reglab/statecodes huggingface dataset:
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-N. Coverage for colorectal cancer screening

§2847-N. Coverage for colorectal cancer screening
1.  Colorectal cancer screening.
For the purposes of this section, "colorectal cancer screening" means all colorectal cancer examinations and laboratory tests recommended by a health care provider in accordance with the most recently published colorectal cancer screening guidelines of a national cancer society.
[PL 2019, c. 86, §4 (AMD).]
2.  Required coverage.
All group health insurance policies, contracts and certificates must provide coverage for colorectal cancer screening for asymptomatic individuals who are:
A. At average risk for colorectal cancer according to the most recently published colorectal cancer screening guidelines of a national cancer society; or   [PL 2019, c. 86, §5 (AMD).]
B. At high risk for colorectal cancer.   [PL 2019, c. 86, §6 (AMD).]
[PL 2019, c. 86, §§5, 6 (AMD).]
3.  Billing.
If a colonoscopy is recommended by a health care provider as the colorectal cancer screening test in accordance with this section and a lesion is discovered and removed during that colonoscopy, the health care provider must bill the insurance company for a screening colonoscopy as the primary procedure.
[PL 2007, c. 516, §3 (NEW); PL 2007, c. 516, §5 (AFF).]
Revisor's Note: §2847-N. Coverage for medically necessary infant formula (As enacted by PL 2007, c. 595, §3 is REALLOCATED TO TITLE 24-A, SECTION 2847-P)
SECTION HISTORY
PL 2007, c. 516, §3 (NEW). PL 2007, c. 516, §5 (AFF). PL 2007, c. 595, §3 (NEW). PL 2007, c. 595, §5 (AFF). PL 2007, c. 695, Pt. C, §15 (RAL). PL 2019, c. 86, §§4-6 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-O. Coverage for hearing aids (REALLOCATED FROM TITLE 24-A, SECTION 2847-M)

§2847-O. Coverage for hearing aids
(REALLOCATED FROM TITLE 24-A, SECTION 2847-M)
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. 695, Pt. A, §29 (RAL).]
2.  Required coverage.
All group health insurance policies, contracts and certificates must provide coverage for the purchase of a hearing aid for each hearing-impaired ear for an individual covered under the policy, contract or certificate 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, §29 (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, §3 (AMD).]
C. The policy, contract or certificate may limit coverage to $3,000 per hearing aid for each hearing-impaired ear every 36 months.   [PL 2019, c. 418, §3 (AMD).]
[PL 2019, c. 418, §3 (AMD).]
3.  Application of coverage.
[PL 2019, c. 418, §4 (RP).]
4.  Limits; coinsurance; deductibles.
Except as otherwise provided in this section, any policy, contract or certificate 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. 695, Pt. A, §29 (RAL).]
SECTION HISTORY
PL 2007, c. 695, Pt. A, §29 (RAL). PL 2015, c. 494, Pt. A, §29 (AMD). PL 2019, c. 418, §§3, 4 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-P. Coverage for medically necessary infant formula (REALLOCATED FROM TITLE 24-A, SECTION 2847-N)

§2847-P. Coverage for medically necessary infant formula
(REALLOCATED FROM TITLE 24-A, SECTION 2847-N)
All group health insurance policies, contracts and certificates must provide coverage for amino acid-based elemental infant formula for children 2 years of age and under in accordance with this section.   [PL 2007, c. 695, Pt. C, §15 (RAL).]
1.  Determination of medical necessity.
Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has submitted documentation that the amino acid-based elemental infant formula is medically necessary health care as defined in section 4301‑A, subsection 10‑A, that the amino acid-based elemental infant formula is the predominant source of nutritional intake at a rate of 50% or greater and that other commercial infant formulas, including cow milk-based and soy milk-based formulas have been tried and have failed or are contraindicated. A licensed physician may be required to confirm and document ongoing medical necessity at least annually.
[PL 2007, c. 695, Pt. C, §15 (RAL).]
2.  Method of delivery.
Coverage for amino acid-based elemental infant formula must be provided without regard to the method of delivery of the formula.
[PL 2007, c. 695, Pt. C, §15 (RAL).]
3.  Required diagnosis.
Coverage for amino acid-based elemental infant formula must be provided when a licensed physician has diagnosed and through medical evaluation has documented one of the following conditions:
A. Symptomatic allergic colitis or proctitis;   [PL 2007, c. 695, Pt. C, §15 (RAL).]
B. Laboratory- or biopsy-proven allergic or eosinophilic gastroenteritis;   [PL 2007, c. 695, Pt. C, §15 (RAL).]
C. A history of anaphylaxis;   [PL 2007, c. 695, Pt. C, §15 (RAL).]
D. Gastroesophageal reflux disease that is nonresponsive to standard medical therapies;   [PL 2007, c. 695, Pt. C, §15 (RAL).]
E. Severe vomiting or diarrhea resulting in clinically significant dehydration requiring treatment by a medical provider;   [PL 2007, c. 695, Pt. C, §15 (RAL).]
F. Cystic fibrosis; or   [PL 2007, c. 695, Pt. C, §15 (RAL).]
G. Malabsorption of cow milk-based or soy milk-based infant formula.   [PL 2007, c. 695, Pt. C, §15 (RAL).]
[PL 2007, c. 695, Pt. C, §15 (RAL).]
4.  Health savings accounts.
Coverage for amino acid-based elemental infant formula under a health insurance policy, contract or certificate issued in connection with a health savings account as authorized under Title XII of the federal Medicare Prescription Drug, Improvement, and Modernization Act of 2003 may be subject to the same deductible and out-of-pocket limits that apply to overall benefits under the policy, contract or certificate.
[PL 2007, c. 695, Pt. C, §15 (RAL).]
SECTION HISTORY
PL 2007, c. 695, Pt. C, §15 (RAL).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-Q. Coverage for services provided by independent practice dental hygienist

§2847-Q. Coverage for services provided by independent practice dental hygienist
1.  Services provided by independent practice dental hygienist.
An insurer that issues group dental insurance or health insurance that includes coverage for dental services shall provide coverage for dental services performed by an independent practice dental hygienist licensed under Title 32, chapter 143 when those services are covered services under the contract and when they are within the lawful scope of practice of the independent practice dental hygienist.
[PL 2015, c. 429, §13 (AMD).]
2.  Limits; coinsurance; deductibles.
A contract that provides coverage for the services required by 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 2009, c. 307, §3 (NEW); PL 2009, c. 307, §6 (AFF).]
3.  Coordination of benefits with dental insurance.
If an enrollee eligible for coverage under this section is eligible for coverage under a dental insurance policy or contract and a health insurance policy or contract, the insurer providing dental insurance is the primary payer responsible for charges under subsection 1 and the insurer providing group health insurance is the secondary payer.
[PL 2009, c. 307, §3 (NEW); PL 2009, c. 307, §6 (AFF).]
4.  Application.
The requirements of this section apply to all policies, contracts and certificates executed, delivered, issued for delivery, continued or renewed in this State. For purposes of this section, all contracts are deemed to be renewed no later than the next yearly anniversary of the contract date.
[PL 2009, c. 307, §3 (NEW); PL 2009, c. 307, §6 (AFF).]
SECTION HISTORY
PL 2009, c. 307, §3 (NEW). PL 2009, c. 307, §6 (AFF). PL 2015, c. 429, §13 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-R. Enrollment of dependent children in dental coverage

§2847-R. Enrollment of dependent children in dental coverage
1.  Offer of dependent coverage; enrollment period.
All group dental insurance policies, contracts and certificates that offer dependent coverage must offer the opportunity to enroll a dependent child in the dental insurance coverage at appropriate rates during the following periods:
A. From birth to 30 days of age; and   [PL 2009, c. 578, §3 (NEW); PL 2009, c. 578, §4 (AFF).]
B. Any open or annual enrollment period.   [PL 2009, c. 578, §3 (NEW); PL 2009, c. 578, §4 (AFF).]
[PL 2009, c. 578, §3 (NEW); PL 2009, c. 578, §4 (AFF).]
Revisor's Note: §2847-R. Coverage for children's early intervention services (As enacted by PL 2009, c. 634, §3; §5 is REALLOCATED TO TITLE 24-A, SECTION 2847-S)
Revisor's Note: §2847-R. Coverage for the diagnosis and treatment of autism spectrum disorders (As enacted by PL 2009, c. 635, §3; §6 is REALLOCATED TO TITLE 24-A, §2847-T)
SECTION HISTORY
PL 2009, c. 578, §3 (NEW). PL 2009, c. 578, §4 (AFF). PL 2009, c. 634, §3 (NEW). PL 2009, c. 634, §5 (AFF). PL 2009, c. 635, §3 (NEW). PL 2009, c. 635, §6 (AFF). PL 2011, c. 420, Pt. A, §25 (RAL). PL 2011, c. 420, Pt. A, §26 (RAL).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-S. Coverage for children's early intervention services (REALLOCATED FROM TITLE 24-A, SECTION 2847-R)

§2847-S. Coverage for children's early intervention services
(REALLOCATED FROM TITLE 24-A, SECTION 2847-R)
1.  Definition.
For purposes of this section, "children's early intervention services" means services provided by licensed occupational therapists, physical therapists, speech-language pathologists or clinical social workers working with children from birth to 36 months of age with an identified developmental disability or delay as described in the federal Individuals with Disabilities Education Act, Part C, 20 United States Code, Section 1411, et seq.
[PL 2011, c. 420, Pt. A, §25 (RAL).]
2.  Required coverage.
All group health insurance policies, contracts and certificates must provide coverage for children's early intervention services in accordance with this subsection.
A. A referral from the child's primary care provider is required.   [PL 2011, c. 420, Pt. A, §25 (RAL).]
B. The policy, contract or certificate may limit coverage to $3,200 per year for each child not to exceed $9,600 by the child's 3rd birthday.   [PL 2011, c. 420, Pt. A, §25 (RAL).]
C. The policy, contract or certificate 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 2011, c. 420, Pt. A, §25 (RAL).]
[PL 2011, c. 420, Pt. A, §25 (RAL).]
SECTION HISTORY
PL 2011, c. 420, Pt. A, §25 (RAL).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-U. Coverage for services provided by dental therapist

§2847-U. Coverage for services provided by dental therapist
1.  Services provided by dental therapist.
An insurer that issues group dental insurance or health insurance that includes coverage for dental services shall provide coverage for dental services performed by a dental therapist licensed under Title 32, chapter 143 when those services are covered services under the contract and when they are within the lawful scope of practice of the dental therapist.
[PL 2019, c. 388, §4 (AMD).]
2.  Limits; coinsurance; deductibles.
A contract that provides coverage for the services required by 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 2013, c. 575, §6 (NEW); PL 2013, c. 575, §10 (AFF).]
3.  Coordination of benefits with dental insurance.
If an enrollee eligible for coverage under this section is eligible for coverage under a dental insurance policy or contract and a health insurance policy or contract, the insurer providing dental insurance is the primary payer responsible for charges under subsection 1 and the insurer providing group health insurance is the secondary payer.
[PL 2013, c. 575, §6 (NEW); PL 2013, c. 575, §10 (AFF).]
SECTION HISTORY
PL 2013, c. 575, §6 (NEW). PL 2013, c. 575, §10 (AFF). PL 2015, c. 429, §14 (AMD). PL 2019, c. 388, §4 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-V. Absolute discretion clauses

§2847-V. Absolute discretion clauses
A group health insurance policy, contract or certificate, including, but not limited to, a group disability income insurance policy, contract or certificate, may not contain a provision purporting to reserve sole or absolute discretion to the insurer to interpret the terms of the contract, to provide standards of interpretation or review, to determine eligibility for benefits, to determine the amount of benefits or to resolve factual disputes. An insurer may not enforce a provision in a policy, contract or certificate that was offered, executed, delivered or issued for delivery in this State and has been continued or renewed by a group policy holder in this State that purports to reserve sole or absolute discretion to the insurer to interpret the terms of the contract, to provide standards of interpretation or review, to determine eligibility for benefits, to determine the amount of benefits or to resolve factual disputes.   [PL 2019, c. 179, §2 (NEW).]
SECTION HISTORY
PL 2019, c. 179, §2 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2847-W. Dental benefit waiting period

§2847-W. Dental benefit waiting period
1.  Enrollee defined.
For the purposes of this section, unless the context otherwise indicates, "enrollee" means a person who is covered under a group policy or contract provided by an insurer.
[PL 2019, c. 605, §6 (NEW).]
2.  No waiting period for enrollee under 19 years of age.
An insurer that issues group dental insurance or health insurance that includes coverage for dental services may not impose a waiting period, as defined in section 2848, subsection 5, for any dental or oral health service or treatment, except for orthodontic treatment, for an enrollee if the enrollee is under 19 years of age.
[PL 2019, c. 605, §6 (NEW).]
SECTION HISTORY
PL 2019, c. 605, §6 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE › 24-A §2848-A. Applicability to certain self-insured employers

§2848-A. Applicability to certain self-insured employers
For purposes of this chapter, an uninsured employee health plan that covers employees working in this State, including the uninsured portion of a partially insured employee health plan, is considered a group medical insurance policy and the employer maintaining the plan is considered an insurer, if the plan is subject to state regulation by virtue of the governmental plan or nonelecting church plan exception to the federal definition of "employee benefit plan" in the federal Employee Retirement Income Security Act, 29 United States Code, Section 1003(b).   [PL 1997, c. 445, §23 (NEW); PL 1997, c. 445, §32 (AFF).]
SECTION HISTORY
PL 1997, c. 445, §23 (NEW). PL 1997, c. 445, §32 (AFF).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE › 24-A §2849-A. Extension of benefits for disabled persons

§2849-A. Extension of benefits for disabled persons
1.  Policies subject to this section.
This section applies to group and blanket policies that provide hospital or medical expense coverage or specific indemnity during hospital confinement. This section does not apply to group policies providing coverage only for dental expense or to group long-term care policies as defined in section 5051 or group short-term and long-term disability policies.
[PL 1999, c. 256, Pt. L, §5 (AMD).]
2.  Requirement.
Every group or blanket policy subject to this section must provide a reasonable extension of benefits for a person who is totally disabled on the date the group or blanket policy is discontinued, or on the date coverage for a subgroup in the policy is discontinued. A premium may not be charged during the period of extension. For a policy providing hospital or medical expense coverage, an extension of benefits provision is reasonable if it provides benefits for covered expenses directly relating to the condition causing total disability for at least 6 months following the effective date of discontinuance. For a policy providing specific indemnity during hospital confinement, "extension of benefits" means that discontinuance of the policy during a disability has no effect on benefits payable for that confinement.
[PL 2007, c. 199, Pt. D, §2 (AMD).]
3.  Description of benefit extension.
The extension of benefits provision must be described in all policies and group certificates. The benefits payable during any period of extension are subject to the regular benefit limits under the policy.
[PL 1989, c. 867, §8 (NEW); PL 1989, c. 867, §10 (AFF).]
4.  Liability after discontinuance.
After discontinuance of a policy, the insurer or health maintenance organization remains liable only to the extent of its accrued liabilities and extensions of benefits.
[PL 1997, c. 604, Pt. H, §1 (AMD).]
4-A.  Coordination of benefits.
If replacement coverage is secured by the group or blanket policyholder from an insurer, nonprofit hospital or medical service organization or health maintenance organization and a totally disabled person is covered under the replacement coverage, the replacement coverage must pay as primary coverage and the replaced coverage must pay as secondary coverage for the covered expenses directly relating to the condition causing total disability during the extension of benefits required under this section.
[PL 2007, c. 199, Pt. D, §3 (AMD).]
5.  Rules.
The superintendent shall adopt rules to define the term "total disability" for purposes of this section. The definition must identify persons who are unable, as a result of disability, to obtain comparable alternative coverage through comparable employment or otherwise.
[PL 1989, c. 867, §8 (NEW); PL 1989, c. 867, §10 (AFF).]
SECTION HISTORY
PL 1989, c. 867, §§8,10 (NEW). PL 1991, c. 695, §8 (AMD). PL 1997, c. 604, §§H1,2 (AMD). PL 1999, c. 256, §§L5,6 (AMD). PL 2007, c. 199, Pt. D, §§2, 3 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE › 24-A §2850. Limitations on exclusion and waiting periods

§2850. Limitations on exclusion and waiting periods
1.  Application.
This section applies to individual, group and blanket medical insurance contracts subject to chapters 33 and 35, except Medicare supplement contracts, converted contracts issued under section 2809‑A and contracts designed to cover specific diseases, hospital indemnity or accidental injury only.
[PL 1999, c. 256, Pt. L, §8 (AMD).]
1-A.  Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Date of enrollment" means the effective date of coverage or, if earlier, the first day of the waiting period for such coverage.   [PL 2001, c. 258, Pt. E, §9 (NEW).]
B. "Preexisting condition exclusion," with respect to coverage, means a limitation or exclusion of benefits relating to a condition based on the fact or perception that the condition was present, or that the person was at particularized risk of developing the condition, before the date of enrollment for coverage, whether or not any medical advice, diagnosis, care or treatment was recommended or received before that date.   [PL 2001, c. 258, Pt. E, §9 (NEW).]
[PL 2001, c. 258, Pt. E, §9 (RPR).]
2.  Limitation.
An individual, group or blanket contract issued by an insurer may not impose a preexisting condition exclusion. This subsection does not limit a carrier's ability to restrict enrollment in an individual contract to open enrollment and special enrollment periods in accordance with section 2736‑C, subsection 11.
A. [PL 2019, c. 5, Pt. A, §16 (RP).]
B. [PL 2019, c. 5, Pt. A, §16 (RP).]
C. [PL 2019, c. 5, Pt. A, §16 (RP).]
D. [PL 2019, c. 5, Pt. A, §16 (RP).]
E. [PL 2019, c. 5, Pt. A, §16 (RP).]
F. [PL 2019, c. 5, Pt. A, §16 (RP).]
[PL 2019, c. 5, Pt. A, §16 (AMD).]
SECTION HISTORY
PL 1989, c. 867, §§8,10 (NEW). PL 1991, c. 695, §11 (AMD). PL 1993, c. 477, §A15 (AMD). PL 1993, c. 477, §F1 (AFF). PL 1993, c. 547, §4 (AMD). PL 1997, c. 370, §C5 (AMD). PL 1997, c. 445, §§28,29 (AMD). PL 1997, c. 445, §32 (AFF). PL 1999, c. 256, §§L8,9 (AMD). PL 2001, c. 258, §§D3,E9 (AMD). PL 2007, c. 199, Pt. A, §8 (AMD). PL 2009, c. 244, Pt. E, §7 (AMD). PL 2011, c. 364, §18 (AMD). PL 2019, c. 5, Pt. A, §16 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE › 24-A §2850-A. Gynecological and obstetrical services (REALLOCATED TO TITLE 24-A, SECTION 2847-F)

§2850-A. Gynecological and obstetrical services
(REALLOCATED TO TITLE 24-A, SECTION 2847-F)
SECTION HISTORY
PL 1995, c. 617, §4 (NEW). PL 1995, c. 617, §6 (AFF). PL 1997, c. 370, §H1 (RAL).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE › 24-A §2850-C. Nondiscrimination

§2850-C. Nondiscrimination
1.  Application.
This section applies to group medical insurance contracts subject to chapter 35 other than contracts designed to cover specific diseases, hospital indemnity or accidental injury only.
[PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).]
2.  Eligibility and premium contributions.
A carrier may not establish rules for eligibility of an individual to enroll, or require an individual to pay a premium or contribution that is greater than that for a similarly situated individual, based on health status, medical condition, claims experience, receipt of health care, medical history, genetic information, evidence of insurability or disability in relation to the individual or a dependent of the individual. Nothing in this section requires a group health plan to provide particular benefits other than those provided under the terms of the plan or restricts the amount an employer may be charged for coverage. Nothing in this section prohibits establishing limitations or restrictions on the amount, level, extent or nature of the benefits for similarly situated individuals enrolled in the plan. Nothing in this section prohibits a carrier from establishing premium discounts or refunds or modifying applicable copayments or deductibles in return for adherence to programs of health promotion and disease prevention.
[PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).]
3.  Applicability of section 4320-L.
In addition to the requirements of this section, a carrier is subject to section 4320‑L.
[PL 2019, c. 5, Pt. C, §1 (NEW).]
SECTION HISTORY
PL 1997, c. 445, §30 (NEW). PL 1997, c. 445, §32 (AFF). PL 2019, c. 5, Pt. C, §1 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 36: CONTINUITY OF HEALTH INSURANCE COVERAGE › 24-A §2850-D. Rules

§2850-D. Rules
Rules adopted pursuant to this chapter are routine technical rules as defined in Title 5, chapter 375, subchapter II‑A.   [PL 1997, c. 445, §30 (NEW); PL 1997, c. 445, §32 (AFF).]
SECTION HISTORY
PL 1997, c. 445, §30 (NEW). PL 1997, c. 445, §32 (AFF).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2851. Scope of provisions

§2851. Scope of provisions
All life insurance and all health insurance in connection with loans or other credit transactions, credit property insurance, credit involuntary unemployment insurance and other consumer credit insurance specifically authorized by the superintendent in rules adopted pursuant to section 2865 are subject to this chapter, except the following:   [PL 2001, c. 471, Pt. D, §25 (AMD).]
1.  Long-term loan.
Insurance in connection with a loan or other credit transaction of more than 15 years' duration;
[PL 1999, c. 256, Pt. H, §1 (NEW).]
2.  Isolated transactions.
Insurance issued in an isolated transaction on the part of the insurer not related to an agreement or a plan for insuring debtors of the creditor;
[PL 2001, c. 138, §4 (AMD).]
3.  Real estate loan.
Insurance in connection with real estate loans when the charge, if any, to the debtor is periodic and not financed;
[PL 2001, c. 138, §4 (AMD).]
4.  Casualty insurance.
Insurance issued pursuant to section 707, subsection 1, paragraph I against loss or damage resulting from failure of debtors to pay their obligations to the insured; or
[PL 2001, c. 138, §4 (NEW).]
5.  Debt cancellation agreements.
Debt cancellation agreements entered into between financial institutions or credit unions and their debtors.
[PL 2001, c. 138, §4 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1975, c. 288, §4 (AMD). PL 1981, c. 175, §3 (RPR). PL 1999, c. 256, §H1 (RPR). PL 2001, c. 138, §4 (AMD). PL 2001, c. 471, §D25 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2851-A. Short title

§2851-A. Short title
This chapter may be known and cited as the "Consumer Credit Insurance Act."   [PL 2001, c. 138, §5 (NEW).]
SECTION HISTORY
PL 2001, c. 138, §5 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2852. Purpose; construction

§2852. Purpose; construction
The purpose of this chapter is to promote the public welfare by regulating consumer credit insurance. Nothing in this chapter is intended to prohibit or discourage reasonable competition. This chapter must be liberally construed.   [PL 2001, c. 138, §6 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 2001, c. 138, §6 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2853. Definitions

§2853. Definitions
For the purpose of this chapter:   [PL 1969, c. 132, §1 (NEW).]
1.
"Credit life insurance" means insurance on the life of a debtor pursuant to or in connection with a specific loan or other credit transaction.
[PL 1969, c. 132, §1 (NEW).]
2.
"Credit health insurance" means insurance on a debtor to provide indemnity for payments becoming due on a specific loan or other credit transaction while the debtor is disabled as defined in the policy.
[PL 1969, c. 132, §1 (NEW).]
2-A.
"Credit involuntary unemployment insurance" means involuntary unemployment insurance insuring a debtor pursuant to or in connection with a specific loan or other credit transaction.
[PL 2001, c. 138, §7 (NEW).]
2-B.
"Credit property insurance" means property insurance on property that is purchased on credit or pledged as collateral on a loan when the insurance is purchased by or issued to the debtor in connection with that loan or credit transaction.
[PL 2001, c. 138, §7 (NEW).]
2-C.
"Consumer credit insurance" means insurance subject to this chapter under section 2851.
[PL 2001, c. 138, §7 (NEW).]
3.
"Creditor" means the lender of money or vendor or lessor of goods, services or property, rights or privileges for which payment is arranged through a credit transaction, or any successor to the right, title or interest of any such lender, vendor or lessor, and an affiliate, associate or subsidiary of any of them, or any director, officer or employee of any of them, or any other person in any way associated with any of them.
[PL 1969, c. 132, §1 (NEW).]
4.
"Debtor" means a borrower of money or a purchaser or lessee of goods, services, property, rights or privileges for which payment is arranged through a credit transaction.
[PL 1969, c. 132, §1 (NEW).]
5.
"Indebtedness" means the total amount payable by a debtor to a creditor in connection with a loan or other credit transaction.
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 2001, c. 138, §7 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2854. Forms available

§2854. Forms available
Consumer credit insurance may be issued only in the following forms:   [PL 2001, c. 138, §8 (AMD).]
1.  Individual life.
Individual policies of life insurance issued to debtors on the term plan;
[PL 1969, c. 132, §1 (NEW).]
2.  Individual accident and health.
Individual policies of health insurance issued to debtors on a term plan, or disability benefit provisions in individual policies of credit life insurance;
[PL 1969, c. 132, §1 (NEW).]
3.  Group life.
Group policies of life insurance issued to creditors providing insurance upon the lives of debtors on the term plan;
[PL 1969, c. 132, §1 (NEW).]
4.  Group accident and health.
Group policies of health insurance issued to creditors on a term plan insuring debtors, or disability benefit provisions in group credit life insurance policies to provide such coverage;
[PL 1969, c. 132, §1 (NEW).]
4-A.  Individual credit property insurance.
Individual policies of property insurance on property that is purchased on credit or pledged as collateral on a loan when the insurance is purchased by or issued to the debtor in connection with that loan or credit transaction;
[PL 2001, c. 138, §8 (NEW).]
4-B.  Group credit property insurance.
Group policies of property insurance on property that is purchased on credit or pledged as collateral on a loan when the insurance is purchased by or issued to the debtor in connection with that loan or credit transaction;
[PL 2001, c. 138, §8 (NEW).]
4-C.  Individual credit involuntary unemployment insurance.
Individual involuntary unemployment policies insuring a debtor pursuant to or in connection with a specific loan or other credit transaction but not including disability insurance policies;
[PL 2001, c. 138, §8 (NEW).]
4-D.  Group credit involuntary unemployment insurance.
Group involuntary unemployment policies insuring a debtor pursuant to or in connection with a specific loan or other credit transaction but not including disability insurance policies; or
[PL 2001, c. 138, §8 (NEW).]
5.  Combination.
A combination under subsections 1 and 2, or under 3 and 4.
[PL 1969, c. 132, §1 (NEW).]
The superintendent may by rules adopted pursuant to section 2865 or chapter 40‑A designate other permissible types of consumer credit insurance.   [PL 2001, c. 138, §8 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 2001, c. 138, §8 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2855. Amounts of insurance

§2855. Amounts of insurance
1.  Credit life insurance.
A. The amount of credit life insurance shall at no time exceed the unpaid amount financed plus earned interest and an allowance for delinquencies as determined by the superintendent or, in the case of open-end credit, the balance upon which a finance charge may be imposed, plus earned interest and an allowance for delinquencies as determined by the superintendent.   [PL 1977, c. 672, §2 (RPR).]
[PL 1977, c. 672, §2 (RPR).]
2.  Agricultural credit commitments.
Notwithstanding subsection 1, paragraph A, insurance on agricultural credit transaction commitments not exceeding 2 years in duration may be written up to the amount of the loan commitment, on a nondecreasing or level term plan.
[PL 1969, c. 132, §1 (NEW).]
3.  Educational credit commitments.
Notwithstanding subsection 1, paragraph A, insurance on educational credit transaction commitments may be written for the amount of the portion of such commitment that has not been advanced by the creditor.
[PL 1969, c. 132, §1 (NEW).]
4.  Credit health insurance.
A. Coverage limited. The total amount of indemnity payable by credit health insurance in the event of disability, as defined in the policy, shall not exceed the aggregate of the periodic scheduled unpaid installments of the indebtedness; and the amount of each periodic indemnity payment shall not exceed the original indebtedness divided by the number of periodic installments.   [PL 1969, c. 132, §1 (NEW).]
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §55 (AMD). PL 1977, c. 672, §2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2856. Term of insurance

§2856. Term of insurance
1.
The term of credit life insurance or credit health insurance shall, subject to acceptance by the insurer, commence on the date when the debtor becomes obligated to the creditor; except that where a group policy provides coverage with respect to existing obligations, the insurance on a debtor with respect to such indebtedness shall commence on the effective date of the policy.
[PL 1969, c. 132, §1 (NEW).]
2.
Where evidence of insurability is required and such evidence is furnished more than 30 days after the date when the debtor becomes obligated to the creditor, the term of the insurance may commence on the date on which the insurer determines the evidence to be satisfactory, and in such event there shall be an appropriate refund or adjustment of any charge to the debtor for insurance.
[PL 1969, c. 132, §1 (NEW).]
3.
The term of such insurance shall not extend more than 15 days beyond the original or revised scheduled maturity date of the indebtedness, except when extended without additional cost to the debtor.
[PL 1969, c. 132, §1 (NEW).]
4.
If the indebtedness is discharged due to renewal or refinancing prior to the scheduled maturity date, the insurance in force shall be terminated before any new insurance may be issued in connection with the renewed or refinanced indebtedness. In all cases of termination prior to scheduled maturity, a refund shall be paid or credited as provided in section 2859.
[PL 1969, c. 132, §1 (NEW).]
5.
For credit involuntary unemployment insurance, benefits must start after a waiting period of not longer than 30 days but need not be retroactive to the first day of unemployment and must have a maximum benefit period of at least 6 months.
[PL 2001, c. 138, §9 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 2001, c. 138, §9 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2860. Authorized insurer, agent required

§2860. Authorized insurer, agent required
All policies of consumer credit insurance may be delivered or issued for delivery in this State only by an insurer authorized to transact such insurance therein, and may be issued only through holders of licenses or authorizations issued by the superintendent.   [PL 2001, c. 138, §13 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 2001, c. 138, §13 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2860-A. Commissions

§2860-A. Commissions
A commission not exceeding 5% of credit life and health insurance premiums, as set forth by rules adopted by the superintendent, may be paid to any creditor who is a licensed credit insurance agent. This section does not prohibit fees paid to a lender for handling or processing credit life or health insurance not exceeding 10% of prima facie premiums as set forth by rules adopted by the superintendent.   [PL 1993, c. 645, Pt. B, §6 (AMD).]
SECTION HISTORY
PL 1993, c. 208, §3 (NEW). PL 1993, c. 645, §B6 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2861. Premium not deemed interest; amount, collection

§2861. Premium not deemed interest; amount, collection
1.
Except as provided in Title 9‑A, section 4‑104, the premium of cost of such insurance when issued through any creditor shall not be deemed interest, or charges, or consideration, or an amount in excess of permitted charges in connection with the loan or other credit transaction, and any benefit or return or other gain or advantage to the creditor arising out of the sale or provision of such insurance shall not be deemed a violation of any other law, general or special, of the State of Maine.
[PL 1973, c. 762, §11 (AMD).]
2.
The amount charged to a debtor for any consumer credit insurance may not exceed the premiums charged by the insurer, as computed at the time the charge to the debtor is determined.
[PL 2001, c. 138, §14 (AMD).]
3.
The insurance premium or other identifiable charge for such insurance may be collected from the insured or included in the finance charge or principal of any loan or other credit transaction at the time such transaction is completed.
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 762, §11 (AMD). PL 2001, c. 138, §14 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2862. Claims

§2862. Claims
1.  Claims reported.
All claims shall be promptly reported to the insurer or its designated claim representative, and the insurer shall maintain adequate claim files. All claims shall be settled as soon as possible and in accordance with the terms of the insurance contract.
[PL 1969, c. 132, §1 (NEW).]
2.  Claims paid.
All claims shall be paid either by draft drawn upon the insurer or by check of the insurer to the order of the claimant to whom payment of the claim is due pursuant to the policy provisions, or upon direction of such claimant to one specified.
[PL 1969, c. 132, §1 (NEW).]
3.  Creditor may not adjust claims.
No plan or arrangement shall be used whereby any person other than the insurer or its designated claim representative shall be authorized to settle or adjust claims. The creditor shall not be designated as claim representative for the insurer in adjusting claims; except that a group policyholder may, by arrangement with the group insurer, draw drafts or checks in payment of claims due to the group policyholder subject to audit and review by the insurer.
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2863. Existing insurance; choice of insurer

§2863. Existing insurance; choice of insurer
When credit life insurance or credit health insurance is required as additional security for any indebtedness, the debtor shall, upon request to the creditor, have the option of furnishing the required amount of insurance through existing policies of insurance owned or controlled by the debtor or of procuring and furnishing the required coverage through any insurer authorized to transact such insurance within this State.   [RR 2021, c. 1, Pt. B, §252 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §252 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2864. Enforcement

§2864. Enforcement
Whenever the superintendent finds that there has been a violation of this chapter or any regulations issued pursuant thereto, and after written notice thereof and hearing given to the insurer or other person authorized or licensed by the superintendent, such hearing to conform to the provisions of Title 5, chapter 375, subchapter 4, the superintendent shall set forth the details of the superintendent's findings together with an order for compliance by a specified date. Such order is binding on the insurer and other person authorized or licensed by the superintendent on the date specified unless sooner withdrawn by the superintendent.   [RR 2021, c. 1, Pt. B, §253 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1977, c. 694, §424 (AMD). RR 2021, c. 1, Pt. B, §253 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 37: CONSUMER CREDIT INSURANCE › 24-A §2865. Rulemaking

§2865. Rulemaking
The superintendent may adopt rules establishing specific requirements and procedures for consumer credit insurance policies, certificates of coverage and rates, consistent with the purposes of this chapter. These rules may specify additional types of consumer credit insurance that may be issued on an individual basis or, pursuant to chapter 40‑A, on a group basis. Rules adopted pursuant to this section are routine technical rules as defined by Title 5, chapter 375, subchapter II‑A.   [PL 2001, c. 138, §15 (NEW).]
SECTION HISTORY
PL 2001, c. 138, §15 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2881. Exemption from chapter

§2881. Exemption from chapter
Legal services insurance, as defined in this chapter, does not include the payment by a voluntary association, other than a voluntary association which is an insurer, on behalf of one of its members of fees, costs or expenses related to or arising out of legal services performed for the member by an attorney who either is an employee of the paying association or who provides the legal services to the association's member, pursuant to an agreement with that association.   [PL 1983, c. 801, §11 (NEW).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2882. Insurers authorized to sell legal services insurance

§2882. Insurers authorized to sell legal services insurance
Upon application to an approval by the superintendent, an insurer incorporated by or under the laws of this State or any foreign or alien insurance company duly licensed to transact insurance in its state of domicile may make application for a certificate of authority to transact the business of legal services insurance, including reinsurance, in this State, if that company is authorized or qualified to be authorized to transact a health insurance business in this State.   [PL 1983, c. 801, §11 (NEW).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2883. Legal services insurance defined

§2883. Legal services insurance defined
"Legal services insurance" is insurance which involves the assumption of a contractual obligation to reimburse the beneficiary against or pay on behalf of the beneficiary all or a portion of the beneficiary's fees, costs or expenses related to or arising out of services performed by or under the supervision of an attorney who is not an employee of or under the control of the insurer directly or indirectly and who is licensed to practice in the jurisdiction in which the services are performed. Legal services insurance may also include provisions for basic legal advice only rendered to the beneficiary, by telephone or mail, by one or more attorneys licensed to practice in the jurisdiction in which the advice is given; none of whom are employees of or under the control of the insurer, directly or indirectly. Legal services insurance does not include the provision of or reimbursement for legal services incidental to other insurance coverages.   [RR 2009, c. 2, §68 (COR).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW). RR 2009, c. 2, §68 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2884. Legal services insurance authorized to be sold on a group basis

§2884. Legal services insurance authorized to be sold on a group basis
An insurance company authorized to write legal services insurance in this State, which for the purposes of this chapter only is considered a form of health insurance, has the power to issue group legal services insurance policies or may, by providing for the mental and emotional welfare of individuals and members of an individual's family by defraying the costs of legal services, include legal services insurance in and as a part of a group health insurance policy. Group legal services insurance is that form of voluntary legal services insurance covering employees or members, with or without their eligible dependents, written under a master policy issued to any governmental corporation, unit, agency or department or to any employer, association of employers or employee leasing company registered pursuant to Title 32, chapter 125, including the trustee or trustees of a fund established by that employer, association of employers or registered employee leasing company, a labor union or other employee organization, including the trustees of a fund established by that labor union or employee organization. The terms "employee" and "employees" have the same meaning as are given to those terms for the purposes of writing group life insurance in this State. Legal services insurance may only be issued in this State on a group policy basis.   [PL 1995, c. 618, §4 (AMD).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW). PL 1995, c. 618, §4 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2885. Filing of group manual rates for informational purposes

§2885. Filing of group manual rates for informational purposes
No policy of group legal services insurance may be delivered in this State until a copy of the group manual rates to be used in calculating the premium for these policies has been filed for informational purposes with the superintendent.   [PL 1983, c. 801, §11 (NEW).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2886. Freedom of selection of attorney

§2886. Freedom of selection of attorney
Beneficiaries of legal services insurance shall not be required to select an attorney other than one of the beneficiary's own choosing to provide covered legal services, except for basic legal advice rendered by telephone or mail, as described in this chapter.   [PL 1983, c. 801, §11 (NEW).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2887. Legal services insurance policy reserves

§2887. Legal services insurance policy reserves
For all legal services insurance policies, the insurer shall establish and maintain thereon a reserve which shall place a sound value on its liabilities under those policies and be not less than the reserve according to appropriate standards set forth in rules issued by the superintendent and, in no event, less in the aggregate than the pro rata gross unearned premiums for those policies.   [PL 1983, c. 801, §11 (NEW).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 38: GROUP LEGAL SERVICES INSURANCE › 24-A §2888. Authority of superintendent to adopt additional rules

§2888. Authority of superintendent to adopt additional rules
The superintendent may also issue rules regarding the content of legal services insurance policies and marketing arrangements, including delivery of legal services by licensed professionals.   [PL 1983, c. 801, §11 (NEW).]
Nothing in this chapter may be construed to authorize the practice of law by any person in violation of Title 4, section 807, or to authorize the superintendent to infringe upon the authority of the Supreme Judicial Court to regulate the practice of law.   [PL 1983, c. 801, §11 (NEW).]
SECTION HISTORY
PL 1983, c. 801, §11 (NEW).