B
24-A §2745-B. Acupuncture services
Status: in_force

All individual insurance policies providing coverage for acupuncture must provide coverage for those services when performed by an acupuncturist licensed pursuant to Title 32, chapter 113‑B, subchapter II , under the same conditions that apply to the services of a licensed physician. [PL 1995, c. 671, §9 (AMD).]
24-A M.R.S. § 763 — ME Code / Title 24-A / Chapter 9 / Section 763
24-A §763. Notice requirements of intent to transfer insurance contract
Status: in_force

1. Notice to policyholders, agents and brokers. Notice to policyholders, agents and brokers is required as follows. A. The transferring insurer shall provide or cause to be provided to each policyholder a notice of transfer by first class mail, addressed to the policyholder's last known address or to the address to which premium notices or other policy documents are sent or, with respect to home service business, by personal delivery with acknowledged receipt. A notice of transfer must also be sent to the transferring insurer's agents or brokers of record on the affected policies. [PL 1993, c. 603 (NEW).] B. The notice of transfer must state or provide: (1) The date the transfer and novation of the policyholder's contract of insurance is proposed to take place; (2) The names and addresses and telephone numbers of the assuming and transferring insurers; (3) That the policyholder has the right to either consent to or reject the transfer and novation; (4) The procedures and time limit for consenting to or rejecting the transfer and novation; (5) A summary of an effect that consenting to or rejecting the transfer and novation has on the policyholder's rights; (6) A statement that the assuming insurer is licensed to write the type of business being assumed in the state where the policyholder resides or is otherwise authorized, as provided in this subchapter, to assume the business; (7) The name and address of the person at the transferring insurer to whom the policyholder should send a written statement of acceptance or rejection of the transfer and novation; (8) The address and phone number of the Bureau of Insurance so that the policyholder may write or call for further information regarding the financial condition of the assuming insurer; and (9) The following financial data for both companies: (a) Ratings for the last 5 years if available or for a lesser period as are available from 2 nationally recognized insurance rating services acceptable to the superintendent including the rating service's explanation of the meaning of the ratings. If ratings are unavailable for a year of the 5-year period, this must also be disclosed; (b) A balance sheet as of December 31st for the previous 3 years if available or for a lesser period as is available and as of the date of the most recent quarterly statement; (c) A copy of the Management's Discussion and Analysis that was filed as a supplement to the previous year's annual statement; and (d) An explanation of the reason for the transfer. [PL 1993, c. 603 (NEW).] C. Notice must be given in a manner that conforms to the following form: NOTICE OF TRANSFER IMPORTANT: THIS NOTICE AFFECTS YOUR CONTRACT RIGHTS. PLEASE READ IT CAREFULLY. Transfer of Policy The [name of assuming insurer] has agreed to replace us as your insurer under [policy or certificate name and number] effective [date]. The [name of assuming insurer] principal place of business is [address]. Certain financial information concerning both companies is attached, including (1) ratings for the time period required by the Bureau of Insurance from 2 nationally recognized insurance rating services; (2) balance sheets for the time period required by the Bureau of Insurance and as of the date of the most recent quarterly statement; (3) a copy of the Management's Discussion and Analysis that was filed as a supplement to the previous year's annual statement; and (4) an explanation of the reason for the transfer. You may obtain additional information concerning [name of assuming insurer] from reference materials in your local library or by contacting the Superintendent of Insurance at [address and phone number]. The [name of assuming insurer] is licensed to write this coverage in your state. The Superintendent of Insurance in your state has reviewed the potential effect of the proposed transaction and has approved the transaction. Your Rights You may choose to consent to or reject the transfer of your policy to [name of assuming insurer]. If you want your policy transferred, you may notify us in writing by signing and returning the enclosed preaddressed, postage-paid card or by writing to us at: [name, address and facsimile number of contact person] Payment of your premium to the assuming company constitutes acceptance of the transaction. A method is provided to allow you to pay the premium while reserving the right to reject the transfer. If you reject the transfer, you may keep your policy with us or exercise an option under your policy. If we do not receive a written rejection you have, as a matter of law, consented to the transfer. Before this consent is final you will be provided a second notice of the transfer 24 months from now. After the second notice is provided, you have one month to reply. If you have paid your premium to the [name of assuming insurer], without reserving your right to reject the transfer, you will not receive a second notice. ( ) This is your first notice. Please respond within 24 months. ( ) This is your second notice. You must respond within one month to reject the transfer of your policy. If we do not hear from you by [date], your policy will be transferred to [name of assuming insurer]. Effect of Transfer If you accept this transfer, [name of assuming insurer] will be your insurer. The insurer has direct responsibility to you for the payment of all claims, benefits and for all other policy obligations. We no longer have an obligation to you. If you accept this transfer, you must make all premium payments and claims submissions to [name of assuming insurer] and direct all questions to [name of assuming insurer]. For your convenience, we have enclosed a preaddressed postage-paid response card. Please take time now to read the enclosed notice and complete and return the response card to us. If you have further questions about this agreement, you may contact [name of transferring insurer] or [name of assuming insurer]. Sincerely, . . . . . . . . . . . . . . . . . . . . . [name of transferring insurer [name of assuming insurer address address phone] phone] [Notice Date] RESPONSE CARD ____ Yes, I accept the transfer of my policy from [name of transferring insurer] to [name of assuming insurer]. ____ No, I reject the proposed transfer of my policy from [name of transferring insurer] to [name of assuming insurer] and wish to retain my policy with [name of transferring insurer]. Date: Signature: Name: Address: [PL 1993, c. 603 (NEW).] D. The notice of transfer must include a preaddressed, postage-paid response card that a policyholder may return as the written statement of acceptance or rejection of the transfer and novation. [PL 1993, c. 603 (NEW).] E. The notice of transfer must be filed as part of the prior approval requirement set forth in subsection 2, paragraph A . [PL 1993, c. 603 (NEW).] [PL 1993, c. 603 (NEW).]

2. Notification and prior approval. The requirements for notification and prior approval are as follows: A. Prior approval by the superintendent is required for a transaction when an insurer domiciled in this State assumes or transfers obligations or risks on contracts of insurance under an assumption reinsurance agreement. An insurer licensed in this State may not transfer obligations or risks on contracts of insurance issued to or owned by residents of this State to an insurer that is not licensed in this State. An insurer domiciled in this State may not assume obligations or risks on contracts of insurance issued to or owned by policyholders residing in another state unless it is licensed in the other state or the insurance regulatory official of that state has approved the assumption. [PL 1993, c. 603 (NEW).] B. A licensed foreign insurer that enters into an assumption reinsurance agreement that transfers the obligations or risks on contracts of insurance issued to or owned by residents of this State shall file or cause to be filed the assumption certificate with the superintendent a copy of the notice of transfer and an affidavit that the transaction is subject to substantially similar requirements in the state of domicile of both the transferring and assuming insurer. [PL 1993, c. 603 (NEW).] C. A licensed foreign insurer that enters into an assumption reinsurance agreement that transfers the obligations or risks on contracts of insurance issued to or owned by residents of this State shall obtain prior approval of the superintendent and be subject to all other requirements of this subchapter unless the transferring and assuming insurers are subject to assumption reinsurance requirements adopted by law or rule in the jurisdiction of their domicile, which are substantially similar to those contained in this subchapter. [PL 1993, c. 603 (NEW).] D. The following factors, along with such factors as the superintendent determines appropriate under the circumstances, must be considered by the superintendent in reviewing a request for approval: (1) The financial condition of the transferring and assuming insurers and the effect the transaction has on the financial condition of each company; (2) The competence, experience and integrity of those persons who control the operation of the assuming insurer; (3) The plans or proposals the assuming party has with respect to the administration of the policies subject to the proposed transfer; (4) Whether the transfer is fair and reasonable to the policyholders of both companies; and (5) Whether the notice of transfer to be provided by the insurer is fair, adequate and not misleading. [PL 1993, c. 603 (NEW).] [PL 1993, c. 603 (NEW).]
24-A M.R.S. § 2813 — ME Code / Title 24-A / Chapter 35 / Section 2813
24-A §2813. "Blanket health insurance" defined
Status: in_force

Blanket health insurance is hereby declared to be that form of health insurance covering groups of persons as enumerated in one of the following paragraphs: [PL 1969, c. 132, §1 (NEW).]

1. Under a policy or contract issued to any common carrier or to any operator, owner or lessee of a means of transportation, who or which shall be deemed the policyholder, covering a group of persons who may become passengers defined by reference to their travel status on such common carrier or such means of transportation. [PL 1969, c. 132, §1 (NEW).]

2. Under a policy or contract issued to an employer, who shall be deemed the policyholder, covering any group of employees, dependents or guests, defined by reference to specified hazards incident to an activity or activities or operations of the policyholder. [PL 1969, c. 132, §1 (NEW).]

3. Under a policy or contract issued to a college, school or other institution of learning, a school district or districts, or school jurisdictional unit, or to the head, principal or governing board of any such educational unit, who or which shall be deemed the policyholder, covering students, teachers, or employees. [PL 1969, c. 132, §1 (NEW).]

4. Under a policy or contract issued to any religious, charitable, recreational, educational, or civic organization, or branch thereof, which shall be deemed the policyholder, covering any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by such policyholder. [PL 1969, c. 132, §1 (NEW).]

5. Under a policy or contract issued to a sports team, camp or sponsor thereof, which shall be deemed the policyholder, covering members, campers, employees, officials or supervisors. [PL 1969, c. 132, §1 (NEW).]

6. Under a policy or contract issued to any volunteer fire department or first aid, emergency management or other such volunteer organization, which is deemed the policyholder, covering any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by the policyholder. [PL 2013, c. 462, §3 (AMD).]

7. Under a policy or contract issued to a newspaper or other publisher, which shall be deemed the policyholder, covering its carriers. [PL 1969, c. 132, §1 (NEW).]

8. Under a policy or contract issued to an association, including a labor union, which has a constitution and bylaws and which has been organized and is maintained in good faith for purposes other than that of obtaining insurance, which shall be deemed the policyholder, covering any group of members or participants defined by reference to specified hazards incident to an activity or activities or operations sponsored or supervised by such policyholder. [PL 1969, c. 132, §1 (NEW).]

9. Under a policy or contract issued to cover any other risk or class of risks which, in the discretion of the superintendent, may be properly eligible for blanket health insurance. The discretion of the superintendent may be exercised on an individual risk basis or class of risks, or both. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

Policies that otherwise meet the description of group policies pursuant to section 2804 , 2805 , 2805‑A , 2806 , 2807 , 2807‑A or 2808‑B are not blanket policies. [PL 2011, c. 238, Pt. B, §1 (NEW).]
24-A M.R.S. § 4222 — ME Code / Title 24-A / Chapter 56 / Section 4222
24-A §4222. Statutory construction and relationship to other laws
Status: in_force

1. Except as otherwise specifically provided, provisions of the insurance law and the laws relating to hospital or medical service corporations do not apply to a health maintenance organization granted a certificate of authority under this chapter. This provision does not apply to an insurer or hospital or medical service corporation licensed and regulated pursuant to the insurance laws of this State except with respect to its health maintenance organization activities, whether those activities are conducted through a subsidiary or as a division or line of business, authorized and regulated pursuant to this chapter. [PL 1993, c. 702, Pt. A, §16 (AMD).]

2. Solicitation of enrollees by a health maintenance organization granted a certificate of authority or its representatives shall not be construed to violate any provision of law relating to solicitation or advertising by health professionals. [PL 1975, c. 503 (NEW).]

3. Any health maintenance organization authorized under this chapter is not deemed to be practicing medicine and is exempt from provisions of law relating to the practice of medicine, except that this subsection may not be asserted by a health maintenance organization as a defense to any action brought by an enrollee pursuant to section 4313 . [PL 1999, c. 742, §1 (AMD).]

4. [PL 1995, c. 625, Pt. A, §26 (RP).]
24-A M.R.S. § 3059 — ME Code / Title 24-A / Chapter 41 / Section 3059
24-A §3059. Insurer valuation of property; increase in premium; notice
Status: in_force

1. Increase in valuation. If an insurer determines that the stated insured value of a property covered by a policy subject to this subchapter should be increased to depict more accurately its current value and the increase in valuation will result in an increase in premium for the policy, then the increase in the stated insured value and the corresponding increase in premium may be implemented only at the time of renewal. [PL 2003, c. 671, Pt. A, §10 (NEW).]

2. Notice. If an insurer increases the stated insured value in accordance with subsection 1 , then the insurer must provide notice to the named insured on the policy at least 30 days prior to the effective date of the renewal policy stating the reason for the increase in premium and the amount of premium increase associated with the increase in valuation. The notice also must state that upon written request by the named insured the insurer will disclose the specific reasons and specific property characteristics that contributed to the resulting increase in stated value. [PL 2003, c. 671, Pt. A, §10 (NEW).]

3. Exemptions. This section does not apply to routinely scheduled increases in valuation under the policy based on inflation or to increases in the stated insured value of a property agreed to by the insured. [PL 2003, c. 671, Pt. A, §10 (NEW).]
24-A M.R.S. § 4313 — ME Code / Title 24-A / Chapter 56-A / Section 4313
24-A §4313. Carrier liability; cause of action
Status: in_force

1. Duty of ordinary care; cause of action. An enrollee may maintain a cause of action against a carrier offering or renewing a health plan in accordance with the following. A. A carrier has the duty to exercise ordinary care when making health care treatment decisions that affect the quality of the diagnosis, care or treatment provided to an enrollee and is liable for damages as provided in this section for harm to an enrollee proximately caused by the failure of the carrier or its agents to exercise such ordinary care. [PL 1999, c. 742, §19 (NEW).] B. A carrier is also liable for damages as provided in this section for harm to an enrollee proximately caused by the health care treatment decisions made by its agents who are acting on the carrier's behalf and over whom the carrier exercised control or influence in the health care treatment decisions that result in the failure to exercise ordinary care. [PL 1999, c. 742, §19 (NEW).] [PL 2007, c. 199, Pt. B, §18 (AMD).]

2. Exhaustion of internal and external review. An enrollee may not maintain a cause of action under this section unless the enrollee or the enrollee's representative: A. Has exhausted all levels of the carrier's internal grievance procedure in accordance with this chapter; and [PL 1999, c. 742, §19 (NEW).] B. Has completed the independent external review process required under section 4312 . [PL 1999, c. 742, §19 (NEW).] [PL 1999, c. 742, §19 (NEW).]

3. Limitation on cause of action. An action under this section must be initiated within 3 years from the earlier of the date of issuance of the written external review decision under section 4312 or the date of issuance of the underlying adverse first-level appeal or first-level grievance determination notice. [PL 1999, c. 742, §19 (NEW).]

4. Jurisdiction; notice and filing. The Superior Court has original jurisdiction over a cause of action under this section. The requirements for notice and filing of a cause of action under this section are governed by the Maine Rules of Civil Procedure. [PL 1999, c. 742, §19 (NEW).]

5. Corporate practice of medicine. Section 4222, subsection 3 or any other law in this State prohibiting a carrier from practicing medicine or being licensed to practice medicine may not be asserted as a defense by a carrier in any action brought pursuant to this section. [PL 1999, c. 742, §19 (NEW).]

6. No obligation for benefits. This section does not create any obligation on the part of a carrier to provide an enrollee any health care treatment or service that is not covered by the enrollee's health plan policy or contract. [PL 1999, c. 742, §19 (NEW).]

7. Admissibility of external review decision. An external review decision is admissible in an action under this section. [PL 1999, c. 742, §19 (NEW).]

8. Affirmative defense. It is an affirmative defense to any action asserted against a carrier under this section that the carrier or any agent for whose conduct the carrier is liable did not control, influence or participate in the health care treatment decision. [PL 1999, c. 742, §19 (NEW).]

9. Damages. In a cause of action under this section, the award of damages must be made in accordance with this subsection. A. Actual or compensatory damages may be awarded. [PL 1999, c. 742, §19 (NEW).] B. Noneconomic damages awarded may not exceed $400,000. [PL 1999, c. 742, §19 (NEW).] C. Punitive damages may not be awarded. [PL 1999, c. 742, §19 (NEW).] [PL 1999, c. 742, §19 (NEW).]

10. Professional negligence. This section does not create any new or additional liability on the part of a carrier for harm caused to an enrollee that is attributable to the professional negligence of a treating physician or other health care practitioner. [PL 1999, c. 742, §19 (NEW).]

11. Employer liability. This section does not create any liability on the part of an employer that assumes risk on behalf of its employees or an employer group purchasing organization. [PL 1999, c. 742, §19 (NEW).]

12. Exemption. This section does not apply to workers' compensation, medical malpractice, fidelity, suretyship, boiler and machinery, property or casualty insurance. [PL 1999, c. 742, §19 (NEW).]

13. Limitation on remedy. The cause of action under this section is the sole and exclusive private remedy under state law for an enrollee against a carrier for its health care treatment decisions that affect the quality of the diagnosis, care or treatment provided to an enrollee, except that this subsection may not be construed to prohibit an enrollee or an enrollee's authorized representative from seeking other remedies specifically available under other provisions of this Title. [PL 1999, c. 742, §19 (NEW).]

14. Wrongful death action. Notwithstanding subsection 13 , an enrollee or an enrollee's authorized representative may bring a cause of action against a carrier for its health care treatment decisions to seek a remedy under either this section or under Title 18‑C, section 2‑807 , but may not seek remedies under both this section and Title 18‑C, section 2‑807 . [PL 2017, c. 402, Pt. C, §76 (AMD); PL 2019, c. 417, Pt. B, §14 (AFF).]
24-A M.R.S. § 952 — ME Code / Title 24-A / Chapter 11 / Section 952
24-A §952. Calculation of reserve liabilities
Status: in_force

1. The superintendent shall annually value, or cause to be valued, the reserve liabilities, hereinafter called reserves, for all outstanding life insurance policies and annuity and pure endowment contracts of every life insurer transacting business in this State in accordance with this subchapter, except that in the case of an alien insurer, such valuation must be limited to its United States business; and may certify the amount of any such reserves, specifying the mortality table or tables, rate or rates of interest and methods, net level premium method or other, used in the calculation of such reserves. In calculating such reserves, the superintendent may use group methods and approximate averages for fractions of a year or otherwise. In lieu of the valuation of the reserves required of any foreign or alien insurer, the superintendent may accept any valuation made, or caused to be made, by the insurance supervisory official of any state or other jurisdiction when such valuation complies with the minimum standard herein provided. For policies and contracts issued before the operative date of the valuation manual or not addressed by the valuation manual, reserves must be determined according to sections 953 to 958‑A . For policies and contracts issued after the operative date of the valuation manual, reserves must be determined according to sections 959 and 960 and as specified by the valuation manual. [PL 2013, c. 238, Pt. C, §3 (AMD).]

2. Any such insurer which at any time shall have adopted any standard of valuation producing greater aggregate reserves than those calculated according to the minimum standard herein provided may, with the approval of the superintendent, adopt any lower standard of valuation, but not lower than the minimum herein provided. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

3. Beginning on the operative date of the valuation manual, a life or health insurer and a casualty or multiple lines insurer transacting health insurance shall comply with the applicable requirements of this subchapter if the insurer is required to hold a certificate of authority to write one or more subject lines of insurance in this State or if the insurer has written, issued or reinsured contracts of one or more subject lines of insurance in this State and has at least one such policy in force or on claim. [PL 2013, c. 238, Pt. C, §4 (NEW).]
24-A M.R.S. § 2910-A — ME Code / Title 24-A / Chapter 39 / Section 2910-A
24-A §2910-A. Subrogation; medical payments coverage
Status: in_force

1. Policy requirements. A casualty insurance policy subject to this chapter may not provide for subrogation or priority over the insured of payment for any hospital, nursing, medical or surgical services or of any expenses paid or reimbursed under the medical payments coverage in the policy in the event the insured is entitled to receive payment or reimbursement from any other person as a result of legal action or claim, except as provided in this section. The coverage may contain a provision that allows the payments if: A. [PL 2011, c. 509, §1 (RP).] B. The provision requires the written approval of the insured; [PL 2009, c. 222, §1 (NEW).] C. The provision provides that the insurer's subrogation right is subject to subtraction to account for the pro rata share of the insured's attorney's fees incurred in obtaining the recovery from another source; and [PL 2009, c. 222, §1 (NEW).] D. The provision is approved by the superintendent. [PL 2009, c. 222, §1 (NEW).] [PL 2011, c. 509, §1 (AMD).]

2. Dispute resolution. In the event of a dispute as to the application of any such provision or the amount available for payment to those claiming payment for services or reimbursement, that dispute must be determined, if the action is pending, before the court in which it is pending; or if no action is pending, by filing an action in any court for determination of the dispute. [PL 1997, c. 369, §2 (NEW).]

3. Exception. Nothing in this section prevents an insurer from exercising its subrogation rights directly against any person legally responsible for the insured's injury. In the event that the insurer pursues its subrogation rights directly against such a person, the insurer's subrogation right is not subject to any subtraction to account for attorney's fees and the insurer is entitled to full recovery. [PL 1997, c. 369, §2 (NEW).]

4. Coordination of benefits and assignment of medical payments coverage. The following provisions apply to coordination of benefits and assignment of medical payments coverage in a casualty insurance policy. A. A carrier, as defined in section 4301‑A, subsection 3 , may not coordinate benefits against medical payments coverage in a casualty insurance policy and may not require medical payments coverage to be primary coverage over any health insurance policy. [PL 2019, c. 182, §1 (NEW).] B. Medical payments coverage in a casualty insurance policy is assignable only by written agreement between the insured and the casualty insurer on a form prescribed or approved by the superintendent. Benefits under medical payments coverage must be applied as directed by the insured. [PL 2025, c. 102, §1 (AMD).] C. The insured has the right to submit a claim for medical expenses under medical payments coverage in a casualty insurance policy. The insured may also submit a claim for medical expenses under a health insurance policy, except that an insured is not entitled to duplicate payment from medical payments coverage and a health insurance policy for the same medical expense. [PL 2019, c. 182, §1 (NEW).] [PL 2025, c. 102, §1 (AMD).]
24-A M.R.S. § 6202 — ME Code / Title 24-A / Chapter 73 / Section 6202
24-A §6202. Certificate of authority required
Status: in_force

1. Requirement. No person or entity may offer continuing care in this State except a provider having obtained an appropriate certificate of authority issued by the superintendent pursuant to this chapter and then in full force and effect. [PL 1987, c. 482, §1 (NEW).]

2. Use of name. No natural person, partnership, unincorporated association, trust or corporation may use the names "continuing care retirement community" or "life-care community" unless the appropriate certificate of authority has been issued by the superintendent. A life-care community may use either name or both. [PL 1987, c. 482, §1 (NEW).]

3. Kinds of communities. There are 2 kinds of communities that qualify for certification. A. To qualify for certification as a life-care community, the provider shall offer a continuing care agreement that explicitly provides all of the following: (1) Full and lifetime prepaid health care, prepaid supportive services and shelter, as prescribed by the department by rule, which include a true continuum of care from independent living through nursing home care; (2) The maintenance fee may not increase, regardless of the level of services provided or a change in accommodations, with the following exceptions: (a) Annual increases in the maintenance fee applicable to all subscribers; and (b) Any increase in the maintenance fee applicable to a specific subscriber resulting from the voluntary selection of an optional service by that subscriber. An optional service is a service or change in accommodations that is not required to be offered in order to qualify for certification as a life-care community under the department's rules; (3) With the exception of maintenance fees and insurance premiums, neither the subscriber nor any 3rd party, other than the subscriber's insurer, is liable for the cost of health care or supportive services other than optional services as defined in subparagraph (2); and (4) The provider shall continue to provide full and lifetime health care, supportive services and shelter without diminution to a subscriber who has not intentionally depleted that subscriber's resources. [PL 1995, c. 452, §6 (AMD).] B. A provider offering a continuing care agreement that does not qualify for certification as a life-care community, as defined in paragraph A , must be certified as a continuing care retirement community if it complies with the other applicable provisions of this chapter. [PL 1995, c. 452, §6 (AMD).] [PL 1995, c. 452, §6 (AMD).]

4. Reasonable time to comply. Any provider who is providing continuing care when this chapter takes effect shall be given a reasonable time to comply with this chapter and the rules promulgated pursuant to this chapter, but not later than one year after the effective date of this chapter. [PL 1987, c. 482, §1 (NEW); PL 1989, c. 343, §3 (AMD); PL 1989, c. 343, §23 (AFF).]

5. Statement of withdrawal. Any provider who, as of the effective date of this chapter, has offered continuing care agreements prior to that date and intends not to offer new continuing care agreements or to renew those agreements shall file a statement to that effect with the superintendent. [PL 1987, c. 482, §1 (NEW).]

6. Preliminary marketing. Upon written approval by the superintendent of the proposed forms of the reservation agreement and the reservation fee escrow agreement referred to in section 6201, subsection 11‑A , and prior to applying for a preliminary certificate of authority or a certificate of authority, a prospective provider may engage in preliminary marketing. [PL 1995, c. 452, §7 (NEW).]
24-A M.R.S. § 2320 — ME Code / Title 24-A / Chapter 25 / Section 2320
24-A §2320. Information furnished insureds; hearings and appeals of insureds
Status: in_force

1. Every rating organization, advisory organization and insurer shall, within a reasonable time after receiving written request therefor and upon payment of such reasonable charge as it may make, furnish to any insured affected by a rate, a prospective loss cost or supplementary rating information made by it, or to the authorized representative of such insured, all pertinent information as to such rate. [PL 1989, c. 797, §21 (AMD); PL 1989, c. 797, §§37, 38 (AFF).]

2. Every rating organization, advisory organization and insurer shall provide within this State reasonable means whereby any person aggrieved by the application of its rating system may be heard, in person or through an authorized representative, on written request to review the manner in which such rating system has been applied in connection with the insurance afforded that person. If the rating organization, advisory organization or insurer fails to grant or reject such request within 30 days after it is made, the applicant may proceed in the same manner as if that application had been rejected. Any party affected by the action of such rating organization, advisory organization or such insurer on such request may, within 30 days after written notice of such action, appeal to the superintendent, who, after a hearing held upon not less than 10 days' written notice to the appellant and to such rating organization, advisory organization or insurer, may affirm or reverse such action. [PL 1989, c. 797, §21 (AMD); PL 1989, c. 797, §§37, 38 (AFF).]

3. Upon a request by a person aggrieved by the application of the rating system or an insurer, or either of their authorized representatives, the person aggrieved has the right to a hearing held by the superintendent without the matter first being heard by the rating organization or insurer pursuant to subsection 2 . Such hearing must be held within 60 days following receipt by the superintendent of a written request for a hearing. At least 30 days' written notice of the date, time and place of the hearing, together with a reasonably accurate description of the subject matter of the hearing, must be provided by the superintendent to the person aggrieved, the insurer and the rating organization. Upon request by any party, the hearing may be continued to allow a reasonable period for conducting investigation of the matter, discovery and preparation of factual and legal materials for the hearing. Each party to a hearing is entitled to only one continuance. Prior to continuation of a hearing, the superintendent shall, upon not less than 5 days' notice to all parties, conduct an informal prehearing conference at which the parties shall identify the issues to be addressed at the hearing, establish a schedule for all investigation, discovery and hearing preparation reasonably necessary based upon the nature and scope of the hearing and establish a date certain for the hearing. [PL 1995, c. 317, §1 (NEW).]
24-A M.R.S. § 2209 — ME Code / Title 24-A / Chapter 24 / Section 2209
24-A §2209. Investigative consumer reports
Status: in_force

1. Required notice. A regulated insurance entity or insurance support organization may not prepare or request an investigative consumer report about an insurance consumer in connection with an insurance transaction involving an application for insurance, a policy renewal, a policy reinstatement or a change in insurance benefits unless the regulated insurance entity complies with the federal Consumer Credit Protection Act, 15 United States Code, Section 1681d and informs the consumer in writing that the consumer may request to be interviewed in connection with the preparation of the investigative consumer report. [PL 2023, c. 405, Pt. A, §84 (AMD).]

2. Personal interview. If an investigative consumer report is to be prepared by the regulated insurance entity, the regulated insurance entity shall institute reasonable procedures to conduct a personal interview when requested by a consumer. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

3. Insurance support organization. If an investigative consumer report is to be prepared by an insurance support organization, the regulated insurance entity requesting the report shall inform the insurance support organization whether a personal interview has been requested by the consumer. The insurance support organization shall institute reasonable procedures to conduct such interviews. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
24-A M.R.S. § 6714 — ME Code / Title 24-A / Chapter 83 / Section 6714
24-A §6714. Delinquent captive insurers
Status: in_force

The provisions of chapter 57 apply to captive insurers. [PL 2009, c. 335, §20 (AMD).]
24-A M.R.S. § 6803 — ME Code / Title 24-A / Chapter 85 / Section 6803
24-A §6803. Settlement provider and producer license; license requirements
Status: in_force

1. License required. Licenses are required in accordance with this subsection. A. A person may not act as a settlement provider without a license from the superintendent issued pursuant to this section and subject to the provisions of this chapter. [PL 2003, c. 636, §6 (AMD).] B. A person may not perform the functions of, or otherwise act as, a settlement producer without a license from the superintendent as a life insurance producer. [PL 2003, c. 636, §6 (AMD).] C. [PL 2003, c. 636, §6 (RP).] C-1. If there is more than one viator on a single policy and the viators are residents of different states, the settlement contract is governed by the law of the state in which the viator having the largest percentage ownership resides or, if the viators hold equal ownership, the state of residence of one viator agreed upon in writing by all viators. [PL 2003, c. 636, §6 (NEW).] D. [PL 2003, c. 636, §6 (RP).] E. [PL 2003, c. 636, §6 (RP).] [PL 2003, c. 636, §6 (AMD).]

2. Application; fee. Application for a settlement provider license must be made to the superintendent by the applicant on a form prescribed by the superintendent. The application must be accompanied by a fee not to exceed $400 in accordance with section 601 . [PL 2003, c. 636, §6 (AMD).]

3. Renewal. A license for a settlement provider is continuous as long as the licensee remains qualified. The settlement provider must pay an annual fee not to exceed $400 in accordance with section 601 . Failure to pay the fee within the terms prescribed may result in the revocation of the license unless cured within 5 days of written notice of failure to pay to the principal office of the licensee. [PL 2003, c. 636, §6 (AMD).]

4. Information required. The applicant for a settlement provider license shall provide such information as the superintendent requires and the information must be submitted on forms required by the superintendent. The superintendent may at any time require the applicant to disclose fully the identity of all stockholders except stockholders owning less than 5% of the shares of an applicant whose shares are publicly traded, partners, officers, directors, members and employees and the superintendent may, in the exercise of the superintendent's discretion, refuse to issue a license to an applicant if not satisfied that any stockholder, partner, director, member or employee of the applicant who may materially influence the applicant's conduct meets the criteria set forth in subsection 6 . A settlement provider shall provide to the superintendent new or revised information about officers, stockholders controlling 10% or more of stock, partners, directors, members or designated employees within 30 days of the change. [PL 2003, c. 636, §6 (AMD).]

5. Authority under license. A settlement provider license issued to any person authorizes all officers, partners, directors, members and key management personnel of that person to act on behalf of the settlement provider, unless such activity requires a license under another provision of this Title. All officers, partners, directors, members and key management personnel of the person must be named in the application and any supplements to the application. [PL 2003, c. 636, §6 (AMD).]

6. Investigation. Upon the filing of an application and the payment of the settlement provider license fee, the superintendent shall make an investigation of the applicant and shall issue a license if the superintendent finds that the applicant: A. Has provided a detailed plan of operation; [PL 1997, c. 430, §1 (NEW); PL 1997, c. 430, §2 (AFF).] B. Is competent and trustworthy and intends to act in good faith in the capacity of a settlement provider; [PL 2003, c. 636, §6 (AMD).] C. Has a good business reputation and has had experience, training or education so as to be qualified as a settlement provider; [PL 2003, c. 636, §6 (AMD).] D. If organized under the laws of this State, has provided a certificate of good standing from this State. If the applicant is a foreign entity, it must provide a certificate of good standing from its state of organization and a certificate of good standing from this State; [PL 2003, c. 636, §6 (AMD).] E. Has no officer, partner, director, member or key management personnel of the applicant that has been found guilty of, or has pleaded guilty or nolo contendere to, any crime involving fraud or moral turpitude, regardless of whether a judgment of conviction has been entered by the court; and [PL 2003, c. 636, §6 (AMD).] F. Has provided an antifraud plan that meets the requirements of section 6818 . [PL 2003, c. 636, §6 (NEW).] [PL 2003, c. 636, §6 (AMD).]

7. Financial responsibility. Evidence of financial responsibility must be provided to the superintendent in accordance with this subsection. A. A settlement provider shall provide evidence of financial accountability. Such evidence may include, but is not limited to, a binding and committed lending facility of at least $1,000,000 with a term of at least one year or a net worth in excess of $100,000. [PL 2003, c. 636, §6 (AMD).] [PL 2003, c. 636, §6 (AMD).]

8. Nonresidents. The superintendent may not issue a settlement provider license to a nonresident applicant unless a written designation of an agent for service of process is filed and maintained with the superintendent or the applicant has filed with the superintendent the applicant's written irrevocable consent that any action against the applicant may be commenced against the applicant by service of process on the superintendent. [PL 2003, c. 636, §6 (AMD).]

9. List. The superintendent shall maintain a complete list of all settlement providers licensed or with license pending in this State. The list must be available upon request to the general public. [PL 2003, c. 636, §6 (AMD).]
24-A M.R.S. § 474 — ME Code / Title 24-A / Chapter 5 / Section 474
24-A §474. Payments deferred
Status: in_force

During any insurance emergency period as described in sections 471 and 472 , the superintendent has authority to postpone or defer, by rules or orders made and issued by the superintendent, for such time or times as the superintendent determines, the payment of any amount payable under the terms of any policy of insurance, annuity or pure endowment contract, and the payment of judgments, notes, drafts, checks, bills of exchange or other forms of payment of claims due from insurers to any person, firm or corporation, whether such claim is liquidated or unliquidated, due or to become due at a day certain, and defer the payment of premiums on policies affected by such postponements or suspensions and may direct payment in full or in part whenever in the superintendent's discretion such payment may be safely consummated. [RR 2021, c. 1, Pt. B, §184 (COR).]
24-A M.R.S. § 1425 — ME Code / Title 24-A / Chapter 16 / Section 1425
24-A §1425. Investigation of license applicants
Status: in_force

When an application for license under this chapter is submitted, the superintendent may investigate the applicant's character, financial responsibility, experience, background and fitness for the license applied for. [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]
24 M.R.S. § 2302-A — ME Code / Title 24 / Chapter 19 / Section 2302-A
24 §2302-A. Utilization review data
Status: in_force

1. Report required. On or before April 1st of each year, every nonprofit hospital or medical service organization which issues or administers a program or contract in this State that contains a provision whereby in nonemergency cases the insured is required to be prospectively evaluated through a prehospital admission certification, preinpatient service eligibility program or any similar preutilization review or screening procedure prior to the delivery of contemplated hospitalization, inpatient or outpatient health care or medical services which are prescribed or ordered by a duly licensed physician shall file a report on the results of that evaluation for the preceding year with the superintendent which shall contain the following: A. The number and type of evaluations performed. (1) For the purposes of this section, the term "type of evaluations" means the following preutilization review categories: Presurgical inpatient days; setting of medical service, such as inpatient or outpatient services; and the number of days of service; [PL 1987, c. 168, §1 (NEW).] B. The result of the evaluation, such as whether the medical necessity of the level of service contemplated by the patient's physician was agreed to or whether benefits paid for the service were reduced by the organization; [PL 1987, c. 168, §1 (NEW).] C. The number and result of any appeals by patients or their physicians as a result of initial review decisions to reduce benefits for services as determined through prospective evaluations; and [PL 1987, c. 168, §1 (NEW).] D. Any complaints filed in a court of competent jurisdiction and served upon an organization filing under this section stating a cause of action against the organization on the basis of damages to patients alleged to have been proximately caused by a delay, reduction or denial of medical benefits by the organization, as determined through prospective evaluations, and the determination of liability or other disposition of the complaint. [PL 1987, c. 168, §1 (NEW).] [PL 1987, c. 168, §1 (NEW).]

2. Maine residents. This section is applicable to evaluations, appeals and complaints relating to Maine residents only. [PL 1987, c. 168, §1 (NEW).]

3. Confidentiality. Any information provided pursuant to this section may not identify the names of patients. If patient names are identified in information provided pursuant to this section, the patient names are confidential. [PL 2023, c. 123, §1 (AMD).]
24-A M.R.S. § 2762 — ME Code / Title 24-A / Chapter 33 / Section 2762
24-A §2762. Coverage for hearing aids
Status: in_force

1. Hearing aid; definition. For purposes of this section, "hearing aid" means a nonexperimental, wearable instrument or device designed for the ear and offered for the purpose of aiding or compensating for impaired human hearing, excluding batteries and cords and other assistive listening devices, including, but not limited to, frequency modulation systems. [PL 2007, c. 452, §2 (NEW).]

2. Required coverage. All individual health policies and contracts must provide coverage for the purchase of a hearing aid for each hearing-impaired ear for an individual covered under the policy or contract in accordance with the following requirements. A. The hearing loss must be documented by a physician or audiologist licensed pursuant to Title 32, chapter 137 . [PL 2015, c. 494, Pt. A, §28 (AMD).] B. The hearing aid must be purchased in accordance with federal and state laws, regulations and rules for the sale and dispensing of hearing aids. [PL 2019, c. 418, §1 (AMD).] C. The policy or contract may limit coverage to $3,000 per hearing aid for each hearing-impaired ear every 36 months. [PL 2019, c. 418, §1 (AMD); PL 2019, c. 418, §7 (AFF).] [PL 2019, c. 418, §1 (AMD); PL 2019, c. 418, §7 (AFF).]

3. Application of coverage. [PL 2019, c. 418, §2 (RP); PL 2019, c. 418, §7 (AFF).]

4. Limits; coinsurance; deductibles. Except as otherwise provided in this section, any policy or contract that provides coverage for services under this section may contain provisions for maximum benefits and coinsurance and reasonable limitations, deductibles and exclusions to the extent that these provisions are not inconsistent with the requirements of this section. [PL 2007, c. 452, §2 (NEW).]
24-A M.R.S. § 223 — ME Code / Title 24-A / Chapter 3 / Section 223
24-A §223. Conduct of examination; access to records; correction
Status: in_force

1. Whenever the superintendent determines to examine the affairs of any person, the superintendent shall designate one or more examiners and instruct them as to the scope of the examination. The superintendent may designate a bureau employee or may designate an examiner outside the bureau who has been retained pursuant to section 208 . Examiners may be attorneys, appraisers, independent actuaries, independent certified public accountants or other professionals and specialists with skills relevant to the examination. The examiner shall, upon demand, exhibit the examiner's official credentials to the person under examination. A. An examiner may not be designated by the superintendent if the examiner directly or indirectly has a conflict of interest or is affiliated with the management of or owns a pecuniary interest in any person subject to examination under sections 221 and 222 . This section may not be construed to preclude automatically an examiner from being: (1) A policyholder or claimant under an insurance policy; (2) A grantor of a mortgage or similar instrument on the examiner's residence to a regulated entity if done under customary terms and in the ordinary course of business; (3) An investment owner in shares of regulated diversified investment companies; or (4) A settlor or beneficiary of a "blind trust" into which any otherwise impermissible holdings have been placed. [PL 1991, c. 828, §7 (NEW).] [PL 2017, c. 169, Pt. B, §11 (AMD).]

2. The superintendent shall conduct each examination in an expeditious, fair and impartial manner, consistent with current guidelines and procedures adopted from time to time by the National Association of Insurance Commissioners and published in its Financial Condition Examiners Handbook or Market Regulation Handbook, as applicable, or their successor publications. [PL 2017, c. 169, Pt. B, §12 (AMD).]

3. Upon any such examination, the superintendent, or the examiner if specifically so authorized in writing by the superintendent, shall have power to administer oaths, and to examine under oath any individual as to any matter relevant to the affairs under examination or relevant to the examination. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

4. Every person being examined, its officers, attorneys, employees, agents and representatives shall make freely available to the superintendent or designated examiners the accounts, records, documents, files, information, assets and matters of that person in that person's possession or control relating to the subject of the examination and shall facilitate the examination. The refusal of any insurer to submit to examination is grounds for revocation or refusal of a license or renewal license. [PL 1991, c. 828, §8 (AMD).]

5. If the superintendent or examiner finds any accounts or records to be inadequate, or inadequately kept or posted, the superintendent may employ experts to reconstruct, rewrite, post or balance them at the expense of the person being examined, if such person has failed to maintain, complete or correct such records or accounting after the superintendent or examiner has given such person written notice and a reasonable opportunity to do so. [RR 2021, c. 1, Pt. B, §166 (COR).]

6. Neither the superintendent nor any examiner shall remove any record, account, document, file or other property of the person being examined from the offices or place of such person, except with the written consent of such person in advance of such removal or pursuant to an order of court duly obtained. This provision shall not be deemed to affect the making and removal of copies or abstracts of any such record, account, document, or file. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

7. Any individual who refuses without just cause to be examined under oath or who willfully obstructs or interferes with the examiners in the exercise of their authority pursuant to this section shall, upon conviction thereof, be subject to a fine of not more than $2,500 or imprisonment for less than a year, or by both. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2536 — ME Code / Title 24-A / Chapter 29 / Section 2536
24-A §2536. Participating, nonparticipating policies -- right to issue
Status: in_force

A life insurer may issue policies on either the participating basis or the nonparticipating basis, or on both bases, if the right or absence of right of participation is reasonably related to the premium charged and the insurer is otherwise not in violation of sections 2159 (unfair discrimination -- life insurance, annuities, and health insurance) or 2160 (rebates -- life, health and annuity contracts). [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 4317-A — ME Code / Title 24-A / Chapter 56-A / Section 4317-A
24-A §4317-A. Prescription drug coverage; out-of-pocket expenses for coinsurance
Status: in_force

1. Out-of-pocket expenses for coinsurance within health plan's total limit. If a carrier that provides coverage for prescription drugs does not include prescription drugs subject to coinsurance under the total out-of-pocket limit for all benefits provided under a health plan, the carrier shall establish a separate out-of-pocket limit not to exceed $3,500 per year for prescription drugs subject to coinsurance provided under a health plan to the extent not inconsistent with the federal Affordable Care Act. [PL 2011, c. 611, §1 (NEW); PL 2011, c. 611, §2 (AFF).]

2. Adjustment of out-of-pocket limits. A carrier may adjust an out-of-pocket limit, as long as any limit for prescription drugs for coinsurance does not exceed $3,500, to minimize any premium increase that might otherwise result from the requirements of this section. Any adjustment made by a carrier pursuant to this subsection is considered a minor modification under section 2850‑B . [PL 2011, c. 611, §1 (NEW); PL 2011, c. 611, §2 (AFF).]

3. Construction. This section may not be construed to prohibit or limit a carrier's ability to establish specialty tiers for prescription drug coverage, to make determinations of medical necessity or to enforce procedures regarding prior authorization or utilization review in accordance with this chapter. [PL 2011, c. 611, §1 (NEW); PL 2011, c. 611, §2 (AFF).]

4. Terms consistent with federal law. For the purposes of this section, the use of the terms "coinsurance" and "out-of-pocket limit" by a carrier must be consistent with the definitions of those terms as prescribed by the Secretary of the United States Department of Health and Human Services pursuant to Section 2715 of the federal Affordable Care Act. [PL 2011, c. 611, §1 (NEW); PL 2011, c. 611, §2 (AFF).]
24-A M.R.S. § 3711 — ME Code / Title 24-A / Chapter 52 / Section 3711
24-A §3711. Operation of the company
Status: in_force

1. Coverage availability. On or after January 1, 1993, the company shall provide workers' compensation and incidental employers' liability coverage to employers otherwise entitled to coverage, but not able to or not electing to purchase coverage in the voluntary insurance market, and not authorized, either individually or as part of a group, to self-insure. An authorized self-insured is eligible for coverage upon termination of self-insurance. [PL 1991, c. 885, Pt. C, §8 (NEW).]

2. Federal coverage. The board shall authorize the availability of federal workers' compensation coverage under the Longshore and Harbor Workers' Compensation Act, 33 United States Code, Section 901, et seq., the Defense Base Act, 42 United States Code, Section 1651, et seq., the Federal Employers Liability Act, 45 United States Code, Section 51, et seq., and any federal maritime or admiralty coverage. The board is authorized to make available Outer Continental Shelf Lands Act, 43 United States Code, Section 1331, et seq., coverage, Nonappropriated Fund Instrumentalities Employees' Retirement Credit Act of 1986, 5 United States Code, Section 8171, et seq., coverage, and any other coverages by special endorsements that may be required of an insured by contract or other needs. [PL 1991, c. 885, Pt. C, §8 (NEW).]

3. Coverage denial. The company shall deny coverage to any employer who owes undisputed premiums to a previous workers' compensation carrier or to the workers' compensation residual market mechanism, or fails to comply with reasonable safety requirements the company is legally authorized to establish. [PL 1991, c. 885, Pt. C, §8 (NEW).]
24-A M.R.S. § 2791 — ME Code / Title 24-A / Chapter 34-B / Section 2791
24-A §2791. Definitions
Status: in_force

As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings. [PL 2019, c. 653, Pt. B, §2 (NEW).]

1. Individual health plan. "Individual health plan" has the same meaning as in section 2736‑C, subsection 1, paragraph C . [PL 2019, c. 653, Pt. B, §2 (NEW).]

2. Small group health plan. "Small group health plan" has the same meaning as in section 2808‑B, subsection 1, paragraph G . [PL 2019, c. 653, Pt. B, §2 (NEW).]
24-A M.R.S. § 4450 — ME Code / Title 24-A / Chapter 57 / Section 4450
24-A §4450. Termination of association
Status: in_force

The superintendent shall by order terminate the operation of the association as to any kind of insurance with respect to which the superintendent has found, after notice and hearing, that there is in effect a statutory plan of the United States Government to avoid excessive delay or financial loss to claimants or policyholders because of insurer insolvency and that provides for protection and benefits to residents of this State not materially less favorable than provided under this subchapter. Such order for termination continues the operation of this subchapter with respect to prior insurer insolvencies not covered by such plan. The order must also provide for a proportionate distribution of the assets of the association to insurers that will cease to be members of the association on the effective date of the order. [RR 2021, c. 1, Pt. B, §391 (COR).]
24-A M.R.S. § 2159 — ME Code / Title 24-A / Chapter 23 / Section 2159
24-A §2159. Unfair discrimination -- life insurance, annuities and health insurance
Status: in_force

1. No person shall make or permit any unfair discrimination between individuals of the same class and equal expectation of life in the rates charged for any contract of life insurance or of life annuity or in the dividends or other benefits payable thereon, or in any other of the terms and conditions of such contract. [PL 1969, c. 132, §1 (NEW).]

2. No person may make or permit any unfair discrimination between individuals of the same class and of essentially the same hazard in the amount of premium, policy fees, or rates charged for any policy or contract of health insurance or in the benefits payable thereunder, or in any of the terms or conditions of such contract, or in any other manner whatever. Nothing in this provision prohibits an insurer from providing incentives for insureds to use the services of a particular provider. [PL 1985, c. 704, §3 (AMD).]

3. It shall be an unfair trade practice in the business of insurance for any insurer to discriminate unfairly against any person who has tested positive for the presence of the human immunodeficiency antigen or the presence of an antibody to the human immunodeficiency virus or who has Acquired Immune Deficiency Syndrome or AIDS, AIDS Related Complex (ARC) or HIV related diseases provided that nothing in this subsection prohibits an insurer from treating individuals of different classes and of unequal expectations of life, or essentially different hazards, differently in accordance with subsection 1 or 2 . [PL 1989, c. 176, §2 (NEW).]

4. It shall not be unfair discrimination for group life insurance policies or contracts subject to chapter 31 to contain an exclusion or restriction for death caused by Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or HIV related diseases which existed 6 months prior to the individual's effective date of insurance if an actuarial justification is filed and approved by the superintendent. The exclusion or restriction may run for no longer than the incontestable period of the policy within the meaning of section 2615 . [PL 1989, c. 176, §2 (NEW).]

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

6. Test results. No insurer may request any person to reveal whether the person has obtained a test for the presence of antibodies to HIV or a test to measure the virus or to reveal the results of such tests taken prior to an application for insurance coverage. [PL 1991, c. 3, §3 (NEW).]

7. Discrimination prohibited; preexposure prophylaxis medication to prevent HIV infection. Notwithstanding any provision of law to the contrary, an insurer authorized to do business in this State may not: A. Limit coverage or refuse to issue or renew coverage of an individual under a life, disability income or long-term care insurance policy due to the fact that the individual has been prescribed preexposure prophylaxis medication to prevent HIV infection; [PL 2019, c. 596, §1 (NEW).] B. Consider the fact that an individual has been issued a prescription for preexposure prophylaxis medication to prevent HIV infection in determining the premium rate for coverage of that individual under a life, disability income or long-term care insurance policy; or [PL 2019, c. 596, §1 (NEW).] C. Otherwise discriminate in the offering, issuance, cancellation, amount of coverage, price or any other condition of a life, disability income or long-term care insurance policy based solely and without any additional actuarial justification upon the fact that an individual has been issued a prescription for preexposure prophylaxis medication to prevent HIV infection. [PL 2019, c. 596, §1 (NEW).] [PL 2019, c. 596, §1 (NEW).]
24-A M.R.S. § 1420-O — ME Code / Title 24-A / Chapter 16 / Section 1420-O
24-A §1420-O. Reciprocity
Status: in_force

1. Reciprocity. The superintendent shall waive any requirements for a nonresident license applicant with a valid license from that person's home state, except the requirements imposed by section 1420‑G , if the applicant's home state awards nonresident licenses to residents of this State on the same basis. [PL 2001, c. 259, §24 (NEW).]

2. Continuing education. Satisfaction of a nonresident producer's home state's continuing education requirements for licensed insurance producers constitutes satisfaction of this State's continuing education requirements if the nonresident producer's home state recognizes the satisfaction of its continuing education requirements imposed upon producers from this State on the same basis. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 420 — ME Code / Title 24-A / Chapter 5 / Section 420
24-A §420. General corporation laws inapplicable to foreign insurers
Status: in_force

The general corporation laws of this State shall not apply as to foreign insurers holding certificates of authority to transact insurance in this State. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 6610 — ME Code / Title 24-A / Chapter 81 / Section 6610
24-A §6610. Termination
Status: in_force

If an arrangement is terminated for any reason, the trust may not be dissolved until all outstanding claims, debts and obligations of the arrangement are paid. The arrangement may retain sufficient funds to provide coverage for an additional period as the trustees of the arrangement consider prudent. In addition, the trustees may purchase additional insurance they consider necessary for protection against potential future claims. Any funds remaining in the arrangement after satisfaction of all obligations must be paid to participating employers or covered employees in an equitable manner meeting with the approval of the superintendent, including, without ruling out other alternatives, equally on a per capita basis to each participating employer or employee who is covered under the arrangement as of the effective date of termination. Written notice of the termination of the arrangement must be provided to each covered employee, the Department of Labor, Bureau of Labor Standards and the superintendent at least 10 days before the effective date of the termination. [PL 1995, c. 618, §12 (AMD).]

If an arrangement provided by a registered employee leasing company is terminated for any reason, written notice of the termination of the arrangement must be provided by the employee leasing company to each covered employee, the client companies involved, the Department of Labor, Bureau of Labor Standards and the superintendent at least 10 days before the effective date of the termination. [PL 1995, c. 618, §12 (NEW).]
24-A M.R.S. § 2204 — ME Code / Title 24-A / Chapter 24 / Section 2204
24-A §2204. Definitions
Status: in_force

As used in this chapter, unless the context indicates otherwise, the following terms have the following meanings. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

1. Adverse underwriting decision. "Adverse underwriting decision" means any of the following actions with respect to consumer insurance transactions involving insurance coverage that is individually underwritten: A. A declination, cancellation or nonrenewal of insurance coverage, in whole or part; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. Failure of a producer or agency to apply for insurance coverage with a specific insurance institution that the producer or agency represents and that is requested by an applicant; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. An offer to insure at higher than standard rates; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] D. Any other increase in any charge for, any reduction in or other adverse or unfavorable change in the terms of coverage or amount of any insurance, existing or applied for. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

2. Affiliate; affiliated. "Affiliate" or "affiliated" means a person that directly, or indirectly through one or more intermediaries, controls, is controlled by or is under common control with another person. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

3. Applicant. "Applicant" means any person who seeks to contract for insurance coverage other than a person seeking group insurance that is not individually underwritten. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

4. Confidential investigative information. "Confidential investigative information" means any information that: A. Relates to a claim for insurance benefits or a civil or criminal proceeding involving an individual; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. Is collected in connection with or in reasonable anticipation of a claim for insurance benefits or a civil or criminal proceeding involving an individual; and [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. Has not been disclosed to 3rd parties in violation of section 2215 . [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

5. Consumer insurance transaction. "Consumer insurance transaction" means an insurance transaction involving insurance primarily for personal, family or household needs rather than business or professional needs. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

6. Consumer report. "Consumer report" has the same meaning as in 15 United States Code, Section 1681a(d). [PL 2013, c. 588, Pt. C, §11 (AMD).]

7. Consumer reporting agency. "Consumer reporting agency" has the same meaning as in Title 10, section 1308, subsection 3 . [PL 2013, c. 588, Pt. C, §11 (AMD).]

8. Control; controlled by; under common control with. "Control," including the terms "controlled by" and "under common control with," means the possession, direct or indirect, of the power to direct or cause the direction of the management and policies of a person, whether through the ownership of voting securities, by contract other than a commercial contract for goods or nonmanagement services or otherwise, unless the power is the result of an official position with or a corporate office held by the person. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

9. Health care. "Health care" means preventative, diagnostic, therapeutic, rehabilitative, maintenance or palliative care, services, procedures or counseling, including appropriate assistance with disease or symptom management and maintenance, that affects an individual's physical, mental or behavioral condition, including individual cells or their components or genetic information, or affects the structure or function of the human body or any part of the human body. "Health care" includes prescribing, dispensing, furnishing or providing to a patient drugs, biologicals, medical devices, health care equipment and supplies or hospice services and the banking of blood, sperm, organs or any other tissue. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

10. Health care facility. "Health care facility" means a facility, institution or entity licensed pursuant to Title 22 that offers health care to persons in this State, including a home health care entity and a hospice program, or a pharmacy licensed pursuant to Title 32 . For the purposes of this chapter, "health care facility" does not include a state mental health institute, the Elizabeth Levinson Center, the Aroostook Residential Center or Freeport Towne Square. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

11. Health care information. "Health care information" means information that: A. Relates to an individual's physical, mental or behavioral condition, personal or family medical history or health care; and [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. Is obtained from a health care provider, from the individual or from the individual's spouse, parent or legal guardian. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

12. Health care practitioner. "Health care practitioner" means a person licensed in this State to provide or otherwise lawfully providing health care, and includes a partnership or corporation made up of health care practitioners, or an officer, employee, agent or contractor of a health care practitioner acting in the course and scope of employment, agency or contract related to or supportive of the provision of health care to an individual. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

13. Health care provider. "Health care provider" means a health care practitioner or health care facility. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

14. Institutional source. "Institutional source" means any person or governmental entity that provides information about an individual to a regulated insurance entity or insurance support organization other than: A. A producer or producer agency; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. The individual who is the subject of the information; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. An individual acting in a personal capacity rather than in a business or professional capacity. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

15. Insurance carrier; carrier. "Insurance carrier" or "carrier" means: A. Any person or entity required to be licensed by the superintendent to assume risk, including without limitation an insurer, nonprofit hospital, medical or health care service organization, health maintenance organization or multiple-employer welfare arrangement; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. A self-funded plan subject to state regulation as described in section 2848‑A ; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. A preferred provider arrangement administrator as defined in section 2671 ; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] D. A 3rd-party administrator, as described in section 1901 , that provides administrative services for an entity that is not a carrier. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] "Carrier" does not include other nonrisk-bearing regulated insurance entities, such as producers or agencies. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

16. Insurance consumer; consumer. "Insurance consumer" or "consumer" means any individual who resides or obtains insurance in this State and: A. Is a past, present or proposed principal insured or certificate holder; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. Is a past, present or proposed policyowner; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. Is a past or present applicant; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] D. Is a past or present claimant; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] E. Derived, derives or is proposed to derive insurance coverage under an insurance policy or certificate subject to this chapter. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

17. Insurance support organization. "Insurance support organization" means any person, other than a regulated insurance entity, health care provider or governmental agency, who regularly engages, in whole or in part, in the practice of assembling or collecting information for the primary purpose of providing the information to carriers, producers or agencies for insurance transactions, including: A. Furnishing consumer reports or investigative consumer reports for use in connection with insurance transactions; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. Collecting personal information from regulated insurance entities or other insurance support organizations for the purpose of detecting or preventing fraud, material misrepresentation or material nondisclosure in connection with insurance underwriting or insurance claim activity. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

18. Insurance transaction. "Insurance transaction" means any transaction that entails: A. The determination of an individual's eligibility for an insurance coverage, benefit or payment; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. The servicing of an insurance application, policy, contract or certificate. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

19. Investigative consumer report. "Investigative consumer report" has the same meaning as in 15 United States Code, Section 1681a(e). [PL 2013, c. 588, Pt. C, §11 (AMD).]

20. Personal information. "Personal information" means any information that identifies an individual gathered in connection with an insurance transaction from which judgments can be made about an individual's character, habits, avocations, finances, occupation, general reputation, credit, health or any other personal characteristics. "Personal information" includes but is not limited to an individual's name and address and health care information. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

21. Policyholder. "Policyholder" means any person who: A. Is a present policyowner; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. In the case of group insurance that is individually underwritten, is a present group certificate holder. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

22. Pretext interview. "Pretext interview" means an interview wherein a person, in an attempt to obtain information, performs one or more of the following acts: A. Pretends to be someone the person is not; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] B. Pretends to represent a person that person is not in fact representing; [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] C. Misrepresents the true purpose of the interview; or [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] D. Refuses to provide that person's identity upon request. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).] [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

23. Regulated insurance entity. "Regulated insurance entity" means any person or entity required to be licensed by the superintendent under this Title or Title 24 , including without limitation a carrier, producer, producer agency or administrator. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]

24. Residual market. "Residual market" means any special-purpose insurer, association, organization or other entity that provides insurance coverage to persons who are unable to obtain it in the voluntary market. [PL 1997, c. 677, §3 (NEW); PL 1997, c. 677, §5 (AFF).]
24-A M.R.S. § 2450 — ME Code / Title 24-A / Chapter 27 / Section 2450
24-A §2450. Eligibility for health insurance in certain cases
Status: in_force

No policy of accident or health insurance, or group or blanket accident or health insurance or renewals thereof, shall be denied or not renewed by the insurer, solely because the mother of the insured has taken or is discovered to have taken diethylstilbestrol, commonly referred to as DES. [PL 1979, c. 415, §3 (NEW).]
24-A M.R.S. § 4317-E — ME Code / Title 24-A / Chapter 56-A / Section 4317-E
24-A §4317-E. Coverage for emergency supply of chronic maintenance drugs
Status: in_force

1. Definition. As used in this section, unless the context otherwise indicates, "chronic maintenance drug" has the same meaning as in Title 32, section 13786‑F, subsection 1 . [PL 2021, c. 566, §1 (NEW).]

2. Coverage required. A carrier offering a health plan in this State must make available coverage for an emergency supply of a chronic maintenance drug dispensed pursuant to Title 32, section 13786‑F in the same manner as coverage for other drugs under the health plan. A carrier may impose any deductible, copayment, coinsurance or other cost-sharing requirement for the chronic maintenance drug as long as the amount of the deductible, copayment, coinsurance or other cost-sharing requirement is applied in the same manner as if the chronic maintenance drug were dispensed as prescribed by a provider. [PL 2021, c. 566, §1 (NEW).]

3. Application. This section does not apply to a health plan offered for use with a health savings account unless the federal Internal Revenue Service determines that the benefits required by this section are permissible benefits in a high deductible health plan as defined in the federal Internal Revenue Code, Section 223(c)(2). [PL 2021, c. 566, §1 (NEW).]
24-A M.R.S. § 3048 — ME Code / Title 24-A / Chapter 41 / Section 3048
24-A §3048. Scope of subchapter
Status: in_force

This subchapter shall apply to policies of insurance, other than automobile insurance and workers' compensation insurance, on risks located or resident in this State which are issued and take effect or which are renewed after the effective date of this subchapter and insuring against any of the following: [PL 1989, c. 502, Pt. A, §99 (AMD).]

1. Loss of or damage to real property which is used solely for residential purposes and which consists of not more than 4 apartments and which is owner-occupied; [PL 1973, c. 239 (NEW).]

2. Loss of or damage to personal property in which natural persons resident in specifically described real property of the kind described in subsection 1 have an insurable interest, except personal property used in the conduct of a commercial or industrial enterprise; [PL 1973, c. 239 (NEW).]

3. Legal liability of a natural person or persons for loss of, damage to or injury to persons or property, but not including policies primarily insuring risks arising from the conduct of a commercial or industrial enterprise. [PL 1973, c. 239 (NEW).]

Any policy written for a term longer than one year or with no fixed expiration date shall be considered, for purposes of this subchapter, written for successive policy terms of one year. [PL 1979, c. 411, §1 (NEW).]
24-A M.R.S. § 3488 — ME Code / Title 24-A / Chapter 47 / Section 3488
24-A §3488. Reorganization of mutual insurer through formation of mutual holding company
Status: in_force

1. Procedure for reorganization as stock insurer. A mutual insurer may be reorganized as a stock insurer within a mutual holding company as provided in this section. The mutual insurer shall submit to the superintendent a reasonable reorganization plan, referred to in this section as the "plan," and the procedure for putting the plan into effect. A hearing must be held on the plan. Notice of the hearing must be provided pursuant to section 230 to the insurer, its directors or trustees, its officers, employees and its policyholders, all of whom have the right to appear and be heard at the hearing. The plan may not take effect unless approved by the superintendent. [PL 1999, c. 656, §5 (NEW).]

2. Plan requirements. The plan must contain provisions for: A. The reorganizing insurer to become a stock insurer; [PL 1999, c. 656, §5 (NEW).] B. The formation of a mutual holding company; [PL 1999, c. 656, §5 (NEW).] C. The members of the reorganizing insurer to become members of the mutual holding company with membership interests therein and the membership interests in the reorganizing insurer to be extinguished; and [PL 1999, c. 656, §5 (NEW).] D. At least 51% of the voting stock issued and outstanding by the reorganized insurer to be acquired and held, directly or through one or more stock holding companies, by the mutual holding company. [PL 1999, c. 656, §5 (NEW).] [PL 1999, c. 656, §5 (NEW).]

3. Number of stock holding companies. The plan may provide for the formation of one or more intermediate stock holding companies. [PL 1999, c. 656, §5 (NEW).]

4. Approval of plan. The superintendent may not approve a plan unless: A. The terms and conditions of the plan are fair and equitable; [PL 1999, c. 656, §5 (NEW).] B. The plan is subject to approval by vote of not less than 2/3 of the insurer's policyholders voting on the plan in person, by proxy or by mail at a meeting of policyholders called by the insurer for that purpose pursuant to reasonable notice of the meeting and procedures as approved by the superintendent. The plan must specify that only persons who were policyholders both at least one year before the submission of the plan to the superintendent and on a subsequent date before the vote found reasonable by the superintendent are entitled to vote. Each eligible policyholder is entitled to one vote; [PL 1999, c. 656, §5 (NEW).] C. The plan, when completed, would provide paid-in capital stock for the reorganized insurer in an amount not less than the minimum paid-in capital stock required of a new domestic stock insurer upon initial authorization to transact like kinds of insurance, together with expendable surplus funds in an amount not less than 1/2 of such required capital stock; and [PL 1999, c. 656, §5 (NEW).] D. The superintendent finds that the insurer's management has not, through reduction in volume of new business written or cancellation or any other means, sought to reduce, limit or affect the number or identity of the reorganizing insurer's members to be entitled to participate in the plan or to secure for the individuals comprising management any unfair advantage through the plan. [PL 1999, c. 656, §5 (NEW).] [PL 1999, c. 656, §5 (NEW).]

5. Compensation. A director, officer, agent or employee of the reorganizing insurer or any other person may not receive any fee, commission or other valuable consideration whatsoever, other than that person's usual regular salary and compensation, for in any manner aiding, promoting or assisting in the reorganization except as set forth in the plan approved by the superintendent. This provision does not prohibit the payment of reasonable fees and compensation to attorneys, accountants or actuaries for services performed in the independent practice of their professions, even though they also may be directors of the insurer. [PL 1999, c. 656, §5 (NEW).]

6. Effective date of plan. The plan becomes effective, after approval by the superintendent and by the policyholders, upon the filing with the superintendent and the Secretary of State of amended and restated articles of incorporation of the reorganized insurer pursuant to section 3310 and articles of incorporation of the mutual holding company and any related stock holding company. [PL 1999, c. 656, §5 (NEW).]

7. Consequence of effective plan. The following are the consequences of a plan that becomes effective pursuant to subsection 6 . A. The reorganizing insurer immediately becomes a domestic stock insurer. [PL 1999, c. 656, §5 (NEW).] B. The members of the reorganizing insurer on the effective date immediately become members of the mutual holding company with membership interests in that holding company. All membership interests in the reorganizing insurer are extinguished. [PL 1999, c. 656, §5 (NEW).] C. A person becoming a policyholder of the reorganized insurer after the effective date of the plan becomes a member of the mutual holding company immediately upon issuance of the policy or contract. [PL 1999, c. 656, §5 (NEW).] D. One hundred percent of the voting stock issued by the reorganized insurer in the reorganization is owned, directly or through one or more stock holding companies, by the mutual holding company. All stock issued by the reorganized insurer in the reorganization is considered duly and validly issued, fully paid and nonassessable. [PL 1999, c. 656, §5 (NEW).] E. The reorganized insurer is a continuation of the reorganizing insurer. The reorganization may not annul, modify or change any of the insurer's existing suits, rights, contracts or liabilities except as provided in the plan. [PL 1999, c. 656, §5 (NEW).] [PL 1999, c. 656, §5 (NEW).]

8. Assistance in determining approval of plan. For the purpose of determining whether a plan meets the requirements of this section and any other relevant provisions of this Title, the superintendent may employ staff personnel and outside consultants. All reasonable costs related to the review of a plan, including those attributable to the use of staff personnel, must be borne by the insurer or insurers making the filing. [PL 1999, c. 656, §5 (NEW).]

9. Injunctive relief and damages. If the reorganizing insurer complies substantially and in good faith with the requirements of subsection 4, paragraph B with respect to the giving of any required notice to policyholders, the insurer's failure to give notice to a person entitled to notice does not impair the validity of the actions and proceedings taken under this section or entitle that person to any injunctive or other equitable relief with respect to those actions and proceedings. This subsection does not impair any claim for damages that person would otherwise have due to failure to give notice. [PL 1999, c. 656, §5 (NEW).]

10. Exclusion of certain insurers. This section does not apply to an insurer authorized to transact life insurance or annuities or an insurer formed pursuant to chapter 52 . [PL 1999, c. 656, §5 (NEW).]
24-A M.R.S. § 2186 — ME Code / Title 24-A / Chapter 23 / Section 2186
24-A §2186. Insurance fraud prevention
Status: in_force

1. Definitions. As used in this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Fraudulent insurance act" means any of the following acts or omissions when committed knowingly and with intent to defraud: (1) Presenting, or causing to be presented, or preparing any information containing false representations as to a material fact with knowledge or belief that the information will be presented by or on behalf of an insured, claimant or applicant to an insurer, insurance producer or other person engaged in the business of insurance concerning any of the following: (a) An application for the issuance or renewal of an insurance policy; (b) The rating of an insurance policy; (c) A claim for payment or benefit pursuant to an insurance policy; (d) Payments made in accordance with an insurance policy; or (e) Premiums paid on an insurance policy; (2) Presenting, or causing to be presented, or preparing any information containing false representations as to a material fact with knowledge or belief that the information will be presented to or by an insurer, insurance producer or other person engaged in the business of insurance concerning any of the following: (a) A document filed with the superintendent or the insurance regulatory official or agency of another jurisdiction; (b) The financial condition of an insurer; (c) The formation, acquisition, merger, reconsolidation, dissolution or withdrawal from one or more lines of insurance in all or part of this State by an insurer; (d) The issuance of written evidence of insurance; or (e) The reinstatement of an insurance policy; (3) Soliciting or accepting new or renewal insurance risks on behalf of an insurer or other person engaged in the business of insurance by a person who knows or should know that the insurer or other person responsible for the risk is insolvent at the time of the transaction; (4) Removing, concealing, altering or destroying the assets or records of an insurer or other person engaged in the business of insurance; (5) Embezzling, abstracting, purloining or converting money, funds, premiums, credits or other property of an insurer or other person engaged in the business of insurance; (6) Transacting the business of insurance in violation of laws requiring a license, certificate of authority or other legal authority for the transaction of the business of insurance; or (7) Attempting to commit, aiding or abetting in the commission of, or conspiring to commit the acts or omissions described in this subsection. [PL 1997, c. 675, §2 (NEW).] B. "Insurer" means an authorized insurance company, fraternal benefit society, reinsurer, surplus lines insurer, unauthorized insurer, nonprofit hospital and medical service organization, health maintenance organization, risk retention group or multiple employer welfare organization. "Insurer" also includes an insurance producer or other person acting on the behalf of an insurer. For the purposes of this section, "insurer" also means the state Medicaid program. [PL 2009, c. 13, §2 (AMD).] [PL 2009, c. 13, §2 (AMD).]

2. Fraudulent insurance acts prohibited. A person may not commit a fraudulent insurance act. [PL 1997, c. 675, §2 (NEW).]

3. Fraud warning required. Fraud warnings are required in accordance with the following. A. All applications and claim forms for insurance used by insurers in this State, regardless of the form of transmission, must contain the following statement or a substantially similar statement permanently affixed to the application or claim form: "It is a crime to knowingly provide false, incomplete or misleading information to an insurance company for the purpose of defrauding the company. Penalties may include imprisonment, fines or a denial of insurance benefits." [PL 1997, c. 675, §2 (NEW).] B. The lack or omission of the statement required in paragraph A does not constitute a defense in any criminal prosecution or civil action for a fraudulent insurance act. [PL 1997, c. 675, §2 (NEW).] C. This subsection applies to all insurers except reinsurers. The statement required in paragraph A must be included in all applications and claim forms filed and approved for use by the superintendent on or after January 1, 1999. [PL 1997, c. 675, §2 (NEW).] [PL 1997, c. 675, §2 (NEW).]

4. Reporting of fraudulent insurance acts. Fraudulent insurance acts must be reported in accordance with this subsection. A. An insurer shall, annually on or before March 1st or within any reasonable extension of time granted by the superintendent, file with the superintendent a report relating to fraudulent insurance acts that the insurer knew or reasonably believed had been committed during the previous calendar year. The report must contain information required by the superintendent in the manner prescribed by the superintendent. The information must be reported on an aggregate basis and may not contain any information identifying any individuals or entities. The superintendent shall adopt by January 1, 1999 rules necessary to define the information that must be reported. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 1997, c. 675, §2 (NEW).] B. On the July 1st following the filing of the initial reports required by paragraph A , and annually thereafter, the superintendent shall report to the joint standing committee of the Legislature having jurisdiction over insurance matters. The report must include aggregate information detailing the fraudulent insurance activity experienced by insurers in this State. [PL 1997, c. 675, §2 (NEW).] [PL 1997, c. 675, §2 (NEW).]

5. Insurer antifraud plans. Within 6 months of the effective date of this Act, every insurer writing direct insurance shall prepare and implement an antifraud plan. This subsection does not apply to any agency, producer or other person acting on behalf of an insurer. The superintendent may review an insurer's antifraud plan to determine if the plan complies with the requirements of this subsection. The antifraud plan must outline specific procedures, appropriate to the lines of insurance the insurer writes in the State, to: A. Prevent, detect and investigate all forms of insurance fraud; [PL 1997, c. 675, §2 (NEW).] B. Educate appropriate employees on the antifraud plan and fraud detection; [PL 1997, c. 675, §2 (NEW).] C. Provide for the hiring of or contracting for fraud investigators; and [PL 1997, c. 675, §2 (NEW).] D. Report insurance fraud to appropriate law enforcement and regulatory authorities in the investigation and prosecution of insurance fraud. [PL 1997, c. 675, §2 (NEW).] [PL 1997, c. 675, §2 (NEW).]

6. Civil penalties. Any violation of this section is subject to civil penalties and other remedies as provided in section 12‑A . Notwithstanding section 2165‑A, subsection 1 , the superintendent may issue emergency cease and desist orders on the basis of conduct involving fraudulent insurance acts. [PL 1997, c. 675, §2 (NEW).]

7. Recovery costs. In a civil action in which it is proven that a person committed a fraudulent insurance act, the court may award reasonable attorney's fees and costs to the insurer. In a civil action in which the insurer alleges that a party committed a fraudulent insurance act that is not established at trial, the court may award reasonable attorney's fees and costs to the party if the allegation is not supported by any reasonable basis of law or fact. [PL 1997, c. 675, §2 (NEW).]
24-A M.R.S. § 1485 — ME Code / Title 24-A / Chapter 16 / Section 1485
24-A §1485. Rule-making authority
Status: in_force

The superintendent may establish by rule reasonable procedures and standards to fulfill the purposes of this subchapter and may contract with third parties for the purpose of fulfilling responsibilities under this subchapter. Rules adopted pursuant to this subchapter are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 1997, c. 457, §23 (NEW); PL 1997, c. 457, §55 (AFF).]
24-A M.R.S. § 2169-A — ME Code / Title 24-A / Chapter 23 / Section 2169-A
24-A §2169-A. Confidentiality of insurance information obtained by lenders
Status: in_force

1. Prohibited use of information. If a lender or creditor requires a purchaser or borrower to provide insurance information in connection with the extension of credit, an insurance agent or broker affiliated with that lender or creditor may not later use the information obtained to solicit or offer insurance directly to the purchaser or borrower. "Insurance information" means copies of insurance policies, binders, rates and expiration dates not otherwise in the possession of the agent or broker. "Affiliate" has the same meaning as set forth in section 1443‑A, subsection 1, paragraph A with respect to financial institutions and credit unions or in Title 9‑A, section 4‑403 with respect to supervised lenders. [PL 1999, c. 127, Pt. A, §42 (AMD).]

2. Use of information with consent. Notwithstanding subsection 1 , an insurance agent or broker affiliated with a lender or creditor may use the insurance information obtained from the purchaser or borrower to solicit or offer insurance to the customer if the customer consents in writing to the use of the information. This consent may not be a condition of the extension of credit to the customer. [PL 1997, c. 315, §27 (NEW).]

3. Information permitted under Fair Credit Reporting Act. Notwithstanding subsection 1 , a lender or creditor may exchange insurance information with its affiliates as permitted under the Fair Credit Reporting Act pursuant to Title 10, chapter 209‑B or 15 United States Code, Chapter 41. [PL 2013, c. 588, Pt. C, §6 (AMD).]
24-A M.R.S. § 4320-E — ME Code / Title 24-A / Chapter 56-A / Section 4320-E
24-A §4320-E. Reinsurance, risk corridors and risk adjustment
Status: in_force

1. Transitional reinsurance program. The superintendent shall establish a transitional reinsurance program for calendar years 2014, 2015 and 2016 as required by Section 1341 of the federal Affordable Care Act. [PL 2011, c. 364, §34 (NEW).]

2. Risk corridors. A carrier shall make any payments required under the risk corridors program established by the Secretary of the United States Department of Health and Human Services for calendar years 2014, 2015 and 2016 as required by Section 1342 of the federal Affordable Care Act. [PL 2011, c. 364, §34 (NEW).]

3. Risk adjustment. The superintendent shall establish a risk adjustment program as required by Section 1343 of the federal Affordable Care Act. [PL 2011, c. 364, §34 (NEW).]
24-A M.R.S. § 7106 — ME Code / Title 24-A / Chapter 91 / Section 7106
24-A §7106. Record-keeping requirements
Status: in_force

1. Provider records. A provider shall keep accurate accounts, books and records concerning transactions regulated under this chapter. The provider's accounts, books and records must include the following: A. Copies of each type of service contract sold; [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] B. The name and address of each service contract holder to the extent furnished by the service contract holder; [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] C. A list of the locations where service contracts are marketed, sold or offered for sale by the provider; and [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] D. Written claims files, which must contain at least the dates and descriptions of claims related to the provider's service contracts. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).] [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

2. Retention period. Except as provided in subsection 4 , a provider shall retain all records required to be maintained by this section for at least 3 years after the specified period of coverage has expired. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

3. Form of records. The records required under this chapter may be, but are not required to be, maintained on a computer disk or other record-keeping medium. If the records are maintained in other than hard copy, the records must be capable of transfer to legible hard copy at the request of the superintendent. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]

4. Discontinuation of business. A provider discontinuing business in this State shall maintain its records until it furnishes to the superintendent satisfactory proof that it has discharged all obligations to service contract holders in this State. [PL 2011, c. 345, §4 (NEW); PL 2011, c. 345, §7 (AFF).]
24-A M.R.S. § 3611 — ME Code / Title 24-A / Chapter 51 / Section 3611
24-A §3611. Guaranty capital shares; increase of paid-in capital
Status: in_force

If an insurer heretofore or hereafter has been authorized to transact insurance upon the basis of guaranty capital shares not 100% paid-in, the unpaid portion of such guaranty or so much thereof as the superintendent deems necessary, shall be paid in at such times as in the opinion of the superintendent is necessary for the adequate protection of the policyholders. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §1 (AMD).]
24-A M.R.S. § 4303-D — ME Code / Title 24-A / Chapter 56-A / Section 4303-D
24-A §4303-D. Provider directories
Status: in_force

1. Requirement. A carrier shall make available provider directories in accordance with this section. A. A carrier shall post electronically a current and accurate provider directory for each of its network plans with the information and search functions described in subsection 2 . In making the directory available electronically, the carrier shall ensure that the general public is able to view all of the current providers for a plan through a clearly identifiable link or tab and without creating or accessing an account or entering a policy or contract number. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] B. A carrier shall update each provider directory at least monthly. The carrier shall periodically audit at least a reasonable sample size of its provider directories for accuracy and retain documentation of such an audit to be made available to the superintendent upon request. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] C. A carrier shall provide a print copy, or a print copy of the requested directory information, of a current provider directory with the information described in subsection 2 upon request of a covered person or a prospective covered person. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] D. For each network plan, a carrier shall include in plain language in both the electronic and print directories the following general information: (1) A description of the criteria the carrier has used to build its provider network; (2) If applicable, a description of the criteria the carrier has used to tier providers; (3) If applicable, how the carrier designates the different provider tiers or levels in the network and identifies for each specific provider, hospital or other type of facility in the network the tier in which each is placed, whether by name, symbols, grouping or another designation, so that a covered person or a prospective covered person is able to identify the provider tier; and (4) If applicable, that authorization or referral may be required to access some providers. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] E. A carrier shall make clear in both its electronic and print directories which provider directory applies to which network plan by including the specific name of the network plan as marketed and issued in this State. The carrier shall include in both its electronic and print directories a customer service e-mail address and telephone number or electronic link that covered persons or the general public may use to notify the carrier of inaccurate provider directory information. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] F. For the information required pursuant to subsections 2 , 3 and 4 in a provider directory pertaining to a health care professional, a hospital or a facility other than a hospital, a carrier shall make available through the directory the source of the information and any limitations on the information, if applicable. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] G. A provider directory, whether in electronic or print format, must accommodate the communication needs of individuals with disabilities and include a link to or information regarding available assistance for persons with limited English proficiency. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).]

2. Information in searchable format. A carrier shall make available through an electronic provider directory, for each network plan, the information under this subsection in a searchable format: A. For health care professionals: (1) The health care professional's name; (2) The health care professional's gender; (3) The participating office location or locations; (4) The health care professional's specialty, if applicable; (5) Medical group affiliations, if applicable; (6) Facility affiliations, if applicable; (7) Participating facility affiliations, if applicable; (8) Languages other than English spoken by the health care professional, if applicable; and (9) Whether the health care professional is accepting new patients; [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] B. For hospitals: (1) The hospital's name; (2) The hospital's type; (3) Participating hospital location; and (4) The hospital's accreditation status. This paragraph does not apply to a carrier that offers network plans that consist solely of limited scope dental plans or limited scope vision plans; and [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] C. For facilities, other than hospitals, by type: (1) The facility's name; (2) The facility's type; (3) Types of services performed; and (4) Participating facility location or locations. This paragraph does not apply to a carrier that offers network plans that consist solely of limited scope dental plans or limited scope vision plans. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).]

3. Additional information. In the electronic provider directories for each network plan, a carrier shall make available the following information in addition to all of the information available under subsection 2 : A. For health care professionals: (1) Contact information. This subparagraph does not apply to a carrier that offers network plans that consist solely of limited scope dental plans or limited scope vision plans; (2) Board certifications. This subparagraph does not apply to a carrier that offers network plans that consist solely of limited scope dental plans or limited scope vision plans; and (3) Languages other than English spoken by clinical staff, if applicable; [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] B. For hospitals, the telephone number. This paragraph does not apply to a carrier that offers network plans that consist solely of limited scope dental plans or limited scope vision plans; and [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] C. For facilities other than hospitals, the telephone number. This paragraph does not apply to a carrier that offers network plans that consist solely of limited scope dental plans or limited scope vision plans. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).]

4. Information available in printed form. A carrier shall make available in print, upon request, the following provider directory information for the applicable network plan: A. For health care professionals: (1) The health care professional's name; (2) The health care professional's contact information; (3) Participating office location or locations; (4) The health care professional's specialty, if applicable; (5) Languages other than English spoken by the health care professional, if applicable; and (6) Whether the health care professional is accepting new patients; [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] B. For hospitals: (1) The hospital's name; (2) The hospital's type; and (3) Participating hospital location and telephone number; and [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] C. For facilities, other than hospitals, by type: (1) The facility's name; (2) The facility's type; (3) Types of services performed; and (4) Participating facility location and telephone number. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).] The carrier shall include a disclosure in the directory that the information included in the directory is accurate as of the date of printing and that covered persons or prospective covered persons should consult the carrier's electronic provider directory on its website to obtain current provider directory information. [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).]

5. Rulemaking. The superintendent may adopt rules to implement this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A . [PL 2017, c. 218, §2 (NEW); PL 2017, c. 218, §3 (AFF).]
24-A M.R.S. § 2386 — ME Code / Title 24-A / Chapter 25 / Section 2386
24-A §2386. Workers' compensation insurance residual market mechanism
Status: in_force

1. Participation. All insurers authorized to write workers' compensation and employers' liability insurance in this State shall participate in the workers' compensation insurance residual market mechanism, which is composed of an Accident Prevention Account and a Safety Pool. The residual market mechanism is not a state fund and the State has no proprietary interest in it or in any contributions made to it. This mechanism is exempt from any budgetary control or supervision by state agencies, except to the extent an insurance company is supervised or controlled by state agencies. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

2. Rules. [PL 1995, c. 289, §7 (RP).]

3. Accident Prevention Account; eligibility. Eligibility for insurance from the Accident Prevention Account is as follows. A. The Accident Prevention Account is an insurance plan that provides for the equitable apportionment among insurers of insurance that may be afforded applicants who are entitled to, but unable to, procure that insurance through ordinary methods because of their demonstrated accident frequency problem, measurably adverse loss ratio over a period of years or demonstrated attitude of noncompliance with safety requirements. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. An employer is eligible for insurance from the Accident Prevention Account if: (1) The employer has at least 2 lost-time claims over $10,000 and a loss ratio greater than 1.0 over the last 3 years for which data is available; and (2) The employer has attempted to obtain insurance in the voluntary market and has been refused by at least 2 insurers that write that insurance in the State. For the purpose of this section, an employer is considered to have been refused if offered insurance only under a retrospective rating plan or plans. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

4. Safety Pool; eligibility. Eligibility under the Safety Pool is as follows. A. The Safety Pool is an insurance plan that provides for an alternative source of insurance for employers with good safety records. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. An employer is eligible for the Safety Pool if that employer: (1) Has had no more than one lost-time claim in the last 3 years for which data is available, regardless of the resulting loss ratio; (2) Has a loss ratio that does not exceed 1.0 or has had no more than one lost-time claim over $10,000 over the last 3 years for which data is available; or (3) Has been in business for less than 3 years, provided that the eligibility terminates if the employer's loss ratio exceeds 1.0 and the employer has at least 2 lost-time claims over $10,000 each at the end of any year. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] C. A member of the Safety Pool who fails to meet eligibility requirements under paragraph B must be ordered to leave the Safety Pool after notice under former Title 39, section 23, subsection 1. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

5. Plan of operation. The superintendent shall adopt rules pursuant to Title 5, chapter 375, subchapter II , establishing a plan of operation for the residual market mechanism. A. The plan must include an experience rating system and merit rating plan providing that the premium of each employer in the account is modified either prospectively or retrospectively. An experience modification may only be applied to the manual rate of the plan. The sensitivity of a rating system may vary by size of the risk involved. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. The plan must include a procedure to handle appeals filed pursuant to former Title 39, section 106, subsection 2, paragraph B. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] C. The plan must provide for premium surcharges for employers in the Accident Prevention Account based on their specific loss experience within a specified period or other factors that are reasonably related to their risk of loss. (1) No premium surcharge may be applied to a risk whose threshold loss ratio is less than 1.0. The threshold loss ratio is based on the ratio of "L" to "P" where: (a) "L" is the actual incurred losses of a risk during the previous 3-year experience period as reported, except that the largest single loss during the 3-year period is limited to the amount of premium charged for the year in which the loss occurred; and (b) "P" is the premium charged to a risk during that 3-year period. (2) Premium surcharges apply to a premium that is experience or merit rating modified. (3) Premium surcharges are based on an insured's adverse deviation from expected incurred losses in the State. The surcharge is based on the ratio of "A" to "B" where: (a) "A" is the actual incurred losses of a risk during the previous 3-year experience period as reported; and (b) "B" is the expected incurred losses of a risk during that period as calculated under the uniform experience or merit rating plan multiplied by the risk's current experience or merit rating modification factor. (4) The premium surcharge is as follows: Ratio of "A" to "B" Surcharge Less than 1.20 None 1.20 or greater, but less than 1.30 5% 1.30 or greater, but less than 1.40 10% 1.40 or greater, but less than 1.50 15% 1.50 or greater 20% [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] D. Commissions under a plan must be established at a level that is neither an incentive nor a disincentive to place an employer in the residual market. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] E. In addition to factors in paragraphs A to C , any servicing contract must be approved on the basis of acceptable price and performance. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] F. If after notice and hearing the superintendent determines that insurers are unwilling to provide services that are reasonably necessary for the operation of the plan, the superintendent may award service contracts within various areas of the State on the basis of acceptable price and performance. If the superintendent chooses to award such contracts, the specifications must give special consideration to loss control, safety engineering and any other factor that affects safety. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] G. Beginning July 1, 1993, the plan must provide for a board of governors, which shall control the affairs and business of the residual market mechanism. The board of governors must be composed of 9 members, 5 of whom represent the business community of the State and 4 of whom represent insurers that are members of the residual market mechanism. The superintendent shall adopt rules to carry out the purposes of this paragraph. (1) The representatives of insurers on the board of governors are elected by the membership at the annual meeting of the residual market mechanism for staggered terms of 3 years, with the first appointments of one member for one year, one member for 2 years and 2 members for 3 years. An insurer or a group of insurers under common ownership, management or control may not be represented by more than one person on the board of governors. [PL 1995, c. 289, §8 (AMD).] [PL 1995, c. 289, §8 (AMD).]

5-A. Immunity. A member of the board of governors of the workers' compensation residual market pool created by Maine Insurance Rule Chapter 440 is immune from liability except for willful misconduct by the board member in the performance of the duties of a board member. [PL 1993, c. 364, §2 (NEW).]

6. Rates. Rate filings for rates in the Accident Prevention Account and the Safety Pool must be made together and are subject to former section 2363 . A. A rate filing for the residual market must include experience and merit rating plans. The experience rating plan is the uniform experience rating plan. The merit plan must provide the maximum credits possible to Safety Pool members on the basis of individual loss experience, including frequency and severity, consistent with this chapter and sound actuarial principles. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. The superintendent shall review the rates, rating plans and rules, including rates for individual classifications and subclassifications, in the Accident Prevention Account and the Safety Pool at least once every 2 years and may review rates more frequently if necessary. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] C. In a residual market rate proceeding, the superintendent may order payment of dividends to insureds in the Safety Pool to the extent that the pool's experience supports them. The superintendent may adopt rules establishing a dividend plan for the Safety Pool to provide an incentive for implementation of safety programs by insureds in the pool. The superintendent may employ outside consultants to assist in the development of these rules, the costs of which must be paid by the Safety Education and Training Fund established under Title 26, section 61 to the extent that funds are available. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

7. Mandatory deductible. A deductible applies to all workers' compensation insurance policies issued to employers in the Accident Prevention Account that meet the following qualifications: A. A net annual premium of $20,000 or more subject to adjustment pursuant to this section in the State; [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. A premium not subject to retrospective rating; and [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] C. The employer's threshold loss ratio, as determined under subsection 4, paragraph B , subparagraph (1), is 1.0 or greater. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] The deductible is $1,000 per claim but applies only to wage loss benefits paid on injuries occurring during the policy year. The sum of all deductibles in one policy year may not exceed the lesser of 15% of net annual premium or $25,000. Each loss to which a deductible applies must be paid in full by the insurer. After the policy year has expired, the employer shall reimburse the insurer the amount of the deductibles. This reimbursement must be considered as premium for purposes of cancellation or nonrenewal. For purposes of calculations required under this section, losses must be evaluated 60 days from the close of the policy year. Annually, on July 1st, the superintendent shall, by rule, adjust the $20,000 premium level established in this subsection to reflect any change in rates for the Accident Prevention Account and any change in wage levels in the preceding calendar year. Changes in wage levels are determined by reference to changes in the state average weekly wage, as computed by the Department of Labor. Any adjustment is rounded off to the nearest $1,000 increment. This subsection takes effect on the effective date of the first approved rate filing after the effective date of this Act. [PL 1995, c. 560, Pt. G, §8 (AMD).]

8. Mandatory retrospective rating. The superintendent may impose retrospective rating plans under the following circumstances: A. The superintendent shall by rule establish standards governing the application of retrospective rating plans under which the superintendent may order, after hearing, a retrospective rating plan for an employer in the Accident Prevention Account who has sufficient size in terms of premium and number of employees to warrant such rating and: (1) For the 3 most recent years for which data is available, an experience modification factor and a loss ratio that may indicate a serious problem of workplace safety; or (2) A demonstrated record of repeated serious violations of workplace health and safety regulations adopted under the Maine Revised Statutes, Title 26, chapter 6 , or 29 United States Code, Chapter 15, whichever is applicable. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] B. The maximum premium, including any applicable surcharge under this section, may not exceed 150% of standard premium. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).] [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

9. Credits for qualifying safety programs. The superintendent shall adopt rules to establish dividend plans and premium credits between 5% and 15% of net annual premiums for policyholders that establish or maintain qualifying safety programs. The rules must identify the classifications by which policyholders are eligible for the credits and establish criteria for qualifying safety programs and procedures to be followed by servicing carriers in approving and auditing compliance with the safety programs. The superintendent may employ outside consultants to assist in the development of rules under this subsection, the costs of which must be paid by the Safety Education and Training Fund established under Title 26, section 61 to the extent that funds are available. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

10. Contracts; consultants. [PL 1995, c. 289, §9 (RP).]

11. Report. [PL 1995, c. 289, §9 (RP).]

12. Rules. [PL 1995, c. 289, §9 (RP).]

13. Producer fees. The servicing carrier in the residual market shall pay a fee to the producer designated by the employer on renewed policies upon payment of premium due. The fee must be 4% of the first $5,000 of renewal premium and 2.5% of renewal premium in excess of $5,000. The fee must be based on the state standard premium. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

14. Termination of residual market mechanism. Workers' compensation and employers liability insurance coverage may not be issued through the workers' compensation insurance residual market mechanism on or after January 1, 1993. [PL 1991, c. 885, Pt. B, §12 (NEW); PL 1991, c. 885, Pt. B, §13 (AFF).]

15. Loan. [PL 1995, c. 289, §9 (RP).]
24-A M.R.S. § 2714 — ME Code / Title 24-A / Chapter 33 / Section 2714
24-A §2714. Physical examination, autopsy
Status: in_force

There shall be a provision as follows: Physical examination and autopsy: The insurer at its own expense shall have the right and opportunity to examine the person of the insured when and as often as it may reasonably require during the pendency of a claim hereunder and to make an autopsy in case of death where it is not forbidden by law. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 901-A — ME Code / Title 24-A / Chapter 11 / Section 901-A
24-A §901-A. Statutory accounting principles; reserves
Status: in_force

1. Principles; admitted assets. In evaluating the financial condition of an insurer, the superintendent shall determine which assets may be recognized as admitted assets and shall value the insurer's admitted assets and the insurer's liabilities: A. In accordance with recognized statutory accounting principles as codified by the National Association of Insurance Commissioners or its successor organization and reflected in the association's accounting practices and procedures manual and valuation of securities manual and their successor publications; and [PL 2001, c. 524, §1 (NEW).] B. In accordance with any additional accounting practices permitted by the superintendent upon the request of the insurer. [PL 2001, c. 524, §1 (NEW).] [PL 2001, c. 524, §1 (RPR).]

2. Reserve required. If the superintendent finds, in view of the character of investments held by a domestic insurer, that it would be prudent for the insurer to establish a special reserve for possible losses or fluctuations in the value of its investments, including realty holdings acquired by mortgage loan default, the superintendent may permit or require the insurer to establish such a reserve, reasonable in amount, and may require that the reserve be maintained and reported in any statement or report of the financial condition of the insurer. [PL 2001, c. 72, §7 (NEW).]

3. Rules. The superintendent may adopt rules to implement the purposes of this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A . [PL 2001, c. 72, §7 (NEW).]
24-A M.R.S. § 2933 — ME Code / Title 24-A / Chapter 40 / Section 2933
24-A §2933. Premium rates
Status: in_force

Premium rates under a mass marketing plan shall comply with all standards set forth in the Maine Insurance Code, including without limitation the requirement that rates shall not be excessive, inadequate or unfairly discriminatory. Rates shall not be deemed to be unfairly discriminatory because different premiums result for policyholders with like loss exposures but different expense factors, or like expense factors but different loss exposures, so long as the rates reflect the difference with reasonable accuracy. Rates shall not be deemed to be unfairly discriminatory if they are averaged broadly among persons insured under a mass marketing plan. [PL 1973, c. 625, §146 (NEW).]
24-A M.R.S. § 405-B — ME Code / Title 24-A / Chapter 5 / Section 405-B
24-A §405-B. Domestic insurers or licensed health maintenance organization; individual health insurance approved in other states
Status: in_force

Notwithstanding any other provision of this Title, a domestic insurer or licensed health maintenance organization authorized to transact individual health insurance in this State may offer for sale in this State an individual health plan duly authorized for sale in Connecticut, Massachusetts, New Hampshire, Rhode Island or Vermont by a parent or corporate affiliate of the domestic insurer or licensed health maintenance organization if the following requirements are met. [PL 2013, c. 388, Pt. B, §3 (AMD).]

1. Certificate of authority from state of domicile. The parent or corporate affiliate of the domestic insurer or licensed health maintenance organization must hold a valid certificate of authority to transact individual health insurance in the state of domicile of the parent or corporate affiliate. [PL 2011, c. 90, Pt. C, §4 (NEW).]

2. Compliance with laws of state of domicile. A policy, contract or certificate of individual health insurance offered for sale in this State by the domestic insurer or licensed health maintenance organization must comply with the applicable individual health insurance laws in the state of domicile of the parent or corporate affiliate and must be actively marketed in that state. [PL 2011, c. 90, Pt. C, §4 (NEW).]

3. Disclosure and reporting. The domestic insurer or licensed health maintenance organization shall meet the requirements of section 4302 for reporting plan information with respect to individual health plans offered for sale in this State and disclose to prospective enrollees how the individual health plans of the parent or corporate affiliate differ from individual health plans offered by other domestic insurers or licensed health maintenance organizations in a format approved by the superintendent. Health plan policies and applications for coverage must contain the following disclosure statement or a substantially similar statement on the face page of the policy or application in a type size of at least 14 points and font that is easily readable by a person with average eyesight: "This policy is issued by a domestic insurer or licensed health maintenance organization but is governed by the laws and rules of (state of domicile of parent or corporate affiliate of domestic insurer or licensed health maintenance organization), which is the state of domicile of the parent or corporate affiliate of the domestic insurer or licensed health maintenance organization. This policy may not be subject to all the insurance laws and rules of the State of Maine, including coverage of certain health care services or benefits mandated by Maine law. Before purchasing this policy, you should carefully review the terms and conditions of coverage under this policy, including any exclusions or limitations of coverage." [PL 2013, c. 388, Pt. B, §4 (AMD).]

4. Grievance procedures. The domestic insurer or licensed health maintenance organization shall meet the requirements of section 4303, subsection 4 for grievance procedures with respect to health plans offered for sale in this State. [PL 2011, c. 90, Pt. C, §4 (NEW).]

5. Sale of policies. A domestic insurer or licensed health maintenance organization may not offer an individual health plan for sale in this State pursuant to this section before January 1, 2014. [PL 2011, c. 90, Pt. C, §4 (NEW).]
24-A M.R.S. § 2151 — ME Code / Title 24-A / Chapter 23 / Section 2151
24-A §2151. Purpose
Status: in_force

The purpose of this chapter is to regulate trade practices in the business of insurance in accordance with the intent of Congress as expressed in the Act of Congress of March 9, 1945, Public Law 15, 79th Congress, by defining or providing for the determination of all such practices in this State which constitute unfair methods of competition or unfair or deceptive acts or practices, by defining or providing for the determination of all such practices in other states by residents of this State which constitute unfair methods of competition or unfair or deceptive acts or practices, and by prohibiting the trade practices so defined or determined. [PL 1985, c. 648, §4 (AMD).]
24-A M.R.S. § 1420-K — ME Code / Title 24-A / Chapter 16 / Section 1420-K
24-A §1420-K. License denial, nonrenewal or revocation
Status: in_force

1. Causes. The superintendent may place on probation, suspend, revoke or refuse to issue or renew an insurance producer's license or may levy a civil penalty in accordance with section 12‑A or take any combination of such actions, for any one or more of the following causes: A. Providing incorrect, misleading, incomplete or materially untrue information in the license application; [PL 2001, c. 259, §24 (NEW).] B. Violating any insurance laws, or violating any rule, regulation, subpoena or order of the superintendent or of another state's insurance commissioner; [PL 2001, c. 259, §24 (NEW).] C. Obtaining or attempting to obtain a license through misrepresentation or fraud; [PL 2001, c. 259, §24 (NEW).] D. Improperly withholding, misappropriating or converting any money or properties received in the course of doing insurance business; [PL 2001, c. 259, §24 (NEW).] E. Intentionally misrepresenting the terms of an actual or proposed insurance contract or application for insurance; [PL 2001, c. 259, §24 (NEW).] F. Having been convicted of a criminal offense as provided in Title 5, section 5301 . Any revocation, suspension or denial of license under this paragraph must be in accordance with Title 5, sections 5302 to 5304 ; [PL 2001, c. 259, §24 (NEW).] G. Having admitted to or been found to have committed any insurance unfair trade practice or fraud; [PL 2001, c. 259, §24 (NEW).] H. Using fraudulent, coercive or dishonest practices, or demonstrating incompetence, untrustworthiness or financial irresponsibility in the conduct of business in this State or elsewhere; [PL 2001, c. 259, §24 (NEW).] I. Having an insurance producer license, or its equivalent, denied, suspended or revoked in any other state, province, district or territory; [PL 2001, c. 259, §24 (NEW).] J. Forging another's name to an application for insurance or to any document related to an insurance transaction; [PL 2001, c. 259, §24 (NEW).] K. Improperly using notes or any other reference material to complete an examination for an insurance license; [PL 2001, c. 259, §24 (NEW).] L. Knowingly accepting insurance business from an individual who is not licensed; [PL 2001, c. 259, §24 (NEW).] M. Failing to comply with an administrative or court order imposing a child support obligation; or [PL 2001, c. 259, §24 (NEW).] N. Failing to pay state income tax or comply with any administrative or court order directing payment of state income tax. [PL 2001, c. 259, §24 (NEW).] [PL 2001, c. 259, §24 (NEW).]

2. Notification. If the superintendent does not renew or denies an application for a license, the superintendent shall notify the applicant or licensee and advise, in writing, the applicant or licensee of the reason for the denial or nonrenewal of the applicant's or licensee's license. The applicant or licensee may make written demand upon the superintendent within 30 days for a hearing before the superintendent to determine the reasonableness of the superintendent's action. The hearing must be held within 30 days of that written demand and pursuant to section 229 . [PL 2001, c. 259, §24 (NEW).]

3. Effect on business entity. The license of a business entity may be suspended, revoked or refused if the superintendent finds, after hearing, that an individual licensee's violation was known or should have been known by one or more of the partners, officers or managers acting on behalf of the partnership or corporation and the violation was neither reported to the superintendent nor corrected. [PL 2001, c. 259, §24 (NEW).]

4. Civil penalties. In addition to or in lieu of any applicable denial, suspension or revocation of a license, a person may, after hearing, be subject to a civil penalty according to section 12‑A . [PL 2001, c. 259, §24 (NEW).]

5. Enforcement powers. The superintendent retains the authority to enforce the provisions of and impose any penalty or remedy authorized by this Title, Title 24 or any other law enforced by the superintendent against any person who is under investigation for or charged with a violation of this Title, Title 24 or any other law enforced by the superintendent, even if the person's license has been surrendered or has lapsed by operation of law. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 2922 — ME Code / Title 24-A / Chapter 39 / Section 2922
24-A §2922. Superintendent's authority to suspend
Status: in_force

In the event of impairment or serious financial difficulty of an insurer, the superintendent shall have the authority to suspend the provisions of this Act from applying to the policies of the financially distressed insurer. [PL 1977, c. 403, §6 (NEW).]
24-A M.R.S. § 6720 — ME Code / Title 24-A / Chapter 83 / Section 6720
24-A §6720. Fees, taxes and assessments
Status: in_force

Except as otherwise specified in this chapter, all fees, taxes and assessments as set out in sections 237 , 601 and 602 apply to captive insurers in the same manner as they apply to other insurers. [PL 1997, c. 435, §1 (NEW).]
24-A M.R.S. § 2525 — ME Code / Title 24-A / Chapter 29 / Section 2525
24-A §2525. Limitation of liability
Status: in_force

1. No policy of life insurance shall be delivered or issued for delivery in this State if it contains any of the following provisions: A. A provision limiting the time within which an action at law or in equity may be commenced on such a policy to less than 3 years after the cause of action has accrued. [PL 1969, c. 132, §1 (NEW).] B. A provision that excludes or restricts liability for death caused in a certain specified manner or occurring while the insured has a specified status, except that a policy may contain provisions excluding or restricting coverage as specified therein in the event of death under any one or more of the following circumstances: (1) Death as a result, directly or indirectly, of war, declared or undeclared, or of action by military forces, or of any act or hazard of such war or action, or of service in the military, naval or air forces or in civilian forces auxiliary thereto, or from any cause while a member of such military, naval or air forces of any country at war, declared or undeclared, or of any country engaged in such military action; (2) Death as a result of aviation or any air travel or flight; (3) Death as a result of a specified hazardous occupation or occupations or avocation; (4) Death while the insured is a resident outside continental United States and Canada; (5) Death within 2 years from the date of issue of the policy as a result of suicide, while sane or insane; or (6) Death within 2 years from the date of issue of an increase in policy face amount, as a result of suicide, while sane or insane. [PL 1999, c. 256, Pt. J, §1 (AMD).] [PL 1999, c. 256, Pt. J, §1 (AMD).]

2. A policy that contains any exclusion or restriction pursuant to subsection 1, paragraph B , subparagraphs (1) to (5) must also provide that, in the event of death under the circumstances to which any such exclusion or restriction is applicable, the insurer will pay an amount not less than the reserve attributable thereto determined according to the commissioners reserve valuation method upon the basis of the mortality table and interest rate specified in the policy for the calculation of nonforfeiture benefits or, if the policy provides for no such benefits, computed according to a mortality table and interest rate determined by the insurer and specified in the policy, with adjustment for indebtedness or dividend credit. [PL 1999, c. 256, Pt. J, §2 (AMD).]

2-A. A policy that contains any exclusion or restriction pursuant to subsection 1, paragraph B , subparagraph (6) must also provide that, in the event of death under the circumstances to which an exclusion or restriction regarding the increase in policy face amount is applicable, the insurer will pay, with respect to the increase in policy face amount, a return of premiums paid. [PL 1999, c. 256, Pt. J, §3 (NEW).]

3. This section shall not apply to group life insurance, health insurance, reinsurance, or annuities, or to any provision in a life insurance policy or contract supplemental thereto relating to disability benefits or to additional benefits in the event of death by accident or accidental means. [PL 1969, c. 132, §1 (NEW).]

4. Nothing contained in this section shall prohibit any provision which in the opinion of the superintendent is more favorable to the policyholder than a provision permitted by this section. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]
24-A M.R.S. § 4111 — ME Code / Title 24-A / Chapter 55 / Section 4111
24-A §4111. Articles of incorporation, constitution and laws -- amendments
Status: in_force

A domestic society may amend its articles of incorporation, constitution or laws in accordance with the provisions thereof by action of its supreme legislative or governing body at any regular or special meeting thereof or, if its articles of incorporation, constitution or laws so provide, by referendum. Such referendum may be held in accordance with the provisions of its articles of incorporation, constitution or laws by the vote of the voting members of the society, by the vote of delegates or representatives of voting members or by the vote of local lodges or branches. No amendment submitted for adoption by referendum shall be adopted unless, within 6 months from the date of submission thereof, a majority of all the voting members of the society shall have signified their consent to such amendment by one of the methods herein specified. [PL 1969, c. 132, §1 (NEW).]

An amendment to the articles of incorporation, constitution or laws of any domestic society does not take effect unless approved by the superintendent, who shall approve such amendment if the superintendent finds that it has been duly adopted and is not inconsistent with any requirement of the laws of this State or with the character, objects and purposes of the society. Unless the superintendent disapproves any such amendment within 60 days after the filing of same, such amendment must be considered approved. The approval or disapproval of the superintendent must be in writing and mailed to the secretary or corresponding officer of the society at its principal office. In case the superintendent disapproves such amendment, the reasons therefor must be stated in such written notice. [RR 2021, c. 1, Pt. B, §327 (COR).]

Within 90 days from the approval thereof by the superintendent, all such amendments, or a synopsis thereof, shall be furnished to all members of the society either by mail or by publication in full in the official organ of the society. The affidavit of any officer of the society or of anyone authorized by it to mail any amendments or synopsis thereof, stating facts which show that same have been duly addressed and mailed, shall be prima facie evidence that such amendments or synopsis thereof have been furnished the addressee. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

Every foreign or alien society authorized to do business in this State shall file with the superintendent a duly certified copy of all amendments of, or additions to, its articles of incorporation, constitution or laws within 90 days after the enactment of same. [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

Printed copies of the constitution or laws as amended, certified by the secretary or corresponding officer of the society, shall be prima facie evidence of the legal adoption thereof. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 1153 — ME Code / Title 24-A / Chapter 13-A / Section 1153
24-A §1153. General qualifications
Status: in_force

1. Eligible investments. No investment, other than real property acquired under section 1156, subsection 2, paragraph D , and personal property incident to that real property or acquired under section 1156, subsection 2, paragraph E , and other than investments acquired under section 1156, subsection 2, paragraph H , subparagraph (2), may be eligible for acquisition unless it is interest bearing, interest accruing, entitled to dividends, if declared, or is otherwise income entitled and is not then in default in any respect and the insurer is entitled to receive for its exclusive account and benefit that interest or those dividends or that income. [PL 1987, c. 399, §14 (NEW).]

2. Bona fide hedging transactions. [PL 1999, c. 715, §9 (RP).]

3. Permitted acquisitions. Nothing in this chapter prohibits the acquisition by an insurer of: A. Securities or property received as a dividend or pursuant to a lawful judicial or nonjudicial plan of reorganization or dissolution or pursuant to a lawful and bona fide agreement of bulk reinsurance, merger or consolidation or through the exercise of rights of conversion, stock warrants or stock options received by it in accordance with this subsection or section 1156 ; [PL 1987, c. 399, §14 (NEW).] B. An investment permitted under section 1156 because that investment is convertible into other securities or stock in which the insurer is not permitted to invest under this chapter or because the insurer receives in connection with that investment stock warrants, whether detachable or nondetachable, stock options, shares of stock, property interests or other assets of any kind; or [PL 1987, c. 399, §14 (NEW).] C. Real or personal property or any interest in that property received in satisfaction of a debt previously owing to that insurer. If any securities received by any insurer in accordance with paragraph A consist in whole or in part of stock or shares of any institution, as defined in section 1156 , or of bonds or other obligations which do not meet the requirements specified in section 1156 , then any of that stock or shares and any bond or obligation of that type so received shall be disposed of within 5 years from the time of its acquisition or before the expiration of any further period or periods of time as may be prescribed in writing by the superintendent or treated as a nonadmitted asset thereafter unless, at any time after acquisition, those securities have met the relevant requirements and the insurer has notified the superintendent of that fact. [PL 1987, c. 399, §14 (NEW).] [PL 1987, c. 399, §14 (NEW).]

4. Derivative transactions. This chapter does not prohibit an insurer from engaging in hedging transactions, income generation transactions and replication or synthetic asset transactions under the following conditions. A. Before entering into any derivative transaction, the board of directors of the insurer shall determine that the insurer, directly or through an investment management subsidiary or affiliate, has adequate professional personnel, technical expertise and systems to implement investment practices involving derivative transactions and approve a derivative instruments use plan that: (1) Describes investment objectives and risk constraints, such as counter-party exposure amounts; (2) Defines permissible transactions including identification of the risks that may be hedged, the assets or liabilities that may be replicated and permissible types of income generation transactions; and (3) Requires compliance with internal control procedures. [PL 1999, c. 715, §10 (NEW).] B. The insurer shall establish written internal control procedures that provide for: (1) A quarterly report to the board of directors that reviews: (a) All derivative transactions entered into, outstanding or closed out; (b) The results and effectiveness of the insurer's implementation of its derivative instruments use plan; and (c) The credit risk exposure to each counter-party for over-the-counter derivative transactions based upon the counter-party exposure amount; (2) A system for determining whether hedging, income generation or replication strategies used by the insurer have been effective; (3) A system of regular reports on at least a monthly basis to management that include: (a) A description of all derivative transactions entered into, outstanding or closed out during the period since the last report; (b) The purpose of each outstanding derivative transaction; (c) A performance review of the derivative instruments program; and (d) The counter-party exposure amounts for over-the-counter derivative transactions; (4) Written authorizations that identify the responsibilities and limitations of authority of persons authorized to effect and maintain derivative transactions; and (5) Documentation appropriate for each transaction including: (a) The purpose of the transaction; (b) The assets or liabilities to which the transaction relates; (c) The specific derivative instrument used in the transaction; (d) For over-the-counter derivative instrument transactions, the name of the counter-party and the counter-party exposure amount; and (e) For exchange-traded derivative instruments, the name of the exchange and the name of the firm that handled the transaction. [PL 1999, c. 715, §10 (NEW).] C. Whenever the derivative transactions entered into under this subsection are not in compliance with this subsection or, if continued, may now or subsequently create a hazardous financial condition of the insurer that affects its policyholders, creditors or the general public, the superintendent may, after notice and an opportunity for a hearing, order the insurer to take such action as may be reasonably necessary to rectify the noncompliance or hazardous financial condition or prevent an impending hazardous financial condition from occurring. [PL 1999, c. 715, §10 (NEW).] D. An insurer may enter into hedging transactions under this subsection if as a result of and after giving effect to each such transaction: (1) The aggregate statutory financial statement value of all outstanding caps, floors, warrants not attached to another financial instrument and options other than collars purchased by the insurer pursuant to this subsection does not exceed 7.5% of its admitted assets; (2) The aggregate statutory financial statement value of all outstanding warrants, caps, floors and options other than collars written by the insurer pursuant to this subsection does not exceed 3% of its admitted assets; and (3) The aggregate potential exposure of all outstanding collars, swaps, forwards and futures entered into or acquired by the insurer pursuant to this subsection does not exceed 6.5% of its admitted assets. With respect to hedging transactions, an insurer shall demonstrate to the superintendent upon request the intended hedging characteristics and effectiveness of the hedging transaction or combination of hedging transactions through cash-flow testing, duration analysis or other appropriate analysis. [PL 1999, c. 715, §10 (NEW).] E. An insurer may enter into an income generation transaction if: (1) As a result of and after giving effect to the transaction, the aggregate statutory financial statement value of admitted assets that are then subject to call or that generate the cash flows for payments required to be made by the insurer under caps and floors sold by the insurer and then outstanding under this paragraph, plus the statutory financial statement value of admitted assets underlying derivative instruments then subject to calls sold by the insurer and outstanding under this paragraph, plus the purchase price of assets subject to puts then outstanding under this paragraph does not exceed 10% of its admitted assets; and (2) The transaction is one of the following types and meets the other requirements specified in this subparagraph that are applicable to that type of transaction: (a) Sales of call options on assets, if the insurer holds or has a currently exercisable right to acquire the underlying assets during the entire period that the option is outstanding; (b) Sales of put options on assets, if the insurer holds sufficient cash, cash equivalents or interests in a short-term investment pool to purchase the underlying assets upon exercise during the entire period that the option is outstanding, and has the ability to hold the underlying assets in its portfolio. If the total market value of all put options sold by the insurer exceeds 2% of the insurer's admitted assets, the insurer shall set aside pursuant to a custodial or escrow agreement cash or cash equivalents having a market value equal to the amount of its put option obligations in excess of 2% of the insurer's admitted assets during the entire period the option is outstanding; (c) Sales of call options on derivative instruments if the insurer holds or has a currently exercisable right to acquire assets generating the cash flow to make any payments for which the insurer is liable pursuant to the underlying derivative instruments during the entire period that the call options are outstanding and has the ability to enter into the underlying derivative transactions for its portfolio; or (d) Sales of caps and floors, if the insurer holds or has a currently exercisable right to acquire assets generating the cash flow to make any payments for which the insurer is liable pursuant to the caps and floors during the entire period that the caps and floors are outstanding. [PL 1999, c. 715, §10 (NEW).] F. An insurer may enter into replication or synthetic asset transactions in accordance with the requirements of the purposes and procedures manual of the National Association of Insurance Commissioners or its successor publication concerning replication or synthetic asset transactions on or after the date on which the National Association of Insurance Commissioners adopts such requirements. [PL 1999, c. 715, §10 (NEW).] G. An insurer may purchase or sell one or more derivative instruments to offset, in whole or in part, any derivative instrument previously purchased or sold, without regard to the quantitative limitations of this subsection as long as the transaction may be recognized as an offsetting transaction in accordance with generally accepted accounting principles. [PL 1999, c. 715, §10 (NEW).] H. Each derivative instrument must be: (1) Traded on a qualified exchange; (2) Entered into with, or guaranteed by, a qualified bank or a qualified business entity; (3) Issued or written by or entered into with the issuer of the underlying interest on which the derivative instrument is based; or (4) In the case of futures, traded through a broker that is registered as a futures commission merchant under the federal Commodity Exchange Act or that has received exemptive relief from such registration under rule 30.10 promulgated under the federal Commodity Exchange Act. [PL 1999, c. 715, §10 (NEW).] [PL 1999, c. 715, §10 (NEW).]
24-A M.R.S. § 1125 — ME Code / Title 24-A / Chapter 13 / Section 1125
24-A §1125. Real estate
Status: in_force

1. Except as provided in section 1127 (leased property), a domestic insurer may invest in real estate only if used for the purposes or acquired in the manners, and within the limits, as follows: A. The building in which it has its principal office, the land upon which the building stands, and such other real estate as may be requisite for the insurer's convenient accommodation in the transaction of its business. The amount so invested shall not aggregate more than 15% of the insurer's assets. [PL 1987, c. 399, §9 (AMD).] B. Real estate acquired in satisfaction of loans, mortgages, liens, judgments, decrees or debts previously owing to the insurer in the due course of its business. [PL 1969, c. 132, §1 (NEW).] C. Real estate acquired in part payment of the consideration on the sale of other real estate owned by it, if such transaction shall have effected a net reduction in the insurer's investments in real estate. [PL 1969, c. 132, §1 (NEW).] D. Real estate acquired by gift or devise, or through merger, consolidation or bulk reinsurance of another insurer under this Title. [PL 1969, c. 132, §1 (NEW).] E. The seller's interest in real estate subject to an agreement of purchase or sale, but the sum invested in any such interest shall not exceed 2/3 of the fair value of such parcel. [PL 1969, c. 132, §1 (NEW).] F. Additional real estate and equipment incident thereto, if necessary or convenient for the purpose of enhancing the sale or other value of real estate previously acquired or held under this section. Such real estate and equipment, together with the real estate for the enhancement of which it was acquired, shall be included, for the purpose of applicable investment limits, and shall be subject to disposal under section 1133 at the same time and under the same conditions as apply to such enhanced real estate. [PL 1969, c. 132, §1 (NEW).] G. Improved real estate, or any interest therein, acquired or held by purchase, lease or otherwise, acquired as an investment for production of income, or acquired to be improved or developed for such investment purposes pursuant to an existing program therefor. The insurer may hold, mortgage, improve, develop, maintain, manage, lease, sell, convey and otherwise dispose of real estate acquired by it under this provision. [PL 1969, c. 132, §1 (NEW).] [PL 1987, c. 399, §9 (AMD).]

2. For the purposes of section 1124 (mortgage loans) and this section, "improved" real property means: A. Farmland used for tillage, crop or pasture; [PL 1969, c. 132, §1 (NEW).] B. Real estate on which permanent improvements, or improvements under construction or in process of construction, suitable for residence, residential, recreational, institutional, commercial or industrial use, are situated; and [PL 1969, c. 132, §1 (NEW).] C. Real estate to be developed for the use or uses set forth in paragraph B , on which improvements, or improvements under construction or in process of construction, such as streets, sidewalks, sewers and utilities which will become an integral part of such development, are situated or abut. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 2542 — ME Code / Title 24-A / Chapter 29 / Section 2542
24-A §2542. Applicability
Status: in_force

Sections 2541 to 2551 shall not apply to any reinsurance, group annuity purchased under a retirement plan or plan of deferred compensation established or maintained by an employer, including a partnership or sole proprietorship, or by an employee organization, or by both, other than a plan providing individual retirement accounts or individual retirement annuities under the United States Internal Revenue Code, Section 408, as now or hereafter amended, premium deposit fund, variable annuity, investment annuity, immediate annuity, any deferred annuity contract after annuity payments have commenced, or reversionary annuity, nor to any contract which shall be delivered outside this State through an agent or other representative of the company issuing the contract. [PL 1979, c. 442, §4 (NEW).]
24-A M.R.S. § 2908 — ME Code / Title 24-A / Chapter 39 / Section 2908
24-A §2908. Cancellation and nonrenewal
Status: in_force

1. As used in this section, unless the context indicates otherwise, the following terms have the following meanings. A. "Cancellation" means termination of a policy at a date other than its expiration date. [PL 1985, c. 671, §1 (NEW).] B. "Expiration date" means the date upon which coverage under a policy ends. It also means, for a policy written for a term longer than one year or with no fixed expiration date, each annual anniversary date of the policy. [PL 1985, c. 671, §1 (NEW).] C. "Nonpayment of premium" means the failure or inability of the named insured to discharge any obligation in connection with the payment of premium on a policy of insurance subject to this section, whether the payments are payable directly to the insurer or its agent or indirectly payable under a premium finance plan or extension of credit. [PL 1985, c. 671, §1 (NEW).] D. "Nonrenewal" means termination of a policy at its expiration date. [PL 1985, c. 671, §1 (NEW).] E. "Renewal" or "to renew" means the issuance of, or the offer to issue by an insurer, a policy succeeding a policy previously issued and delivered by the same insurer or an affiliate of the insurer or the issuance of a certificate or notice extending the terms of an existing policy for a specified period beyond its expiration date. For the purposes of this section, the transfer of a policy from an insurer to an affiliate is considered a policy renewal. [PL 2007, c. 188, Pt. C, §1 (AMD).] [PL 2007, c. 188, Pt. C, §1 (AMD).]

2. Except as provided in subsection 8 , no contract of casualty insurance may be cancelled by an insurer prior to the expiration of the policy, except for one or more of the following grounds: A. Nonpayment of premium; [PL 1985, c. 671, §1 (NEW).] B. Fraud or material misrepresentation made by or with the knowledge of the named insured in obtaining the policy, continuing the policy or in presenting a claim under the policy; [PL 1985, c. 671, §1 (NEW).] C. Substantial change in the risk which increases the risk of loss after insurance coverage has been issued or renewed, including, but not limited to, an increase in exposure due to rules, legislation or court decision; [PL 1985, c. 671, §1 (NEW).] D. Failure to comply with reasonable loss control recommendations; [PL 1985, c. 671, §1 (NEW).] E. Substantial breach of contractual duties, conditions or warranties; or [PL 1985, c. 671, §1 (NEW).] F. Determination by the superintendent that the continuation of a class or block of business to which the policy belongs will jeopardize a company's solvency or will place the insurer in violation of the insurance laws of this State or any other state. [PL 1985, c. 671, §1 (NEW).] The grounds listed in paragraphs A to E shall be contained in all policies issued, issued for delivery or renewed on or after the effective date of this section. Insurers shall have 30 days from the effective date of this section to notify insureds of these grounds for cancellation on policies issued or issued for delivery before the effective date of this section. [PL 1985, c. 671, §1 (NEW).]

3. If a policy has been issued for a term longer than one year and, for additional premium consideration, a premium has been guaranteed, the insurer may not refuse to renew the policy or increase the policy premium for the term of that policy. [PL 1985, c. 671, §1 (NEW).]

4. If an insurer offers or purports to renew a contract, but on less favorable terms to the insured or at higher rates or a higher rating plan, the new terms or rates and rating plan may take effect on the renewal date, if the insurer has provided the insured 30 days notice. If the insurer has not so notified the contract holder, the contract holder may elect to cancel the renewal policy within the 30-day period after receipt of the notice or delivery. Earned premium for the period of coverage for such time as the renewal contract may have been in force, shall be calculated pro rata at the lower of the current or previous year's rate. If the insured accepts the renewal, the premium increase, if any, and other changes shall be effective immediately following the prior policy's expiration or anniversary date. This section does not apply if the change is a rate, form or plan filed with the superintendent and applicable to the entire class of business to which the policy belongs or to a premium increase based on the altered nature or extent of the risk insured against. [PL 1985, c. 671, §1 (NEW).]

5. Cancellation or nonrenewal is not effective until notice is received by the insured as follows. A. Except for workers' compensation insurance, cancellation may not be effective prior to 10 days after receipt by the insured of a notice of cancellation. Notice of cancellation of workers' compensation insurance is subject to Title 39‑A, section 403, subsection 1 . The notice must state the effective date of and the reason or reasons for cancellation. [PL 1991, c. 885, Pt. E, §31 (AMD); PL 1991, c. 885, Pt. E, §47 (AFF).] B. Nonrenewal subject to this section shall not be effective prior to 30 days after receipt of written notice by the insured. If an insurer provides a notice of nonrenewal as described in this subsection and thereafter extends the policy 90 days or less, an additional notice of nonrenewal is not required with respect to this extension. [PL 1985, c. 671, §1 (NEW).] C. A post-office certificate of mailing to the named insured at the named insured's last known address is conclusive proof of receipt of notice on the 3rd calendar day after mailing. [RR 2021, c. 1, Pt. B, §255 (COR).] D. For policies providing automobile physical damage coverage, like notice of cancellation or nonrenewal must also be given to any party named in a loss payable clause. [PL 2007, c. 188, Pt. C, §2 (NEW).] [RR 2021, c. 1, Pt. B, §255 (COR).]

6. Any insured who has received a notice of an insurer's intent to cancel a policy may, within 45 days of the receipt of the notice, request a hearing before the superintendent. The purpose of this hearing shall be limited to establishing the existence of the proof or evidence given by the insurer in its notice of cancellation. The burden of proof of the reason for cancellation shall be upon the insurer. The superintendent shall have the authority to order that a policy remain in effect both pending and, if the superintendent finds in favor of the insured, subsequent to a hearing. If the superintendent finds in favor of the insurer at a hearing, the superintendent may order the policy to remain in force for 14 days to allow the insured to obtain other coverage. [PL 1989, c. 172, §3 (AMD).]

7. Except as provided in Title 10, chapter 209‑B , no insurer or licensed agent or employee of the insurer may be held liable in any civil action for statements made in a notice of cancellation or nonrenewal or at a hearing held under this section if the statements were made in good faith and, in the case of cancellation, are reasonably related to the grounds for cancellation. [PL 2013, c. 588, Pt. C, §12 (AMD).]

8. Except for the definitions in subsection 1 and cancellation notice requirements set forth in subsection 5 , this section does not apply to any insurance policy that has not been previously renewed if the policy has been in effect less than 60 days at the time notice of cancellation is mailed or otherwise delivered. This section does not apply to any policy subject to the Maine Automobile Insurance Cancellation Control Act, subchapter II . This section does not apply to any assigned risk program. The superintendent may suspend, in whole or in part, the applicability of this section to any insurer if, in the superintendent's discretion, its application will endanger the ability of the insurer to fulfill its contractual obligations. [PL 1997, c. 126, §5 (AMD).]

9. This section applies to all contracts of casualty insurance, except surplus lines contracts, delivered or issued for delivery in this State, both before and after the effective date of this section. Provisions in this section relating to nonrenewal of policies shall take effect 30 days after the effective date of this section. [PL 1989, c. 172, §3 (AMD).]
24-A M.R.S. § 3410 — ME Code / Title 24-A / Chapter 47 / Section 3410
24-A §3410. Destruction of records
Status: in_force

1. An insurer may destroy its obsolete records after expiration of such reasonable period after completion of the transactions to which they relate as the insurer may deem proper. The insurer may so destroy its closed files relating to losses and claims arising under its policies after the first to occur of the following events: A. Completion of a regular examination of the insurer by the superintendent and to which the closed file was subject; or [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).] B. Expiration of 6 years after the file was duly closed. [PL 1969, c. 132, §1 (NEW).] [PL 1969, c. 132, §1 (NEW); PL 1973, c. 585, §12 (AMD).]

2. Records preserved on microfilm or other similar process and freely retrievable shall not be deemed to have been destroyed. [PL 1969, c. 132, §1 (NEW).]

3. This section shall not relieve the insurer of any responsibility or liability otherwise arising under law with respect to the existence and availability of any record. [PL 1969, c. 132, §1 (NEW).]
24-A M.R.S. § 1449 — ME Code / Title 24-A / Chapter 16 / Section 1449
24-A §1449. Reporting and accounting for premiums
Status: in_force

All premiums and return premiums received by an insurance producer are trust funds received by the licensee in a fiduciary capacity in accordance with this section. [PL 2003, c. 35, §1 (RPR).]

1. Return premiums; accounting and payment to an insured. The licensee shall account for and pay the return premiums to the insured or apply the return premiums to outstanding balances of any insured within 30 days from the date of receipt. The date of receipt is the date the money is actually received or the date the credit is posted by the insurer, health maintenance organization, fraternal benefit society or nonprofit hospital or medical service organization to the licensee's account. [PL 2003, c. 35, §1 (NEW).]

2. Premiums; accounting and payment to an insurer. The licensee shall promptly account for and pay premiums to the insurer, health maintenance organization, fraternal benefit society or nonprofit hospital or medical service organization in accordance with the contract between the insurer, health maintenance organization, fraternal benefit society or nonprofit hospital or medical service organization and the licensee. [PL 2003, c. 35, §1 (NEW).]
24-A M.R.S. § 4348-A — ME Code / Title 24-A / Chapter 56-C / Section 4348-A
24-A §4348-A. Use of untrue, deceptive or misleading advertisement prohibited
Status: in_force

A pharmacy benefits manager or representative of a pharmacy benefits manager may not cause or knowingly permit the use of any advertisement, promotion, solicitation, representation, proposal or offer that is untrue, deceptive or misleading. [PL 2021, c. 371, §1 (NEW).]
24-A M.R.S. § 2937 — ME Code / Title 24-A / Chapter 40 / Section 2937
24-A §2937. Disclosure required
Status: in_force

Every insurer, agent or broker selling insurance pursuant to a mass marketing plan shall, prior to sale, make full and fair disclosure to prospective insureds of all features of such plan, whether favorable or unfavorable, including, but not limited to, the stability of the premium rates, benefits, duration of coverage, policyholder services, conversion privileges available, and the financial and interlocking interests in the plan, if any, of the sponsoring employer, association, organization or group. [PL 1973, c. 625, §146 (NEW).]
24-A M.R.S. § 2321-B — ME Code / Title 24-A / Chapter 25 / Section 2321-B
24-A §2321-B. Insurers and advisory organizations; prohibited activity
Status: in_force

1. No insurer or advisory organization may: A. Attempt to monopolize, or combine or conspire with any other person to monopolize an insurance market; or [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).] B. Engage in a boycott, on a concerted basis, of an insurance market. [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).] [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).]

2. No insurer may agree with any other insurer or with an advisory organization to mandate adherence to or to mandate use of any rate, rating plan, rating schedule, rating rule, policy or bond form, rate classification, rate territory, underwriting rule, survey, inspection or similar material, except as needed to develop statistical plans permitted by section 2323 . A. The fact that 2 or more insurers, whether or not members or subscribers of an advisory organization, use consistently or intermittently the same rates, rating plans, rating schedules, rating rules, policy or bond forms, rate classifications, rate territories, underwriting rules, surveys or inspections or similar materials is not sufficient in itself to support a finding that an agreement exists. [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).] B. Two or more insurers having a common ownership or operating in this State under common management or control may act in concert between or among themselves with respect to any matters pertaining to those activities authorized in this chapter as if they constituted a single insurer. [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).] [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).]

3. No insurer or advisory organization may make any arrangement with any other insurer, advisory organization, or other person that has the purpose or effect of restraining trade unreasonably or of substantially lessening competition in the business of insurance. [PL 1989, c. 797, §23 (NEW); PL 1989, c. 797, §§37, 38 (AFF).]
24-A M.R.S. § 6904 — ME Code / Title 24-A / Chapter 87 / Section 6904
24-A §6904. Board of Trustees of Dirigo Health
Status: in_force

Dirigo Health operates under the supervision of the Board of Trustees of Dirigo Health established in accordance with this section. [PL 2007, c. 447, §4 (AMD).]

1. Appointments. The board consists of 9 voting members and 3 ex officio, nonvoting members as follows. A. The 9 voting members of the board are appointed by the Governor, subject to review by the joint standing committee of the Legislature having jurisdiction over health insurance matters and confirmation by the Senate in accordance with this paragraph. (1) Five members qualified in accordance with subsection 2‑A, paragraph A are appointed by the Governor. (2) One member qualified in accordance with subsection 2‑A, paragraph A is appointed by the Governor and must be selected from candidates nominated by the President of the Senate. (3) One member qualified in accordance with subsection 2‑A, paragraph B is appointed by the Governor and must be selected from candidates nominated by the Speaker of the House. (4) One member qualified in accordance with subsection 2‑A, paragraph B is appointed by the Governor and must be selected from the candidates nominated by the Senate Minority Leader. (5) One member qualified in accordance with subsection 2‑A, paragraph B is appointed by the Governor and must be selected from candidates nominated by the House Minority Leader. [PL 2007, c. 447, §4 (AMD).] B. The 3 ex officio, nonvoting members of the board are: (1) The Commissioner of Professional and Financial Regulation or the commissioner's designee; (3) The Commissioner of Administrative and Financial Services or the commissioner's designee; and (4) The Treasurer of State or the treasurer's designee. [PL 2011, c. 90, Pt. J, §22 (AMD).] [PL 2011, c. 90, Pt. J, §22 (AMD).]

2. Qualifications of voting members. [PL 2007, c. 447, §4 (RP).]

2-A. Qualifications of voting members. Voting members of the board must be qualified in accordance with this subsection. A. Six of the voting members of the board must have knowledge of and experience in one or more of the following areas: (1) Health care purchasing; (2) Health insurance; (3) MaineCare; (4) Health policy and law; (5) State management and budgeting; (6) Health care financing; (7) Labor or consumer advocacy; and (8) Marketing. [PL 2007, c. 447, §4 (NEW).] B. Three of the voting members of the board must have knowledge of and experience in one or more of the following areas: (1) Accounting; (2) Banking; (3) Securities; and (4) Insurance. [PL 2007, c. 447, §4 (NEW).] C. Except as provided in this paragraph, a voting member of the board may not be: (1) A representative or employee of a health insurance carrier authorized to do business in this State; (2) A representative or employee of a health care provider operating in this State; (3) Affiliated with a health or health-related organization regulated by State Government; or (4) A representative or employee of Dirigo Health. A nonpracticing health care practitioner, retired or former health care administrator or retired or former employee of a health insurance carrier is not prohibited from being considered for board membership as long as that person is not currently affiliated with a health or health-related organization. [PL 2007, c. 447, §4 (NEW).] [PL 2007, c. 447, §4 (NEW).]

3. Terms of office. Voting members serve 3-year terms. Voting members may serve up to 2 consecutive terms. Of the initial appointees, one member serves an initial term of one year, 2 members serve initial terms of 2 years and 2 members serve initial terms of 3 years. Any vacancy for an unexpired term must be filled in accordance with subsections 1 and 2‑A . Members reaching the end of their terms may serve until replacements are named. [PL 2007, c. 447, §4 (AMD).]

4. Chair. The Governor shall appoint one of the voting members as the chair of the board. [PL 2003, c. 469, Pt. A, §8 (NEW).]

5. Quorum. Five voting members of the board constitute a quorum. [PL 2007, c. 447, §4 (AMD).]

6. Affirmative vote. An affirmative vote of 5 members is required for any action taken by the board. [PL 2007, c. 447, §4 (AMD).]

7. Compensation. A member of the board must be compensated according to the provisions of Title 5, section 12004‑G, subsection 14‑D ; a member must receive compensation whenever that member fulfills any board duties in accordance with board bylaws. [PL 2003, c. 469, Pt. A, §8 (NEW).]

8. Meetings. The board shall meet monthly and may also meet at other times at the call of the chair or the executive director. All meetings of the board are public proceedings within the meaning of Title 1, chapter 13, subchapter 1 . [PL 2007, c. 447, §4 (AMD).]
24-A M.R.S. § 1420-I — ME Code / Title 24-A / Chapter 16 / Section 1420-I
24-A §1420-I. Assumed names
Status: in_force

An insurance producer doing business under any name other than the producer's legal name is required to notify the superintendent prior to using the assumed name. [PL 2001, c. 259, §24 (NEW).]
24-A M.R.S. § 2742 — ME Code / Title 24-A / Chapter 33 / Section 2742
24-A §2742. Child coverage
Status: in_force

1. Definitions. For the purposes of this section, unless the context otherwise indicates, the following terms have the following meanings. A. "Dependent children" means children who are under 19 years of age and are children, stepchildren or adopted children of, or children placed for adoption with the policyholder, member or spouse of the policyholder or member. [PL 1993, c. 666, Pt. A, §3 (NEW).] B. "Placed for adoption" means the assumption and retention of a legal obligation by a person for the total or partial support of a child in anticipation of adoption of the child. If the legal obligation ceases to exist, the child is no longer considered placed for adoption. [PL 1993, c. 666, Pt. A, §3 (NEW).] [PL 1993, c. 666, Pt. A, §3 (RPR).]

2. Coverage. All insurance policies or plans issued in accordance with the requirements of section 2741 must provide unmarried women policyholders with the coverage or option of coverage for dependent children, under the same terms and conditions and at appropriate rates as are extended to married policyholders with dependents. [PL 1991, c. 200, Pt. B, §3 (NEW).]

3. Financial dependency. Financial dependency of dependent children on the policyholder or the spouse of the policyholder may not be required as a condition for eligibility coverage. [PL 1991, c. 200, Pt. B, §3 (NEW).]

4. Adopted children. All individual policies issued in accordance with the requirements of this section must provide the same benefits to dependent children placed for adoption with the policyholder or spouse of the policyholder under the same terms and conditions as apply to natural dependent children or stepchildren of the policyholder or spouse of the policyholder, irrespective of whether the adoption has become final. [PL 1993, c. 666, Pt. A, §4 (NEW).]

5. Compliance. An insurer issuing policies under this chapter must comply with 42 United States Code, Section 1396g‑1. If a parent is required by a court or administrative order to provide health coverage for a child and the parent is eligible for family health coverage through an insurer, the insurer shall permit either of the child's parents or the Department of Health and Human Services to enroll the child under the family coverage without regard to any enrollment season restrictions if the child is otherwise eligible for the coverage. An insurer must provide policy information to the custodial parent of any dependent child so that the custodial parent can obtain benefits for the child directly from the insurer. An insurer must permit the custodial parent of any dependent child to submit claims for covered services without the approval of the noncustodial parent. If the custodial parent approves, an insurer must permit the provider to submit claims for covered services without the approval of the noncustodial parent. An insurer shall make payment on claims submitted under this section directly to the custodial parent or, if the custodial parent approves, to the provider. [PL 1997, c. 795, §8 (AMD); PL 2003, c. 689, Pt. B, §6 (REV).]

6. Nondiscrimination. An insurer may not impose requirements on a state agency that has been assigned the rights of an individual eligible for medical assistance and who is covered for health benefits from the insurer that are different from requirements applicable to an agent or assignee of any other individual so covered. If a child is otherwise eligible for health coverage, an insurer may not refuse to provide the coverage for the child because the child is eligible for medical assistance under Title 22 . [PL 1997, c. 795, §9 (NEW).]
24-A M.R.S. § 2517 — ME Code / Title 24-A / Chapter 29 / Section 2517
24-A §2517. Standard provisions -- annuity and pure endowment contracts
Status: in_force

1. No annuity or pure endowment contract, other than reversionary annuities, also called survivorship annuities, or group annuities and except as stated herein, shall be delivered or issued for delivery in this State unless it contains in substance each of the provisions specified in sections 2518 to 2523 . Any of such provisions not applicable to single premium annuities or single premium pure endowment contracts shall not, to that extent, be incorporated therein. [PL 1969, c. 132, §1 (NEW).]

2. This section shall not apply to contracts for deferred annuities included in, or upon the lives of beneficiaries under, life insurance policies, nor to variable annuity contracts. [PL 1969, c. 132, §1 (NEW).]

3. The superintendent shall adopt rules regarding the suitability of sales of annuities for the purpose of protecting the consumer and furthering uniformity of laws with other states. Rules adopted pursuant to this section are routine technical rules pursuant to Title 5, chapter 375, subchapter 2‑A . [PL 2005, c. 65, Pt. B, §1 (NEW).]