reglab/statecodes huggingface dataset:
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2614. Grace period

§2614. Grace period
The group life insurance policy shall contain a provision that the policyholder is entitled to a grace period of 31 days for the payment of any premium due except the first, during which grace period the death benefit coverage shall continue in force, unless the policyholder shall have given the insurer written notice of discontinuance in advance of the date of discontinuance and in accordance with the terms of the policy. The policy may provide that the policyholder shall be liable to the insurer for the payment of a pro rata premium for the time the policy was in force during such grace period.   [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 31: GROUP LIFE INSURANCE › 24-A §2615. Incontestability

§2615. Incontestability
1.
The group life insurance policy must contain a provision that the validity of the policy may not be contested, except for nonpayment of premium, after it has been in force for 2 years from its date of issue; and that no statement made by any person insured under the policy relating to the person's insurability may be used in contesting the validity of the insurance with respect to which such statement was made after such insurance has been in force prior to the contest for a period of 2 years during such person's lifetime nor unless it is contained in a written instrument signed by the person; except that any such provision may not preclude the assertion at any time of defenses based upon provisions in the policy that relate to eligibility for coverage.
[RR 2021, c. 1, Pt. B, §227 (COR).]
2.
[PL 1981, c. 150, §19 (RP).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §§18,19 (AMD). RR 2021, c. 1, Pt. B, §227 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2616. Application; statements deemed representations

§2616. Application; statements deemed representations
The group life insurance policy must contain a provision that a copy of the application, if any, of the policyholder must be attached to the policy when issued, that all statements made by the policyholder or by the persons insured are deemed representations and not warranties and that no statement made by any person insured may be used in any contest, unless a copy of the instrument containing the statement is or has been furnished to such person or, in the event of death or incapacity of the insured person, to the person's beneficiary or personal representative.   [RR 2021, c. 1, Pt. B, §228 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §20 (AMD). RR 2021, c. 1, Pt. B, §228 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2617. Insurability

§2617. Insurability
The group life insurance policy must contain a provision setting forth the conditions, if any, under which the insurer reserves the right to require a person eligible for insurance to furnish evidence of individual insurability satisfactory to the insurer as a condition to part or all of the individual's coverage.   [RR 2021, c. 1, Pt. B, §229 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §229 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2618. Misstatement of age

§2618. Misstatement of age
The group life insurance policy shall contain a provision specifying an equitable adjustment of premiums or of benefits or both to be made in the event the age of a person insured has been misstated, such provision to contain a clear statement of the method of adjustment to be used.   [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 31: GROUP LIFE INSURANCE › 24-A §2619. Payment of benefits

§2619. Payment of benefits
The group life insurance policy shall contain a provision that any sum becoming due by reason of the death of the person insured shall be payable to the beneficiary designated by the person insured, except that where the policy contains conditions pertaining to family status the beneficiary may be the family member specified by the policy terms, subject to the provisions of the policy, in the event there is no designated beneficiary, as to all or any part of such sum, living at the death of the person insured, and subject to any right reserved by the insurer in the policy and set forth in the certificate to pay at its option a part of such sum not exceeding $2,000 to any person appearing to the insurer to be equitably entitled thereto by reason of having incurred funeral or other expenses incident to the last illness or death of the person insured.   [PL 1981, c. 150, §21 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §21 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2620. Information as to insurance

§2620. Information as to insurance
The group life insurance policy must contain a provision that the insurer will issue to the policyholder for delivery to each person insured printed information as to the insurance protection to which the person is entitled and the rights and conditions set forth in sections 2621, 2622, 2623 and 2628. The insurer shall also provide for distribution by the policyholder to each member of the insured group a statement setting forth to whom the benefits under such policy are payable.   [RR 2021, c. 2, Pt. A, §73 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1975, c. 183, §1 (AMD). PL 1981, c. 150, §22 (AMD). RR 2021, c. 1, Pt. B, §230 (COR). RR 2021, c. 2, Pt. A, §73 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2621. Conversion on termination of eligibility

§2621. Conversion on termination of eligibility
There must be a provision that if the insurance, or any portion of it, on a person covered under the policy or on the dependent of a person covered, ceases because of termination of employment or of membership in the class or classes eligible for coverage under the policy, such person is entitled to have issued to the person by the insurer, without evidence of insurability, an individual policy of life insurance without disability or other supplementary benefits, as long as application for the individual policy is made, and the first premium paid to the insurer, within 31 days after such termination, and:   [RR 2021, c. 1, Pt. B, §231 (COR).]
1.
The individual policy shall, at the option of such person, be on any one of the forms then customarily issued by the insurer at the age and for the amount applied for, except that the group policy may exclude the option to elect term insurance;
[PL 1981, c. 150, §24 (AMD).]
2.
The individual policy shall be in an amount not in excess of the amount of life insurance which ceases because of such termination less the amount of any life insurance for which such person is or becomes eligible under the same or any other group policy within 31 days after such termination; provided, that any amount of insurance which shall have matured on or before the date of such termination as an endowment payable to the person insured, whether in one sum or in installments or in the form of an annuity, shall not, for the purposes of this provision, be included in the amount which is considered to cease because of such termination; and
[PL 1969, c. 132, §1 (NEW).]
3.
The premium on the individual policy must be at the insurer's then customary rate applicable to the form and amount of the individual policy, to the class of risk to which such person then belongs, and to the person's age attained on the effective date of the individual policy.
[RR 2021, c. 1, Pt. B, §232 (COR).]
Subject to the same conditions set forth in this section, the conversion privilege shall be available: To a surviving dependent, if any, at the death of the employee or member, with respect to the coverage under the group policy which terminates by reason of the death; and to the dependent of the employee or member upon termination of coverage of the dependent, while the employee or member remains insured under the group policy, by reason of the dependent ceasing to be a qualified family member under the group policy.   [PL 1981, c. 150, §25 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §§23-25 (AMD). RR 2021, c. 1, Pt. B, §§231, 232 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2622. Conversion on termination of policy

§2622. Conversion on termination of policy
The group life insurance policy must contain a provision that if the group policy terminates or is amended so as to terminate the insurance of any class of insured persons, every person insured thereunder at the date of such termination whose insurance terminates, including the insured dependent of a covered person, and who has been so insured for at least 5 years prior to such termination date is entitled to have issued to the person by the insurer an individual policy of life insurance, subject to the same conditions and limitations as are provided by section 2621, except that the group policy may provide that the amount of such individual policy may not exceed the smaller of:   [RR 2021, c. 1, Pt. B, §234 (COR).]
1.
The amount of the person's life insurance protection ceasing because of the termination or amendment of the group policy, less the amount of any life insurance for which the person is or becomes eligible under a group policy issued or reinstated by the same or another insurer within 31 days after such termination; and
[RR 2021, c. 1, Pt. B, §233 (COR).]
2.
$10,000.
[PL 1981, c. 150, §26 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §26 (AMD). RR 2021, c. 1, Pt. B, §§233, 234 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2623. Death pending conversion

§2623. Death pending conversion
The group life insurance policy must contain a provision that if a person insured under the policy, or the insured dependent of a covered person, dies during the period within which the person would have been entitled to have an individual policy issued to the person in accordance with section 2621 or 2622 and before such an individual policy becomes effective, the amount of life insurance that the person would have been entitled to have issued to the person under such individual policy is payable as a claim under the group policy, whether or not application for the individual policy or the payment of the first premium therefor has been made.   [RR 2021, c. 2, Pt. A, §74 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §27 (AMD). RR 2021, c. 1, Pt. B, §235 (COR). RR 2021, c. 2, Pt. A, §74 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2624. Information to debtor

§2624. Information to debtor
In the case of a policy insuring the lives of debtors, a provision that the insurer will furnish to the policyholder for delivery to each debtor insured under the policy a certificate of insurance describing the coverage and specifying that the death benefit shall first be applied to reduce or extinguish the indebtedness.   [PL 1981, c. 150, §28 (RPR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 150, §28 (RPR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2625. Notice as to conversion right

§2625. Notice as to conversion right
If any individual insured under a group life insurance policy hereafter delivered in this State becomes entitled under the terms of such policy to have an individual policy of life insurance issued to the individual without evidence of insurability, subject to making of application and payment of the first premium within the period specified in such policy, and if such individual is not given notice of the existence of such right at least 15 days prior to the expiration date of such period, then, in such event the individual must have an additional period within which to exercise such right, but nothing herein contained may be construed to continue any insurance beyond the period provided in such policy. This additional period expires 15 days next after the individual is given such notice but in no event may such additional period extend beyond 60 days next after the expiration date of the period provided in such policy. Written notice presented to the individual or mailed by the policyholder to the last known address of the individual or mailed by the insurer to the last known address of the individual as furnished by the policyholder constitutes notice for the purpose of this section.   [RR 2021, c. 1, Pt. B, §236 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §236 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2626. Rate of premiums (REPEALED)

§2626. Rate of premiums
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §44 (AMD). PL 1973, c. 585, §12 (AMD). PL 1975, c. 196 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2627. Application of dividends, rate reductions (REPEALED)

§2627. Application of dividends, rate reductions
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §45 (AMD). PL 1991, c. 200, §D1 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2627-A. Dividends and experience refunds

§2627-A. Dividends and experience refunds
The following requirements apply to all group life insurance with the exception of insurance in which the policyholder is subject to the fiduciary standards of the federal Employee Retirement Income Security Act of 1974, ERISA, 29 United States Code, Section 1001‑1381 (1975).   [PL 1991, c. 200, Pt. D, §2 (NEW).]
1.  Refunds.
The amount by which any dividend, experience refund or rate reduction exceeds the amount of premium contributed by the group policyholder for the same period must be refunded to the employees, members or debtors in proportion to their premium contributions for that period, except as provided in subsection 2.
[PL 1991, c. 200, Pt. D, §2 (NEW).]
2.  Refund amounts less than $25 per employee, member or debtor.
If the refunds required by subsection 1 would average less than $25 per employee, member or debtor, then the group policyholder may request approval from the superintendent to apply those amounts in a different manner. The superintendent shall approve the request if, in the superintendent's opinion, the manner of application proposed would be for the sole benefit of insured employees, members or debtors.
[PL 1991, c. 200, Pt. D, §2 (NEW).]
SECTION HISTORY
PL 1991, c. 200, §D2 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2628. Total disability

§2628. Total disability
Where active employment is a condition of insurance, the group life insurance policy shall contain a provision that an insured may continue coverage during the insured's total disability by timely payment to the policyholder of that portion, if any, of the premium that would have been required from the insured had total disability not occurred. The continuation shall be on a premium paying basis for a period of 6 months from the date on which the total disability started, but not beyond the earlier of:   [PL 1981, c. 150, §29 (NEW).]
1.
Approval by the insurer of continuation of the coverage under any disability provision which the group insurance policy may contain; or
[PL 1981, c. 150, §29 (NEW).]
2.
The discontinuance of the group insurance policy.
[PL 1981, c. 150, §29 (NEW).]
SECTION HISTORY
PL 1981, c. 150, §29 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2629. Acquired Immune Deficiency Syndrome

§2629. Acquired Immune Deficiency Syndrome
No group life insurance policy delivered or issued for delivery in this State may provide more restrictive coverage for death resulting from Acquired Immune Deficiency Syndrome (AIDS), AIDS Related Complex (ARC) or HIV related diseases than the death resulting from any other disease or sickness or exclude coverage for death resulting from AIDS, ARC or HIV related diseases except through an exclusion under which deaths resulting from all sicknesses and diseases are treated the same or as provided by section 2159, subsection 4. This section shall not apply to death by accident or accidental means.   [PL 1989, c. 176, §4 (NEW).]
SECTION HISTORY
PL 1989, c. 176, §4 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 31: GROUP LIFE INSURANCE › 24-A §2630. Suicide

§2630. Suicide
A group life insurance policy delivered or issued for delivery in this State may not contain a more restrictive exclusion from liability for death resulting from suicide than death by suicide, while sane or insane, within 2 years from the date coverage commences or within 2 years of an increase in coverage.   [PL 2001, c. 89, §3 (NEW).]
SECTION HISTORY
PL 2001, c. 89, §3 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2670. Short title

§2670. Short title
This chapter may be cited as the "Preferred Provider Arrangement Act."   [PL 1999, c. 609, §4 (AMD).]
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1999, c. 609, §4 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2671. Definitions

§2671. Definitions
As used in this chapter, unless the context indicates otherwise, the following terms have the following meanings.   [PL 1985, c. 704, §4 (NEW).]
1.
"Administrator" means any person, other than a carrier, that administers a preferred provider arrangement. An administrator does not include a health maintenance organization licensed pursuant to chapter 56 or a nonprofit health care plan regulated by the superintendent pursuant to Title 24. An employer exempt from the applicability of this chapter under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) is not considered an administrator.
[PL 1999, c. 609, §5 (AMD).]
1-A.
"Capitation" has the same meaning as defined in section 4331, subsection 2.
[PL 1999, c. 609, §5 (NEW).]
2.
[PL 1999, c. 609, §5 (RP).]
2-A.
"Carrier" means an insurance company licensed in accordance with this Title, a fraternal benefit society authorized pursuant to chapter 55 or a nonprofit hospital or medical service organization licensed pursuant to Title 24. An employer exempted from the applicability of this chapter under the federal Employee Retirement Income Security Act of 1974, 29 United States Code, Sections 1001 to 1461 (1988) is not considered a carrier.
[PL 1999, c. 609, §5 (NEW).]
2-B.
"Enrollee" means an individual entitled to reimbursement for expenses of health care services under a health plan.
[PL 1999, c. 609, §5 (NEW).]
3.
"Health care services" means health care services or products rendered or sold by a provider within the scope of the provider's legal authorization.
[PL 1985, c. 704, §4 (NEW).]
3-A.
"Health plan" means a plan offered or administered by a carrier that provides for the financing or delivery of health care services to persons enrolled in the plan.
[PL 1999, c. 609, §5 (NEW).]
4.
[PL 1999, c. 609, §5 (RP).]
5.
[PL 1999, c. 609, §5 (RP).]
6.
"Preferred provider" means a provider who enters into a preferred provider arrangement with an administrator or carrier.
[PL 1999, c. 609, §5 (AMD).]
7.
"Preferred provider arrangement" means a contract, agreement or arrangement between a carrier or administrator and a provider in which the provider agrees to provide services to a health plan enrollee whose plan benefits include incentives for the enrollee to use the services of that provider.
[PL 1999, c. 609, §5 (AMD).]
8.
"Provider" means an individual or entity duly licensed or otherwise legally authorized to provide health care services, including, but not limited to, the treatment of physical health and mental health and provision for medical supplies and pharmaceutical supplies.
[PL 1999, c. 609, §5 (AMD).]
9.
"Superintendent" means the Superintendent of Insurance.
[PL 1999, c. 609, §5 (AMD).]
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1995, c. 332, §P1 (AMD). PL 1999, c. 609, §5 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2672. Selective contracting authorized

§2672. Selective contracting authorized
Carriers or administrators may enter into preferred provider arrangements with providers of their choice. In selecting preferred providers, carriers or administrators may consider, among other factors, price differences between or among providers, geographic accessibility, specialization and projected utilization by enrollees. Selective contracting does not constitute unreasonable discrimination against or among providers.   [PL 1999, c. 609, §6 (AMD).]
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1999, c. 609, §6 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2673. Policies, agreements or arrangements with incentives or limits on reimbursement authorized (REPEALED)

§2673. Policies, agreements or arrangements with incentives or limits on reimbursement authorized
(REPEALED)
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1989, c. 588, §A49 (RPR). PL 1999, c. 609, §7 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2673-A. Preferred provider arrangements

§2673-A. Preferred provider arrangements
1.  Filing with superintendent; disapproval.
A carrier or administrator who proposes to offer a preferred provider arrangement shall file with the superintendent proposed agreements, rates, geographic service areas, provider networks and other materials relevant to the proposed arrangement. The superintendent shall disapprove any preferred provider arrangement if the arrangement contains any unjust, unfair or inequitable provisions; unreasonably restricts access and availability of health care services; or fails to comply with other requirements of this chapter, chapter 56‑A or rules adopted by the superintendent.
[PL 1999, c. 609, §8 (NEW).]
2.  Considered separate preferred provider arrangements.
If health plans offered by the same carrier have different geographic service areas, or if there are preferred providers in one health plan who are nonpreferred providers in another health plan offered by the same carrier or administered by the same administrator or who are in a different preference tier if the plan is a multitier plan, then the plans represent different preferred provider arrangements and must be separately filed and approved.
[PL 1999, c. 609, §8 (NEW).]
3.  Rules.
Preferred provider arrangements offered by carriers that are subject to chapter 56‑A must be in compliance with applicable provisions of that chapter and any rules adopted under that chapter. Employer-sponsored plans that are exempt from this chapter pursuant to federal law and administrators offering preferred provider arrangements to employer-sponsored plans are not subject to the provisions of chapter 56‑A or rules adopted under that chapter, provided either the administrator or any other participating entity, other than the self-insured employer, does not undertake insurance risk. The superintendent may adopt rules establishing procedures for filing and approval of preferred provider arrangements, including the time period within which the superintendent must act on a completed application; specific criteria for determining when a term or condition is unjust, unfair or inequitable or has the effect of unreasonably restricting access and availability to health care services; and standards consistent with this chapter and chapter 56‑A for the ongoing operation and oversight of approved provider arrangements. The rules may prohibit the carrier from applying a benefit level differential to enrollees who must travel an unreasonable distance to obtain the service. Rules adopted pursuant to this subsection are routine technical rules pursuant to Title 5, chapter 375, subchapter II‑A.
[PL 1999, c. 609, §8 (NEW).]
SECTION HISTORY
PL 1999, c. 609, §8 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2674. Requirements applicable to administrators (REPEALED)

§2674. Requirements applicable to administrators
(REPEALED)
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1999, c. 609, §9 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2674-A. Requirements for administrators and carriers

§2674-A. Requirements for administrators and carriers
1.  Registration fee.
All administrators of a preferred provider arrangement shall register with the superintendent and pay an annual registration fee pursuant to section 601, subsection 20. The superintendent shall by rule establish criteria for the registration, including minimum solvency requirements. Rules adopted pursuant to this subsection are routine technical rules pursuant to Title 5, chapter 375, subchapter II‑A.
[PL 1999, c. 609, §10 (NEW).]
2.  Compilation of current listing.
The bureau shall compile and maintain a current listing of administrators and carriers offering preferred provider arrangements authorized under this chapter.
[PL 1999, c. 609, §10 (NEW).]
3.  Prohibition against insurance risk.
Except as specifically authorized in section 2676, an administrator may provide administrative services only and may not accept insurance risk.
[PL 1999, c. 609, §10 (NEW).]
4.  Approval required before marketing or making available.
A carrier may not issue a health plan incorporating a preferred provider arrangement and an administrator may not market or otherwise make available a preferred provider arrangement until the superintendent pursuant to section 2673‑A has approved the arrangement.
[PL 1999, c. 609, §10 (NEW).]
5.  Registration as insurance administrator.
In addition to meeting the requirements of the preferred provider arrangement, each preferred provider administrator who directly or indirectly transfers funds, manages funds, adjusts claims or asserts control over the transfer of funds for the purpose of payment of provider services shall register with the superintendent as an insurance administrator pursuant to chapter 18.
[PL 1999, c. 609, §10 (NEW).]
6.  Provision of document to beneficiary.
Each preferred provider administrator shall inform all carriers that the carriers must provide to each enrollee of any health plan subject to this chapter a plan description that complies with the requirements of and rules adopted under chapter 56‑A, subchapter I.
[PL 1999, c. 609, §10 (NEW).]
SECTION HISTORY
PL 1999, c. 609, §10 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2675. Requirements applicable to insurers (REPEALED)

§2675. Requirements applicable to insurers
(REPEALED)
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1989, c. 588, §§A50-52 (AMD). PL 1999, c. 609, §11 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2676. Risk transfer

§2676. Risk transfer
Preferred provider arrangements may include capitated payments that are limited to the health services provided by the provider.   [PL 1999, c. 609, §12 (AMD).]
Preferred provider arrangements may embody risk transfer between carriers and providers in accordance with the provisions of chapter 56‑A, subchapter III. Any other acceptance of insurance risk by a person that does not hold a valid certificate of authority or license and is not exempt by law from licensure constitutes the unauthorized transaction of insurance within the meaning of section 404 and chapter 21.   [PL 1999, c. 609, §12 (NEW).]
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1989, c. 588, §A53 (RPR). PL 1999, c. 609, §12 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2677. Alternative health care benefits (REPEALED)

§2677. Alternative health care benefits
(REPEALED)
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1987, c. 34, §2 (AMD). PL 1989, c. 588, §A54 (RPR). PL 1993, c. 600, §B19 (AMD). PL 1999, c. 609, §13 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2677-A. Payment for nonpreferred providers

§2677-A. Payment for nonpreferred providers
1.  Nonpreferred providers.
A carrier incorporating a preferred provider arrangement into a health plan shall provide for payment of covered health care services rendered by providers that are not preferred providers.
[PL 1999, c. 609, §14 (NEW).]
2.  Benefit level.
The benefit level differential between services rendered by preferred providers and nonpreferred providers may not exceed 20% of the allowable charge for the service rendered, except that the superintendent may waive this requirement for a given benefit plan. Compliance with this requirement for a given benefit plan may be demonstrated on an aggregate basis. This demonstration of compliance must be based on a reasonably anticipated mix of claims certified by a qualified actuary who is a member of the American Academy of Actuaries or a successor organization. As used in this subsection, "allowable charge" means the amount that would be payable for services under the preferred provider arrangement including deductible and coinsurance amounts.
[PL 2001, c. 369, §3 (AMD).]
SECTION HISTORY
PL 1999, c. 609, §14 (NEW). PL 2001, c. 369, §3 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2678. Annual experience report

§2678. Annual experience report
On or before April 1st of each year, an administrator or carrier who issues or administers a program, policy or contract in this State that includes incentives for the enrollee to use the services of a provider who has entered into an agreement with the carrier or administrator shall file a report of its activities for the preceding year with the superintendent. The report must be in the form prescribed by the superintendent and at a minimum must contain the following:   [PL 1999, c. 609, §15 (AMD).]
1.
A provider directory that includes the name, address and scope of license of each preferred provider; and
[PL 1999, c. 609, §15 (AMD).]
2.
[PL 1999, c. 609, §15 (RP).]
3.
Annual information specified in chapter 56‑A or rules adopted under that chapter. Annual information reported to the superintendent pursuant to chapter 56‑A under another license must be referenced in the report and not reported in a duplicate manner.
[PL 1999, c. 609, §15 (NEW).]
SECTION HISTORY
PL 1985, c. 704, §4 (NEW). PL 1999, c. 609, §15 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2678-A. Annual report (REPEALED)

§2678-A. Annual report
(REPEALED)
SECTION HISTORY
PL 1989, c. 588, §A55 (NEW). PL 1999, c. 609, §16 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2679. Utilization review data (REPEALED)

§2679. Utilization review data
(REPEALED)
SECTION HISTORY
PL 1987, c. 168, §3 (NEW). PL 1999, c. 609, §17 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32: PREFERRED PROVIDER ARRANGEMENT ACT › 24-A §2680. Standardized claim form

§2680. Standardized claim form
Administrators providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed health care practitioner or licensed hospital shall accept the current standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted electronically. An administrator may not be required to accept a claim submitted on a form other than the applicable form specified in this section and may not be required to accept a claim that is not submitted electronically, except from a health care practitioner who is exempt pursuant to Title 24, section 2985.   [PL 2003, c. 469, Pt. D, §5 (AMD); PL 2003, c. 469, Pt. D, §9 (AFF).]
SECTION HISTORY
PL 1993, c. 477, §D9 (NEW). PL 1993, c. 477, §F1 (AFF). PL 1999, c. 609, §18 (RPR). PL 2003, c. 218, §5 (AMD). PL 2003, c. 469, §D5 (AMD). PL 2003, c. 469, §D9 (AFF).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2691. Scope

§2691. Scope
1.  Health insurance policies.
This chapter applies to individual health insurance policies subject to chapter 33 and to group health insurance policies and certificates subject to chapter 35.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
2.  Dental plans and vision care plans.
This chapter applies to dental plans and vision care plans only as specified.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
3.  Policies not subject to this chapter.
This chapter does not apply to:
A. Individual policies or contracts issued pursuant to a conversion privilege under a policy or contract of group or individual insurance when that group or individual policy or contract includes provisions that are inconsistent with the requirements of this chapter;   [PL 2001, c. 410, Pt. C, §1 (NEW).]
B. Policies issued to employees or members as additions to franchise plans in existence on the effective date of this chapter;   [PL 2001, c. 410, Pt. C, §1 (NEW).]
C. Medicare supplement policies subject to chapter 67;   [PL 2001, c. 410, Pt. C, §1 (NEW).]
D. Long-term care insurance policies subject to chapters 68 and 68‑A;   [PL 2003, c. 428, Pt. G, §2 (AMD).]
E. Group disability income protection coverage; or   [PL 2001, c. 410, Pt. C, §1 (NEW).]
F. Insurance policies supplemental to the Civilian Health and Medical Program of the Uniformed Services, CHAMPUS, 10 United States Code, Chapter 55 (2000).   [PL 2001, c. 410, Pt. C, §1 (NEW).]
[PL 2003, c. 428, Pt. G, §2 (AMD).]
SECTION HISTORY
PL 2001, c. 410, §C1 (NEW). PL 2003, c. 428, §G2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2692. Definitions

§2692. Definitions
As used in this chapter, unless the context otherwise indicates, the following terms have the following meanings.   [PL 2001, c. 410, Pt. C, §1 (NEW).]
1.  Certificate.
"Certificate" means a statement of the coverage and provisions of a policy of group health insurance that has been delivered or issued for delivery in this State. "Certificate" includes riders, endorsements and enrollment forms, if attached.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
2.  Dental plan.
"Dental plan" means insurance written to provide coverage for dental treatment.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
3.  Direct response advertising.
"Direct response advertising" means a solicitation through a sponsoring or endorsing entity or individually through mail, telephone, the Internet or other mass communication media.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
4.  Form.
"Form" means a policy, contract, rider, endorsement or application as provided in section 2412.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
5.  Policy.
"Policy" means an entire contract between the insurer and the insured, including riders, endorsements and the application, if attached.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
6.  Vision care plan.
"Vision care plan" means insurance written to provide coverage for eye care.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
SECTION HISTORY
PL 2001, c. 410, §C1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2693. Standards for policy provisions

§2693. Standards for policy provisions
1.  Rules regarding manner, content and required disclosure.
The superintendent may adopt rules to establish specific standards, including standards of full and fair disclosure, that set forth the manner, content and required disclosure for the sale of individual and group health insurance. The superintendent may adopt additional rules to establish specific standards for the sale of dental plans and vision care plans.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
2.  Rules regarding prohibited policies or provisions.
The superintendent may adopt rules that specify prohibited policies or policy provisions not otherwise specifically authorized by statute that, in the opinion of the superintendent, are unjust, unfair or unfairly discriminatory to the policyholder or a person insured under the policy or to a beneficiary of the policy.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
SECTION HISTORY
PL 2001, c. 410, §C1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2694. Minimum standards for benefits

§2694. Minimum standards for benefits
The superintendent shall adopt rules to establish minimum standards for benefits under individual and group health insurance. These rules must clarify the meaning of limited benefits health insurance as referred to in chapters 33, 35 and 56‑A. The rules must also set minimum standards for benefits for each of the following categories of coverage:   [PL 2001, c. 410, Pt. C, §1 (NEW).]
1.  Basic hospital expense coverage.
Basic hospital expense coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
2.  Basic medical-surgical expense coverage.
Basic medical-surgical expense coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
3.  Basic hospital and medical-surgical expense coverage.
Basic hospital and medical-surgical expense coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
4.  Hospital confinement indemnity coverage.
Hospital confinement indemnity coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
5.  Individual major medical expense coverage.
Individual major medical expense coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
6.  Individual basic medical expense coverage.
Individual basic medical expense coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
7.  Individual disability income protection coverage.
Individual disability income protection coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
8.  Accident only coverage.
Accident only coverage;
[PL 2001, c. 410, Pt. C, §1 (NEW).]
9.  Specified disease coverage.
Specified disease coverage; and
[PL 2001, c. 410, Pt. C, §1 (NEW).]
10.  Specified accident coverage.
Specified accident coverage.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
This section does not preclude the issuance of a policy or contract that combines 2 or more of the categories of coverage in subsections 1 to 10.   [PL 2001, c. 410, Pt. C, §1 (NEW).]
SECTION HISTORY
PL 2001, c. 410, §C1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2694-A. Physician performance measurement, reporting and tiering programs

§2694-A. Physician performance measurement, reporting and tiering programs
1.  Performance measurement, reporting and tiering programs.
An insurer delivering or issuing for delivery within the State any individual health insurance policy or group health insurance policy or certificate shall annually file with the superintendent on or before October 1, 2010 and annually by October 1st in subsequent years a full and true statement of its criteria, standards, practices, procedures and programs that measure or tier health care provider performance with respect to quality, cost or cost-efficiency. The statement must be on a form prepared by the superintendent and may be supplemented by additional information required by the superintendent. The statement must be verified by the oath of the insurer's president or vice-president, and secretary or chief medical officer. A filing and supporting information are public records notwithstanding Title 1, section 402, subsection 3, paragraph B.
[PL 2013, c. 383, §2 (AMD).]
2.  Duties.
The superintendent shall review the statements, if any, assemble the statements in one table using a side-by-side comparison format and provide an analysis identifying the commonalities and differences of the statements. Notwithstanding any provision of law to the contrary, the superintendent shall adopt by rule a program and performance measures designed to:
A. Ensure transparency and fairness and promote the continued strengthening of measurement programs to meet patients' needs;   [PL 2009, c. 350, Pt. B, §1 (NEW).]
B. Promote the consistency, efficiency and fairness of physician performance measurement; and   [PL 2009, c. 350, Pt. B, §1 (NEW).]
C. Promote an appropriate balance between innovation and standardization.   [PL 2009, c. 350, Pt. B, §1 (NEW).]
[PL 2009, c. 350, Pt. B, §1 (NEW).]
3.  Advisory panel.
[PL 2011, c. 90, Pt. J, §20 (RP).]
4.  Rulemaking.
The superintendent may adopt rules to implement this section. Rules adopted pursuant to this subsection are major substantive rules as defined in Title 5, chapter 375, subchapter 2‑A.
[PL 2009, c. 350, Pt. B, §1 (NEW).]
SECTION HISTORY
PL 2009, c. 350, Pt. B, §1 (NEW). PL 2011, c. 90, Pt. J, §20 (AMD). PL 2013, c. 383, §2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2696. Preexisting conditions

§2696. Preexisting conditions
1.  Exclusion based on preexisting condition limited after 12 months.
Notwithstanding the provisions of section 2706, subsection 2, division (b), if an insurer elects to use a simplified application or enrollment form, with or without a question as to the prospective insured's health at the time of application or enrollment but without any questions concerning the prospective insured's health history or medical treatment history, the policy must cover any loss occurring after the policy has been in force for 12 months from any preexisting condition not specifically excluded from coverage by terms of the policy, and, except for such specific exclusions, the policy or certificate may not include wording that would permit a defense based upon preexisting conditions, other than rescission for affirmative misrepresentations, after it has been in force for 12 months.
[PL 2001, c. 410, Pt. C, §1 (NEW).]
2.  Exclusion based on preexisting condition limited after 6 months.
Notwithstanding the provisions of subsection 1 and section 2706, subsection 2, division (b), an insurer that issues a specified disease policy or certificate may not deny a claim for any covered loss that begins after the policy or certificate has been in force for at least 6 months, unless that loss results from a preexisting condition that was diagnosed by a physician before the date of application for coverage or that first manifested itself within the 6 months immediately preceding the application date. Other defenses based upon preexisting conditions are not permitted except for rescission for misrepresentation. This subsection applies regardless of whether the policy or certificate is issued on the basis of a detailed application form, a simplified application form or an enrollment form.
[PL 2007, c. 199, Pt. G, §1 (AMD).]
SECTION HISTORY
PL 2001, c. 410, §C1 (NEW). PL 2007, c. 199, Pt. G, §1 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 32-A: TYPES OF HEALTH INSURANCE › 24-A §2697. Rulemaking

§2697. Rulemaking
The superintendent may adopt rules to carry out the purposes of this chapter. Rules adopted pursuant to this chapter are major substantive rules as defined by Title 5, chapter 375, subchapter II‑A.   [PL 2001, c. 410, Pt. C, §1 (NEW).]
SECTION HISTORY
PL 2001, c. 410, §C1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2701. Scope of chapter

§2701. Scope of chapter
Nothing in this chapter shall apply to or affect:   [PL 1969, c. 132, §1 (NEW).]
1.
Any policy of liability or workers' compensation insurance with or without supplementary expense coverage therein;
[PL 1989, c. 502, Pt. A, §94 (AMD).]
2.
Any group or blanket policy, except that:
A. Sections 2736, 2736‑A and 2736‑B apply to group Medicare supplement policies as defined in chapter 67, group nursing home care and long-term care insurance policies as defined in chapter 68 or 68‑A;   [PL 2003, c. 428, Pt. G, §3 (AMD).]
B. Section 2752 applies with respect to mandated benefits for group or blanket health policies; and   [PL 1995, c. 332, Pt. J, §1 (AMD).]
C. Sections 2736, 2736‑A, 2736‑B and 2736‑C apply to:
(1) Association groups as defined by section 2805‑A, except as to any employer subgroups of the association group when the employer is a member of the group and provides coverage through the group as a bona fide employee benefit;
(1-A) Credit union groups as defined by section 2807‑A; and
(2) Other groups as defined by section 2808, except:
(a) Employee leasing companies registered pursuant to Title 32, chapter 125; and
(b) As to any employer subgroups of the other group when the employer provides coverage to its employees through the group as a bona fide employee benefit.   [PL 2009, c. 244, Pt. F, §1 (AMD).]
[PL 2009, c. 244, Pt. F, §1 (AMD).]
3.
Life insurance, endowment or annuity contracts, or contracts supplemental thereto which contain only such provisions relating to health insurance as:
A. Provide additional benefits in case of death or dismemberment or loss of sight by accident or accidental means, or as   [PL 1969, c. 132, §1 (NEW).]
B. Operate to safeguard such contracts against lapse, or to give a special surrender value or special benefit or an annuity in the event that the insured or annuitant becomes totally and permanently disabled, as defined by the contract or supplemental contract;   [PL 1983, c. 801, §8 (AMD).]
[PL 1983, c. 801, §8 (AMD).]
4.
Reinsurance; and
[PL 1983, c. 801, §8 (AMD).]
5.
Legal services insurance.
[PL 1983, c. 801, §9 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1983, c. 801, §§8,9 (AMD). PL 1985, c. 648, §9 (AMD). PL 1989, c. 502, §A94 (AMD). PL 1989, c. 556, §A4 (AMD). PL 1991, c. 701, §5 (AMD). PL 1995, c. 332, §J1 (AMD). PL 2001, c. 258, §E1 (AMD). PL 2003, c. 428, §G3 (AMD). PL 2005, c. 121, §B1 (AMD). PL 2009, c. 244, Pt. F, §1 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 33: HEALTH INSURANCE CONTRACTS › 24-A §2702. Short title

§2702. Short title
This chapter may be cited as the "Uniform Health Policy Provision Law".   [PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW).