Source: https://www1.maine.gov/pfr/insurance/review_checklists/Rate_filing_Ind_Medicare_Supplement.htm
Timestamp: 2015-03-02 01:24:09
Document Index: 735867951

Matched Legal Cases: ['§12', '§5016', '§12', '§12', '§ 2736', '§11', '§2707', '§2709', '§13', '§2706', '§5002', '§5002', '§8', '§5006', '§5010', '§19', '§5002']

MS05I - Individual Medicare Supplement Plans : Form & Rate Filing Review Checklists : Bureau of Insurance
> Company Services > Review Checklists > MS05I - Individual Medicare Supplement Plans Maine Bureau of Insurance
MS05I - Individual Medicare Supplement Plans
(Amended 11/2011)
Medicare Supplement policies must comply with all provisions in the most current NAIC model law with revisions for the following Maine specific deviations: Guaranteed Issue Rule Chapter 275,§12
Maine permits eligible persons to enroll under a policy up to 90 days from the termination date under Section 12(A)(1). Third Party Notice, Cancellation and Reinstatement
Rule Chapter 580
24-A M.R.S.A. §5016
Third party notice of cancellation and reinstatement for cognitive impairment or functional incapacity.
Eligibility (additional language) Rule Chapter 275,§12(A)(2)
Additional language to Section 12(A)(2), an eligible person includes an individual enrolled under an employee welfare benefit plan that is primary to Medicare and the plan terminates, or the plan ceases to provide health benefits to the individual because the individual leaves the plan. Eligibility (additional eligibility provisions) Rule Chapter 275,§12(B)(7),(8) and 12(C)(2)
Eligible persons also include, pursuant to Bureau Rule Chapter 275 Sections 12(B)(7),(8) and 12(C)(2):
The individual is eligible for Medicare Part B and is enrolled in an individual health plan as defined by Title 24-A M.R.S.A. § 2736-C and the enrollment in the individual health plan ceases because:
a. The issuer has withdrawn from the individual health insurance market in Maine; or
b. The issuer is insolvent or is otherwise unable to continue providing coverage; or
8. The individual is eligible for Medicare Part B and is enrolled in Title XIX of the Social Security Act (Medicaid), other than coverage consisting solely of immunization benefits under Section 1928, and enrollment in Medicaid ceases because the individual is no longer eligible.
Eligible persons would also include persons described in Section 12(B)(5) (regarding Medicare +Choice products) are entitled to the same Medicare supplement policy in which the individual was most recently previously enrolled, if available from the same insurer.
a. If the policy is not available, the insurer shall reinstitute the prior policy subject to the conditions listed in Section 8(A)(7).
b. If the issuer of the prior policy has become insolvent or has otherwise ceased doing business, and the prior policy was a standardized plan defined in Section 9, then the eligible person shall be entitled to the same plan from any issuer currently offering the plan.
c. If the issuer of the policy has become insolvent or has otherwise ceased doing business, and the prior policy was not a standardized plan defined in Section 9, then the eligible person shall be entitled to a Medicare supplement policy which has a benefit package classified as Plan A, B, C, D, E, F, or G offered by any issuer. If the prior coverage included prescription drug benefits, Plans H, I, and J are included.
Eligibility (open enrollment) Rule Chapter 275, §11(A)
Open Enrollment, Section 11(A) Each Medicare beneficiary shall be entitled to a 6-month open enrollment period beginning on the date he or she first enrolls for benefits under Medicare Part B, and each individual enrolled for benefits under Medicare Part B before turning 65 shall be entitled to an additional 6-month open enrollment period beginning on his or her 65th birthday. Grace period 24-A M.R.S.A. §2707
Unless the premiums are paid on either a weekly or monthly basis, Maine's minimum grace period is 31 days. Notice of claim 24-A M.R.S.A. §2709
Maine requires the notice of claim provision to give the insured the option of sending notice to any authorized agent of the company or to the company at the stated address. Notice to the agent is deemed notice to the insurer under this section. Payment of claims Rule Chapter 275, §13
An issuer shall comply with Section 1882(c)(3) of the Social Security Act (as enacted by Section 4081(b)(2)(C) of the Omnibus Budget Reconciliation Act of 1987 (OBRA) 1987, Pub. L. No. 100-203).
Time limit on certain defenses 24-A M.R.S.A. §2706
Maine's contestable period for health insurance policies is 3 years from the date of issue. Guaranteed Renewal Rule Chapter 275 Sec. 8 (A)(5)
Pre-existing Conditions 24-A M.R.S.A. §5002-A and Rule Chapter 275 Sec. 8 (A)(1)
No more than 6 months. Benefit Levels 24-A M.R.S.A. §5002-A and Rule Chapter 275 Sec. 8 (B) and Sec. 9
Standardized Plans Permitted Commissions Rule Chapter 275 Sec. 16
First year commission is no more than two-hundred percent (200%) of the commission paid for selling or servicing the policy in the second year.
The commission provided in subsequent (renewal) years must be the same as that provided in the second year or period and must be provided for no fewer than five (5) renewal years.
Required Disclosure Rule 275 Sec. 17
Shall have a notice prominently printed on the first page of the policy stating that the policyholder has the right to return the policy within thirty (30) days of its delivery and to have the premium refunded if, after examination of the policy. Issuers shall provide an outline of coverage.
Conversion (group policies only) Rule Chapter 275, §8(A)(5)(c) and (d)
Maine requires a conversion privilege on termination of policy or eligibility. Advertisements Filing of advertisements 24-A M.R.S.A. §5006-A, §5010-A, and Rule Chapter 275, §19
Any advertisement to be used in connection with Medicare Supplement products must be filed and approved with the Bureau prior to use.. All advertising materials shall specifically disclose the availability of Medicare supplemental products to those persons eligible for Medicare because of disability. Continuity of Coverage
24-A M.R.S.A. §5002-B
Must contain the provisions of Persons Provided Continuity of Coverage, Prohibitions Against Continuity, Low-Cost Drugs For The Elderly or Disabled Program, and Determination of Benefits.