Resolve, Regarding Legislative Review of Portions of Chapter 755: Health Insurance Classifications, Disclosure and Minimum Standards, a Major Substantive Rule of the Department of Professional and Financial Regulation, Bureau of Insurance
Maine Legislature, Session 121, LD 1865
Committee Amendment CA_A_H797 (House)

COMMITTEE AMENDMENT ,A, to H.P. 1388, L.D. 1865, "Resolve, 
Regarding Legislative Review of Portions of Chapter 755: 
Health 
Insurance Classifications, Disclosure and Minimum Standards, 
a 
Major Substantive Rule of the Department of Professional and 
Financial Regulation, Bureau of Insurance" 
Amend the resolve by striking out the title and substituting 
the following: 
'Resolve, Regarding Legislative Review of Chapter 755: Health 
Insurance Classifications, Disclosure and Minimum Standards, 
a 
Major Substantive Rule of the Department of Professional and 
Financial Regulation, Bureau of Insurance' 
Further amend the resolve by striking out everything after 
the 
emergency 
preamble 
and before 
the 
emergency clause 
and 
inserting in its place the following: 
'Sec. 1. Adoption. Resolved: 
That final adoption of Chapter 
755: 
Health Insurance Classifications, Disclosure and Minimum 
Standards, a provisionally adopted major substantive rule of the 
Department of Professional and Financial Regulation, Bureau of 
Insurance that has been submitted to the Legislature for review 
pursuant to the Maine Revised Statutes, Title 5, chapter 375, 
subchapter 2-11. is authorized only if the following changes are 
made. 
1. 
In Section 
4(K) 
with 
regard to 
the definition of 
preexisting condition, the look-back period for 
a preexisting 
condition is changed from 12 months to 24 months. 
Page l-LR2789(2) 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. A .. to H.P. 1388, L.D. 1865 
2. 
In 
Section 
5(A) 
with 
regard 
to 
prohibited policy 
provisions, language is added to clarify that that section is not 
intended 
to 
restrict 
the 
use 
of 
elimination 
periods 
for 
disability income benefits. 
3. 
In Section 6(A) with regard to minimum standards for 
health insurance benefits generally, language is added to permit 
an insurer to void or contest a policy or deny claims for a 
sickness first manifested before the effective date of the policy 
that 
was 
fraudulently 
not 
disclosed 
or 
fraudulently 
misrepresented in an application for coverage. 
4. 
In Section 6(A)(8) with regard to minimum standards for 
health insurance benefits generally, 
the maximum 
time period 
between the date of an accident and the date of loss is shortened 
from 180 days to 90 days for accidental death and dismemberment 
benefits and from 90 days to 30 days for disability coverage. 
5. 
In Section 6(H) with regard to minimum standards for 
individual disability income protection coverage, 
the maximum 
elimination period is changed from 365 days to 730 days in cases 
of coverage having a benefit period of more than 2 years, and the 
shortest permissible maximum benefit period is changed from 6 
months to 3 months. 
6. 
In Section 6(J)(2)(c) with regard to specified disease 
coverage, language is added to provide an exception for lump-sum 
benefits based on diagnosis of a specified disease. 
7. 
In Section 6(J)(4) and Section 6(J)(5) with regard to 
specified disease coverage, 
language is added to permit the 
Superintendent of Insurance to approve different minimum benefits 
for cancer coverage on an expense-incurred basis or a per diem 
indemnity basis if the superintendent determines that the minimum 
benefits are in the interest of the consumer.' 
SUMMARY 
This amendment authorizes final adoption of 
Health 
Insurance 
Classifications, 
Disclosure 
Standards, 
a 
Major 
Substantive 
Rule 
of 
the 
Professional 
and 
Financial 
Regulation, 
Bureau 
provided that these specified changes are made. 
Chapter 755: 
and 
Minimum 
Department 
of 
of 
Insurance 
1. 
With regard to the definition of preexisting condition 
exclusion, the look-back period is changed from 12 months to 24 
months. 
COMMITTEE AMENDMENT 
COMMITTEE AMENDMENT .. A .. to H.P. 1388, L.D. 1865 
2. 
With regard to prohibited policy provisions, language is 
added to clarify that the section is not intended to restrict the 
use of elimination periods for disability income benefits. 
3. 
With regard to minimum standards for health insurance 
benefits generally, language is added to permit an insurer to 
void or contest a policy or deny claims for a sickness first 
manifested before the effective date of the policy that was 
fraudulently not disclosed or fraudulently misrepresented in an 
application for coverage. 
4. 
With regard to mJ.nJ.mum standards for health insurance 
benefits generally, the maximum time period between the date of 
an accident and the date of loss is shortened from 180 days to 90 
days for accidental death and dismemberment benefits and from 90 
days to 30 days for disability coverage. 
5. 
Wi th 
regard 
to 
minimum 
standards 
for 
indi vidual 
disability income protection coverage, the maximum elimination 
period is changed from 365 days to 730 days in cases of coverage 
having a benefit period of more than 2 years, and the shortest 
permissible maximum benefit period is changed from 6 months to 3 
months. 
6. 
With regard to specified disease coverage, language is 
added to provide an exception for 
lump-sum benefits based on 
diagnosis of a specified disease. 
7. 
With regard to specified disease coverage, language is 
added 
to permit 
the 
Superintendent of 
Insurance 
to 
approve 
different 
minimum 
benefits 
for 
cancer 
coverage 
on 
an 
expense-incurred basis or a 
per diem indemnity basis if the 
superintendent determines that the minimum benefits are in the 
interest of the consumer. 
The amendment also 
clarifies the 
language 
changes the 
to 
reflect 
title of 
that all 
required legislative review. 
;FISCAL NOTE REQUIRED 
,<~ee ~ttach~d) 
the resolve 
of 
Chapter 
and 
COMMITTEE AMENDMENT 
Fiscal Detail and Notes 
Approved: 03/22/04 ~ae 
Office of Fiscal and Program Review 
LD 1865 
Resolve, Regarding Legislative Review of Portions of Chapter 755: 
Health Insurance Classifications, Disclosure and Minimum Standards, a 
Major Substantive Rule of the Department of Professional and Financial 
Regulation, Bureau of Insurance 
LR2789(02) 
Fiscal Note for Bill as Amended by Committee Amendment" " 
Committee: Insurance and Financial Services 
Fiscal Note Required: Yes 
Fiscal Note 
Minor cost increase - Other Special Revenue Funds 
Additional cost to the Department of Professional and Financial Regulation can be absorbed utilizing existing 
resources. 
LR2789(2) - Fiscal Note - Page 1 of 1