reglab/housing_qa huggingface dataset:
24-A ME Rev Stat § 5011 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 67: MEDICARE SUPPLEMENT INSURANCE POLICIES|24-A §5011. Rating restrictions

 §5011. Rating restrictions 1.  Community rating.  This subsection applies to any policy delivered or issued for delivery on or after January 1, 1993. It also applies, as of the first policy or certificate anniversary on or after January 1, 1993, to policies or certificates delivered or issued for delivery in 1992.   A. Rates for policies subject to this subsection may not vary based on age, gender, health status, claims experience, policy duration, industry or occupation.   [PL 1991, c. 740, §13 (NEW).]B. In revising rates for standardized plans, an issuer shall pool all experience for standardized plans under individual policies. Experience may be pooled separately for each standardized plan or experience for similar benefits in different standardized plans may be pooled, including, but not limited to, basing the component of the rate for skilled nursing coinsurance on the pooled experience of all standardized plans that include that benefit. Group plans may be rated separately. A group with credible experience may be rated differently than other groups.   [PL 2001, c. 258, Pt. F, §4 (AMD).]C. An issuer that offers both group and individual plans may not use stricter medical underwriting standards for any group plan than it uses for individual plans.   [PL 2001, c. 258, Pt. F, §5 (NEW).]D. An issuer may not use stricter medical underwriting standards than any affiliated issuer uses for its individual plans.   [PL 2001, c. 258, Pt. F, §5 (NEW).][PL 2001, c. 258, Pt. F, §§4, 5 (AMD).] 2.  Discounts.  Issuers that do not vary rates for a standardized plan based on age, gender, health status, claims experience, policy duration, industry or occupation, and that do not refuse issue of that plan to any individual or group based on health status, may provide discounts on that plan to individuals who purchase coverage during their initial period of enrollment in Medicare Part B at or after 65 years of age, subject to approval by the superintendent. The superintendent may adopt rules governing the appropriate use of discounts.   [PL 2003, c. 428, Pt. H, §7 (AMD).] SECTION HISTORY PL 1991, c. 740, §13 (NEW). PL 2001, c. 258, §§F4,5 (AMD). PL 2003, c. 428, §H7 (AMD).
24-A ME Rev Stat § 5012 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 67: MEDICARE SUPPLEMENT INSURANCE POLICIES|24-A §5012. Annual guaranteed issue period

 §5012. Annual guaranteed issue period During a guaranteed issue period of at least one month each calendar year, as established by the issuer, every issuer shall offer standardized Medicare Supplement Plan A, as defined by rule, to all applicants on a basis that does not deny coverage to any individual or group based on health status, claims experience, receipt of health care, or medical condition.   [PL 1991, c. 740, §13 (NEW).]SECTION HISTORY PL 1991, c. 740, §13 (NEW).
24-A ME Rev Stat § 5013 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 67: MEDICARE SUPPLEMENT INSURANCE POLICIES|24-A §5013. Notice regarding policies that are not Medicare supplement policies

 §5013. Notice regarding policies that are not Medicare supplement policies Any individual accident and sickness insurance policy or group insurance certificate, including the contract of a nonprofit hospital and medical service or health care plan issued for delivery in this State to persons eligible for Medicare, must notify insureds that the policy or certificate is not a Medicare supplement policy or certificate. The notice must be either printed on or attached to the first page of the outline of coverage delivered to insureds or, if no outline of coverage is delivered, to the first page of the policy or certificate. The notice must be in no less than 12-point type and must contain the following language:"THIS (POLICY OR CERTIFICATE) IS NOT A MEDICARE SUPPLEMENT (POLICY OR CERTIFICATE). If you are eligible for Medicare, review the Medicare Supplement Buyer's Guide available from the company. If you have a Medicare supplement policy or major medical policy, this coverage may be more than you need. For information call the Bureau of Insurance at (toll-free phone number)."  [PL 1995, c. 570, §8 (AMD).]This section does not apply to a Medicare supplement policy; a policy issued pursuant to a contract under the Federal Social Security Act, 42 United States Code, Section 1395, et seq., Section 1876; a disability income policy; or a policy identified in section 5001‑A, subsection 2.   [PL 1995, c. 570, §8 (AMD).]SECTION HISTORY PL 1991, c. 740, §13 (NEW). PL 1993, c. 154, §4 (AMD). PL 1995, c. 570, §8 (AMD).
24-A ME Rev Stat § 5014 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 67: MEDICARE SUPPLEMENT INSURANCE POLICIES|24-A §5014. Additional penalties

 §5014. Additional penalties 1.  Penalties.  In addition to any other applicable penalties for violations of this Title or Title 24, the superintendent may order issuers violating any provision of this chapter or any rule adopted pursuant to this chapter to:   A. Comply with the provisions of this chapter; or   [PL 1995, c. 570, §9 (NEW).]B. Cease marketing any Medicare supplement policy or certificate in this State that is directly or indirectly related to a violation.   [PL 1995, c. 570, §9 (NEW).][PL 1995, c. 570, §9 (NEW).] 2.  Election of penalty options.  The superintendent may exercise any of the penalty options provided by this section, in combination or in sequence, as the superintendent considers appropriate.   [PL 1995, c. 570, §9 (NEW).] SECTION HISTORY PL 1995, c. 570, §9 (NEW).
24-A ME Rev Stat § 5015 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 67: MEDICARE SUPPLEMENT INSURANCE POLICIES|24-A §5015. Right to repurchase (REPEALED)

 §5015. Right to repurchase (REPEALED)SECTION HISTORY PL 1997, c. 370, §D1 (NEW). PL 1999, c. 36, §5 (RP).
24-A ME Rev Stat § 5016 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 67: MEDICARE SUPPLEMENT INSURANCE POLICIES|24-A §5016. Notification prior to cancellation; restrictions on lapse or termination due to cognitive impairment or functional incapacity

 §5016. Notification prior to cancellation; restrictions on lapse or termination due to cognitive impairment or functional incapacity 1.  Notice of cancellation.  An insurer that issues Medicare supplement policies shall provide notification to the insured person and another person, if designated by the insured, prior to cancellation of a Medicare supplement policy for nonpayment of premiums.   [PL 2011, c. 123, §4 (NEW); PL 2011, c. 123, §5 (AFF).] 2.  Right to reinstatement.  Within 90 days after cancellation, termination or lapse of coverage due to nonpayment of premium, a policyholder, a person authorized to act on behalf of the policyholder or a dependent of the policyholder covered under the policy may request reinstatement of the policy on the basis that the loss of coverage was a result of the policyholder's cognitive impairment or functional incapacity. An insurer may require a medical demonstration that the policyholder suffered from cognitive impairment or functional incapacity at the time of cancellation, termination or lapse. If the medical demonstration is waived or substantiates the existence of a cognitive impairment or functional incapacity at the time of policy cancellation to the satisfaction of the insurer, the policy must be reinstated. The medical demonstration may be at the expense of the policyholder.   A policy reinstated pursuant to this subsection must cover any loss or claim occurring from the date of the termination, cancellation or lapse and must be issued without any evidence of insurability. Within 15 days after request from an insurer, a policyholder of a policy reinstated pursuant to this subsection shall pay any unpaid premium from the date of the last premium payment at the rate that would have been in effect had the policy remained in force. If the premium is not paid as required, the policy may not be reinstated and the insurer is not responsible for claims incurred after the initial date of cancellation. If an insurer denies a request for reinstatement, the insurer shall notify the policyholder that the policyholder may request a hearing before the superintendent.   [PL 2011, c. 123, §4 (NEW); PL 2011, c. 123, §5 (AFF).] 3.  Rules.  The superintendent may adopt rules to implement the requirements of this section. Rules adopted pursuant to this subsection are routine technical rules as defined in Title 5, chapter 375, subchapter 2-A. The requirements of this section apply to all policies and certificates executed, delivered, issued for delivery, continued or renewed in this State.   [PL 2011, c. 123, §4 (NEW); PL 2011, c. 123, §5 (AFF).] SECTION HISTORY PL 2011, c. 123, §4 (NEW). PL 2011, c. 123, §5 (AFF).
24-A ME Rev Stat § 5051-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5051-A. Required and prohibited provisions

 §5051-A. Required and prohibited provisions 1.  Prohibited provisions.  A long-term care policy may not:   A. Contain coverage for skilled nursing facilities only;   [PL 1989, c. 556, Pt. B, §3 (NEW).]B. Exclude coverage for skilled, intermediate or custodial care received by a resident of a skilled nursing or intermediate care facility;   [PL 1989, c. 556, Pt. B, §3 (NEW).]C. Require a prior hospital stay as a condition for any policy benefits;   [PL 1989, c. 556, Pt. B, §3 (NEW).]D. Require a prior skilled nursing facility stay as a condition for intermediate care facility benefits; or   [PL 1989, c. 556, Pt. B, §3 (NEW).]E. Require prior institutionalization as a condition of receipt of home health care benefits.   [PL 1989, c. 556, Pt. B, §3 (NEW).][PL 1989, c. 556, Pt. B, §3 (NEW).] 2.  Required provisions.  A long-term care policy must provide:   A. Custodial care benefits that are at least 50% of those provided for skilled nursing care in a nursing facility provided that the benefits need not exceed usual, customary and reasonable charges;   [PL 1989, c. 556, Pt. B, §3 (NEW).]B. Benefits for home health care services rendered by a home health care provider;   [PL 1989, c. 556, Pt. B, §3 (NEW).]C. Home health care coverage for at least 90 visits in any continuous 12-month period during which coverage is in force; and   [PL 1989, c. 556, Pt. B, §3 (NEW).]D. Per visit benefits for home health care services which are at least 50% of the daily benefit for skilled nursing facility confinement provided that the benefit need not exceed usual, customary and reasonable charges.   [PL 1989, c. 556, Pt. B, §3 (NEW).][PL 1989, c. 556, Pt. B, §3 (NEW).] SECTION HISTORY PL 1989, c. 556, §B3 (NEW).
24-A ME Rev Stat § 5051-B (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5051-B. Alternative policies

 §5051-B. Alternative policies 1.  Innovative long-term care products permitted.  Notwithstanding section 5051‑A, an insurer, organization or plan may offer a long-term care policy, within the meaning of section 5051, subsection 1, which does not meet one or more of the requirements of section 5051‑A if the Superintendent of Insurance finds that:   A. For each requirement of section 5051‑A which is not satisfied, there is a valid reason why that requirement is inappropriate for the policy design in question;   [PL 1989, c. 556, Pt. B, §3 (NEW).]B. The total package of benefits provided is at least as comprehensive as that required by section 5051‑A; and   [PL 1989, c. 556, Pt. B, §3 (NEW).]C. Availability of the policy would be in the best interest of the public taking into consideration the following factors:   (1) Whether the policy accomplishes the goal of providing dependable benefits for long-term care; and   (2) Whether the plans for marketing the policy contain adequate safeguards to minimize any confusion that may be caused to consumers by the failure of the policy to fall within the established guidelines of this section.   [PL 1989, c. 556, Pt. B, §3 (NEW).][PL 1989, c. 556, Pt. B, §3 (NEW).] 2.  Qualifications for tax incentives.  If the superintendent finds that a policy meets the criteria of subsection 1, the superintendent, in determining whether to certify the policy for tax incentives under section 5054, shall consider the policy to comply with each of the requirements of section 5051‑A.   [PL 1989, c. 556, Pt. B, §3 (NEW).] SECTION HISTORY PL 1989, c. 556, §B3 (NEW).
24-A ME Rev Stat § 5052 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5052. Specific standards

 §5052. Specific standards 1.  Standards for long-term care, home health care and nursing home care policies.  The superintendent may adopt rules to establish specific standards for policy provisions of long-term care, home health care and nursing home care policies. The standards must be in addition to and in accordance with applicable laws of this State, including chapters 33 and 35, and may include, but are not limited to:   A. Terms of renewability;   [PL 1985, c. 648, §12 (NEW).]B. Initial and subsequent conditions of eligibility;   [PL 1985, c. 648, §12 (NEW).]C. Nonduplication of coverage;   [PL 1985, c. 648, §12 (NEW).]D. Probationary periods;   [PL 1985, c. 648, §12 (NEW).]E. Benefit limitations, exceptions and reductions;   [PL 1985, c. 648, §12 (NEW).]F. Elimination periods;   [PL 1985, c. 648, §12 (NEW).]G. Requirements for replacement;   [PL 1985, c. 648, §12 (NEW).]H. Recurrent confinements; and   [PL 1985, c. 648, §12 (NEW).]I. Definition of terms.   [PL 1985, c. 648, §12 (NEW).][PL 1997, c. 604, Pt. D, §3 (AMD).] 2.  Prohibited policy provision.  The superintendent may adopt rules that specify prohibited provisions not otherwise specifically authorized by law that, in the opinion of the superintendent, are unjust, unfair, inequitable or unfairly discriminatory to any person insured or proposed for coverage under a long-term care, home health care or nursing home care policy.   [PL 1997, c. 604, Pt. D, §3 (AMD).] SECTION HISTORY PL 1985, c. 648, §12 (NEW). PL 1997, c. 604, §D3 (AMD).
24-A ME Rev Stat § 5052-A (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5052-A. Trial examination period

 §5052-A. Trial examination period Nursing home care, home health care and long-term care policies must have a notice prominently printed on the first page of the policy or certificate or attached to the first page stating in substance that the applicant has the right to return the policy or certificate within 30 days of its delivery and to have the premium refunded if for any reason, after examination of the policy or certificate, the applicant is not satisfied.   [PL 1997, c. 604, Pt. D, §4 (AMD).]SECTION HISTORY PL 1991, c. 200, §C1 (NEW). PL 1997, c. 604, §D4 (AMD).
24-A ME Rev Stat § 5053 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5053. Rulemaking, disclosure standards, compensation

 §5053. Rulemaking, disclosure standards, compensation The superintendent may adopt reasonable rules to provide for the full and fair disclosure of information in connection with the sale of long-term care, home health care and nursing home care policies, including, but not limited to, an outline of coverage requirements and requirements relating to the replacement sale of the policies and compensation or commission to an agent or representative for the sale of a nursing home care, home health care or long-term care policy or certificate.   [PL 1997, c. 604, Pt. D, §5 (AMD).]The superintendent may adopt reasonable rules setting or limiting the rate of compensation or commission to an agent or other representative for the sale of a nursing home care, home health care or long-term care policy or certificate and regarding replacement sale of a nursing home care, home health care or long-term care policy or certificate.   [PL 1997, c. 604, Pt. D, §5 (AMD).]SECTION HISTORY PL 1985, c. 648, §12 (NEW). PL 1991, c. 200, §C2 (AMD). PL 1997, c. 604, §D5 (AMD).
24-A ME Rev Stat § 5054 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5054. Certification by superintendent

 §5054. Certification by superintendent 1.  Filing of form.  Any insurer, nonprofit hospital or medical service organization, or nonprofit health care plan may, at the time it files a policy or contract for approval for issuance or delivery in the State, or at any time thereafter, request that the superintendent certify the policy or contract as a long-term care policy within the meaning of section 5051.   Within 60 days of receipt of a request for certification, the superintendent shall:   A. Certify in writing that the policy or contract complies with this section;   [PL 1989, c. 556, Pt. B, §4 (NEW).]B. Deny the request in writing, stating the reasons for denial; or   [PL 1989, c. 556, Pt. B, §4 (NEW).]C. Notify the insurer or nonprofit hospital or medical service organization or nonprofit health care plan, in writing, that an insufficient basis exists for determining whether a certification should be made, indicating in what respects the request was insufficient.   [PL 1997, c. 604, Pt. D, §6 (AMD).][PL 1997, c. 604, Pt. D, §6 (AMD).] 2.  Standards for compliance.  The superintendent shall certify a policy or contract submitted for review under this section as a long-term care policy if the superintendent finds that the policy or contract:   A. Is a long-term care policy within the meaning of section 5051; and   [PL 1989, c. 556, Pt. B, §4 (NEW).]B. Complies with all standards applicable to long-term care policies as set forth in this chapter and in chapters 27, 33 and 35 and in rules adopted pursuant to any of those chapters by the superintendent. Waivers granted under the rules shall be taken into consideration.   [PL 1989, c. 556, Pt. B, §4 (NEW).][PL 1989, c. 556, Pt. B, §4 (NEW).] SECTION HISTORY PL 1989, c. 556, §B4 (NEW). PL 1997, c. 604, §D6 (AMD).
24-A ME Rev Stat § 5055 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5055. Tax incentives available

 §5055. Tax incentives available 1.  Reduced premium tax.  Any insurance company choosing to offer an insurance policy which is certified by the superintendent as a long-term care policy shall qualify for the reduced tax on premiums collected under Title 36, section 2513.   [PL 1989, c. 556, Pt. B, §4 (NEW).] 2.  Income tax reduction.  Any person paying premiums for a policy or contract which is certified by the superintendent as a long-term care policy shall qualify for the income tax deduction provided for in Title 36, section 5122.   [PL 1989, c. 556, Pt. B, §4 (NEW).] 3.  Credit for employers.  An employer providing long-term care benefits to its employees may qualify for the tax credit provided by Title 36, section 2525‑A or 5217-C.   [PL 2017, c. 170, Pt. G, §1 (AMD).] 4.  Life insurance riders.  With respect to life insurance riders that qualify as long-term care policies, the tax incentives provided by this section shall apply only to that portion of the premium attributable to the rider.   [PL 1989, c. 556, Pt. B, §4 (NEW).] 5.  Provision of records.  Any person who holds a group long-term care policy pursuant to or under which premiums are paid in whole or in part by certificate holders or other 3rd parties shall provide to those certificate holders or 3rd parties adequate and timely records to enable those persons to have knowledge of the tax reduction to which they may be entitled under subsection 2 and under Title 36, section 5122.   [PL 1989, c. 556, Pt. B, §4 (NEW).] SECTION HISTORY PL 1989, c. 556, §B4 (NEW). PL 2017, c. 170, Pt. G, §1 (AMD).
24-A ME Rev Stat § 5056 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5056. Standards for marketing

 §5056. Standards for marketing Every insurer, health care service plan or other entity marketing nursing home care, home health care or long-term care insurance coverage in this State, directly or through its producers, shall:   [PL 1997, c. 604, Pt. D, §7 (AMD).]1.  Policy comparison.  Establish marketing procedures to ensure that any comparison of policies by its agents or other producers is fair and accurate;   [PL 1991, c. 200, Pt. C, §3 (NEW).] 2.  Excessive insurance.  Establish marketing procedures to ensure that excessive insurance is not sold or issued. The procedures must include a specific standard for persons covered by Medicaid;   [PL 1991, c. 200, Pt. C, §3 (NEW).] 3.  Replacement policy.  Establish marketing procedures that set forth a mechanism or formula for determining whether a replacement policy or certificate contains benefits clearly and substantially greater than the benefits under the replaced policy; and   [PL 1991, c. 200, Pt. C, §3 (NEW).] 4.  Compliance procedures.  Establish auditable procedures for verifying compliance with the standards set out in this section.   [PL 1991, c. 200, Pt. C, §3 (NEW).] SECTION HISTORY PL 1991, c. 200, §C3 (NEW). PL 1997, c. 604, §D7 (AMD).
24-A ME Rev Stat § 5057 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68: NURSING HOME CARE AND LONG-TERM CARE INSURANCE POLICIES|24-A §5057. Applicability

 §5057. Applicability This chapter applies only to policies and certificates issued before January 1, 2000.   [PL 1999, c. 292, §1 (NEW).]SECTION HISTORY PL 1999, c. 292, §1 (NEW).
24-A ME Rev Stat § 5071 (2021)
2021 Maine Revised Statutes|TITLE 24-A: MAINE INSURANCE CODE|Chapter 68-A: LONG-TERM CARE INSURANCE|24-A §5071. Scope

 §5071. Scope This chapter applies to long-term care insurance policies or certificates delivered or issued for delivery in this State on or after January 1, 2000, except it does not apply to certificates issued under policies issued in other states to employer groups as described in section 2804 and labor union groups as described in section 2805. This chapter is not intended to supersede the obligations of entities subject to this chapter to comply with the substance of other applicable insurance laws to the extent that these laws are not inconsistent with the requirements of this chapter, except that laws and rules designed and intended to apply to Medicare supplement insurance may not be applied to long-term care insurance. Notwithstanding this chapter, any product advertised, marketed or offered as long-term care insurance is subject to this chapter.   [PL 1999, c. 292, §2 (NEW).]SECTION HISTORY PL 1999, c. 292, §2 (NEW).