reglab/statecodes huggingface dataset:
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2806. Trustee groups

§2806. Trustee groups
A group of individuals may be insured under a policy issued to a trust or to the trustee or trustees of a fund established by 2 or more employers, or by one or more labor unions or similar employee organizations, or by one or more employers and one or more labor unions or similar employee organizations, which trust or trustee or trustees shall be deemed the policyholder, to insure employees of the employers or members of the unions or organizations for the benefit of persons other than the employers or the unions or organizations, subject to the following requirements.   [PL 1981, c. 147, §5 (RPR).]
1.
The persons eligible for insurance shall be all of the employees of the employers or all of the members of the unions or organizations, or all of any class or classes thereof. The policy may provide that the term "employees" includes retired employees, the individual proprietor or partners if an employer is an individual proprietorship or a partnership and directors of a corporate employer. The policy may provide that the term "employees" includes the trustees or their employees, or both, if their duties are principally connected with that trusteeship.
[PL 1981, c. 147, §5 (RPR).]
2.
The premium for the policy shall be paid from funds contributed by the employer or employers of the insured persons or by the union or unions or similar employee organizations, or by both, or from funds contributed by the insured persons or from both the insured persons and the employer or union or similar employee organization. Except as provided in subsection 3, a policy on which no part of the premium is to be derived from funds contributed by the insured persons specifically for their insurance must insure all eligible persons, except those who reject such coverage in writing.
[PL 1981, c. 147, §5 (RPR).]
3.
Except as provided in section 2736‑C, section 2808‑B and chapter 36, an insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
[PL 1999, c. 256, Pt. G, §4 (AMD).]
4.
[PL 1981, c. 147, §5 (RP).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §§50,51 (AMD). PL 1977, c. 655, §2 (AMD). PL 1981, c. 147, §5 (RPR). PL 1989, c. 867, §§5,10 (AMD). PL 1999, c. 256, §G4 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2807. Debtor groups

§2807. Debtor groups
A group of individuals may be insured under a policy issued to a creditor, or its parent holding company or to a trustee or trustees or agent designated by 2 or more creditors, which creditor, holding company, affiliate, trustee, trustees or agent shall be deemed the policyholder, to insure debtors of the creditor or creditors, as the case may be, all as defined and set forth under section 2604‑A, provided that the amount of indemnity payable with respect to any person insured thereunder shall not at any time exceed the aggregate of the periodic scheduled unpaid installments, including, with respect to mortgage indebtedness, such real estate taxes and insurance costs incident to the mortgaged property as may become due during the scheduled period and provided that nothing in this paragraph may be construed or deemed to apply to or affect disability benefit provisions in group credit life insurance policies as authorized under section 2604‑A.   [PL 1981, c. 698, §109 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1979, c. 127, §§156-A (AMD). PL 1981, c. 147, §6 (AMD). PL 1981, c. 698, §109 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2807-A. Credit union groups

§2807-A. Credit union groups
A group of individuals may be insured under a policy issued to a credit union or to a trustee or trustees or agent designated by 2 or more credit unions, which credit union, trustee, trustees or agent is considered the policyholder, to insure members of the credit union or credit unions for the benefit of persons other than the credit union or credit unions, trustee or trustees or agent or any of their officials, subject to the following requirements.   [PL 1981, c. 147, §7 (NEW).]
1.
The members eligible for insurance are all of the members of the credit union or credit unions or all of any class or classes thereof.
[PL 1981, c. 147, §7 (NEW).]
2.
The premium for the policy shall be paid either from funds of the credit union or from funds contributed by the insured members specifically for their insurance, or from both. Except as provided in subsection 3, a policy on which no part of the premium is to be derived from funds contributed by the insured members specifically for their insurance must insure all eligible members, except those who reject the coverage in writing.
[PL 1981, c. 147, §7 (NEW).]
3.
Except as provided in section 2736‑C, section 2808‑B and chapter 36, an insurer may exclude or limit the coverage on any member as to whom evidence of individual insurability is not satisfactory to the insurer.
[PL 1999, c. 256, Pt. G, §5 (AMD).]
SECTION HISTORY
PL 1981, c. 147, §7 (NEW). PL 1989, c. 867, §§6,10 (AMD). PL 1999, c. 256, §G5 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2808. Other groups

§2808. Other groups
Group health insurance offered to a resident of this State under a group health insurance policy issued to a group other than one described in sections 2804 to 2807‑A is subject to the following requirements.   [PL 1981, c. 147, §8 (RPR).]
1.
No group health insurance policy may be delivered in this State, pursuant to this section, unless the superintendent finds that:
A. The policyholder is a bona fide group formed for purposes other than procurement of insurance;   [PL 1987, c. 476, §4 (AMD).]
B. The issuance of the group policy would be actuarially sound;   [PL 1981, c. 147, §8 (NEW).]
C. The issuance of the group policy would result in economies of acquisition or administration; and   [PL 1987, c. 476, §4 (AMD).]
D. The benefits are reasonable in relation to the premiums charged.   [PL 1981, c. 147, §8 (NEW).]
[PL 1987, c. 476, §4 (AMD).]
2.
No group health insurance coverage may be offered in this State, pursuant to this section, by an insurer under a policy issued in another state, unless the superintendent has made a determination that the requirements of subsection 1, paragraphs A, B, C and D have been met.
[PL 1987, c. 476, §5 (RPR).]
2-A.
Notwithstanding subsections 1 and 2, an employee leasing company registered pursuant to Title 32, chapter 125 qualifies as an eligible group for purposes of the purchase of group health insurance as provided in this section.
[PL 1997, c. 393, Pt. A, §26 (AMD).]
3.
The premium for the policy shall be paid either from the policyholder's funds or from funds contributed by the covered persons, or from both.
[PL 1981, c. 147, §8 (NEW).]
4.
Except as provided in section 2736‑C, section 2808‑B and chapter 36, an insurer may exclude or limit the coverage on any person as to whom evidence of individual insurability is not satisfactory to the insurer.
[PL 1999, c. 256, Pt. G, §6 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). PL 1981, c. 147, §8 (RPR). PL 1987, c. 476, §§4,5 (AMD). PL 1989, c. 867, §§7,10 (AMD). PL 1995, c. 618, §3 (AMD). PL 1997, c. 393, §A26 (AMD). PL 1999, c. 256, §G6 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2808-A. Rating practices in group health insurance (REPEALED)

§2808-A. Rating practices in group health insurance
(REPEALED)
SECTION HISTORY
PL 1989, c. 422, §2 (NEW). PL 1991, c. 353 (AMD). PL 1991, c. 696 (AMD). PL 1991, c. 828, §24 (AMD). PL 1995, c. 332, §B1 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2809. Coverage of family, dependents; continuation of coverage

§2809. Coverage of family, dependents; continuation of coverage
1.
Any policy of group health insurance issued pursuant to sections 2804 (employee groups), 2805 (labor union groups), 2805‑A (association groups), 2806 (trustee groups), 2807‑A (credit union groups) or 2808 (other groups) may include coverage for members of the family or dependents of individuals otherwise insured in such groups.
[PL 1981, c. 147, §9 (AMD).]
1-A.
Any such policy of group health insurance that provides coverage for family members or dependents of individuals in the insured group may not define the terms "family" or "dependent" to exclude from coverage those minor children of any covered individual who do not reside with that individual. Insurers must comply with 42 United States Code, Section 1396g‑1.
[PL 1995, c. 418, Pt. C, §3 (AMD).]
2.
Any group health insurance policy which contains provisions for the payment by the insurer of benefits for expenses incurred on account of hospital, nursing, medical or surgical services for members of the family or dependents of an individual in the insured group may provide for the continuation of such benefit provisions, or any part or parts thereof, after the death of such individual.
[PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1981, c. 147, §9 (AMD). PL 1985, c. 652, §51 (AMD). PL 1995, c. 418, §C3 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2810. Group health insurance payments; beneficiaries

§2810. Group health insurance payments; beneficiaries
The benefits payable under any policy or contract of group health insurance shall be payable to the employee or other insured member of the group or to some beneficiary or beneficiaries designated by him, other than the employer or the association or any officer thereof as such; but if there is no designated beneficiary as to all or any part of the insurance at the death of the employee or member, then the amount of insurance payable for which there is no designated beneficiary shall be payable to the estate of the employee or member, except that the insurer may in such case, at its option, pay such insurance to any one or more of the following surviving relatives of the employee or member: Wife, husband, mother, father, child or children, brothers or sisters; and except that payment of benefits for expenses incurred on account of hospitalization or medical or surgical aid, as provided in section 2811, may be made by the insurer to the hospital or other person or persons furnishing such aid. Payment so made shall discharge the insurer's obligation with respect to the amount of insurance so paid.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2811. Payment of expenses

§2811. Payment of expenses
Any policy or contract of group health insurance may include provisions for the payment by the insurer of benefits for expenses incurred, by the employee or other member of the insured group, on account of hospitalization or medical or surgical aid for the employee, the employee's spouse, the employee's child or children, or other persons chiefly dependent upon the employee for support and maintenance.   [RR 2021, c. 1, Pt. B, §244 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §244 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2812. Readjustment of premium rate (REPEALED)

§2812. Readjustment of premium rate
(REPEALED)
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §52 (AMD). PL 1991, c. 200, §D3 (RP).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2812-A. Dividends and experience refunds

§2812-A. Dividends and experience refunds
The following requirements apply to all group health 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, §4 (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, §4 (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, §4 (NEW).]
SECTION HISTORY
PL 1991, c. 200, §D4 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2814. Blanket health insurance; payments; beneficiaries

§2814. Blanket health insurance; payments; beneficiaries
All benefits under any blanket health insurance policy are payable to the person insured, or to the person's designated beneficiary or beneficiaries, or to the person's estate, as are specified in the policy, except that if the person insured be a minor, such benefits may be made payable to the person's parent, guardian or other person actually supporting the person, or to a person or persons chiefly dependent upon the person for support and maintenance.   [RR 2021, c. 1, Pt. B, §245 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). RR 2021, c. 1, Pt. B, §245 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2815. Legal liability of policyholders

§2815. Legal liability of policyholders
Nothing contained in this chapter shall be deemed to affect the legal liability of policyholders for the death of or injury to any member of any such group.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2816. Requirements

§2816. Requirements
No policy of group or blanket health insurance shall, except as provided in section 2829, be delivered or issued for delivery in this State, unless the policy contains in substance each and all of the provisions set forth in sections 2817 to 2828, or provisions which in the opinion of the superintendent are more favorable to the holders of such certificates or not less favorable to the holders of such certificates and more favorable to policyholders. Insurers offering policies under this chapter shall offer to certificate holders the right of review and arbitration set forth in section 2747, subsection 1, with respect to denials of medical expense reimbursement benefits based upon the grounds set forth in section 2747, subsection 2, except that the requirement of section 2747, subsection 1 shall not apply to certificate holders in groups subject to the United States Employee Retirement Income Security Act of 1974, Public Law 93-406, as amended, or to any policy or certificate holder to whom the insurer voluntarily extends a review similar to that which it provides to persons insured under group policies subject to that Act.   [PL 1981, c. 698, §110 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §53 (AMD). PL 1981, c. 205, §3 (AMD). PL 1981, c. 698, §110 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2817. Applicant's statements; waivers, amendments

§2817. Applicant's statements; waivers, amendments
There shall be a provision that no statement made by the applicant for insurance shall avoid the insurance or reduce benefits thereunder unless contained in the written application signed by the applicant; and a provision that no agent has authority to change the policy or to waive any of its provisions; and that no change in the policy shall be valid unless approved by an officer of the insurer and evidenced by indorsement on the policy, or by amendment to the policy signed by the policyholder and the insurer.   [PL 1969, c. 132, §1 (NEW).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2818. Statements in application

§2818. Statements in application
There shall be a provision that all statements contained in any such application for insurance shall be deemed representations and not warranties.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2819. New employees, members

§2819. New employees, members
There shall be a provision that all new employees or new members, as the case may be, in the groups or classes eligible for such insurance must be added to such groups or classes for which they are respectively eligible.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2820. Renewal of policy

§2820. Renewal of policy
There shall be a provision stating the conditions under which the insurer may decline to renew the policy.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2821. Individual certificates

§2821. Individual certificates
Except in the case of blanket health insurance, a provision that the insurer shall issue to the policyholder, for delivery to each member of the insured group, an individual certificate or printed information setting forth in summary form a statement of the essential features of the insurance coverage of such employee or such member and in substance the provisions of sections 2821 to 2828. The insurer shall also provide for distribution by the policyholder to each member of the insured group a statement, where applicable, setting forth to whom the benefits under such policy are payable. If dependents are included in the coverage, only one certificate or printed summary need be issued for each family unit.   [PL 1975, c. 183, §2 (AMD).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1969, c. 177, §54 (AMD). PL 1975, c. 183, §2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2822. Age limits

§2822. Age limits
There shall be a provision specifying the ages, if any there be, to which the insurance provided therein shall be limited; and the ages, if any there be, for which additional restrictions are placed on benefits and the additional restrictions placed on the benefits at such ages.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2823. Notice of claim

§2823. Notice of claim
There shall be a provision that written notice of sickness or of injury must be given to the insurer within 30 days after the date when such sickness or injury occurred. Failure to give notice within such time shall not invalidate nor reduce any claim, if it shall be shown not to have been reasonably possible to give such notice and that notice was given as soon as was reasonably possible.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2823-A. Explanation and notice to parent

§2823-A. Explanation and notice to parent
If the insured is covered as a dependent child, and if the insurer is so requested by a parent of the insured, the insurer shall provide that parent with:   [PL 2009, c. 244, Pt. B, §2 (AMD).]
1.  Payment or denial of claim.
An explanation of the payment or denial of any claim filed on behalf of the insured, except to the extent that the insured has the right to withhold consent and does not affirmatively consent to notifying the parent;
[PL 2009, c. 244, Pt. B, §2 (AMD).]
2.  Change in terms and conditions.
An explanation of any proposed change in the terms and conditions of the policy; or
[PL 1989, c. 556, Pt. D, §3 (NEW).]
3.  Notice of lapse.
Reasonable notice that the policy may lapse, but only if the parent has provided the insurer with the address at which the parent may be notified.
[PL 1989, c. 556, Pt. D, §3 (NEW).]
In addition, any parent who is able to provide the information necessary for the insurer to process a claim must be permitted to authorize the filing of any claims under the policy.   [PL 2009, c. 244, Pt. B, §2 (AMD).]
SECTION HISTORY
PL 1989, c. 556, §D3 (NEW). PL 2009, c. 244, Pt. B, §2 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2823-B. Standardized claim forms

§2823-B. Standardized claim forms
All insurers providing group medical expense insurance on an expense-incurred basis providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed health care practitioner must accept the current standardized claim form for professional services approved by the Federal Government and submitted electronically. All insurers providing group medical expense insurance on an expense-incurred basis providing payment or reimbursement for diagnosis or treatment of a condition or a complaint by a licensed hospital must accept the current standardized claim form for professional or facility services, as applicable, approved by the Federal Government and submitted electronically. An insurer 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. All services provided by a health care practitioner in an office setting must be submitted on the standardized federal form used by noninstitutional providers and suppliers. Services in a nonoffice setting may be billed as negotiated between the insurer and health care practitioner. For purposes of this section, "office setting" means a location where the health care practitioner routinely provides health examinations, diagnosis and treatment of illness or injury on an ambulatory basis whether or not the office is physically located within a facility.   [PL 2005, c. 97, §3 (AMD).]
SECTION HISTORY
PL 1993, c. 477, §D11 (NEW). PL 1993, c. 477, §F1 (AFF). PL 2003, c. 218, §7 (AMD). PL 2003, c. 469, §D7 (AMD). PL 2003, c. 469, §D9 (AFF). PL 2005, c. 97, §3 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2824. Proof of loss

§2824. Proof of loss
There shall be a provision that in the case of claim for loss of time for disability, written proof of such loss must be furnished to the insurer within 30 days after the commencement of the period for which the insurer is liable, and that subsequent written proofs of the continuance of such disability must be furnished to the insurer at such intervals as the insurer may reasonably require, and that in the case of claim for any other loss, written proof of such loss must be furnished to the insurer within 90 days after the date of such loss. Failure to furnish such proof within such time shall not invalidate nor reduce any claim, if it shall be shown not to have been reasonably possible to furnish such proof and that such proof was furnished as soon as was reasonably possible.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2825. Forms for proof of loss

§2825. Forms for proof of loss
There shall be a provision that the insurer will furnish to the policyholder such forms as are usually furnished by it for filing proof of loss. If such forms are not furnished before the expiration of 15 days after the insurer received notice of any claim under the policy, the person making such claim shall be deemed to have complied with the requirements of the policy as to proof of loss upon submitting within the time fixed in the policy for filing proof of loss, written proof covering the occurrence, character and extent of the loss for which claim is made.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2826. Examination, autopsy

§2826. Examination, autopsy
There shall be a provision that the insurer shall have the right and opportunity to examine the person of the insured when and so often as it may reasonably require during the pendency of claim under the policy and also the right and opportunity to make an autopsy in case of death where it is not prohibited by law.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2827. Time for payment of benefits

§2827. Time for payment of benefits
There shall be a provision that all benefits payable under the policy, other than benefits for loss of time, will be payable not more than 60 days after receipt of proof, and that, subject to due proof of loss, all accrued benefits payable under the policy for loss of time will be paid not later than at the expiration of each period of 30 days during the continuance of the period for which the insurer is liable, and that any balance remaining unpaid at the termination of such period will be paid immediately upon receipt of such proof.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2827-A. Assignment of benefits

§2827-A. Assignment of benefits
All policies and certificates providing benefits for medical or dental care on an expense-incurred basis must contain a provision permitting the insured to assign benefits for such care to the provider of the care. An assignment of benefits under this section does not affect or limit the payment of benefits otherwise payable under the policy or certificate.   [PL 1999, c. 21, §3 (AMD).]
SECTION HISTORY
PL 1997, c. 604, §E3 (NEW). PL 1999, c. 21, §3 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2828. Time for suits

§2828. Time for suits
There shall be a provision that no action at law or in equity shall be brought to recover on the policy prior to the expiration of 60 days after proof of loss has been filed in accordance with the requirements of the policy and that no such action shall be brought at all, unless brought within 2 years from the expiration of the time within which proof of loss is required by the policy.   [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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2829. Exceptions

§2829. Exceptions
1.
Any portion of any such policy, delivered or issued for delivery in this State, which purports, by reason of the circumstances under which a loss is incurred, to reduce any benefits promised thereunder to an amount less than that provided for the same loss occurring under ordinary circumstances, shall be printed in such policy and in each certificate issued thereunder, in bold face type and with greater prominence than any other portion of the rest of such policy or certificate, respectively; and all other exceptions of the policy shall be printed in the policy and certificate with the same prominence as the benefits to which they apply.
[PL 1969, c. 132, §1 (NEW).]
2.
If any such policy contains any provision which affects the liability of the insurer because of any violation of law by the insured during the term of the policy, it shall be in the following form: The insurer shall not be liable for death, injury incurred or disease contracted, to which a contributing cause was the insured's commission of or attempt to commit a felony, or which occurs while the insured is engaged in an illegal occupation.
[PL 1969, c. 132, §1 (NEW).]
3.
If any such policy contains any provision which affects the liability of the insurer because of the insured's use of intoxicating liquor or narcotics or hallucinogenic drugs during the term of the policy, it shall be in the following form: The insurer shall not be liable for death, injury incurred or disease contracted while the insured is intoxicated or under the influence of narcotics or hallucinogenic drugs unless administered on the advice of a physician.
[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 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2829-A. Disability benefit offsets

§2829-A. Disability benefit offsets
1.  Disclosure to persons eligible for coverage.
For any policy or contract subject to this chapter that provides disability income benefits, if the benefits under that policy or contract are subject to reduction due to other sources of income, then the insurer shall include in any written enrollment material and certificate of coverage developed by the insurer that is intended to be distributed to persons eligible for coverage under the policy or contract a clear and conspicuous notice that accurately explains all types of other sources of income that may result in a reduction of the benefits payable under the policy or contract. The notice requirement under this section does not apply to an advertisement intended for the general public.
[PL 2005, c. 42, §2 (NEW).]
2.  Recovery of disability benefit overpayments.
For claims filed after January 1, 2006, an insurer that is entitled to reduce disability income benefit payments when the insured receives income from other sources and that is entitled to recover overpayments through offsets against current payments to the insured may not recover such overpayments at a rate greater than 20% of the net benefit per benefit payment period unless:
A. For policies applied for after September 13, 2003, the insurer has complied with the requirements of subsection 1;   [PL 2005, c. 42, §2 (NEW).]
B. The insurer effects the offset of benefits within 60 days of notice to the insurer, or such later date as the insurer begins paying benefits to the insured, that the insured is receiving or is entitled to receive income that may result in a reduction of benefits payable under the policy;   [PL 2005, c. 42, §2 (NEW).]
C. The overpayment did not result from the insurer's miscalculation of benefit reductions or the insurer's miscalculation of benefits payable under the policy; and   [PL 2005, c. 42, §2 (NEW).]
D. The insurer provided the insured with clear and conspicuous written notice that accurately explains to the insured all types of other sources of income that may result in a reduction of the benefits payable under the policy within 30 days of the date a claim for disability benefits was filed.   [PL 2005, c. 42, §2 (NEW).]
[PL 2005, c. 42, §2 (NEW).]
SECTION HISTORY
PL 2003, c. 321, §2 (NEW). PL 2005, c. 42, §2 (RPR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2830. Omissions, modifications: superintendent may approve

§2830. Omissions, modifications: superintendent may approve
The superintendent may approve any form of group or blanket health insurance policy, or any form of certificate or printed information to be issued under such policy, that omits or modifies any of the provisions hereinbefore required, if the superintendent considers such omission or modification suitable for the character of such insurance and not unjust to the persons insured thereunder.   [RR 2021, c. 1, Pt. B, §246 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1973, c. 585, §12 (AMD). RR 2021, c. 1, Pt. B, §246 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2831. Hospital, medical benefits; direct payment

§2831. Hospital, medical benefits; direct payment
Any such group or blanket policy may include benefits payable on account of hospital or medical or surgical aid for an employee or other member of the group insured by such policy, the employee's or other member's spouse, child or children or other dependents, and may provide that, at the insured's option, any such benefits be paid by the insurer directly to the hospital, physician, surgeon doctor, nurse or other person furnishing services covered by such provisions of the policy.   [RR 2021, c. 1, Pt. B, §247 (COR).]
SECTION HISTORY
PL 1969, c. 132, §1 (NEW). PL 1987, c. 219 (AMD). RR 2021, c. 1, Pt. B, §247 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2832. Maternity benefits for unmarried women certificate holders and the minor dependents of certificate holders with dependent or family coverage required

§2832. Maternity benefits for unmarried women certificate holders and the minor dependents of certificate holders with dependent or family coverage required
All group or blanket health insurance policies, contracts and certificates shall provide the same maternity benefits for unmarried women certificate holders, and the minor dependents of certificate holders with dependent or family coverage, as is provided married certificate holders with maternity coverage and the wives of certificate holders with maternity coverage. This requirement applies to all group or blanket insurance written or renewed after the effective date of this Act, and includes, but is not limited to, all types and forms of group insurance issued by individual companies or corporations.   [PL 2003, c. 517, Pt. B, §11 (AMD).]
SECTION HISTORY
PL 1975, c. 276, §3 (NEW). PL 1975, c. 428, §3 (NEW). PL 1975, c. 471, §2 (NEW). PL 1975, c. 562 (NEW). PL 1975, c. 770, §§105-107 (RP). PL 1979, c. 663, §146 (AMD). PL 2003, c. 517, §B11 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2832-A. Mandated offer of domestic partner benefits

§2832-A. Mandated offer of domestic partner benefits
1.  Definition.
[PL 2021, c. 567, §33 (RP).]
2.  Mandated offer of domestic partner benefits.
All group or blanket health insurance policies or contracts issued by any insurer operating pursuant to this chapter must make available to group policyholders the option for additional benefits for the domestic partner of a certificate holder, at appropriate rates and under the same terms and conditions as those benefits or options for benefits are provided to spouses of married certificate holders covered under a group policy.
[PL 2001, c. 347, §3 (NEW); PL 2001, c. 347, §5 (AFF).]
3.  Financial dependency.
Financial dependency of a domestic partner on the certificate holder may not be required as a condition for eligibility for coverage.
[PL 2001, c. 347, §3 (NEW); PL 2001, c. 347, §5 (AFF).]
4.  Evidence of domestic partnership.
As a condition of eligibility for coverage, an insurer or group policyholder may require a certificate holder and the certificate holder's domestic partner to sign an affidavit attesting that the certificate holder and the certificate holder's domestic partner meet the definition of domestic partner under Title 1, section 72, subsection 2‑C and to show documentation of joint ownership or occupancy of real property, such as a joint deed, joint mortgage or a joint lease, or the existence of a joint credit card, joint bank account or powers of attorney in which each domestic partner is authorized to act for the other.
[PL 2021, c. 567, §34 (AMD).]
5.  Preexisting conditions.
A domestic partner is subject to the same provisions on coverage of preexisting conditions as any spouse or dependent of a certificate holder.
[PL 2001, c. 347, §3 (NEW); PL 2001, c. 347, §5 (AFF).]
6.  Termination of domestic partner benefits.
An insurer may terminate coverage in accordance with other applicable provisions of this Title for the domestic partner of a certificate holder upon notification by the certificate holder that the domestic partner relationship has terminated.
[PL 2021, c. 567, §35 (AMD).]
7.  Construction.
This section does not prohibit an insurer from negotiating a policy providing domestic partner benefits to a policyholder that does not comply with the requirements of this section.
[PL 2001, c. 347, §3 (NEW); PL 2001, c. 347, §5 (AFF).]
8.  Exemption.
This section does not apply to accidental injury, specified disease, hospital indemnity, Medicare supplement, disability income, long-term care and other limited benefit health insurance policies.
[PL 2001, c. 347, §3 (NEW); PL 2001, c. 347, §5 (AFF).]
SECTION HISTORY
PL 2001, c. 347, §3 (NEW). PL 2001, c. 347, §5 (AFF). PL 2021, c. 567, §§33-35 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2833. Child coverage

§2833. Child coverage
1.  Definitions.
For the purposes of this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Dependent children" means children who are under 19 years of age and are children, stepchildren or adopted children of, or children placed for adoption with, the certificate holder, member or spouse of the certificate holder or member.   [PL 1993, c. 666, Pt. A, §5 (NEW).]
B. "Placed for adoption" means the assumption and retention of a legal obligation by a person for the total or partial support of a child in anticipation of adoption of the child. If the legal obligation ceases to exist, the child is no longer considered placed for adoption.   [PL 1993, c. 666, Pt. A, §5 (NEW).]
[PL 1993, c. 666, Pt. A, §5 (RPR).]
2.  Coverage.
All group or blanket health insurance plans issued in accordance with the requirements of section 2832 must provide unmarried women certificate holders with the option of coverage of their children from the date of birth. A certificate holder who, pursuant to the laws of this State or any other state, has been adjudicated or has acknowledged the certificate holder to be the father of an illegitimate child must be given the option of coverage for that child from the date of the certificate holder's adjudication or acknowledgement of paternity. This optional coverage must be the same as that provided the children of a married certificate holder with family or dependent coverage.
[RR 2021, c. 1, Pt. B, §248 (COR).]
3.  Financial dependency.
Financial dependency of dependent children on the certificate holder or the spouse of the certificate holder may not be required as a condition for eligibility for coverage.
[PL 1991, c. 200, Pt. B, §4 (NEW).]
4.  Adopted children.
All group or blanket health insurance policies and certificates issued in accordance with the requirements of this section must provide the same benefits to dependent children placed for adoption with the certificate holder or spouse of the certificate holder under the same terms and conditions as apply to natural dependent children or stepchildren of the certificate holder, irrespective of whether the adoption has become final.
[PL 1993, c. 666, Pt. A, §6 (NEW).]
SECTION HISTORY
PL 1975, c. 276, §3 (NEW). PL 1979, c. 663, §147 (AMD). PL 1985, c. 652, §52 (AMD). PL 1991, c. 200, §B4 (RPR). PL 1993, c. 666, §§A5,6 (AMD). RR 2021, c. 1, Pt. B, §248 (COR).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2833-A. Extension of coverage for dependent children

§2833-A. Extension of coverage for dependent children
Notwithstanding section 2822, a group health insurance policy that provides coverage for a dependent child at certain ages only if the child is a student must continue that coverage if the child is unable to remain enrolled in school on a full-time basis due to a mental or physical illness or an accidental injury. This coverage may be terminated at the age at which coverage for students terminates under the terms of the policy. An insurer may require, as a condition of eligibility for continued coverage in accordance with this section, that the student provide written documentation from a health care provider and the student's school that the student is no longer enrolled in school on a full-time basis due to a mental or physical illness or accidental injury.   [PL 2005, c. 532, §2 (NEW).]
SECTION HISTORY
PL 2005, c. 532, §2 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2833-B. Mandatory offer to extend coverage for dependent children up to 26 years of age

§2833-B. Mandatory offer to extend coverage for dependent children up to 26 years of age
1.  Dependent child; definition.
As used in this section, "dependent child" means the child of a person covered under a group health insurance policy.
A. [PL 2019, c. 5, Pt. A, §13 (RP).]
B. [PL 2019, c. 5, Pt. A, §13 (RP).]
C. [PL 2019, c. 5, Pt. A, §13 (RP).]
D. [PL 2007, c. 514, §8 (RP).]
[PL 2019, c. 5, Pt. A, §13 (AMD).]
2.  Offer of coverage.
Notwithstanding section 2822, a group health insurance policy that offers coverage for a dependent child must offer such coverage, at the option of the parent, until the dependent child attains 26 years of age. If the dependent child has a disability, the policy must offer coverage in accordance with section 2833‑C.
[PL 2021, c. 520, §3 (AMD).]
3.  Notice.
[PL 2007, c. 514, §10 (NEW); MRSA T. 24-A §2833-B, sub-§3 (RP).]
SECTION HISTORY
PL 2007, c. 115, §2 (NEW). PL 2007, c. 115, §5 (AFF). PL 2007, c. 514, §§6-10 (AMD). PL 2019, c. 5, Pt. A, §13 (AMD). PL 2021, c. 520, §3 (AMD).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2833-C. Mandatory offer of coverage for certain adults with disabilities

§2833-C. Mandatory offer of coverage for certain adults with disabilities
1.  Definitions.
As used in this section, unless the context otherwise indicates, the following terms have the following meanings.
A. "Dependent child" has the same meaning as in section 2833‑B, subsection 1.   [PL 2021, c. 520, §4 (NEW).]
B. "Disability" means a physical, mental, intellectual or developmental disability that renders a person incapable of self-sustaining employment.   [PL 2021, c. 520, §4 (NEW).]
[PL 2021, c. 520, §4 (NEW).]
2.  Offer of coverage.
A group health insurance policy that offers coverage for a dependent child must offer such coverage, at the option of the parent, for a dependent child with a disability, regardless of age.
[PL 2021, c. 520, §4 (NEW).]
3.  Proof of disability.
A parent shall furnish proof of a dependent child's disability to the insurer within 31 days of the dependent child's attainment of the limiting age established in section 2833‑B, subsection 2 and subsequently as may be required by the insurer, but the insurer may not require proof more frequently than annually after the 2-year period following the dependent child's attainment of the limiting age.
[PL 2021, c. 520, §4 (NEW).]
SECTION HISTORY
PL 2021, c. 520, §4 (NEW).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2834. Newborn children coverage

§2834. Newborn children coverage
All group and blanket health insurance policies and certificates providing coverage on an expense-incurred basis must provide that health insurance benefits are payable for a newly born child of the insured or subscriber from the moment of birth. An adopted child is deemed to be newly born to the adoptive parents from the date of the signed placement agreement. Preexisting conditions of an adopted child may not be excluded from coverage.   [PL 2003, c. 517, Pt. A, §5 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]
The coverage for newly born children must consist of coverage of injury or sickness or other benefits provided by the policy, including the necessary care and treatment of medically diagnosed congenital defects and birth abnormalities.   [PL 1997, c. 604, Pt. C, §3 (AMD).]
If payment of a specific premium or subscription fee is required to provide coverage for a child, the policy or contract may require that notification of birth of a newly born child and payment of the required premium or fees must be furnished to the insurer or nonprofit service or indemnity corporation within 31 days after the date of birth in order to have the coverage continue beyond that 31-day period. The payment may be required to be retroactive to the date of birth. Benefits required by section 2834‑A must be paid regardless of whether coverage under this section is elected.   [PL 1997, c. 604, Pt. C, §3 (AMD).]
The requirements of this section apply to all policies and certificates delivered or issued for delivery in this State.   [PL 2003, c. 517, Pt. A, §6 (AMD); PL 2003, c. 517, Pt. A, §13 (AFF).]
SECTION HISTORY
PL 1975, c. 770, §108 (NEW). PL 1993, c. 686, §12 (AMD). PL 1993, c. 686, §13 (AFF). PL 1995, c. 332, §N3 (AMD). PL 1997, c. 604, §C3 (AMD). PL 2003, c. 517, §§A5,6 (AMD). PL 2003, c. 517, §A13 (AFF).
2023 Maine Revised Statutes › TITLE 24-A: MAINE INSURANCE CODE › Chapter 35: GROUP AND BLANKET HEALTH INSURANCE › 24-A §2834-A. Maternity and routine newborn care

§2834-A. Maternity and routine newborn care
An insurer that issues group contracts and certificates providing maternity benefits, including benefits for childbirth, shall provide coverage for services related to maternity and routine newborn care, including coverage for hospital stay, in accordance with the attending physician's or attending certified nurse midwife's determination in conjunction with the mother that the mother and newborn meet the criteria outlined in the "Guidelines for Perinatal Care," published by the American Academy of Pediatrics and the American College of Obstetrics and Gynecology. For the purposes of this section, "routine newborn care" does not include any services provided after the mother has been discharged from the hospital. For the purposes of this section, "attending physician" includes the obstetrician, pediatrician or other physician attending the mother and newborn. Benefits for routine newborn care required by this section are part of the mother's benefit. The mother and the newborn are treated as one person in calculating the deductible, coinsurance and copayments for coverage required by this section.   [PL 2003, c. 517, Pt. B, §12 (AMD).]
SECTION HISTORY
PL 1995, c. 615, §3 (NEW). PL 2001, c. 258, §A3 (AMD). PL 2003, c. 517, §B12 (AMD).