reglab/statecodes huggingface dataset:
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4123. Reinsurance

§4123. Reinsurance
A domestic society may, by a reinsurance agreement, cede any individual risk or risks in whole or in part to an insurer, other than another fraternal benefit society, having the power to make such reinsurance and authorized to do business in this State, or if not so authorized, one which is approved by the superintendent, but no such society may reinsure substantially all of its insurance in force without the written permission of the superintendent. It may take credit for the reserves on such ceded risks to the extent reinsured, but no credit shall be allowed as an admitted asset or as a deduction from liability, to a ceding society for reinsurance made, ceded, renewed, or otherwise becoming effective after January 1, 1970, unless the reinsurance is payable by the assuming insurer on the basis of the liability of the ceding society under the contract or contracts reinsured without diminution because of the insolvency of the ceding society.   [PL 1973, c. 625, §154 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1973, c. 625, §154 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4124. Licenses

§4124. Licenses
A license must be issued to each fraternal benefit society that qualifies under this chapter. The license continues in full force and effect until suspended or revoked by the superintendent. Upon issuance of the license and annually thereafter the society shall pay the superintendent a fee that is the same as for an insurer as provided in section 601. A duly certified copy or duplicate of such license is prima facie evidence that the licensee is a fraternal benefit society within the meaning of this chapter. On or before July 1st of each year, the superintendent shall forward to each fraternal benefit society an itemized bill of the amount due for the filing of the annual statement and the amount due for the certificate of authority annual fee.   [PL 1997, c. 592, §68 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1973, c. 625, §155 (AMD). PL 1977, c. 682, §5 (RPR). PL 1997, c. 592, §68 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4125. Foreign or alien society -- admission

§4125. Foreign or alien society -- admission
No foreign or alien society shall transact business in this State without a license issued by the superintendent. Any such society may be licensed to transact business in this State upon filing with the superintendent:   [PL 1973, c. 585, §12 (AMD).]
1.
A duly certified copy of its charter or articles of incorporation;
[PL 1969, c. 132, §1 (NEW).]
2.
A copy of its constitution and laws, certified by its secretary or corresponding officer;
[PL 1969, c. 132, §1 (NEW).]
3.
A power of attorney to the superintendent as prescribed in section 4129;
[PL 1973, c. 585, §12 (AMD).]
4.
A statement of its business under oath of its president and secretary or corresponding officers in a form prescribed by the superintendent, duly verified by an examination made by the supervising insurance official of its home state or other state, territory, province or country, satisfactory to the superintendent of this State;
[PL 1973, c. 585, §12 (AMD).]
5.
A certificate from the proper official of its home state, territory, province or country that the society is legally incorporated and licensed to transact business therein;
[PL 1969, c. 132, §1 (NEW).]
6.
Copies of its certificate forms; and
[PL 1969, c. 132, §1 (NEW).]
7.
Such other information as the superintendent considers necessary; and upon a showing that its assets are invested in accordance with the provisions of this chapter.
[RR 2021, c. 1, Pt. B, §330 (COR).]
Any foreign or alien society desiring admission to this State shall have the qualifications required of domestic societies organized under this chapter.   [PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). RR 2021, c. 1, Pt. B, §330 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4127. Petition for suspension, revocation or refusal of license of foreign or alien society (REPEALED)

§4127. Petition for suspension, revocation or refusal of license of foreign or alien society
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1977, c. 694, §432 (AMD). PL 1999, c. 547, §B78 (AMD). PL 1999, c. 547, §B80 (AFF). PL 2009, c. 13, §4 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4127-A. Suspension, revocation or refusal of license of foreign or alien society

§4127-A. Suspension, revocation or refusal of license of foreign or alien society
The superintendent may suspend, revoke or refuse the license of a foreign or alien society transacting or applying to transact business in this State as set out in this section.   [PL 2009, c. 13, §5 (NEW).]
1.  Investigation.
If, upon investigation, the superintendent finds that a foreign or alien society transacting or applying to transact business in this State has exceeded its powers, has failed to comply with any of the provisions of this chapter, is not fulfilling its contracts in good faith or is conducting its business fraudulently or in a manner hazardous to its members or creditors or the public, the superintendent shall notify the society of the deficiency or deficiencies and state in writing the reasons that warrant suspension, revocation or refusal of the society's license. The notice must require that the deficiency or deficiencies be corrected.
After receipt of the notice, the society has 30 days to comply with the superintendent's request for correction, and if the society fails to comply, the superintendent shall notify the society of the findings of noncompliance and require the society to show cause, on a date set by the superintendent, why its license should not be suspended, revoked or refused. If on that date the society does not present good and sufficient reason why its authority to do business in this State should not be suspended, revoked or refused, the superintendent may suspend or refuse the license of the society to do business in this State until satisfactory evidence is furnished to the superintendent that the suspension or refusal should be withdrawn or the superintendent may revoke the authority of the society to do business in this State.
[PL 2009, c. 13, §5 (NEW).]
2.  Continue contracts.
Nothing in this section may be construed as preventing any foreign or alien society from continuing in good faith all contracts made in this State during the time the society was legally authorized to transact business in this State.
[PL 2009, c. 13, §5 (NEW).]
3.  Enforcement action.
Nothing in this section may be construed as limiting the superintendent's authority to take enforcement action under section 12‑A in connection with violations of applicable provisions of this Title.
[PL 2009, c. 13, §5 (NEW).]
SECTION HISTORY
PL 2009, c. 13, §5 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4128. Licensing of agents

§4128. Licensing of agents
Insurance producers of societies must be licensed in accordance with chapter 16 except that no insurance producer's license is required if:   [PL 2023, c. 405, Pt. A, §93 (AMD).]
1.  Officer devoting substantial time to activities other than solicitation or negotiation of insurance contracts.
An officer, employee or secretary of a society or of any subordinate lodge or branch of that society devotes substantially all of the officer's, employee's or secretary's time to activities other than the solicitation or negotiation of insurance contracts and receives no commission or other compensation directly dependent upon the number or amount of contracts solicited or negotiated;
[PL 2023, c. 405, Pt. A, §93 (AMD).]
2.  Agent devoting less than 50% of time to solicitation and procurement of insurance contracts.
An agent or representative of a society devotes less than 50% of the agent's or representative's time to the solicitation and procurement of insurance contracts for the society. A person who in the preceding calendar year has solicited and procured life insurance in excess of $200,000, face amount, or, in the case of any other kind or kinds of insurance that the society may write, on the persons of more than 25 individuals and who has received or will receive a commission or other compensation for the solicitation and procurement is presumed to be devoting 50% of the person's time to the solicitation or procurement of insurance contracts for the society; or
[PL 2023, c. 405, Pt. A, §93 (AMD).]
3.  Persons who do not effect insurance.
A member of a society does not effect insurance and that member's solicitation or negotiation is incidental to securing new members for the member's society and that member's only remuneration consists of prizes in the form of merchandise or payments of a nominal amount.
[PL 2023, c. 405, Pt. A, §93 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1977, c. 446, §1 (RPR). PL 1997, c. 457, §48 (AMD). PL 1997, c. 457, §55 (AFF). RR 2021, c. 1, Pt. B, §§332-334 (COR). PL 2023, c. 405, Pt. A, §93 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4129. Service of process

§4129. Service of process
Every society authorized to do business in this State shall appoint in writing an agent located in the State upon whom all lawful process in any action or proceeding against it is served and shall agree in writing that any lawful process against it that is served on the agent is of the same legal force and validity as if served upon the society and that the authority continues in force so long as any liability remains outstanding in this State. Copies of such appointment certified by the appointed agent are deemed sufficient evidence of the appointment and may be admitted in evidence with the same force and effect as the original.   [PL 1997, c. 592, §69 (AMD).]
Service may only be made upon the appointed agent or, if absent, upon the person in charge. It must be made in duplicate and constitutes sufficient service upon the society. When legal process against a society is served upon the appointed agent, the appointed agent shall forthwith forward one of the duplicate copies by registered mail, prepaid, directed to the secretary or corresponding officer. Legal process may not be served upon a society except as provided in this section.   [PL 1997, c. 592, §69 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 590, §40 (AMD). PL 1973, c. 585, §12 (AMD). PL 1997, c. 457, §49 (AMD). PL 1997, c. 592, §69 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4130. Injunction

§4130. Injunction
No application or petition for injunction against any domestic, foreign or alien society, or branch thereof, shall be recognized in any court of this State unless made by the Attorney General upon request of the superintendent.   [PL 1973, c. 585, §12 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4131. Review

§4131. Review
All decisions and findings of the superintendent made under the provisions of this chapter shall be subject to review by proper proceedings in any court of competent jurisdiction in this State.   [PL 1973, c. 585, §12 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4132. Funds

§4132. Funds
All assets shall be held, invested and disbursed for the use and benefit of the society and no member or beneficiary shall have or acquire individual rights therein or become entitled to any apportionment or the surrender of any part thereof, except as provided in the contract.   [PL 1969, c. 132, §1 (NEW).]
A society may create, maintain, invest, disburse and apply any special fund or funds necessary to carry out any purpose permitted by the laws of such society.   [PL 1969, c. 132, §1 (NEW).]
Every society, the admitted assets of which are less than the sum of its accrued liabilities and reserves under all of its certificates when valued according to standards required for certificates issued after one year from the effective date of this chapter, shall, in every provision of the laws of the society for payments by members of such society, in whatever form made, distinctly state the purpose of the same and the proportion thereof which may be used for expenses, and no part of the money collected for mortuary or disability purposes or the net accretions thereto shall be used for expenses.   [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 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4133. Investments

§4133. Investments
A society shall invest its funds only in such investments as are authorized by the laws of this State for the investment of assets of life insurers and subject to the limitations thereon. Any foreign or alien society permitted or seeking to do business in this State which invests its funds in accordance with the laws of the state, district, territory, country or province in which it is incorporated, shall be held to meet the requirements of this section for the investment of funds.   [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 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4135. Examination of domestic societies

§4135. Examination of domestic societies
The superintendent, or any person the superintendent may appoint, has the power of visitation and examination into the affairs of any domestic society and the superintendent shall make such examination at least once in every 3 years. The superintendent may employ assistants for the purpose of such examination, and the superintendent, or any person the superintendent may appoint, has free access to all books, papers and documents that relate to the business of the society. The minutes of the proceedings of the supreme legislative or governing body and of the board of directors or corresponding body of a society must be in the English language. In making any such examination the superintendent may summon and qualify as witnesses under oath and examine its officers, agents and employees or other persons in relation to the affairs, transactions and condition of the society. A summary of the report of the superintendent and such recommendations or statements of the superintendent as may accompany such report must be read at the first meeting of the board of directors or corresponding body of the society following the receipt thereof, and if directed so to do by the superintendent, must also be read at the first meeting of the supreme legislative or governing body of the society following the receipt thereof. A copy of the report, recommendations and statements of the superintendent must be furnished by the society to each member of such board of directors or other governing body. The expense of each examination and of each valuation, including compensation and actual expense of examiners, must be paid by the society examined or whose certificates are valued, upon statements furnished by the superintendent.   [RR 2021, c. 1, Pt. B, §337 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). RR 2021, c. 1, Pt. B, §337 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4136. Examination of foreign and alien societies

§4136. Examination of foreign and alien societies
The superintendent, or any person whom the superintendent may appoint, may examine any foreign or alien society transacting or applying for admission to transact business in this State. The superintendent may employ assistants and the superintendent, or any person the superintendent may appoint, has free access to all books, papers and documents that relate to the business of the society. The superintendent may in the superintendent's discretion accept, in lieu of such examination, the examination of the insurance department of the state, territory, district, province or country where such society is organized. The compensation and actual expenses of the examiners making any examination or general or special valuation must be paid by the society examined or by the society whose certificate obligations have been valued, upon statements furnished by the superintendent.   [RR 2021, c. 1, Pt. B, §338 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). RR 2021, c. 1, Pt. B, §338 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4137. No adverse publications

§4137. No adverse publications
Pending, during or after an examination or investigation of a society, either domestic, foreign or alien, the superintendent may not make public any financial statement, report or finding, nor may the superintendent permit to become public any financial statement, report or finding affecting the status, standing or rights of any society, until a copy thereof has been served upon the society at its principal office and the society has been afforded a reasonable opportunity to answer any such financial statement, report or finding and to make such showing in connection therewith as it may desire.   [RR 2021, c. 1, Pt. B, §339 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). RR 2021, c. 1, Pt. B, §339 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4138. Misrepresentation (REPEALED)

§4138. Misrepresentation
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1991, c. 797, §10 (AMD). PL 2001, c. 421, §§B91,92 (AMD). PL 2001, c. 421, §C1 (AFF). PL 2009, c. 13, §6 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4138-A. Enforcement; unfair methods of competition and unfair and deceptive acts and practices

§4138-A. Enforcement; unfair methods of competition and unfair and deceptive acts and practices
A society authorized to do business in this State is subject to the provisions of section 12‑A and chapter 23. Nothing in such provisions may be construed as applying to or affecting the right of any society to determine its eligibility requirements for membership or as applying to or affecting the offering of benefits exclusively to members or persons eligible for membership in the society by a subsidiary corporation or affiliated organization of the society or the offering of benefits only to its members.   [PL 2009, c. 13, §7 (NEW).]
SECTION HISTORY
PL 2009, c. 13, §7 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4139. Discrimination and rebates (REPEALED)

§4139. Discrimination and rebates
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 2009, c. 13, §8 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4139-A. Funeral service contracts

§4139-A. Funeral service contracts
Every society is subject to the provisions of section 2176.   [PL 1989, c. 206, §3 (NEW).]
SECTION HISTORY
PL 1989, c. 206, §3 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4140. Taxation

§4140. Taxation
Every society organized or licensed under this chapter is hereby declared to be a charitable and benevolent institution, and all of its funds shall be exempt from all and every state, county, district, municipal and school tax other than taxes on real estate and office equipment.   [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 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4141. Exemptions

§4141. Exemptions
Except as herein provided, societies shall be governed by this chapter and shall be exempt from all other provisions of the insurance laws of this State, not only in governmental relations with the state, but for every other purpose. No law hereafter enacted shall apply to them, unless they be expressly designated therein.   [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 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4142. Exemption of certain societies

§4142. Exemption of certain societies
Nothing contained in this chapter shall be so construed as to affect or apply to:   [PL 1969, c. 132, §1 (NEW).]
1.
Grand or subordinate lodges of societies, orders or associations now doing business in this State which provide benefits exclusively through local or subordinate lodges;
[PL 1969, c. 132, §1 (NEW).]
2.
Orders, societies or associations which admit to membership only persons engaged in one or more crafts or hazardous occupations, in the same or similar lines of business, insuring only their own members and their families, and the ladies' societies or ladies' auxiliaries to such orders, societies or associations;
[PL 1969, c. 132, §1 (NEW).]
3.
Domestic societies which limit their membership to employees of a particular city or town, designated firm, business house or corporation which provide for a death benefit of not more than $400 or disability benefits of not more than $350 to any person in any one year, or both; or
[PL 1969, c. 132, §1 (NEW).]
4.
Domestic societies or associations of a purely religious, charitable or benevolent description, which provide for a death benefit of not more than $400 or for disability benefits of not more than $350 to any one person in any one year, or both.
[PL 1969, c. 132, §1 (NEW).]
Any such society or association described in subsections 3 or 4 supra which provides for death or disability benefits for which benefit certificates are issued, and any such society or association included in subsection 4 which has more than 1,000 members, shall not be exempted from the provisions of this chapter but shall comply with all requirements thereof.   [PL 1969, c. 132, §1 (NEW).]
No society which, by the provisions of this section, is exempt from the requirements of this chapter, except any society described in subsection 2, shall give or allow, or promise to give or allow to any person any compensation for procuring new members.   [PL 1969, c. 132, §1 (NEW).]
Every society which provides for benefits in case of death or disability resulting solely from accident, and which does not obligate itself to pay natural death or sick benefits shall have all of the privileges and be subject to all the applicable provisions and regulations of this chapter except that the provisions thereof relating to medical examination, valuations of benefit certificates, and incontestability shall not apply to such society.   [PL 1969, c. 132, §1 (NEW).]
The superintendent may require from any society or association, by examination or otherwise, such information as will enable the superintendent to determine whether such society or association is exempt from this chapter.   [RR 2021, c. 1, Pt. B, §340 (COR).]
Societies, exempted under this section, shall also be exempt from all other provisions of the insurance laws of this State.   [PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). RR 2021, c. 1, Pt. B, §340 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 55: FRATERNAL BENEFIT SOCIETIES › 24-A §4143. Penalties

§4143. Penalties
1.  False or fraudulent statement in application.
A person who intentionally or knowingly makes a false or fraudulent statement in or relating to an application for membership or for the purpose of obtaining money from or a benefit in any society commits a Class E crime.
[PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]
2.  Perjury.
A person who intentionally or knowingly makes a false or fraudulent statement in any verified report or declaration under oath required or authorized by this chapter or of any material fact contained in a sworn statement concerning the death or disability of a member for the purpose of procuring payment of a benefit named in the certificate commits the crime of perjury and is subject to the penalties prescribed by law.
[PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]
3.  Soliciting membership in society not licensed to do business.
A person who solicits membership for or in any manner assists in procuring membership in a society not licensed to do business in this State commits a civil violation for which a fine of not less than $50 and not more than $200 may be adjudged.
[PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]
4.  General penalty.
A person who intentionally or knowingly violates or neglects or refuses to comply with the provisions of this chapter for which a penalty is not otherwise prescribed is subject to the penalties under section 12‑A.
[PL 2003, c. 452, Pt. M, §1 (NEW); PL 2003, c. 452, Pt. X, §2 (AFF).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1991, c. 797, §11 (AMD). PL 2003, c. 452, §M1 (RPR). PL 2003, c. 452, §X2 (AFF).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4201. Short title

§4201. Short title
This chapter may be cited as the Health Maintenance Organization Act of 1975.   [PL 1975, c. 503 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4202. Definitions (REPEALED)

§4202. Definitions
(REPEALED)
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1989, c. 842, §§1-3 (AMD). PL 1991, c. 709, §1 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4205. Powers of health maintenance organizations

§4205. Powers of health maintenance organizations
1.
The powers of health maintenance organizations include, but are not limited to the following:
A. Subject to such licensure laws or regulations as are applicable, the purchase, lease, construction, renovation, operation or maintenance of hospitals, medical facilities, or both, and their ancillary equipment, and such property as may reasonably be required for its principal office or for such other purposes as may be necessary in the transaction of the business of the organization;   [PL 1975, c. 503 (NEW).]
B. The making of loans to a medical group under contract with it in furtherance of its program or the making of loans to a corporation or corporations under its control for the purpose of acquiring or constructing medical facilities and hospitals or in furtherance of a program providing health care services to enrollees;   [PL 1975, c. 503 (NEW).]
C. The furnishing of health care services through providers which are under contract with or employed by the health maintenance organization;   [PL 1975, c. 503 (NEW).]
D. The contracting with any person for the performance on its behalf of certain functions such as marketing, enrollment and administration;   [PL 1975, c. 503 (NEW).]
E. The contracting with an insurance company licensed in this State for the provision of insurance or indemnity or with a nonprofit hospital or medical service organization for reimbursement against the cost of health care services provided by the health maintenance organization;   [PL 1975, c. 503 (NEW).]
F. The offering, in addition to basic health care services, of:
(1) Additional health care services;
(2) Indemnity benefits covering out-of-area services;
(3) Indemnity benefits, in addition to those relating to out-of-area services.   [PL 1975, c. 503 (NEW).]
[PL 1975, c. 503 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4205-A. Continuity of licensure; business combinations

§4205-A. Continuity of licensure; business combinations
When a health maintenance organization authorized pursuant to this chapter merges or consolidates with an insurer or a nonprofit hospital, medical or health care service organization and operations of the surviving entity include those of a health maintenance organization, the surviving entity succeeds on a continuing basis to the authority possessed by the merging entities if:   [PL 1993, c. 702, Pt. A, §13 (NEW).]
1.  Plan approved.
The superintendent has approved the plan of merger or consolidation, pursuant to section 4203, subsection 1;
[PL 1993, c. 702, Pt. A, §13 (NEW).]
2.  Entity financially qualified.
The entity is financially qualified pursuant to the provisions of sections 410 and 4204‑A; and
[PL 1993, c. 702, Pt. A, §13 (NEW).]
3.  Entity otherwise qualified.
The entity is otherwise qualified pursuant to this chapter.
[PL 1993, c. 702, Pt. A, §13 (NEW).]
SECTION HISTORY
PL 1993, c. 702, §A13 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4206. Governing body

§4206. Governing body
1.
The governing body of any health maintenance organization may include providers, other individuals, or both.
[PL 1975, c. 503 (NEW).]
2.
Such governing body shall establish a mechanism to afford the enrollees an opportunity to participate in matters of policy and operation through the establishment of advisory panels, by the use of advisory referenda on major policy decisions or through the use of other mechanisms.
[PL 1975, c. 503 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4208. Annual and interim reports

§4208. Annual and interim reports
1.
Every health maintenance organization shall file annual and quarterly financial statements substantially similar to those required of health insurers under sections 423, 423‑A and 423‑D, verified by at least 3 principal officers, and shall provide a copy of each statement to the Commissioner of Health and Human Services. The superintendent may by rule or order require the filing of more frequent reports.
[PL 2017, c. 169, Pt. A, §11 (AMD).]
1-A.
The annual and quarterly statements must be prepared in accordance with the National Association of Insurance Commissioners annual and quarterly statement instructions and must follow practices and procedures prescribed by the National Association of Insurance Commissioners accounting practices and procedures manual for health maintenance organizations. If the health maintenance organization is operated as a division or line of business by an insurer or by a nonprofit hospital or medical service corporation, the superintendent shall designate the applicable portions of the financial statement form that must be filed, so as to eliminate information that is inapplicable to health maintenance organizations that are not separately incorporated and to minimize duplication between the statement filed under this section and the overall financial statement of the insurer or nonprofit hospital or medical service corporation.
[PL 2017, c. 169, Pt. A, §11 (NEW).]
1-B.
Every health maintenance organization shall file an annual audit opinion substantially similar to those required of insurers under section 221‑A.
[PL 2017, c. 169, Pt. A, §11 (NEW).]
2.
[PL 1993, c. 313, §34 (RP).]
3.
The annual and quarterly statements must include, if required by the Commissioner of Health and Human Services or by the superintendent:
A. A summary of information compiled pursuant to section 4204 in the form required by the Commissioner of Health and Human Services; and   [PL 2017, c. 169, Pt. A, §11 (AMD).]
B. Other information related to the performance of the health maintenance organization that is necessary to enable the superintendent to carry out the superintendent's duties under this chapter.   [PL 1993, c. 313, §35 (NEW).]
[PL 2017, c. 169, Pt. A, §11 (AMD).]
4.
The superintendent may refuse to continue or may suspend or revoke the certificate of authority of a health maintenance organization failing to file an annual or quarterly statement when due.
[PL 2017, c. 169, Pt. A, §11 (AMD).]
SECTION HISTORY
PL 1975, c. 293, §4 (AMD). PL 1975, c. 503 (NEW). PL 1991, c. 709, §6 (AMD). PL 1993, c. 313, §§33-35 (AMD). PL 2017, c. 169, Pt. A, §11 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4210. Open enrollment

§4210. Open enrollment
1.
After a health maintenance organization has been in operation 24 months, it shall have an annual open enrollment period of at least one month during which it accepts enrollees up to the limits of its capacity, as determined by the health maintenance organization, in the order in which they apply for enrollment. To the extent not inconsistent with the requirements of chapter 36 and sections 2736‑C and 2808‑B as qualified by section 4222‑B, subsection 3, a health maintenance organization may apply to the superintendent for authorization to impose such underwriting restrictions upon enrollment as are necessary to preserve its financial stability, to prevent excessive adverse selection by prospective enrollees or to avoid unreasonably high or unmarketable charges for enrollee coverage for health care services. The superintendent shall approve or deny the application within 10 days of the receipt of that application from the health maintenance organization.
[PL 1995, c. 332, Pt. O, §4 (AMD).]
2.
Health maintenance organizations providing or arranging for services exclusively on a group contract basis may limit the open enrollment provided for in this section to all members of the group or groups covered by such contracts.
[PL 1975, c. 503 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1995, c. 332, §O4 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4210-A. Continuity of health insurance coverage (REPEALED)

§4210-A. Continuity of health insurance coverage
(REPEALED)
SECTION HISTORY
PL 1989, c. 867, §§9,10 (NEW). PL 1995, c. 332, §O5 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4211. Complaint system

§4211. Complaint system
1.
Every health maintenance organization shall establish and maintain a complaint system which has been approved by the superintendent, after consultation with the Commissioner of Health and Human Services, to provide reasonable procedures for the resolution of written complaints initiated by enrollees concerning health care services and general operating procedures.
[PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
2.
Each health maintenance organization shall submit to the superintendent and the Commissioner of Health and Human Services an annual report in a form prescribed by the superintendent after consultation with the Commissioner of Health and Human Services that includes:
A. A description of the procedures of such complaint system;   [PL 1975, c. 503 (NEW).]
B. The total number and disposition of complaints handled through the complaint system and a compilation of causes underlying the complaints filed. Complaints concerning access to chiropractic providers and the results of those complaints must be separately identified; and   [PL 1993, c. 669, §4 (AMD).]
C. The number, amount and disposition of malpractice claims settled during the year by the health maintenance organization.   [PL 1975, c. 503 (NEW).]
[RR 2003, c. 2, §87 (COR).]
3.
The health maintenance organization shall maintain records of written complaints filed with it concerning other than health care services and shall submit to the superintendent a summary report at such times and in such format as the superintendent may require. Such complaints involving other persons shall be referred to such persons with a copy to the superintendent.
[PL 1975, c. 503 (NEW).]
4.
The superintendent and the Commissioner of Health and Human Services may examine such complaint system.
[PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
SECTION HISTORY
PL 1975, c. 293, §4 (AMD). PL 1975, c. 503 (NEW). PL 1993, c. 669, §4 (AMD). RR 2003, c. 2, §87 (COR). PL 2003, c. 689, §B7 (REV).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4212. Prohibited practices

§4212. Prohibited practices
1.
No health maintenance organization, or representative thereof, may cause or knowingly permit the use of advertising which is untrue or misleading, solicitation which is untrue or misleading, or any form of evidence of coverage which is deceptive. For purposes of this chapter:
A. A statement or item of information shall be deemed to be untrue if it does not conform to fact in any respect which is or may be significant to an enrollee of, or person considering enrollment in, a health maintenance organization;   [PL 1975, c. 503 (NEW).]
B. A statement or item of information shall be deemed to be misleading, whether or not it may be literally untrue, if, in the total context in which such statement is made or such item of information is communicated, such statement or item of information may be reasonably understood by a reasonable person, not possessing special knowledge regarding health care coverage, as indicating any benefit or advantage or the absence of any exclusion, limitation or disadvantage of possible significance to an enrollee of, or person considering enrollment in, a health maintenance organization, if such benefit or advantage or absence of limitation, exclusion or disadvantage does not in fact exist;   [PL 1975, c. 503 (NEW).]
C. An evidence of coverage shall be deemed to be deceptive if the evidence of coverage taken as a whole, and with consideration given to typography and format, as well as language, shall be such as to cause a reasonable person, not possessing special knowledge regarding health maintenance organizations and evidences of coverage therefor, to expect benefits, services, charges or other advantages which the evidence of coverage does not provide or which the health maintenance organization issuing such evidence of coverage does not regularly make available for enrollees covered under such evidence of coverage.   [PL 1975, c. 503 (NEW).]
[PL 1975, c. 503 (NEW).]
2.
An enrollee may not be cancelled nor denied renewal except for the following:
A. Fraud or material misrepresentation;   [PL 1995, c. 332, Pt. O, §6 (NEW).]
B. Failure to pay the charge for coverage;   [PL 1995, c. 332, Pt. O, §6 (NEW).]
C. When the provisions of the State's community rating law are applicable, as provided by section 2736‑C, subsection 3, paragraph B and section 2808‑B, subsection 4, paragraph B; or   [PL 1995, c. 332, Pt. O, §6 (NEW).]
D. Other reasons promulgated by the superintendent.   [PL 1995, c. 332, Pt. O, §6 (NEW).]
[PL 1995, c. 332, Pt. O, §6 (RPR).]
3.
No health maintenance organization, unless licensed as an insurer, may use in its name, contracts or literature any of the words "insurance", "casualty", "surety", "mutual" or any other words descriptive of the insurance, casualty or surety business or deceptively similar to the name or description of any insurance or surety corporation doing business in this State.
[PL 1975, c. 503 (NEW).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1995, c. 332, §O6 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4213. Regulation of agents

§4213. Regulation of agents
The superintendent may, after notice and hearing pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II, promulgate such reasonable rules and regulations as are necessary to provide for the licensing of agents. An agent means a person directly or indirectly associated with a health maintenance organization who engages in solicitation or enrollment.   [PL 1977, c. 694, §433 (AMD).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1977, c. 694, §433 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4214. Powers of insurers and nonprofit hospital or medical service corporations

§4214. Powers of insurers and nonprofit hospital or medical service corporations
1.
Subject to the provisions of sections 222, 3479 to 3482 and chapters 13 and 13‑A, an insurance company licensed in this State or a nonprofit hospital, medical or health care service organization may establish, maintain, own, merge with, organize and operate a health maintenance organization under this chapter, either directly as a division or line of business, or indirectly through a subsidiary or affiliate. Subject to the provisions of section 222 and chapters 13 and 13‑A, 2 or more such insurance companies, or nonprofit hospital, medical or health care service organizations, or subsidiaries or affiliates, may jointly organize and operate a health maintenance organization. The business of an insurer or hospital or medical service corporation that establishes, maintains, owns, merges with, organizes or operates a health maintenance organization is considered to include the providing of health care by a health maintenance organization.
[PL 1993, c. 702, Pt. A, §14 (AMD).]
1-A.
A domestic insurer that establishes, maintains, merges with or organizes and operates a health maintenance organization as a division or line of business is governed in its investment of funds allocated to that line of business by the provisions of section 4204, subsection 3‑A.
[PL 1993, c. 702, Pt. A, §15 (NEW).]
2.
Notwithstanding any provision of this Title, an insurer or a nonprofit hospital and medical service corporation may contract with a health maintenance organization to provide insurance or similar protection against the cost of care provided through health maintenance organizations and to provide coverage in the event of the failure of the health maintenance organization to meet its obligations.
[PL 1975, c. 503 (NEW).]
3.
The enrollees of a health maintenance organization constitute a permissible group, under such laws, and shall not be counted as part of any group for the purposes of chapter 35. Among other things, under such contracts, the insurer or nonprofit hospital or medical service corporation may make benefit payments to health maintenance organizations for health care services rendered by providers pursuant to the health maintenance organization.
[PL 1975, c. 503 (NEW).]
4.
[PL 1989, c. 842, §16 (RP).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1989, c. 842, §16 (AMD). PL 1993, c. 702, §§A14,15 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4215. Examinations

§4215. Examinations
1.
The superintendent may make an examination of the affairs of any health maintenance organization as often as the superintendent considers it necessary for the protection of the interests of the people of this State, but not less frequently than once every 3 years. The superintendent may defer making an examination for no more than 2 additional years. In lieu of the superintendent's making an examination of a foreign or alien health maintenance organization, the superintendent may accept a full report of the most recent examination certified by the chief regulatory official of another state with responsibility for the financial oversight of health maintenance organizations.
[PL 2021, c. 16, §13 (AMD).]
2.
The Commissioner of Health and Human Services may make an examination concerning the quality of health care services of any health maintenance organization as often as the commissioner considers it necessary for the protection of the interests of the people of this State, but not less frequently than once every 3 years.
[RR 2021, c. 1, Pt. B, §346 (COR).]
3.
Every health maintenance organization shall submit its books and records relating to health care services to such examinations and in every way facilitate them. For the purpose of examinations, the superintendent and the Commissioner of Health and Human Services may administer oaths to and examine the officers and agents of the health maintenance organization.
[PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
4.
The expenses of examinations under this section shall be assessed against the organization being examined and remitted to the superintendent or the Commissioner of Health and Human Services for whom the examination is being conducted.
[PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
5.
In lieu of such examination, the superintendent or Commissioner of Health and Human Services may accept the report of an examination made by persons holding comparable office of another state.
[PL 1975, c. 503 (NEW); PL 2003, c. 689, Pt. B, §7 (REV).]
SECTION HISTORY
PL 1975, c. 293, §4 (AMD). PL 1975, c. 503 (NEW). PL 2003, c. 689, §B7 (REV). PL 2021, c. 16, §13 (AMD). RR 2021, c. 1, Pt. B, §346 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4217. Rehabilitation, liquidation or conservation of health maintenance organizations

§4217. Rehabilitation, liquidation or conservation of health maintenance organizations
Any rehabilitation, liquidation or conservation of a health maintenance organization must be deemed to be the rehabilitation, liquidation or conservation of an insurance company and must be conducted under the supervision of the superintendent pursuant to the laws governing the rehabilitation, liquidation or conservation of insurance companies. The superintendent may institute summary proceedings in the same manner as provided in the laws governing delinquent insurers, and the superintendent may apply for an order directing the superintendent to rehabilitate, liquidate or conserve a health maintenance organization when in the superintendent's opinion the continued operation of the health maintenance organization would be hazardous either to the enrollees or to the people of this State.   [RR 2021, c. 1, Pt. B, §348 (COR).]
SECTION HISTORY
PL 1975, c. 503 (NEW). RR 2021, c. 1, Pt. B, §348 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4218. Regulations

§4218. Regulations
The superintendent may, after notice and hearing pursuant to the Maine Administrative Procedure Act, Title 5, chapter 375, subchapter II, promulgate reasonable rules and regulations as are necessary or proper to carry out this chapter. Such rules and regulations shall be subject to review in accordance with sections 229 to 236.   [PL 1977, c. 694, §435 (AMD).]
SECTION HISTORY
PL 1975, c. 503 (NEW). PL 1977, c. 694, §435 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 56: HEALTH MAINTENANCE ORGANIZATIONS › 24-A §4218-A. Compliance with the Affordable Care Act

§4218-A. Compliance with the Affordable Care Act
The superintendent may adopt and amend rules, establish standards and enforce federal statutes and regulations in order to carry out the purposes of the federal Affordable Care Act. Rules or amendments to rules adopted pursuant to this section, including amendments to major substantive rules, are routine technical rules as defined in Title 5, chapter 375, subchapter 2‑A.   [PL 2011, c. 364, §19 (NEW).]
SECTION HISTORY
PL 2011, c. 364, §19 (NEW).