reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 2680 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT|24-A §2680. Standardized claim form

 §2680. Standardized claim form Administrators providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed health care practitioner or licensed hospital shall accept the current standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted electronically. An administrator may not be required to accept a claim submitted on a form other than the applicable form specified in this section and may not be required to accept a claim that is not submitted electronically, except from a health care practitioner who is exempt pursuant to Title 24, section 2985.   [PL 2003, c. 469, Pt. D, §5 (AMD); PL 2003, c. 469, Pt. D, §9 (AFF).]SECTION HISTORY PL 1993, c. 477, §D9 (NEW). PL 1993, c. 477, §F1 (AFF). PL 1999, c. 609, §18 (RPR). PL 2003, c. 218, §5 (AMD). PL 2003, c. 469, §D5 (AMD). PL 2003, c. 469, §D9 (AFF).
24-A ME Rev Stat § 2691 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2691. Scope

 §2691. Scope 1.  Health insurance policies.  This chapter applies to individual health insurance policies subject to chapter 33 and to group health insurance policies and certificates subject to chapter 35.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 2.  Dental plans and vision care plans.  This chapter applies to dental plans and vision care plans only as specified.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 3.  Policies not subject to this chapter.  This chapter does not apply to:   A. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance when that group or individual policy or contract includes provisions that are inconsistent with the requirements of this chapter;   [PL 2001, c. 410, Pt. C, §1 (NEW).]B. Policies issued to employees or members as additions to franchise plans in existence on the effective date of this chapter;   [PL 2001, c. 410, Pt. C, §1 (NEW).]C. Medicare supplement policies subject to chapter 67;   [PL 2001, c. 410, Pt. C, §1 (NEW).]D. Long-term care insurance policies subject to chapters 68 and 68-A;   [PL 2003, c. 428, Pt. G, §2 (AMD).]E. Group disability income protection coverage; or   [PL 2001, c. 410, Pt. C, §1 (NEW).]F. Insurance policies supplemental to the Civilian Health and Medical Program of the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55 (2000).   [PL 2001, c. 410, Pt. C, §1 (NEW).][PL 2003, c. 428, Pt. G, §2 (AMD).] SECTION HISTORY PL 2001, c. 410, §C1 (NEW). PL 2003, c. 428, §G2 (AMD).
24-A ME Rev Stat § 2692 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2692. Definitions

 §2692. Definitions As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.   [PL 2001, c. 410, Pt. C, §1 (NEW).]1.  Certificate.  "Certificate" means a statement of the coverage and provisions of a policy of group health insurance that has been delivered or issued for delivery in this State. "Certificate" includes riders, endorsements and enrollment forms, if attached.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 2.  Dental plan.  "Dental plan" means insurance written to provide coverage for dental treatment.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 3.  Direct response advertising.  "Direct response advertising" means a solicitation through a sponsoring or endorsing entity or individually through mail, telephone, the Internet or other mass communication media.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 4.  Form.  "Form" means a policy, contract, rider, endorsement or application as provided in section 2412.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 5.  Policy.  "Policy" means an entire contract between the insurer and the insured, including riders, endorsements and the application, if attached.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 6.  Vision care plan.  "Vision care plan" means insurance written to provide coverage for eye care.   [PL 2001, c. 410, Pt. C, §1 (NEW).] SECTION HISTORY PL 2001, c. 410, §C1 (NEW).
24-A ME Rev Stat § 2693 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2693. Standards for policy provisions

 §2693. Standards for policy provisions 1.  Rules regarding manner, content and required disclosure.  The superintendent may adopt rules to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content and required disclosure for the sale of individual and group health insurance. The superintendent may adopt additional rules to establish specific standards for the sale of dental plans and vision care plans.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 2.  Rules regarding prohibited policies or provisions.  The superintendent may adopt rules that specify prohibited policies or policy provisions not otherwise specifically authorized by statute that, in the opinion of the superintendent, are unjust, unfair or unfairly discriminatory to the policyholder or a person insured under the policy or to a beneficiary of the policy.   [PL 2001, c. 410, Pt. C, §1 (NEW).] SECTION HISTORY PL 2001, c. 410, §C1 (NEW).
24-A ME Rev Stat § 2694 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2694. Minimum standards for benefits

 §2694. Minimum standards for benefits The superintendent shall adopt rules to establish minimum standards for benefits under individual and group health insurance. These rules must clarify the meaning of limited benefits health insurance as referred to in chapters 33, 35 and 56-A. The rules must also set minimum standards for benefits for each of the following categories of coverage:   [PL 2001, c. 410, Pt. C, §1 (NEW).]1.  Basic hospital expense coverage.  Basic hospital expense coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 2.  Basic medical-surgical expense coverage.  Basic medical-surgical expense coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 3.  Basic hospital and medical-surgical expense coverage.  Basic hospital and medical-surgical expense coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 4.  Hospital confinement indemnity coverage.  Hospital confinement indemnity coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 5.  Individual major medical expense coverage.  Individual major medical expense coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 6.  Individual basic medical expense coverage.  Individual basic medical expense coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 7.  Individual disability income protection coverage.  Individual disability income protection coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 8.  Accident only coverage.  Accident only coverage;   [PL 2001, c. 410, Pt. C, §1 (NEW).] 9.  Specified disease coverage.  Specified disease coverage; and   [PL 2001, c. 410, Pt. C, §1 (NEW).] 10.  Specified accident coverage.  Specified accident coverage.   [PL 2001, c. 410, Pt. C, §1 (NEW).] This section does not preclude the issuance of a policy or contract that combines 2 or more of the categories of coverage in subsections 1 to 10.   [PL 2001, c. 410, Pt. C, §1 (NEW).]SECTION HISTORY PL 2001, c. 410, §C1 (NEW).
24-A ME Rev Stat § 2694-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2694-A. Physician performance measurement, reporting and tiering programs

 §2694-A. Physician performance measurement, reporting and tiering programs 1.  Performance measurement, reporting and tiering programs.  An insurer delivering or issuing for delivery within the State any individual health insurance policy or group health insurance policy or certificate shall annually file with the superintendent on or before October 1, 2010 and annually by October 1st in subsequent years a full and true statement of its criteria, standards, practices, procedures and programs that measure or tier health care provider performance with respect to quality, cost or cost-efficiency. The statement must be on a form prepared by the superintendent and may be supplemented by additional information required by the superintendent. The statement must be verified by the oath of the insurer's president or vice-president, and secretary or chief medical officer. A filing and supporting information are public records notwithstanding Title 1, section 402, subsection 3, paragraph B.   [PL 2013, c. 383, §2 (AMD).] 2.  Duties.  The superintendent shall review the statements, if any, assemble the statements in one table using a side-by-side comparison format and provide an analysis identifying the commonalities and differences of the statements. Notwithstanding any provision of law to the contrary, the superintendent shall adopt by rule a program and performance measures designed to:   A. Ensure transparency and fairness and promote the continued strengthening of measurement programs to meet patients' needs;   [PL 2009, c. 350, Pt. B, §1 (NEW).]B. Promote the consistency, efficiency and fairness of physician performance measurement; and   [PL 2009, c. 350, Pt. B, §1 (NEW).]C. Promote an appropriate balance between innovation and standardization.   [PL 2009, c. 350, Pt. B, §1 (NEW).][PL 2009, c. 350, Pt. B, §1 (NEW).] 3.  Advisory panel.   [PL 2011, c. 90, Pt. J, §20 (RP).] 4.  Rulemaking.  The superintendent may adopt rules to implement this section. Rules adopted pursuant to this subsection are major substantive rules as defined in Title 5, chapter 375, subchapter 2-A.   [PL 2009, c. 350, Pt. B, §1 (NEW).] SECTION HISTORY PL 2009, c. 350, Pt. B, §1 (NEW). PL 2011, c. 90, Pt. J, §20 (AMD). PL 2013, c. 383, §2 (AMD).
24-A ME Rev Stat § 2696 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2696. Preexisting conditions

 §2696. Preexisting conditions 1.  Exclusion based on preexisting condition limited after 12 months.  Notwithstanding the provisions of section 2706, subsection 2, division (b), if an insurer elects to use a simplified application or enrollment form, with or without a question as to the prospective insured's health at the time of application or enrollment but without any questions concerning the prospective insured's health history or medical treatment history, the policy must cover any loss occurring after the policy has been in force for 12 months from any preexisting condition not specifically excluded from coverage by terms of the policy, and, except for such specific exclusions, the policy or certificate may not include wording that would permit a defense based upon preexisting conditions, other than rescission for affirmative misrepresentations, after it has been in force for 12 months.   [PL 2001, c. 410, Pt. C, §1 (NEW).] 2.  Exclusion based on preexisting condition limited after 6 months.  Notwithstanding the provisions of subsection 1 and section 2706, subsection 2, division (b), an insurer that issues a specified disease policy or certificate may not deny a claim for any covered loss that begins after the policy or certificate has been in force for at least 6 months, unless that loss results from a preexisting condition that was diagnosed by a physician before the date of application for coverage or that first manifested itself within the 6 months immediately preceding the application date. Other defenses based upon preexisting conditions are not permitted except for rescission for misrepresentation. This subsection applies regardless of whether the policy or certificate is issued on the basis of a detailed application form, a simplified application form or an enrollment form.   [PL 2007, c. 199, Pt. G, §1 (AMD).] SECTION HISTORY PL 2001, c. 410, §C1 (NEW). PL 2007, c. 199, Pt. G, §1 (AMD).
24-A ME Rev Stat § 2697 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 32-A: TYPES OF HEALTH INSURANCE|24-A §2697. Rulemaking

 §2697. Rulemaking The superintendent may adopt rules to carry out the purposes of this chapter. Rules adopted pursuant to this chapter are major substantive rules as defined by Title 5, chapter 375, subchapter II-A.   [PL 2001, c. 410, Pt. C, §1 (NEW).]SECTION HISTORY PL 2001, c. 410, §C1 (NEW).
24-A ME Rev Stat § 2701 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2701. Scope of chapter

 §2701. Scope of chapter Nothing in this chapter shall apply to or affect:   [PL 1969, c. 132, §1 (NEW).]1.  Any policy of liability or workers' compensation insurance with or without supplementary expense coverage therein;   [PL 1989, c. 502, Pt. A, §94 (AMD).] 2.  Any group or blanket policy, except that:   A. Sections 2736, 2736-A and 2736-B apply to group Medicare supplement policies as defined in chapter 67, group nursing home care and long-term care insurance policies as defined in chapter 68 or 68-A;   [PL 2003, c. 428, Pt. G, §3 (AMD).]B. Section 2752 applies with respect to mandated benefits for group or blanket health policies; and   [PL 1995, c. 332, Pt. J, §1 (AMD).]C. Sections 2736, 2736-A, 2736-B and 2736-C apply to:   (1) Association groups as defined by section 2805‑A, except as to any employer subgroups of the association group when the employer is a member of the group and provides coverage through the group as a bona fide employee benefit;   (1-A) Credit union groups as defined by section 2807‑A; and   (2) Other groups as defined by section 2808, except:   (a) Employee leasing companies registered pursuant to Title 32, chapter 125; and   (b) As to any employer subgroups of the other group when the employer provides coverage to its employees through the group as a bona fide employee benefit.   [PL 2009, c. 244, Pt. F, §1 (AMD).][PL 2009, c. 244, Pt. F, §1 (AMD).] 3.  Life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as:   A. Provide additional benefits in case of death or dismemberment or loss of sight by accident or accidental means, or as   [PL 1969, c. 132, §1 (NEW).]B. Operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract;   [PL 1983, c. 801, §8 (AMD).][PL 1983, c. 801, §8 (AMD).] 4.  Reinsurance; and   [PL 1983, c. 801, §8 (AMD).] 5.  Legal services insurance.   [PL 1983, c. 801, §9 (NEW).] SECTION HISTORY PL 1969, c. 132, §1 (NEW). PL 1983, c. 801, §§8,9 (AMD). PL 1985, c. 648, §9 (AMD). PL 1989, c. 502, §A94 (AMD). PL 1989, c. 556, §A4 (AMD). PL 1991, c. 701, §5 (AMD). PL 1995, c. 332, §J1 (AMD). PL 2001, c. 258, §E1 (AMD). PL 2003, c. 428, §G3 (AMD). PL 2005, c. 121, §B1 (AMD). PL 2009, c. 244, Pt. F, §1 (AMD).
24-A ME Rev Stat § 2702 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2702. Short title

 §2702. Short title This chapter may be cited as the "Uniform Health Policy Provision Law".   [PL 1969, c. 132, §1 (NEW).]SECTION HISTORY PL 1969, c. 132, §1 (NEW).
24-A ME Rev Stat § 2703 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2703. Scope, format of policy

 §2703. Scope, format of policy No policy of health insurance shall be delivered or issued for delivery to any person in this State unless it otherwise complies with this Title, and complies with the following:   [PL 1969, c. 132, §1 (NEW).]1.  The entire money and other considerations therefore shall be expressed therein;   [PL 1969, c. 132, §1 (NEW).] 2.  The time when the insurance takes effect and terminates shall be expressed therein;   [PL 1969, c. 132, §1 (NEW).] 3.  It shall purport to insure only one person, except that a policy may insure, originally or by subsequent amendment, upon the application of an adult member of a family, who shall be deemed the policyholder, any 2 or more eligible members of that family, including husband, wife, dependent children or any children under a specified age which shall not exceed 23 years and any other person dependent upon the policyholder;   [PL 1969, c. 132, §1 (NEW).] 4.  The style, arrangement and overall appearance of the policy shall give no undue prominence to any portion of the text, and every printed portion of the text of the policy and of any endorsements or attached papers shall be plainly printed in light-faced type of a style in general use, the size of which shall be uniform and not less than ten-point with a lower case unspaced alphabet length not less than one hundred and twenty-point; the "text" shall include all printed matter except the name and address of the insurer, name or title of the policy, the brief description, if any, and captions and subcaptions;   [PL 1969, c. 132, §1 (NEW).] 5.  The exceptions and reductions of indemnity shall be set forth in the policy and, other than those contained in sections 2705 to 2729, shall be printed, at the insurer's option, either included with the benefit provision to which they apply, or under an appropriate caption such as "Exceptions", or "Exceptions and Reductions", except that if an exception or reduction specifically applies only to a particular benefit of the policy, a statement of such exception or reduction shall be included with the benefit provision to which it applies;   [PL 1969, c. 132, §1 (NEW).] 6.  Each such form, including riders and endorsements, shall be identified by a form number in the lower left-hand corner of the first page thereof; and   [PL 1969, c. 132, §1 (NEW).] 7.  The policy shall contain no provision purporting to make any portion of the charter, rules, constitution or bylaws of the insurer a part of the policy unless such portion is set forth in full in the policy, except in the case of the incorporation of, or reference to, a statement of rates or classification of risks, or short-rate table filed with the superintendent.   [PL 1973, c. 585, §12 (AMD).] SECTION HISTORY PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD).
24-A ME Rev Stat § 2704 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2704. Required provisions; captions -- omissions -- substitutions

 §2704. Required provisions; captions -- omissions -- substitutions 1.  Except as provided in subsection 2, each such policy delivered or issued for delivery to any person in this State shall contain the provisions specified in sections 2705 to 2716, in the words in which the same appear; except that the insurer may, at its option, substitute for one or more of such provisions corresponding provisions of different wording approved by the superintendent which are in each instance not less favorable in any respect to the insured or the beneficiary. Each such provision shall be preceded individually by the applicable caption shown, or, at the option of the insurer, by such appropriate individual or group captions or subcaptions as the superintendent may approve.   [PL 1973, c. 585, §12 (AMD).] 2.  If any such provision is in whole or in part inapplicable to or inconsistent with the coverage provided by a particular form of policy, the insurer, with the approval of the superintendent, shall omit from such policy any inapplicable provision or part of a provision, and shall modify any inconsistent provision or part of a provision in such manner as to make the provision as contained in the policy consistent with the coverage provided by the policy.   [PL 1973, c. 585, §12 (AMD).] SECTION HISTORY PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD).
24-A ME Rev Stat § 2705 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2705. Entire contract -- changes

 §2705. Entire contract -- changes There shall be a provision as follows:   [PL 1969, c. 132, §1 (NEW).]Entire contract; changes: This policy, including the endorsements and the attached papers, if any, constitutes the entire contract of insurance. No change in this policy shall be valid until approved by an executive officer of the insurer and unless such approval be endorsed hereon or attached hereto. No agent has authority to change this policy or to waive any of its provisions.   [PL 1969, c. 132, §1 (NEW).]SECTION HISTORY PL 1969, c. 132, §1 (NEW).
24-A ME Rev Stat § 2706 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2706. Time limit on certain defenses

 §2706. Time limit on certain defenses There shall be a provision as follows:   [PL 1969, c. 132, §1 (NEW).]Time limit on certain defenses: (a) After 3 years from the date of issue of this policy no misstatements, except fraudulent misstatements, made by the applicant in the application for such policy shall be used to void the policy or to deny a claim for loss incurred or disability, as defined in the policy, commencing after the expiration of such 3-year period.   [PL 1969, c. 132, §1 (NEW).]1.  The foregoing policy provision shall not be so construed as to affect any legal requirement for avoidance of a policy or denial of a claim during such initial 3-year period, nor to limit the application of sections 2717 through 2723 in the event of misstatement with respect to age or occupation or other insurance.   [PL 1969, c. 132, §1 (NEW).] 2.  A policy which the insured has the right to continue in force subject to its terms by the timely payment of premium 1 until at least age 50 or, 2 in the case of a policy issued after age 44, for at least 5 years from its date of issue, may contain in lieu of the foregoing the following provision, from which the clause in parentheses may be omitted at the insurer's option, under the caption "Incontestable:"   [PL 1969, c. 132, §1 (NEW).] After this policy has been in force for a period of 3 years during the lifetime of the insured (excluding any period during which the insured is disabled), it shall become incontestable as to the statements contained in the application.   [PL 1969, c. 132, §1 (NEW).](b) No claim for loss incurred or disability, as defined in the policy, commencing after 3 years from the date of issue of this policy shall be reduced or denied on the ground that a disease or physical condition not excluded from coverage by name or specific description effective on the date of loss had existed prior to the effective date of coverage of this policy.   [PL 1969, c. 132, §1 (NEW).]SECTION HISTORY PL 1969, c. 132, §1 (NEW).
24-A ME Rev Stat § 2707 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 33: HEALTH INSURANCE CONTRACTS|24-A §2707. Grace period

 §2707. Grace period There shall be a provision as follows:   [PL 1969, c. 132, §1 (NEW).]A grace period of . . . . ., insert a number not less than "7" for weekly premium policies, "10" for monthly premium policies and "31" for all other policies, days will be granted for the payment of each premium falling due after the first premium, during which grace period the policy shall continue in force.   [PL 1969, c. 132, §1 (NEW).]A policy in which the insurer reserves the right to refuse any renewal shall have, at the beginning of the above provision:   [PL 1969, c. 132, §1 (NEW).]Unless not less than 30 days prior to the premium due date the insurer has delivered to the insured or has mailed to the insured's last address as shown by the records of the company written notice of its intention not to renew this policy beyond the period for which the premium has been accepted.   [RR 2021, c. 1, Pt. B, §237 (COR).]SECTION HISTORY PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §237 (COR).